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eMRCS questions > Pre/post operative care > Flashcards

Pre/post operative care Flashcards

1
Q

When should you stop ferrous sulphate prior to colonoscopy

A

7 days as can effect purgative effectiveness

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2
Q

Bowel regime for bowel imaging

A

ERCP- Clotting, antibiotics, Vitamin K if jaundiced

Diagnostic OGD- Nil by mouth for 6 hours

Flexible sigmoidoscopy- Phosphate enema 30 minutes pre procedure

Colonoscopy- Check U+E and if normal, prescribe oral purgatives e.g. picolax

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3
Q

Fluid management of surgical patients

A

Hartmann’s when a crystalloid is needed for resuscitation or replacement of fluids.

Avoid 0.9% N. Saline (due to risk of hyperchloraemic acidosis) unless patient vomiting or has gastric drainage.

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

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4
Q

Causes of pyrexia post op

A

Actelectasis - abdo surgery, mild pyrexia, chest signs- within 48hrs

UTI- indwelling catheter,

Wound infection- erythema, mild pyrexia- 5-7 days

Anastomotic leak- swinging fevers, ileus -7d

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5
Q

Surgical patients requiring thromboprophylaxis

A

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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6
Q

What reduces the effectiveness of local

A

Infected tissue

Acidotic environment- ionise in alkaline

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7
Q

Doses of local

A

Agent Dose plain Dose with adrenaline
Lignocaine 3mg/Kg 7mg/Kg
Bupivacaine 2mg/Kg 2mg/Kg
Prilocaine 6mg/Kg 9mg/Kg

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8
Q

Optimal fluid management pre op for elective

A

Avoid solids 6 hours
Clear fluids until 2 hours
Carb loading drink in between
Avoid IV fluids

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9
Q

Monitoring of heparin

A

APTT

No need for LMWH

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10
Q

Different types of central lines and there uses

A

Central tunnelled- Hickman, good for long term therapeutic

Non tunneled

PICC- less complications on insertion
More prone to infection

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11
Q

Thromboprophyaxis in paediatric cases

A

None

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12
Q

Chemical types of local

A

All amino amide

Apart from procaine and benzocaine- Amino ester

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13
Q

Absolute CI to tourniquet

A

AV fistula
Severe peripheral vascular disease
Previous vascular surgery
Bone fracture or thrombosis at the site of tourniquet application

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14
Q

Physiological effects of inflating then deflating the tourniquet

A

Post inflation
Increased systemic vascular resistance, increased CVP and increased BP
Slower gradual increase in BP over time
Induced hypercoagulable state
Slow increase in core temperature

Post deflation
Fall in CVP, BP and SVR
Increased end tidal carbon dioxide
Enhanced fibrinolysis
Fall in core temperature
Raised serum potassium and lactate levels

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15
Q

Factors effecting wound healing

A

Mnemonic to remember factors affecting wound healing: 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

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16
Q

CI of lidocaine

A

Any cardiac rhythm disorders

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17
Q

Urine sodium in dehydration

A

<20mmol

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18
Q

Biochem features of dehydration

A

Hypernatraemia
Rising haematocrit
Metabolic acidosis
Rising lactate
Increased serum urea to creatinine ratio
Urinary sodium <20 mmol/litre
Urine osmolality approaching 1200mosmol/kg

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19
Q

Closure for peri anal abscess

A

Secondary closure

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20
Q

Dyes or injections prior to surgeries

A

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.

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21
Q

Metallic heart valves anticoagulants prior to surgery

A

Bridge to heparin

Stop this 6 hrs prior to surgery

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22
Q

Local used in regional block

A

Prilocaine
Due to less cardiotoxic

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23
Q

Use of lidocaine vs bupivacaine

A

It has a much longer duration of action than lignocaine and this is of use in that it may be used for topical wound infiltration at the conclusion of surgical procedures with long duration analgesic effect.

