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MRCS A(My Own) > Pre And Perioperative > Flashcards

Pre And Perioperative Flashcards

1
Q

unfrictioneted heparin overdose

A

Give protamine sulphate

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2
Q

DVT complication develops in

A

The following surgical patients are at increased risk of deep vein thrombosis:
Surgery greater than 90 minutes at any site or greater than 60 minutes if the procedure involves the lower limbs or pelvis
Acute admissions with inflammatory process involving the abdominal cavity
Expected significant reduction in mobility
Age over 60 years
Known malignancy
Thrombophilia
Previous thrombosis
BMI >30
Taking hormone replacement therapy or the contraceptive pill
Varicose veins with phlebitis

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3
Q

Dehydration diagnosis

A

Diagnosing dehydration can be complicated, laboratory features include:
Hypernatraemia
Rising haematocrit
.Metabolic acidosis
Rising lactate
Increased serum urea to creatinine ratio
Urinary sodium <20 mmol/litre
Urine osmolality approaching 1200mosmol/k

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4
Q

Postoperative optimi urine output is

A

0,5ml/kg/hr

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5
Q

Postoperative oliguria is

A

<30ml/hr for 4 consecutive hours

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6
Q

Bupivacaine and lidocaine dosage with and without adrenaline

A

Bupivcaine without is 2mg/kg and with is 3mg/kg
Lidocaine without is 3mg/kg ND with is 7mg/kg

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7
Q

Amaximum dose of lidocaine in adults is

A

200mg
Thus if according to weight the dosage is more than we will not increase it to more than 200

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8
Q

CABG is preferred in

A

The guidelines state that CABG is the preferred treatment in high-risk patients with severe ventricular dysfunction or diabetes mellitus.

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9
Q

which is the excellent conduit for coronary artery bypass

A

internal mammary artery is an excellent conduit for coronary artery bypass

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10
Q

Indications for CABG

A

Left main stem stenosis or equivalent (proximal LAD and proximal circumflex)

Triple vessel disease

Diffuse disease unsuitable for PCI

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11
Q

Incisions for CABG

A

Midline sternotomy or left sub mammary incision

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12
Q

What happens when both IMA are used for bypass

A

Use of both is associated with increased risk of sternal wound dehiscence

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13
Q

Perioperative risk for CABG is calculated by

A

Perioperative risk is quantified using the Parsonnet and Euroscores and unit outcomes are audited using this data.

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14
Q

Among all structure which arebehind sternum, which needs to be divided

A

The interclavicular ligament lies at the upper end of a median sternotomy and is routinely divided to provide access

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15
Q
A

fibrocartilage

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16
Q

risk factors for recurrent Venous thromboembolism

A

SIGN also state that the following are risk factors for recurrent VTE:
previous unprovoked VTE
male sex
obesity
thrombophilias

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17
Q

Which antipsychotics causes VTE

A

Olanzapine

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18
Q

Drugs causing VTE

A

Medication

combined oral contraceptive pill: 3rd generation more than 2nd generation

hormone replacement therapy

raloxifene and tamoxifen

antipsychotics (especially olanzapine) have recently been shown to be a risk factor

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19
Q

Swinging pyrexia in

A

Anastomotic leak

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20
Q

Central line sepsis

A

Groin lines and those for TPN have the highest risk of central lin sepiai

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21
Q

Most common site of aortic dissection

A

Ascending aorta

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22
Q

Stanford classification of Aortic dissection

A

Type A: Proximal to subclavian
Type B: Distal to subclavian

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23
Q

Rx of aortic dissection

A

Proximal (Type A) lesions are usually treated surgically, type B lesions are usually managed non operatively

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24
Q

a popular choice drug in managing complex peri anal Crohns

A

Infliximab

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25
Q

Imatinib used in

A

Gastrointestinal stromal tumours
Chronic myeloid leukaemia

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26
Q

Bevacizumab is used for

A

Colorectal cancer
Renal
Glioblastoma

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27
Q

Trastuzumab is used in

A

Breast cancer with HER receptor

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28
Q

Basiliximab is used in patients with

A

Renal transplants

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29
Q

Cetuximab is used in

A

EGF positive colorectal cancers as it is EGF inhibitor

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30
Q

Which biological agents are used in
Crohns disease
Rheumatoid disease

A

Adalimumab
Infliximab
Etanercept

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31
Q

Gastrointestinal stromal tumours are treated by which biological agents

A

Imatinib

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32
Q

Some procedures require special preparation:
Thyroid surgery
Parathyroid surgery
Sentinel node biopsy
Surgery involving the thoracic duct;
Pheochromocytoma surgery
Surgery for carcinoid tumours
Colorectal cases
Thyrotoxicosis

A

Thyroid surgery; vocal cord check.
Parathyroid surgery; consider methylene blue to identify gland.
Sentinel node biopsy; radioactive marker/ patent blue dye.
Surgery involving the thoracic duct; consider administration of cream.
Pheochromocytoma surgery; will need alpha and beta blockade.
Surgery for carcinoid tumours; will need covering with octreotide.
Colorectal cases; bowel preparation (especially left sided surgery)
Thyrotoxicosis; lugols iodine/ medical therapy.

