Variant 1 (2021/22) Flashcards
Which of the following anaesthetics has
analgesic properties? {MCQs}
- Sevoflurane
- Nitrous oxide
- Diazepam
- Propofol
- Nitrous oxide
Oxygen consumption: {MCQs}
- In health, is critically dependent on
oxygen delivery - Is increased under general anaesthesia
- Is increased in malignant hyperthermia
- Is approximately 2L/min in the resting
adult
- Is increased in malignant hyperthermia
In the diagnosis of brainstem death: {MCQs}
- Spinal reflexes may be present
- An EEG must be flat for 24 hours
- Consultation with a neurologist is
needed - Blood must be sent for drug screening
- Spinal reflexes may be present
Which of the following does the qSOFA
score include? {MCQs}
- Altered mental status
- Ramsay sedation score >2 points
- pO2<50mmHg
- pCO2>45mmHg
- Altered mental status
What does GCS=9 points E2M5V2 mean? {MCQs}
- Opens eye on verbal stimulation,
localizes pain, inappropriate words - Opens eye to pain, localizes pain,
incomprehensive words - Opens eye to speech, localizes pain,
inappropriate words - Opens eye to pain, withdraw from pain,
inappropriate words
- Opens eye to pain, localizes pain,
incomprehensive words
Suxamethonium does NOT cross the
placenta because of: {MCQs}
- Placental cholinesterase
- Its high degree of ionization
- It being an elongated molecule
- High protein binding
- Its high degree of ionization
Which of the following factors exerts the
greatest effect on the extent of spread of local
anesthetic following subarachnoid block with
hyperbaric bupivacaine? {MCQs}
- Patient position
- Barbotage
- Added epinephrine
- Total dose of drug
- Patient position
Which of the following opioids are most
commonly administered into the intrathecal
(spinal) space? {MCQs}
- Morphine and fentanyl
- Fentanyl and sufentanil
- Morphine and sufentanil
- Fentanyl and remifentanil
- Morphine and fentanyl
Which of the following is NOT a type of
circulatory shock? {MCQs}
- Neurogenic shock
- Spinal shock
- Cardiogenic shock
- Obstructive shock
- Spinal shock
A patient with a head injury becomes
unconscious and develops signs of raised ICP.
Management in the acute phase includes: {MCQs}
- Performing an immediate lumbar
puncture - Obtaining an electroencephalogram
- Ordering a digital subtraction angiogram
- Treatment with mannitol
- Treatment with mannitol
The following findings occur with a large
pulmonary embolus: {MCQs}
A. An increase in pulmonary artery pressure
B. A decrease in right atrial pressure
C. An increase in left atrial pressure
D. An increase in physiological dead-space
E. An increase in right ventricular pressure
A. An increase in pulmonary artery pressure
D. An increase in physiological dead-space
E. An increase in right ventricular pressure
Which of the following is NOT an indication
for endotracheal intubation?
A. Maintenance of a patent airway
B. To provide positive pressure ventilation
C. Pulmonary toilet
D. Pneumothorax
E. GCS=6
A. Maintenance of a patent airway
B. To provide positive pressure ventilation
C. Pulmonary toilet
E. GCS=6
Which are contraindications for using
N2O?
A. Middle ear occlusion
B. Pneumothorax
C. High blood pressure
D. Bowel obstruction
E. Chronic kidney failure
A. Middle ear occlusion
B. Pneumothorax
D. Bowel obstruction
Causes of prolonged postoperative
recovery of consciousness are:
A. Acromegaly
B. Intraoperative intracerebral event
C. Myxoedema
D. Prolonged action of muscle relaxants
E. Hypoventilation
ALL answers are correct!
Which of the following can cause Acute
respiratory distress syndrome (ARDS)?
A. Acute heart failure
B. Sepsis
C. Pneumonia
D. Acute Pancreatitis
E. Massive blood transfusion
B. Sepsis
C. Pneumonia
D. Acute Pancreatitis
E. Massive blood transfusion
In acute cardiac tamponade there is:
A. muffled heart sounds
B. hypotension
C. bradycardia
D. distended jugular veins
E. cyanosis and cold extremities
A. muffled heart sounds
B. hypotension
D. distended jugular veins
E. cyanosis and cold extremities
Treatment of an anaphylactic reaction
includes:
A. Epinephrine
B. Corticosteroids
C. Crystalloid solutions
D. Antihistamines
E. Antibiotics
A. Epinephrine ??
B. Corticosteroids
C. Crystalloid solutions
D. Antihistamines
Preoxygenation
A. is increasing oxygen reserve in the functional
residual capacity
B. as part of a rapid sequence induction
occurs before induction of anaesthesia
C. can be started in the ward prior to coming to OR
D. should be performed through an
anaesthetic circuit and a high oxygen flow rate
and the mask held just off the face
E. allows for acceptable oxygenation during
10 minutes of apnoea
A. is increasing oxygen reserve in the functional
residual capacity
B. as part of a rapid sequence induction
occurs before induction of anaesthesia
D. should be performed through an
anaesthetic circuit and a high oxygen flow rate
and the mask held just off the face
Difficult intubation is associated with:
A. a short thick neck
B. limited mouth opening
C. dental abscess
D. limited neck movements
E. a Mallampati grade I
A. a short thick neck
B. limited mouth opening
C. dental abscess
D. limited neck movements
Which of the following does occur in
response to trauma?
A. Rise in urinary sodium
B. Water retention
C. Sodium retention
D. Rise in serum sodium
E. Rise in urinary nitrogen
B. Water retention
C. Sodium retention
E. Rise in urinary nitrogen
[CASE 1]
A 45-year old male patient that has had a motor vehicle accident is transported to the emergency department.