Lidocaine faster onset

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24
Q

Presentation of atelectasis post op

A

 w/i first 48hrs
 Mild pyrexia
 Dyspnoea
 Dull bases ̄c ↓AE

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25
Q

Mx of wound dehiscence

A

Replace abdo contents and cover ̄c sterile soaked gauze
 IV Abx: broad spec
 Opioid analgesia
 Call senior and arrange theatre
 Repair in theatre
 Wash bowel
 Debride wound edges
 Close ̄c deep non-absorbable sutures (e.g. nylon)
 May require VAC dressing or grafting

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26
Q

RF for wound dehiscence

A

Pre-Operative Factors
 ↑ age
 Smoking
 Obesity, malnutrition, cachexia
 Comorbs: e.g. BM, uraemia, chronic cough, Ca  Drugs: steroids, chemo, radio

Operative Factors
 Length and orientation of incision
 Closure technique: follow Jenkin’s Rule  Suture material

Post-operative Factors
 ↑ IAP: e.g. prolonged ileus → distension  Infection
 Haematoma / seroma formation

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27
Q

Mx of post op ileus

A

IV fluids and NGT
TPN if prolonged

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28
Q

Cause of reduced urine output post op

A

Post-renal
 Commonest cause
 Blocked / malsited catheter  Acute urinary retention
Pre-renal: hypovolaemia
Renal: NSAIDs, gentamicin

 Anuria usually = blocked or malsited catheter
 Oliguria usually = inadequate fluid replacemen

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29
Q

When is heparin given in vascular and cardiac bypass surgeries

A

Vascular- 3,000 units of systemic heparin 3-5 minutes prior to cross clamping

Bypass- 30,000 units is given prior to going on cardiopulmonary bypass

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30
Q

A thin bluish - white margin appears around the graft

A

Re epithelierisation

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31
Q

LA for scalp lesions

A

Lidocaine with adrenaline

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32
Q

Wound healing process

A

Haemostasis

Inflammation- Typically days 1-5
Neutrophils migrate into wound (function impaired in diabetes).
Growth factors released, including basic fibroblast growth factor and vascular endothelial growth factor.
Fibroblasts replicate within the adjacent matrix and migrate into wound.
Macrophages and fibroblasts couple matrix regeneration and clot substitution.

Regeneration
Typically days 7 to 56
Platelet derived growth factor and transformation growth factors stimulate fibroblasts and epithelial cells.
Fibroblasts produce a collagen network.
Angiogenesis occurs and wound resembles granulation tissue.

Remodelling
From 6 weeks to 1 year
Longest phase of the healing process and may last up to one year (or longer).
During this phase fibroblasts become differentiated (myofibroblasts) and these facilitate wound contraction.
Collagen fibres are remodeled.
Microvessels regress leaving a pale scar.

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33
Q

How should DM be managed intra operatively

A

Cases operated on first
Sliding scale for insulin or poorly controlled- K supplementation

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34
Q

Options for surgical nutrition and when they are used

A

Nutrition requirements < 4 wks:
Fine bore NG tube as well as oral diet
(bike accident, head injury, comatose, no basal skull #; slow recovery;)
Naso-jejanal for acute severe pancreatitis

Nutrition requirements > 4 wks :
PEG (most case)
NCJ (Needle Catheter Jejunostomy);
Use after major GI surgery; Small bowel stoma done

TPN use
Pre-operative pt. & needs to be optimized prior 2surgery
Low BMI & Low albumin
Projectile vomiting due 2PS occurred due to obstructing tumor(excludes oral /NG route) Post operative entero-cutaneous fistula

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35
Q

Patients identified as being malnourished

A

BMI < 18.5 kg/m2
* unintentional weight loss of > 10% over 3-6/12
* BMI < 20 kg/m2 and unintentional weight loss of > 5% over 3-6/12

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36
Q

Parenteral nutrition guidelines

A

for feeding < 14 days consider feeding via a peripheral venous catheter
* for feeding > 30 days use a tunneled subclavian line
* continuous administration in severely unwell patients
* if feed needed > 2 weeks consider changing from continuous to cyclical feeding
* don’t give > 50% of daily regime to unwell patients in first 24-48h

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37
Q

Those at risk of referring syndrome

A

BMI < 16 kg/m2

  • Unintentional weight loss >15% over 3-6 months
  • Little nutritional intake > 10 days
  • Hypokalaemia, Hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
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38
Q

Kcal aim for refeeding syndrome risk and those are who aren’t

A

10/kcal/kg per day- RS

25- not as risk

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39
Q

When is cell salvage CI

A

Malignancy

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40
Q

Physiological response to surgery

A

Neuro- sympathetic

Acute phase response- TNF-α, IL-1, IL-2, IL-6, interferon and prostaglandins are released

Endocrine
Increases ACTH and cortisol production:
increases protein breakdown
increases blood glucose levels
* Aldosterone increases sodium reabsorption
* Vasopressin increases water reabsorption and causes vasoconstriction

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41
Q

Causative agents of malignant hyperthermia

A

Halothane
Suxamethosium

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42
Q

Cause, ix and mx of malignant hyperthermia

A

Excessive release of Ca
Hyperpyrexia and rigidity

CK raised

Dantrolene

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43
Q

Spinal anaesthesia SE

A

hypotension, sensory and motor block, nausea and urinary retention.

