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Final > Specific diseases > Flashcards

Specific diseases Flashcards

1
Q

What are the criteria of the STOP-BANG assessment?

A

Snoring
Tiredness during the day
Observed cessation in breathing
Pressure (BP) high
BMI >35 kg/m2
Age >50
Neck circumference >40cm
Gender male

≤ 2 - excludes OSA
3-4 - intermediate risk of OSA
≥ 5 - high risk of OSA

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2
Q

What is the AHI?

A

Apnoea-Hypopnoea Index
The number of apnoeas or hypopnoeas lasting >10s recorded in 1 hour

≥5 mild
≥15 moderate
≥30 severe

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3
Q

What constitutes a significant desaturation in OSA?

A

Desaturations >4% if ≥5 in 1 hour

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4
Q

Which features of OSA does nocturnal CPAP most improve? (3)

A

CCF
Platelet aggregation
Dysrhythmias

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5
Q

Which features of OSA should prompt to postpone surgery and optimise?

A

Untreated CCF
Hypercapnoea with PaCO₂ >6.5

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6
Q

What is the most common and most severe muscular dystrophy?

A

Duchenne Muscular Dystrophy (DMD)

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7
Q

What is the incidence of DMD?

A

1 in 3500 male live births (LB)

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8
Q

Define muscular dystrophy

A

Inherited disorder characterised by progressive muscle weakness, without evidence of denervation
Caused by mutations in genes (usually those involved in making muscle proteins)
X-linked recessive

Post-junctional neuromuscular disorder

Dystrophy = tissue degeneration
Muscular dystrophy = muscular tissue degeneration

Progressive muscular weakness, pseudohypertrophy (muscle contractures), poor balance, progressive inability to walk, scoliosis, waddling gait, Gowers’ sign

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9
Q

What are the cardiac effects of DMD? (3)

A

Cardiomyopathy
Arrhythmias
Conduction defects
Heart failure

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10
Q

What are the respiratory effects of DMD? (4)

A

Respiratory muscle weakness
Swallowing impairment
Improper secretion management
Recurrent chest infections
Scoliosis resulting in restrictive lung defects
Failure to wean from ventilation

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11
Q

What are the neurological effects of DMD?

A

Learning disability

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12
Q

What is the typical life expectancy in DMD?

A

15-25 years

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13
Q

What is pseudohypertrophy?

A

False enlargement of muscle

Dystrophin absence renders sarcolemma weak → muscle fibres inadequately tethered → replaced with fibrous connective tissue → pseudohypertrophy

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14
Q

What are the biochemical abnormalities found in DMD?

A

Raised CK

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15
Q

What are the common operations in DMD?

A

Orthopaedic:
Scoliosis corrections

Cardiac:
Angiography
Valve replacement

Ophthalmic:
Cataracts

Incidental:
Dental work 2° to low IQ

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16
Q

Why should you perform lung function tests in DMD?

A

FVC <20ml/kg associated with increased mortality

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17
Q

List 3 acquired, non-drug related causes of Long QT

A

Subarachnoid haemorrhage
Anorexia Nervosa
Hypothermia
Hypocalcaemia
Hypokalaemia

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18
Q

How do you diagnose long QT?

A

QTc greater than 450 ms men, 460 ms women

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19
Q

What is your perioperative anaesthetic management of Long QT?

A

Seek cardiologist opinion
Check electrolytes
Perform ECG with valsalva
Stop any drugs that increase QTc
Continue beta blockers
Avoid suxamethonium
Obtund pressor response to laryngoscopy
Avoid use of reversal (use sugammadex)
Consider transvenous pacing

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20
Q

Pathophysiology of long QT?

A

Depolarisation abnormality
Malfunction in cardiac ion channels

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21
Q

What is porphyria?

A

Group of disorders characterised by an inherited or acquired abnormality in the enzymes relating to haem synthesis

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22
Q

What is the pathophysiology of porphyria?

A

Failure in haem synthesis → accumulation of porphyrins and precursors (ALA, aminolaevulinic acid, and PBG, porphobilinogen)

23
Q

Which enzyme is an important rate limiting step in porphyria?

A

ALA synthetase

24
Q

What is the incidence of porphyria?

A

1 in 20,000

25
Q

How is a diagnosis of porphyria confirmed?

A

Urinary ALA and porphobilinogen (PBG)

26
Q

What are the different types of porphyria?

A

Acute
Hereditary
Intermittent
Variagate

27
Q

Which premedication drugs are considered SAFE in porphyria?

A

NONE

28
Q

Which induction agents are considered SAFE in porphyria?

A

Propofol only

29
Q

Which maintenance agents are considered SAFE in porphyria?

A

Most volatiles
N₂O

30
Q

Which analgesics are considered SAFE in porphyria?

A

Paracetamol
Aspirin
Codeine

Opioids:
Fentanyl
Alfentanil
Morphine
Pethidine

31
Q

Which local anaesthetics are considered SAFE in porphyria?

