Random Crap I Should Know

Question 1

Child-Pugh score

Answer 1

Each 1-3 points.
Used to predict surgical mortality

A - 5/6;
B 7-9 points
c - >10; >50% mortality; 1 year survival 45%, 2yr 33%

Bilirubin 50
Albumin (g/l) >35, 30-35, 2.3
Encephalopathy none, grade 1-2, grade 3-4
Ascites none, moderate, marked

Question 2

Sarcoidosis is;

Answer 2

A multi system granulomatous disease that causes non caseating granulomas in involved organs

Lung disease in 50 %; restrictive or obstructive picture, skin issues, laryngeal sarcoid, may have mediastinal mass

Question 3

SLE is;

Answer 3

A chronic autoimmune inflammatory condition

Pericarditis, libman-Sachs endocarditis, accelerated CAD
Pulm HTN, interstitial lung disease, risk of PE
Small vessel vasculitus
Renal involvement
Joint issues in 90%
High risk thromboembolic events

May be on steroids

Question 4

Signs of an innocent murmur in a child

Answer 4

Clinically well, growing normally, feeding normally
Pulses are normal
No history of recurrent chest infection
Murmur is;
Soft
EarlySystolic or continuous 
Often varies with posture 
No thrill
Quality - blowing, musical

Question 5

Nerves to block for scalp block

Answer 5

7 paired nerves;
Supraorbital - V1
Supratroachlear - V1
Zygomaticotemporal - V2
Auriculotemporal - V3
Lesser occipital - cn2/3
Greater occipital - cn2
Greater auricular - cn2/3

Question 6

Non technical skills

Answer 6

Situational awareness
Team working
Task management
Decision making

Question 7

Effects of quitting smoking

Answer 7

1 day - HbCO levels and nicotine levels lower; better oxygen delivery
3 weeks - improved wound healing
6-8 weeks - sputum volume not > than non smokers, improved pulmonary function
>6/12 - improved immune function

Ask, advise, refer

Question 8

Classification of equipment;

Answer 8

Critical - will penetrate skin, mucous membranes, enter vascular system. Must be sterilised.

Semi-critical - will be in contact with intact mucous membranes or be contaminated with readily transmissible organisms. Need high level disinfection or sterilisation.

Non-critical - intact skin, or no direct patient contact. Low level disinfection or cleaning.

Question 9

Hand hygiene solution contains;

Answer 9

2-4% chlorhex and 60-95% alcohol

Question 10

Classification of equipment re cleaning;

C = critical
SC = semi critical
NC = non critical

Answer 10

Face mask - SC
Laryngoscope - c
Bougie - c
Breathing systems - used for more than one patient if bacterial filter used
Sampling line - need viral filter
Surfaces/monitor - cleaned between each patient with detergent and water
Flexible bronch - C
Ultrasound - will depend on what used for; NC use, just clean; SC use - use a cover; critical use will need high level disinfectiono

Question 11

Definitions asepsis, disinfection, sterilisation

Answer 11

Asepsis - prevention of microbial contamination of living tissues or sterile materials

Disinfection - inactivation of non-sporting organisms using thermal or chemical means

Sterilisation - compete destruction of all microorganisms including spores

Question 12

Systemic sclerosis;

Answer 12

Immune activation, vascular damage and deposition of collagen

Classified as;
limited cutaneous - hands/face and CREST
Diffuse cutaneous - risk of renal, lung, CVS disease

Develop -
Myocarditis and conduction abnormalities
Pulmonary fibrosis and HTN
Chronic renal failure
Oesophageal hypomotility
Thick skin - difficult iv access
Limited mouth opening

Question 13

ETT size for children;

Depth;

Size of LMA

Answer 13

Age/4 +4

Age/2 + 12

LMA - on packaging
1, 5kg
1.5 5-10kg
2 10-20kg
2.5 20-30
3 >30kg

Question 14

Assessment before any procedure;

Answer 14

Simple!