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44
Q

Epidural use and disadvantages

A

preferred option following major open abdominal procedures

  • Disadvantages of epidurals is that they usually confine patients to bed, especially if a motor block is present. In addition an indwelling urinary catheter is required. Which may not only impair mobility but also serve as a conduit for infection. They are contraindicated in coagulopathies.
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45
Q

When TAP blocks are used, which LA

A

extensive laparoscopic abdominal procedures

Bupivicaine

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46
Q

What do you prepare skin with

A

skin with alcoholic chlorhexidine (Lowest incidence of SSI)

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47
Q

When do prophylactic antibiotics needs to be given

A

placement of prosthesis or valve

  • clean-contaminated surgery - (e.g resp GI)
    contaminated surgery
  • If a tourniquet is to be used, give prophylactic antibiotics earlier
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48
Q

Types of wound contamination

A

Clean : Non-infected skin with no hollow organ is cut
Clean-contaminated : Cut of hollow organ except COLON (e.g. GB, unruptured Appendix)
Contaminated : Colon incision; open #; animal/ human bites; colon insion ē minimal spillage.
Dirty : Perforation; wounds made in presence of pus; perforated viscus/traumatic wound>4hrs

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49
Q

Mx options for wound dehiscence

A

Resuture- wound edges healthy- deep tension sutures used

Wound dressing- granulation tissue, high output bowel fistula

Bogota bag-if wound cannot be closed- need theatre return

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50
Q

+ diagnostic peritoneal lavage

A

-RBC>100000/mm .
- WBC> 500/mm3
- Gm staining showing organisms

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51
Q

Indications of preoperative steroid cover

A

Pituitary or adrenal surgery
>10mg 3m
Evidence of cushing

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52
Q

Mx of pts on pre op steroids

A

For patient on >10mg pred for 3m

Usual dose +
Minor surgery- 50mg pre op HC IV
25mg every 8hrs for 24hrs

Intermediate- 50mg pre op and 25mg every 8h for 24 hrs

Major- 100mg pre, 200mg infusion >24hrs

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53
Q

Warfriin before surgery

A

Stop 3-5d before
Heparin bridge
INR <1.2 open surgery, 1.5 invasive procedures

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54
Q

Antiplatelets before surgery

A

Stop 7d-14 before

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55
Q

When to stop LMWH before surgery

A

6hrs

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56
Q

Metformin before surgery

A

Stop 48 hours before

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57
Q

In what timeframe should you delay surgery if there’s been a CVA

A

<6w
Aim to wait for 6m

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58
Q

What is a ring block

A

Field block in digit or penis

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59
Q

Levels where brachial plexus block is performed

A

Intersclaene- trunks
supra/infraclavicualr - divisions
axillary - cords

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60
Q

Femoral block

A

1cm lateral to pulsation of femoral artery at inguinal ligament

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61
Q

Sciatic block

A

Lateral, anterior or posterior

2cm lateral to ischial tuberosity

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62
Q

Intercostal nerve block

A

Feel posterior angle of rib
Insert needle just below edge of rib

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63
Q

Complications of epidural

A

Post dural tap headache
Infection
Haematoma
Urinary retention

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64
Q

When should spinal catheters be removed when anti coagulated

A

12 hours post LMWH
Then can restart AC after 2 hours

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65
Q

ASA classification

A

1- normal
2- mild disease
3-severe that limits activity but not incapacitating
4- constant threat to life
5- not expected to survive

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66
Q

DIfferent inductive agents

A

Thiopental sodium - negative inotrope, cheaper, not used with laryngeal
Propofol - antiemetic effect, used if using laryngeal mask
Etomidate- better for CV unstable pats- induces adrenal suppression