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33
Q

Which hypoglycemic has to be stopped pre operatively

A

Met forming 48 hours prior

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34
Q

Preoperative insulin infusion in type 1 diabetic

A

Insulin should not be stopped in patients with type 1 diabetes and omission of more than one meal will usually require a variable rate insulin infusion

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35
Q

Paste like anesthetic used for ENT surgeriew

A

Cocaine

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36
Q

Drug interactions of lidocaine

A

Beta blockers, ciprofloxacin, phenytoin

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37
Q

Cocaine use percentage

A

4 and 10 %

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38
Q

Which anesthetic is used for topical wound infiltration at the conclusion of surgical procedures

A

Bupivcaine bcx of its long duration of action

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39
Q

Which anesthetic contra indicated in regional blockage in case the tourniquet fails6

A

Bupivcaine as it’s cardiotoxic

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40
Q

Drug of choice in bier block

A

Prilocaine

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41
Q

Acidic environment and local anesthetic

A

They don’t work as acidic environment disintegrate the drug

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42
Q

Max dose of
Lignocaine 1% plain -
Lignocaine 1% with 1 in 200,000 adrenaline -
Bupivacaine 0.5%

A

3mg/ Kg - 200mg (20ml)
7mg/Kg - 500mg (50ml)
2mg/kg- 150mg (30ml)

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43
Q

Adrenaline with local anesthetic is contraindicated in patients

A

contra indicated in patients taking MAOI’s or tricyclic antidepressants.

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44
Q

Heparin dosage in CABG

A

A dose of 30,000 units is given just prior to going on cardiopulmonary bypass.

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45
Q

Which kind of heparin to be given before surgery

A

Unfractionated heparin

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46
Q

Drugs need to be stopped prior to surgery and before how long

A

oral contraceptive pill for a month,
aspirin or clopidogrel for 2 weeks before surgery

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47
Q

oral contraceptive pills should be stopped how long before surgery

A

oral contraceptive pill for a month,

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48
Q

Aspirin or clopidogrel should be stopped how long prior to surgery

A

2 weeks

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49
Q

INRrange for open vs jnvasive procedures

A

Open: <1.2
Invasive: <1.5

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50
Q

Fractionated Heparin inhibits only

A

Inhibits only factor Xa

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51
Q

During infractionated heparin what we should check

A

Un fractionated heparin

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52
Q

Heparin inhibits which factors

A

7,9,10,11 &12.

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53
Q

Tinzapin and
Enoxaprin dosage

A

Both are Frac Heparin
Once daily
Twice daily

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54
Q

Negative acute phase protein

A

Albumin
it’s increasing Levels indicate good recovery

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55
Q

Malignant hyperpyrexia is treated by

A

Dantrolene sodium Img/kg IV upto 10mg/kg max dose

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56
Q

Why Na avoided in old adults

A

risk of hyperchloraemic acidosis

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57
Q

Fluid of ccrystalloid in old adults

A

Ringer’s lactate or Hartmann’s

58
Q

Na in old adults can be given only when

A

patient is vomiting or has gastric drainage.

59
Q

Fluid of choice in Sodium losses secondary to diuretics.

A

Hartmann solution

60
Q

When 5% dextrose as well as colloid should be given.

A

critically ill patient who is unable to excrete Na or H20 leading to a 5% risk of interstitial oedema

61
Q

Adult requirement daily for fluid
Na
K

A

50-100mmol /day
40-80 mmol /day

62
Q

5% dextrose as resuscitation or maintenance fluid

A

Use 4%/0.18% dextrose saline or 5% dextrose in maintenance fluids

63
Q

IV fluid resuscitation Criteria

A

use crystalloids that contain sodium in the range 130-154 mmol/l, with a bolus of 500 ml over less than 15 minutes

64
Q

Mackler triad

A

The Mackler triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema. It typically presents in middle aged men with a background of alcohol abuse.

65
Q

Oral fluid prior elective surgery

A

stop
Solid 6 hours pre-operatively
Fluid 2 hours

66
Q

IV cannula for any long term therapy like AML

A

Groshong lines and Hickman lines

67
Q

There can’t be given through peripheral line

A

inotropes and irritant drugs such as TPN

68
Q

No use of central line in rapid rates of infusion due to

A

lumens are relatively narrow and thus they do not allow particularly rapid rates of infusion.