He has a head and chest trauma. On admission he is unresponsive, pain stimulation leads to opening of the eyes and flexion of the upper extremities, with no verbal response. His pupils are dilated with normal reaction towards light. He has jugular vein distention.
After being provided with 8l/min oxygen via face mask his SpO2 is 88% and decreasing. His HR is decreasing rapidly from 130 to 50bpm and his blood pressure is 70/30mmHg.
On auscultation there is no breathing in the right hemithorax.
A) What is the most likely cause of the rapidly deteriorating condition?
B) What will your treatment strategy consist of?
C) How would you asses the patients’ neurological status?
A) Cause of the Rapidly Deteriorating condition is DUE to: RIGHT-Sided TENSION Pneumothorax w/ Mediastinal Shift TO Left, causing CARDIAC TAMPONADE
B) Treatment: Fluid Resuscitation / Emergency Needle THORACOSTOMY / CT for Head Trauma
C)
Eyes = To Pain (2)
Verbal = Unresponsive (1)
Motor = Flexion Withdrawal (4) == GCS 7
[CASE 2]
A 24-year-old man comes to the emergency
department because he has had fever, elevated
blood glucose level, and confusion during the
past three hours.
His BP is 86/42 mmHg. The heart rate is 131 beats per minute, and respirations 38 per minute. SpO2 is 93% on room air.
Physical examination shows dry mucous membranes and delayed capillary refill.
Laboratory studies show serum potassium level
of 3.7 mmol/L and serum glucose level of 38 mmol/L.
Arterial blood gas analysis shows pH of 6.98.
A) Interpret BGA
B) What is the most likely cause?
C) Suggest a Treatment Plan
A) Px has Metabolic Acidosis w/ Respiratory Compensation; Also Hypoxaemic
B) DUE to Diabetic Ketoacidosis, DUE to HIGH Glucose + LOW Bicarbonate levels; A Ketone DRIP TEST would confirm Dx
C) Treatment:
- CORRECT the Acidosis w/ Insulin + IV Fluids
- REPLACE Calcium + Potassium
- TROMETHAMINE Injection to correct Metabolic Acidosis
[WRITING I] - INTRAVENOUS Anaesthesia - Definition; Advantages / Disadvantages
DEF = IVA is used to INDUCE a state of REVERSIBLE loss of consciousness, characterised w/ amnesia, hypnosis, muscle relaxation + analgesia
EXAMPLES incl = Thiopental / Propofol / Ketamine
ADV = Easy + Quick Admin / Precise control of Dose / NO Dependence on Breathing
DISADV = Rate of Elimination depends on Organ + Enzyme Function / Risk of Allergies / Risk of Systemic Infections
[WRITING II] - Complications of EPIDURAL & SPINAL Anaesthesia - Prophylaxis + Treatment
COMPLICATIONS
- Puncture of the DURA MATER, can result in POST-OP Headache
- Epidural / Spinal Haematoma
- Epidural Abscess
- TOTAL Spinal A = Cause Hypotension / Apnoea / Coma
- HIGH Spinal A = Cause Hypotension / Bradycardia / Resp Distress
PROPHYLAXIS / TREATMENT
- For POST-OP Headaches = Rehydration + NSAIDs
- For Epidural / Spinal Haematoma = Surgical DECOMPRESSION
- For Epidural Abscess = Antibiotics
- For Resp Distress = Mechanical Ventilation
- For Hypotension = Haemodynamic Support w/ VASOPRESSORS
- For Urinary VOIDING = Use Urinary Catheters
[WRITING III] - Definition, Classification, Criteria, for Diagnosis of ACIDOSIS
{Explain Respiratory + Metabolic Acidosis}
DEF = Blood pH is BELOW 7.35, DUE to Resp / Metabolic Process
CLASSIFICATION
1) Respiratory = pC02 is MORE than 45 mmol / L
- With a LOW pH
- DUE to Resp Failure (COPD / Asthma), Airway Obs, Neuromuscular Disorders, Electrolyte Abnormalities, Sedatives / Anaesthetics or Stroke
2) Metabolic = LOW Bicarbonate; LOWER than 22 mmol / L
- With a LOW pH
- Either be HIGH ANION Gap (HIGH Lvls of Acids such as Lactic, KBs) = Diabetic Ketoacidosis, and Lactic Acidosis
- NORMAL ANION Gap = Diarrhoea, Renal Tubular Acidosis, and Addison’s Disease
[WRITING IV] - Acute Respiratory Distress Syndrome (ARDS) - Etiology, Phases of Evolution, Criteria for Diagnosis
ARDS = State of Resp Distress, which can beb DUE to Trauma, Acute Pancreatitis or Obstetric Complications
ETIOLOGY
1. SYSTEMIC CAUSES = Sepsis, Trauma, Shock and Acute Pancreatitis
- PRIMARY DAMAGE to LUNG = Pneumonia, Aspiration, Inhaled Toxins / Injury or Drowning
PHASES OF EVOLUTION (Pathogenesis)
1) EXUDATIVE = Formation of Pulmonary Oedema
2) FIBROPROLIFERATIVE = Fibrosis, DUE to DECREASED Surfactant + BUIL-UP of FIBRIN from Exudate
DIAGNOSIS (Using BERLIN Criteria - 4 Points)
1. Lung Injury by ACUTE Onset, shows First Symptoms within 1 week, followed by Resp Symptoms
- Chest X-Ray shows BILATERAL Opacities
- Resp Failure NOT DUE to HF
- pa02/ / Fi02 Ratio is LESS than 300 mmHg