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67
Q

Muscle relaxants

A

Suxamtheonium- depolarising- hydrolysed slower than Ach

Non depolarising- slower onset, longer duratioon
Acracurium, vecuronium

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68
Q

GA maintainence drugs

A

Halothane
Enflurane
Isolfurance
NO

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69
Q

Antidote for prilocaine

A

Methylene blue

May be used in piere block

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70
Q

Which surgeries would be scarless

A

Fetal

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71
Q

Formation of scar

A

Haemastasis- mins to hours- vasospasm, fibrin clot- platelets

Next stages can happen concurrently
Inflammation Days, neutrophil, macrophage, fibroblast

Regen 7d-2m- weeks - fibroblast- produce collagen, endothelial cells, macrophages

Remodelling 1m-1y- myofibroblasts, vessels regress

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72
Q

Hypertrophic vs keloid scar

A

Hypertrophic- stay within scar limit- can be excised

Keloid- do not respect limit- cannot be excised - steroids, silicone

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73
Q

Which factors is affected by warfarin

A

2,7,9,10 protein C

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74
Q

What increases vs inhibits warfarin

A

Increase- by inhibiting CYP450
Cipro/cimetidine
Omeprazole/ Fluconazole/metronidazole
Valproate
Erythromycin

Inhibit
Rifampicin
Barbituates
Carbmazepine

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75
Q

CI for caudal anaesthesia

A

Spina bifida
Meningitis
RICP

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76
Q

Spinal anaesthesia location, dose, how quickly the effect

A

L1/2
In subarachnoid
2.5-3.5 buvi

2-5 mins

Block more dense
Headache more common
Hypotension more rapid

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77
Q

Epidural anaesthesia location, dose, onset

A

Between dura mate and ligaments flavum

15-20 of buvi

15-20 mins

Hypotension low
Headache not as common

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78
Q

Patient has bone mets not controlled on medication what to do

A

Radiotherapy

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79
Q

Patient has pancreatic mets not controlled on medication what to do

A

Coeliac block

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80
Q

Patient with oesophectomy that’s unsafe to swallow mx

A

Jejunostomy as stomach now intrathoracic

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81
Q

Nasaljujenal benefits and placement

A

Less food pooling
Less aspiration risk
Placed surgically

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82
Q

Long term TPN effect on liver

A

Fatty liver
Derranged LFT
A calculi cholecystitis

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83
Q

Feeding for perforated oesophagus

A

TPN

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84
Q

Pancreatitis with poor appetite feeding

A

Nasal jejenostomy

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85
Q

Head injury no signs of skull base fracture feeding

A

NG tube

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86
Q

Subtotal colectomy with poor appetite feeding

A

NG tube

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87
Q

High output fistula feeding

A

TPN

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88
Q

Crohns disease with multiple fistula

A

TPN

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89
Q

When is TAP block administered

A

During operation

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90
Q

When is a tracheostomy performed

A

If requiring ventilation over roughly 1m- long term

Useful for slow wheaning

To reduce dead space

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91
Q

When is a laryngeal mask used and what risks

A

Short day surgery
Swift onset anaesthesia - fluranes, no muscles relaxants needed
Used in paediatric

Poor control of reflux

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92
Q

Fever and diarrhoea in leukaemia post transfusion

A

GVHD- immunocomprismed

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93
Q

What day after transfusion does GVHD occur

A

4-30d GVHD

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94
Q

Cells found in TRALI

A

Neutrophils

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95
Q

Non immune SE of blood transfusion

A

Hypocalcaemia
Hyperkalaemia
CCF- TACO

96
Q

Plts storage temp, days stored and bacteria associated

A

Room temp
Must be used in 5 days

Gram +

97
Q

RBC storage temp, days stored and bacteria associated

A

4 degrees
50-60 d

Gram -

98
Q

Which blood product most likely to cause urticaria

A

FFP

99
Q

Which blood product most likely to cause pyrexia

A

RBC

100
Q

What condition is cryoprecipitate used

A

vWD
As lots of factor 8 and vWF

101
Q

What can be used for vWD if undergoing minor/MAJOR procedure

A

TXA- minor

Desmopressin- major

102
Q

Types of inotropes, the receptors and effects

A

Noradrenaline- a- vasopressor

Adrenaline- a and b- increase output and PVR

Dopamine- B1- CO
Dobutamine- B1+2- increase CO, reduce PVR

Milrinone- PDE inhibitor- cAMP icnrease- short half life- PVR reduces, increase contractility- reduces pulmonary resistance - vasodilator