69
Q

Groshong and Hickman lines are inserted in

A

Internal jugular vein

70
Q

Good site for venous cut dowm

A

Long saphenous
Antecubital ( prefer median basilic vein)

71
Q

Central venous acces is mostly through 2hich veins

A

Subclavian and
Internal jugular vein

72
Q

Diff between low molecular and unfractionated heparin

A

Low molecular: no measurement of APTT needed
Unfractionated: Measurement of APTT needed

73
Q

Lignocaine is used as

A

Local Anesthetic
Class IB antiarrythmic

74
Q

Which type of Wound healing is affected in diabetes

A

Migration of neutrophils into wound

75
Q

Mnemonic to remember factors affecting wound healing:

A

DID NOT HEAL

D iabetes
I nfection, irradiation
D rugs eg steroids, chemotherapy

N utritional deficiencies (vitamin A, C & zinc, manganese), Neoplasia
O bject (foreign material)
T issue necrosis

H ypoxia
E xcess tension on wound
A nother wound
L ow temperature, Liver jaundice

76
Q

Diff between hypertrophic and keloid scars

A

Hypertrophic: don’t grow outside it’s boundary
Keloid: Grow outside it’s boundary

77
Q

Delayed primary closure versus secondary

A

In delayed the wound is sutured back before formation of granulation tissue
In secondary it is formed after formation of granulation tissue.

78
Q

Preferred test for aortic dissection is

A

CT angiography of chest

79
Q

aortic dissection has which kind of murmur

A

Loud diastolic murmur which is of aortic regurgitation

80
Q

Diagnosis of Boerhaaves syndrome is by

A

CT contrast swallow

81
Q

Diagnosis of Peptic ulcer perforation

A

Erect chest x-ray which may show a small amount of free intra-abdominal air (very large amounts of air are more typically associated with colonic perforation).

82
Q

Main peri-operative concern in people with aortic Stenosis

A

They can’t increase their cardiac output

83
Q

investigation of choice for aortic stenosis

A

trans thoracic echocardiography is the

84
Q

Meangradient in Severe aortic stenosis

A

> 40mmhg

85
Q

EcG finding in proximal aortic dissection

A

ST-segment elevation in leads II, III, and aVF
bez mostly right cardiac ostia is involved

86
Q

If ECG ShowII, III and aVF ST elevation then D/D willbe

A

1 Inf wall MI
2 Ascending Aortic dissection
Look for other-symptom tearing chestpain, pericardial effusion, carotid dissection and absent subclavian pulse in aortic dissection

87
Q

Symptoms of aortic dissection

A

tearing chestpain, pericardial effusion, carotid dissection and absent subclavian pulse in aortic dissection

88
Q

Test of choic ein warfarin and heparin

A

War: PT
Heparin: APTT

89
Q

Low molecular weight heparin is

A

Fractionated

90
Q

Fractionated heparin is

A

Has long half life
Decrease HIT

91
Q

Stop heparin howmany hour ago to surgery

A

6 hours

92
Q

Diabetes Rx of type I and II prior tosurgery

A

Type I: Insulin sliding scale
Type II: Waitand watch policy with regular blood glucose levels measurement

93
Q

methylene blue to identify

A

Parathyroid for surgery

94
Q

Sentinel node biopsy check before surgery through

A

patent blue dye

95
Q

What to do before
Pheochromocytoma surgery;

A

Give first alpha then beta blockade

96
Q

Drug for carcinoid tumor

A

Octreotide

97
Q

Most commen injury 2° central line is

A

Tension Pneumothorax
It exacerbates whon Positive pressure ventilation is given & causes hemodynamic instability

98
Q

Ifextremity and anesthetic required then

A

Don’t use Adrenaline

99
Q

If Zadek procedure thenwhich anesthetic

A

Ring block with 1% lignocaine alone

100
Q

Dosage of local anaesthetic agents

A

0.5% = 5 mg/ml
1% =10mg/ml
2% =20mg/ml,

101
Q

Post operative use of local analgesia

A

Analgesia (eg epidural for laparotomy) • Respiratory function (allows deep inspiration and pain-free chest physiotherapy)

102
Q

Topical Anesthetics

A

EMLA cream before cannulation in children
Lidocaine gel before urethral catheterisation
Xylocaine spray before gastroscopy

103
Q

Brachial plexus blocks may be performed at different levels:

A

Interscalene block (trunks)
Supra-/infraclavicular block (divisions) Axillary block (cords)

104
Q

Femoralblock

A

The femoral nerve lies at a point that is 1 cmlateral to the pulsation of the femoral artery as it exits from under the inguinal ligament and 2 cmdistal to the ligament.

