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26/7 LOs > SAQs > Flashcards

SAQs Flashcards

1
Q

CNS Adverse effects of propofol?

A

Excitatory phenomena - hiccups, twitches, tremors, involuntary movements

Low therapeutic index between sedation and GA

Reduced cerebral blood flow

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2
Q

Symptoms of propofol infusion syndrome?

A

Metabolic acidosis (lactic)
Rhabdomyolysis
Hyperlipidaemia
Bradycardia arrest

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3
Q

Why does TEC 5 or other plenum vaporiser need an anti-spilling mechanism?

A

Previous spelling into bypass chamber

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4
Q

What is the safety system in place when two vaporisers are running at once?

A

Interlock system

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5
Q

What is the boiling point of des?

A

22.8 degrees, only slightly above room temp

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6
Q

What does Tec 6 do differently?

A

heating des to 39 degrees, 2atm

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7
Q

How does Tec 6 ensure that the flow of des is proportional to the carrier gas flow?

A
  1. Carrier gas flow restricted by an office, so that the pressure of carrier gas is proportional to gas flow
  2. Pressure transducer adjusts the resistor on des flow.

The resistor adjustment ensures that des flow is proportional to gas flow.

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8
Q

What is the component of aminophylline?

A

80% theophylline

20% ethylenediamine

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9
Q

What is the mechanisms of action of theophylline?

A

inhibits adenosine receptors to facilitate catecholamines from adrenal medulla.

High dose inhibit PDE

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10
Q

What are the side effects of theophylline?

A 
Low therapeutic index. 
CVS - arrhythmia
CNS - reduce seizure threshold 
Renal - weak diuretic 
Endo - increase secretion of gastrin and PTH
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11
Q

What is the 90% decrement time of servo at

  • 30 mins
  • 120 mins
  • 300 mins
A
  • 5- 10 mins
  • 20 mins
  • 60 mins
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12
Q

How much can naloxone reverse the effect of tramadol?

A

30% only

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13
Q

Describe the pathophysiology of aspirin toxicity

A

uncoupling of oxidative phosphorylation -> increase O2 consumption and CO2 production.

Children particularly at risk

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14
Q

What are the symptoms of aspirin toxicity

A

seizure, cerebral oedema, cardiac arrest

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15
Q

Overall effect of ageing on pain?

A

Reduced nociceptive response to noxious stimuli
Increased susceptibility to analgesic toxicity
Reduced ability to communicate
Frequently underrated

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16
Q

How does the CNS compensate for age related neuronal atrophy?

What’s the magnitude of this atrophy?

A

Redundancy - more neurons than required for normal function.
Neuroplasticity - more connections formed between remaining neurons
Neurogenesis - produce more neurons in hippocampus and basal ganglia

10% loss by age 80

17
Q

Why is there a reduced SNS response to pain in the elderly?

A

Age related reduction in adrenergic receptors, compensated by increased level of catecholamine release -> overall reduce SNS tone.

Results in reduced SNS response to painful stimuli

18
Q

Content of NaCl 0.9%?

A

154 mmol/L Na

154 mmol/L Cl

19
Q

Content of 4% albumin?

A

40g/L albumin
Na 140 mmol/L
Cl 128 mmol/L
Octanoate 6.4 mmol/L

20
Q

Specific indications for 4% albumin?

A

liver failure
Hypoalbuminaemia
Haemorrhage

21
Q

Why is 4% albumin iso-oncotic?

A

Albumin content, large protein, bound to intravascular space.

provides 20-30 mmHg of oncotic pressure, hence iso-oncotic

22
Q

IPPV effect on left heart?

A

Inspiration - initial increase in preload -> increase CO
followed by sustained reduction in preload

expiration - decrease PVR -> increase capacitance -> increase pulmonary blood volume -> further reduce LV preload

23
Q

What is the FRC under anaesthesia / paralysis?

A

FRC 30 ml/kg on supine

25 with paralysis

24
Q

Broadly speaking, what are the three main ways for kidneys to regulate body water?

A
  1. Regulate intake (low body volume -> renin -> ATII -> stimulation of thirst)
  2. Regulate GFR (auto regulation)
  3. Regulate reabsorption / excretion
25
Q

Describe the structure of RBC

A

4x Haem, with iron Fe2+ in the centre

4x globin

26
Q

How is iron from RBC recycled?

A

RBCs are destroyed in the reticulo-endothelial system after 120 days.

Released iron transported via transferrin to the bone marrow for re-incorporation

27
Q

How is globin from RBC recycled?

A

A2B2 mainly -> broken down into amino acids for recycling

28
Q

Describe the fate of haem before reaching the liver

A

Haem -> haem oxygenase -> biliverdin (in RES)

Biliverdin -> biliverdin reductase -> bilirubin unconjugated

29
Q

What is the enzyme for the conjugation of bilirubin?

A

UDP glucuronly transferase

30
Q

What is the permissive action of glucocorticoid

A

Small amount of glucocorticoid is required to exert action of catecholamine and glucagon

Hypothermia -> calorigenic effect needs glucocorticoid.

31
Q

How does glucocorticoid exert anti-inflammatory effect

A

affects nuclear transcription

  • Reduce some cytokine production.
  • Reduce eicosanoids via phospholipase A2 inhibition
32
Q

How does glucocorticoid affect immune function?

A

Reduction in cytokine -> reduce WBC chemotaxis / activation / proliferation

33
Q

How does glucocorticoid affect haem system?

A

Increase RBC, neutrophil, platelet production

Reduce eosinophils, basophils

34
Q

What are the consequences of increased resonance in the measuring system?

A

Falsely elevated SBP, reduced DBP, MAP unaffected

35
Q

what is the typical dose of cephazolin?

A

1g for adult <70kg
2g 70-120kg
3g >120kg

36
Q

Mechanism of action of GTN?

A

Prodrug -> needs thin-containing compounds to release NO

37
Q

What are the advantages of COX-2 inhibitors cf. non-selective?

A
  • decreased GI bleed incidence
  • Does not affect platelet function
  • improved quality of analgesia
38
Q

What is the volume of distribution of alfentanil

A

0.4 L/kg

39
Q

Why is fentanyl’s T1/2B longer than alfentanil?

A

Fentanyl Vdss = 4L/kg, clearance 13ml/kg/min
Alfentanyl Vdss = 0.4L/kg, 6ml/kg/min

10x the Vdss, and only 2x the clearance

T1/2 = VD/Cl

26/7 LOs (5 decks)

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