Phenylephinephrine- a1- increase PVR and pulmonary

Isoprenaline- B1+2- increase CO reduce PVR- bradycardia

103
Q

Etmodiate SE

A

Adrenal Suppressor

Negative inotrope- good for heart

No analgesic properties

104
Q

Which agent is used for rapid induction

A

Sodium thiopental

105
Q

Which muscles relaxants cause histamine release

A

Actracurium and other tetras

Vercuronium and sux do not

106
Q

What does TPN not contain in preliminary

A

Fibre

107
Q

What monitoring do you measure for TPN

A

Weight: daily if fluid balance concerns, otherwise weekly reducing to monthly

BMI: at start of feeding and then monthly
If weight cannot be obtained: monthly mid arm circumference or triceps skin fold thickness

Daily electrolytes until levels stable. Then once or twice a week.

Weekly glucose, phosphate, magnesium, LFTs, Ca, albumin, FBC, MCV

levels if stable
2-4 weekly Zn, Folate, B12 and Cu levels if stable
3-6 monthly iron and ferritin levels, manganese (if on home parenteral regime)
6 monthly vitamin D
Bone densitometry initially on starting home parenteral nutrition then every 2 year

108
Q

Enzyme deficiency in malignant hyperthermia

A

Pseudocholinesterase

109
Q

Which anaesthetic agent has strongest anti emetic

A

Propofol

110
Q

New AF and fever 5d post resection

A

Anastomotic leak

111
Q

Pulmonary oedema CVP

A

> 18mmHg

112
Q

When do anti platelets need to be stopped before surgery

A

5-7d before

113
Q

Etomidate pros and cons

A

Good is CV unstable

Can cause adrenal suppression

No analgesia

Vomitting after is common

114
Q

Muddy brown casts in urine

A

Acute tubular necrosis

115
Q

CI to suxamathonium

A

If extensive tissue necrosis e.g in burns

Can cause hyperkalaermia due to muscle contractions leading to cardiac arrest in these patients

116
Q

Complication of Dextrans

A

Anaphylaxis

They inhibit platelet aggregation and leucocyte plugging- improving flow in sepsis

117
Q

Halothane SE

A

Hepatotoxicity

118
Q

Pulmonary function test results

A

Obstructive lung disease
FEV1- reduced
FVC- reduced
FEV1/FVC- <70%
Asthma
COPD
Bronchiectasis

Restrictive
FEV11- reduced
FVC-sig reduced
FEV1/FVC- normal or high
Fibrosis
Sarcoidosis
ARDS
Scoliosis
NMD

119
Q

Post haemorrhoidectomy analgesia

A

Caudal Block

120
Q

Part of ERAS

A

Optimise pre existing conditions and nutrition pre admission

Minimise starvation- carb loading drink 2hrs pre procedure- omitted in diabetics with complex insulin

Avoid excess IV during procredure

Post op- early movement, drain removal, catheters, oral nutrition

121
Q

What is used for intubation in small children

A

Uncuffed endotracheal tube- reduce risk of tracheal injury

122
Q

ARDS physiology

A

Loss of surfactant and increased eleastse release from neutrophils

Fluid accumulation and reduced diffusion

123
Q

CI to epidural

A

Active infection- e.g appendicitis

124
Q

SOFA scoring use and factors

A

Organ dysfunction in sepsis

PaO2
Plts
Bilirubin
MAP, dopamine/nor/adrenaline use
GCS
Creatinine
Urine output

125
Q

Test for brain death

A

Fixed pupils which do not respond to sharp changes in the intensity of incident light

No corneal reflex
Absent oculo-vestibular reflexes - no eye movements following the slow injection of at least 50ml of ice-cold water into each ear in turn (the caloric test)

No response to supraorbital pressure

No cough reflex to bronchial stimulation or gagging response to pharyngeal stimulation

No observed respiratory effort in response to disconnection of the ventilator for long enough (typically 5 minutes)

126
Q

Cardiogenic shock PAOC, CO and SVR

A

PAOC- high- fluid overload
CO- low
SVR- high

127
Q

Septic shock PAOC, CO and SVR

A

POAC- low
CO-high
SVR-low

128
Q

Hypovolaemic shock PAOC, CO and SVR

A

POAC- low
CO-low- due to low preload
SVR-high

129
Q

What is used to reverse depolarising NM blockers and what adverse effects can they cause