105
Q

Femoralblock is suitable for

A

This is suitable for analgesia covering the anterior thigh, knee and femur.

106
Q

Intercostal block

A

Posterior angle of the rib at the posterior axillary line and insert the needle just below the edge of the rib

107
Q

COLLOIDS example

A

:
Human albumin
Gelofusine
Dextrose 40
Hydroxyethyl starch

108
Q

Perianal abscesswound closure thorugh

A

S3condary intention

109
Q

ERCP preparation

A

Clotting, antibiotics, Vitamin K if jaundiced

110
Q

Diagnostic OGD preparation

A

Nil by mouth for 6 hours

111
Q

Flexible sigmoidoscopy preparation

A

Phosphate enema 30 minutes pre procedure

112
Q

Colonoscopy preparation

A

Check U+E and if normal, prescribe oral purgatives e.g. picolax( oral Picosulphate 1 day prior)

113
Q

Rx of keloid scar

A

Injection of Triamnicilone

114
Q

Amino Ester vs amino amide anesthetics

A

AE: Procaine and Benzocaine
AA: All other Anesthetics

115
Q

Which anesthetics are amino Ester and not amino aside type

A

Procaine and Benzocaine

116
Q

Lignocaine MOA

A

Lignocaine blocks sodium channels.

117
Q

If first pain then anesthesia is due to which drug

A

Lignocain3 as it first enhances then suppresses nervous system

118
Q

Drug wh8ch should be stopped prior to colonoscopy

A

Ferrous sulphate
7 days prior

119
Q

To diagnose Fe defi anemia gut, how to prepare

A

Stop ferrous sulphate 7 days pre procedure and administer oral purgative1 day prior

120
Q

What blood test to be done before colonoscopy

A

UCE as purgative e can cause electrolyte imbalance

121
Q

Anesthetic for bier block

A

Only 1% prilocaine without adrenaline

122
Q

LMWH and renal function

A

Don’t give if impaired renal function

123
Q

Rev3rsal of Dabigatran

A

Idarucizumab

124
Q

Continues infusion of which heparin

A

Unfractionated

125
Q

Which anticoagulant is used as a prophylaxis in hip and knee surgery.

A

Dabigatran

126
Q

Atrop8ne is used to treat

A

low heart rate (bradycardia), reduce salivation and bronchial secretions before surgery or as an antidote for overdose of cholinergic drugs or mushroom poisoning

127
Q

Alcoholic+acute pancreatitis+clinically dehydrated with normal renal function and UCE
What fluid to give

A

Harrtmann

128
Q

sodium losses secondary to diuretics
Which fluid to give

A

Hartmann

129
Q

CHAD Score is used for

A

The CHADS score assesses whether a patient should be warfarinised if they have atrial fibrillation

130
Q

Which graft shows late stenosis in CABG

A

Saphenous vein

131
Q

Lateral chest radiograph

A

to assess distance between front of right ventricle and back of sternum

132
Q
  1. Aspirin: cyclo-oxygenase (COX) inhibitor
  2. Clopidogrel
  3. Abciximab(andsimilar drugs)
A
  1. inhibits thromboxane A2 production fromarachidonic acid .
  2. platelet ADP-receptor antagonist .
  3. infusible glycoprotein (GP) IIb and IIIa inhibitors
133
Q

Antibiotic prophylaxis b3fore CABG

A

Cefuroxime IVin 3 doses is the most commonly used antibiotic.

134
Q

The aims of cardioplegia are

A

Cardioplegia : •Maintenanceofastillsurgicalfield •Maintenanceofmyocardialenergystoresbyabolitionofmyocardialcontraction

135
Q
A

procedures to assess distance between front of right ventricle and back of sternum

136
Q

Cardioplegia aim

A

•Maintenance of a still surgical field •Maintenance of myocardial energy stores by abolition of myocardial contraction.

137
Q

Physiological condition for CAB

A

Non pulsation flow to get mean perfusion pressure of 6mmHg
Systemic cooling 30 to 32°C

138
Q

Thromboprophylaxis in children with risk criteria

A

None

139
Q

What to use to prevent clotting prior to surgery in a patient with hepatic dysfunction

A

Ffp

140
Q

Rich source of Factor VIII and fibrinogen

A

Cryoprecipitate

141
Q

SAG-Mannitol Blood

A

Removal of all plasma from a blood unit and substitution with:

Sodium chloride

Adenine

Anhydrous glucose

Mannitol

MRCS A(My Own) (28 decks)

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