Consent
Iv access
Monitoring
Position
Local anaesthetic
Evaluate

Question 15

Active cardiac conditions

Answer 15

Unstable coronary syndromes (Mi last 30 days, CCS 3 or 4)
Dulecompensated failure
Severe valve disease
Significant arrhythmias

Question 16

Drugs that raise PVR

Answer 16

Nitrous
Ketamine
Protamine

Question 17

WHO pulm HTN classification.

Answer 17

1. Arterial - portal HTN, shunts
2. Venous - MR
3. Due to respiratory disease or hypoxia
4. Due to thrombus
5. Due to direct vasculature changes

Question 18

Monitoring during anaesthesia;
Required
Available
Should be available

Answer 18

Must;
O2 analyser
Sats
ETCO3
ETAA
Disconnection alarm

Clinical monitoring must occur; circulation, ventilation, oxygenation

Should;
ECG
NIBP
Temp
NMT

Available;
IBP
CVP
5lead
BID
TOE
CO monitor
Resp mechanics

Question 19

Preventive vs pre-emptive analgesia

Answer 19

Pre emptive - given before incision to try and reduce pain

Preventive - an intervention that has benefit that lasts longer than 5xt 1/2

Question 20

CRPS diagnosis

Answer 20

Vasomotor/colour
Sudomotor
Sensory
Motor

2 signs, 3 symptoms

And pain disproportionate to inciting event

Question 21

Indications for CEA;

Answer 21

Symptomatic >70% stenosis NNT 6 to reduce risk of stroke

50-69% stenosis NNT 22

Asymptomatic - absolute risk reduction 1%/year CEA vs medical management

Question 22

Bridging therapy for anticoagulation for AF;

Answer 22

CCF
HTN
Age >75
Diabetes
CVA/TiA/thromboembolism - 2
Vascular disease
Age 65-75
Sex female

Score >/= 2 - anticoag indicated
- 2% stroke risk
Score 1- discussion

Score >/=6 - bridging recommended

Question 23

Filter modes for ECG

Answer 23

Diagnostic - minimal filtering
- good representation but lots of interference
Monitor - maximal filtering
- good rhythm monitor but poor assessment of ST segments
ST segment

5 lead, V5 and 2 = highest detection of changes

Question 24

Stages of diastole;

Answer 24

Isovolumetric relaxation
Early rapid filling (E wave)
Diastasis
Late rapid filling (A wave)

Usually E:A > 1 (a only provides 30%)

Mild - reversal
Progresses with E:A >1.5 ( with pseudo normalisation in between)

Question 25

Quality assurance

Answer 25

An organised process that assesses and evaluates health services to improve practice or quality of care Planning Implementation Review Setting standards

Question 26

Classification acute renal dysfunction;

Answer 26

RIfLE ``` Risk creat x 1.5, u/o low 6 hours Injury creat x 2, u/o low 12 hours Failure creat x3, Anuria 12 hrs Loss - complete loss for > 4 weeks End stage - complete loss >3/12 ```

Question 27

CTG recording; Early decels Late decels Variable decels

Answer 27

Early - head compression Late - uteroplacental insufficiency Variable - umbilical cord compression

Question 28

Requirements for pneumonectomy/lobectomy;

Answer 28

Lobectomy; FEV1 >1.5L or >80% predicted Need to be able to climb 3 flights stairs ``` Pneumonectomy; FEV1 >2L Ppo-FEV1 0.7-0.8l Need to be able to climb 5 flights stairs - approx equal to VO2 max >20ml/kg/min If VO2 max ```

Question 29

Power supply in theatres

Answer 29

Mains power plus two levels of redundancy (white sockets = only connected to mains); 1. SPS (secondary power supply), Onsite generator (secondary power supply) - red sockets = connects to sps This does take 15seconds or 2 mins to connect 2. Uninterrupted power - back up battery bank = dark blue power circuit