A

Neostigmine

Bradycardia

130
Q

Where do inotropes have to be administered and what is the exception to the rule

A

Central line

Metaraminol can be peripheral

131
Q

Treatment of burning post amputation

A

Pregabalin or amitriptyline

132
Q

Pain relief for trigeminal neuralgia

A

Carbamazepine

133
Q

What electrolyte disturbance does suxamethonium cause

A

Hyperkalaemia

Due to the Na/K not keeping up with K efflux from contractions

134
Q

Major abdo surgery- when can patient resume eating

A

If malnourished and safe swallow and post op caesarean, gynaecological or abdominal surgery, aim for oral intake within 24h

135
Q

Analgesia post op for child following ochidoplexy

A

Caudal

136
Q

Tx of acute diatonic reaction

A

Procyclidine

137
Q

SE of amitriptyline

A

Orthostatic hypotension

138
Q

TPN in liver failure

A

Fatty acids removed

139
Q

Kcal per day in TPN and in acute unwell

A

25-35 per day
More in acutely unwell

140
Q

Amount in 1% lidocaine

A

100mg in 10ml

As 1% means 1g/100ml

141
Q

Max lidocaine in adult

A

200mg

3mg/kg below that

142
Q

Preservation of what would prevent dumping syndrome

A

Pylorus

143
Q

Repair technique of bladder laceration

A

In layers with absorbable sutures

144
Q

Protein intake for surgical patient

A

0.8-1.5

145
Q

Ventilation with laminar flow reduces wound infection by

A

2x

146
Q

Incision for renal tumours

A

Upper pole- thoracolumbar

Lower- flank incision

147
Q

Order of ligation of vessel in nephrectomy and is adrenal gland removal necessary

A

Artery then vein

Adrenal removal is not required unless CT suggests involvement

148
Q

Homan vs Charles vs thompson technqiue

A

Charles- excision of lymph tissue with skin graft

Homan- removal of skin and subcut with primary closure

Thompson- excision of subcutaneous and tunnel of dermal flap into muscle compartment of leg

149
Q

Ladd procedure steps

A

Usually rotates 270 Anticlockwise

DJ normally to left

This doesn’t occur

Urgent laparotomy
Rotate volvulus anticlockwise

Return small bowel to right and caecum and colon to left and perform appendectomy

150
Q

Reason for laparoscopic surgeries causing difficult oxygenation in COPD patients

A

Increased IAP
Reduce FRC, VC and pul compliance
Increase peak airway pressure
In COPD prone to collapse

Often require positive end expiratory pressure in order to achieve adequate gas exchange

151
Q

Patient with metabolic alkalosis secondary to NG output with ileus- what fluid replacement

A

Saline

152
Q

Most common complication of laparoscopic surgery

A

Haemorrhage

153
Q

Sterilisation method for medical equipment

A

Sterilisation of surgical instruments typically takes place in an autoclave which uses pressurised steam at a temperature of 134 degrees
Or using ethylene or formaldehyde

Endoscopy- glutaldehyde for 22 hrs

Gamma radiatio- disposable products- needles, syringes

154
Q

Short bowel syndrome symptoms

A

Weight loss
Diarrhoea
Dehydration
High output stoma

155
Q

Store length of platelets and in humans

A

5 days
10 days in human

Suspended in plasma

156
Q

Lipids effect on Na

A

Pseudo hyponatraemia

157
Q

When should a drain be removed

A

If has stopped or decreased to <25ml/day

158
Q

Which diseases are screening in blood donations

A

HIV
Hep B, C
Syphilis

159
Q

Epidural in situ- patient complaining of worse neuro symptoms ix

A

MRI spine

160
Q

Who is a pre op ECG required for

A

Undergoing major surgery
Poor exercise tolerance
MI hx
HTN
Rheumatic fever or other heart conditions

161
Q

Consent forms

A

1- adult consent where consciousness will be impaired eg GA
2- parental- used even if child has capacity
3- consciousness not impaired
4- lack capacity

162
Q

Order of splenic vessel division and prophylaxis

A

Artery before vein and offer lifelong penicillin prophylaxis

163
Q

Sign in , sing out and timeout

A

Sign in - before induction of anaesthesia, check identity, procedure, consent, risks, blood loss