A

Bupivacaine
Prilocaine

32
Q

Which uterotonics are considered SAFE in porphyria?

A

Oxytocin

33
Q

Define BMI

A

Body mass index, kg/m2

Mass / height^2

34
Q

What is the WHO BMI classification?

A

Underweight <18.5
Healthy weight: 18.5-24.9
Overweight: 25-29.9
Obesity: 30+
- Class 1 Obesity: 30-34.9
- Class 2 Obesity: 35-39.9
- Class 3 Obesity: 40+ (morbid)

35
Q

What is morbid obesity?

A

BMI > 40, or
BMI > 35 with a recognised co-morbidity:
- T2DM
- Sleep disordered breathing
- HTN
- Cardiovascular disease
- Cerebrovascular disease

36
Q

Define central obesity

A

Waist circumference > 88 cm in a woman
Waist circumference > 102 cm in a man;
or a waist-to-height ratio > 0.55

37
Q

What risks is OSA specifically associated with in the perioperative period? (4)

A

OSA patients have double the incidence of:
- Postoperative desaturation
- Respiratory failure
- Postoperative cardiac events
- ICU admission

38
Q

What is obesity hypoventillation syndrome?

A

A triad of:
1. Obesity (BMI > 35)
2. Sleep disordered breathing (usually OSA)
3. Daytime hypercapnoea (PaCO₂> 6 kPa)

39
Q

What is the typical compliance with nocturnal CPAP for OSA?

A

Around 50%

40
Q

Obesity Hypoventilation Syndrome - pathophysiology (3)

A

Leptin intolerence / resistance
Reduction in CO₂ chemoreceptor sensitivity
Particularly susceptible to opioid respiratory depression

41
Q

What are the cardiovascular sequelae of obesity? (5)

A

HTN
Increased cardiac output and cardiac work
Pulmonary HTN
CCF
Arrhythmias
- 2° to sino-atrial node dysfunction and fatty infiltration of the conducting system
- 1.5x RR for atrial fibrillation
- Increased risk of sudden cardiac death
- Increased incidence of prolonged QT interval

42
Q

Which anaesthetic drugs should be dosed on Lean Body Weight?

A

Induction agents
- Propofol (induction)
- Thiopental
- Fentanyl

Non-depolarising Muscle Relaxants:
- Rocuronium
- Atracurium
- Vecuronium

Morphine
Paracetamol
Bupivacaine
Lidocaine

43
Q

Which anaesthetic drugs should be dosed on Adjusted Body Weight

A

Propofol (infusion)
Antibiotics
Low molecular weight heparin
Alfentanil
Neostigmine (maximum 5 mg)
Sugammadex

44
Q

Ideal Body Weight

A

IBW = height (cm) - x
x = 105 in females
x = 100 in males

45
Q

Lean Body Weight

A

The patient’s weight excluding fat
Many of the formulae for calculating lean body weight are complex but one of the most widely used is that ofJanmahasatianet al.

46
Q

Adjusted Body Weight

A

ABW = IBW + 0.4(TBW - IBW)

Adding 40% of the excess weight to the IBW

47
Q

What is OS-MRS?

A

Obesity Surgery Mortality Risk Stratification:
BMI > 50
Male
Age > 45 years
Hypertension
Risk factors for pulmonary embolism
- Previous VTE
- Venocaval filter
- Sleep disordered breathing
- Pulmonary HTN

Mortality:
Class A: 0-1 points: 0.2-0.3%
Class B: 2–3 points: 1.1-1.5%
Class C: 4–5 points: 2.4-3%

48
Q

What are the main benefits of a pre-operative discussion in bariatric surgery?

A

Promote smoking cessation
Discuss importance of VTE-prophylaxis and early mobilisation
Plan management of medication before admission
Remind patients to bring their own CPAP machine
Commence “Liver Shrinking” diet
Ensure CPAP adherence

49
Q

What collar size is associated with a difficult airway?

A

> 43cm

50
Q
A
51
Q

How much epidural catheter should be left in the space in bariatric cases

A

At least 5 cmto prevent catheter migration

52
Q

Why might suxamethonium be a bad idea in bariatric cases?

A

Suxamethonium associated fasciculationsincrease oxygen consumptionand have been shown toshorten the safe apnoea time
It isunlikely to wear offbefore profound hypoxia occurs

53
Q

List some general techniques to deliver a “Safe Sleep-Disordered-Breathing Anaesthetic”

A

Avoid GA/Sedatives where possible
Use short acting agents
Use DoA monitoring to limit anaesthetic load
Use neuromuscular monitoring to ensure complete reversal of block before waking
Maximal use of local anaesthetic and multimodal opioid sparing analgesia
Maintain head–up position throughout recovery
Monitor of oxygen saturations until mobile
Reinstate CPAP early

54
Q

Describe the basic pathophysiology of acromegaly

A

Eosinophilic adenoma
Excess growth hormone production

Final (21 decks)

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