Question 30

Adverse effects of transfusion;

Answer 30

``` Immediate; Febrile reaction Allergic urticarial reaction Severe allergic reaction Acute haemolytic reaction Bacterial contamination TRALI Volume overload Hypothermia Citrate toxicity Potassium effects ``` ``` Delayed; Delayed haemolysis Alloimmunisation Transfusion associated graft vs host Immunomondulatory effects Iron accumulation Infectious disease transmission ```

Question 31

Block for lower leg surgery;

Answer 31

Sciatic nerve; Find popliteal artery with probe under leg. Tibial nerve lateral to it. Common peroneal is superficial to the tibial. They join together usually 5-10cm from knee crease. Saphenous nerve; branch of femoral. Supplies medial aspect Lies medial to femoral artery, below sartorius muscle

Question 32

How does aortic Doppler estimate cardiac output;

Answer 32

CO = VTI x CSA x HR VTI - velocity-time index - calculated using descending aortic flow -> velocity time curve -> AUC CSA - cross sectional area, use USS or algorhythm

Question 33

Grades of murmur

Answer 33

1 listen carefully 2 soft but heard readily 3 easily heard immediately 4 thrill and loud 5 thrill heard with just rim touching chest 6 thrill audible with stethoscope off chest wall

Question 34

Values of ejection fraction

Answer 34

Normal >55% Mildly impaired 45-54% Moderate 30-44% Severely impaired

Question 35

Nerves of lumbar plexus

Answer 35

``` Iliohypogastric Ilioingiinal Genitofemoral Lateral femoral cutaneous Femoral Obituarator ``` T12-L4

Question 36

Pre-thoracotomy assessment

Answer 36

Respiratory mechanics; ppoFEV1 >40% low risk Calculated; preop FEV1 x (1- functional tissue removed/100) Gas exchange; DLCO ; predixted 20ml/kg/min good = 5 flights stairs If ppoVO2 max

Question 37

Post op delirium vs POCD

Answer 37

POD- a change in mental state characterised by a reduced awareness of the environment and a disturbance in attention. Between 1-3 days post op. May be associated with hallucinations, disorientation. Increased mortality. Ketamine appears to reduce incidence. POCD- a deterioration in cognition temporally related to surgery. Need preop neuropsychological testing to confirm. 25%. >60s at 1 week, 1% unresolved at 2 years. ? Due to micro emboli or inflammatory response.

Question 38

Pre eclamptic BP 170/110, headache proteinuria. Which not used to control hypertension;

Answer 38

Magnesium

Question 39

Commonest organism causing meningitis post spinal;

Answer 39

Strep salivarius

Question 40

Bias

Answer 40

Systematic deviation from the truth Selection - use random allocation, clear inclusion/exclusion criteria Performance - ensure blinding Measurement - standard measure Attrition - due to withdrawal - assess using intention to treat Reporting - all results reported Publication - negative studies published

Question 41

Systematic review

Answer 41

Formal process Involves identification, appraisal and evaluation Used to draw conclusions about a specific issue Includes; Literature review using clearly defined and reproducible search criteria Faster and cheaper than reexamination Can include large and small studies Meta analysis (statistical analysis) can then provide level one evidence

Question 42

How to determine sample size

Answer 42

Alpha error - probability of committing type 1 error Beta - probability of committing type 2 error Effect size - small differences harder to detect Variance - increased variance needs bigger numbers Test statistic - how sensitive is the test

Question 43

Trauma induced coagulopathy

Answer 43

Due to; depletion, dysfunction and dilution Exacerbated by; hypothermia, acidosis, fluid resus ``` Characterised by; Factor five inhibition Low fibrinogen Systemic anticoagulation Impaired platelet function ``` ``` Management; Early detection MBT protocol Prevent hypothermia and treat acidosis Use TXA and calcium Consider factor 7 ```