Time out- just before operation
Correct ID, location and schedule, check antibiotics, allergies, medical implants

Sign out- discuss procedure done, counts of instruments, any equipment problems, post op plan

164
Q

ABPI for TED stockings

A

08-1.3 safe class 2
0.5- 0.8- class 1

<0.5- not safe

165
Q

Patient with severe pitting oedema, what mx of thrombophrophylaxis

A

Flowtron boots

TED CI

166
Q

Bleeding time definition

A

Time between making a wound and bleeding to stop

Usually 1-9mins

Test of plt function

167
Q

Can diathermy be used with a pacemaker in situ

A

Bipolar yes

Monopolar- pad has to be well away from pacemaker

168
Q

Cutting vs coagulation diathermy

A

Cutting- continuous current

Coagulation- interrupted

169
Q

How long is aspirin stopped before surgery

A

7 days

170
Q

Pressure and time for tourniquet in proximal arm

A

50 mmHg above systolic and 60 mins

171
Q

ECG changes with swans Ganz catheter and resolution

A

RBBB in 5%
Resolves in 24 hrs

172
Q

Feed cause of diarrhoea

A

Hyperosmolar feed
Bacterial contamination
Low temp feed
Reduced intestinal absorptive capacity

173
Q

Essentials of TPN

A

Nitrogen
Carbs
Fat
Ca, Mg, Fe, Zn, Mn, Copper, fluoride, iodine, chloride
Vitamins

174
Q

Most useful marker of nutritional recovery status

A

Serum albumin

175
Q

Venous line left open on insertion complication

A

Venous air embolism

176
Q

DIC levels

A

Low plts
low fibrinogen
prolonged PT
Increased D dimer

177
Q

Max amount of blood collected for autologous transfusion of pre collected blood

A

4-5 units

178
Q

Insulin levels after surgery

A

Low in Ebb
High in flow - but resistant

179
Q

Shrinking of split vs full thickness graft

A

Full intiially shrinks more due to more elastin in dermis

Split contract considerably more after

180
Q

Retractor used when converting laporasopic to open

A

Bookwalter

181
Q

Fiochietto retractor

A

Rectractor used to separate ribs in thoracic surgery

182
Q

Weinlager retractor

A

Self retaining- usually used in herniotomy, FP bypass, plastic, joint procedures

183
Q

Gelpi retractor

A

Self retaining
Orthopaedic and spinal

184
Q

Sweetheart retractor

A

Heart shaped
Used for cheeks, tongue and lips

185
Q

Max time for tourniquet

A

2 hrs

186
Q

% of TG digested in saliva

A

10-30%

187
Q

Current, frequency and voltage of diathermy

A

Current and voltage low
Frequency high

188
Q

% of patient requiring conversion to open cholecystectomy and those who can go home same day

A

5% converted

60% go home sam day

189
Q

Venous access for TPN

A

<14 d peripheral
>14 central

190
Q

Electrolyte abnormalities low Mg can contribute too and symtpoms

A

Low Ca and K

Low ca so muscle weakness, twitching

191
Q

Function of factor XIII

A

Stabilising factor
Cross links fibrin

Not a serine protease like other factors

192
Q

Position on table for left thoracotomy

A

Right lateral position

193
Q

DAPT for MI scheduled for elective surgery what mx

A

Delay surgery

194
Q

Major haemorrhage definition

A

Loss of >50% volume in 3hrs

> 100% in 24

> 150ml per minute

195
Q

Long acting insulin before surgery

A

80% before

All others stopped

196
Q

Storage and use time of FFP

A

-25

Once thawed sued within 24h at 4 degrees

36 months storied

197
Q

Suture for vascular anastomosis

A

Polypropylene 6-0

Mono non absorbable

198
Q

Needle for tendon repair

A

Round bodied needle

199
Q

First signs of large blood loss

A

Tachycardia

200
Q

Normal fluid regime for 70kg man

A

500ml NaCL with 20mmol K 8 hrs

1L dextrose with 20mmol 8 hrs

500ml Dextrose with 20mmol K 8 hrs

201
Q

Best way to assess fluid status

A

Urine output

202
Q

When should a trachy tube be changed

A

3 days post op

203
Q

Principals of diathermy pad placement

A

Close to op site
Away from prosthetics
Well vascularised
Shaved
Good contact

204
Q

Blade used for minor cutaneous lesions, abdomen and arrteriotomy

A

Number 15- abdomen

10- skin, muscle, cutaneous

11- arteries - pointy

205
Q

Calories required per day for surgical patient

A

25-30

2000 for 70kg

206
Q

Protein fat glucose ratio for surgical patient

A

20:30:50

207
Q

SE of Mg infusion

A

Cardiac arrhythmia

Nausea
Thirst
Hypotension
Resp depression
Confusion
Loss of reflexes
Muscle weakness

208
Q

When to give chlorpropamide with surgery

A

Stopped once the insulin infusion is commenced and not restarted until the patient is eating and drinking normally.

Sulfonulurea

209
Q

When to use alginate vs foam vs hydrogel vs hydrocolloid vs iodine dressings

A

Alginate- wound producing fluid

Foam- wet

Hydrogel- dry

Hydrocolloid- clean

Iodine- infected and exudate

210
Q

What can be a haem SE of TPN

A

Acute folate def if not given as well
Megaloblastic

211
Q

Emergency surgery, MRSA +, what to do

A

Continue surgery

Cover with appropriate Abx

Side room

212
Q

Class 2 haemorrhage shock sx

A

15-30

Tachycardia
Lower pulse pressure due to symp vasoconstriction
Agitated but oriented

213
Q

Use of drains

A

Detect post op bleeds, remove pus or fluid

Doesn’t help healing

214
Q

What size of trachy correlates to

A

Internal diameter

215
Q

Those requiring U+E before surgery

A

> 60
CV disease
Renal disease
Diabetes
Steroids/ACEi

216
Q

Urinary osmolality, sodium and creatine of pre renal vs renal cause

A

Pre renal
Osm >500
Na <20
Creatinine >40

Renal
Osm <350
Na >40
Creatinine <20

217
Q

Sign for middle lobe consolidation

A

Indistinct right heart border

218
Q

Third space loss definition and constituants

A

Temporary internal loss of extracellular fluid into space not participating in normal transport

Composition similar to interstitial fluid

219
Q

Patient post embolectomy, pulse not findable on same leg, what next ?

A

Measure compartment pressure

220
Q

Effect of tourniquet on nerves

A

Neuropraxia

221
Q

CEPOD classification

A

1- immediate- life threatening
2- urgent- acute onset- appendectomy, compund fracture- washout within 6 hrs
3-expidited- early treatment- acute cholecystectomy
4- elective

222
Q

Zinc function intracellularly

A

RNA and DNA synthesis

223
Q

When is a post op MI most likely to occur

A

Day 1

224
Q

When should pre op ECG and lung function be conducted

A

ASA 1 over 65
ASA 2

Resp disease lung functions

225
Q

Class of Nd YAG laser and protection

A

Class 4
Glasses
Wave length determines penetration

226
Q

Most effective way of reducing heat loss in pateint

A

Heated blanket

227
Q

Imaging radiation risk

A

Limb 0.01 apart from hip 0.3
Then chest 0.02 3 days BG
Then abdo 0.7 4months

Lumbar spine x ray 1.2 8 months

CT head 2 1 yr
CT chest 8 3.6yrs
CT AP 10 4.5 yrs

228
Q

When is artificial nutrition required

A

Oral intake absent or likely to be absent for 5-7d

229
Q

What time period is a prev MI CI for major surgery

A

Within 6m

230
Q

Metabolic complications of TPN

A

Hyper/oglycaemia
High/low Na
High/low K
High/low Ca

Def in folate, Zn, P , Mg

231
Q

Anastomosis of free flap construction of breast

A

Internal mammary

DIEP- deep inferior episode

SGAP- superior gluteal artery

232
Q

Cause of hypotension in spinal

A

Reduction in symp
Splanchnic vasdoialtion and pooling

233
Q

Op max length of time for spinal

A

<2hrs

234
Q

Patient chewing gum when NBM how long to wait for surgery

A

2 hrs

235
Q

Ventilation support for ARDS

A

Low tidal volumes

Also give nutritional supplementation NG

236
Q

Medications stopped before surgery and timings

A

Lithium- 24hrs
ACEi- 24 hrs
K sparing- day of

Aspirin- 7-14d
Warfarin- 5d
Oestrogen- 4w

eMRCS questions (45 decks)

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