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Anaesthesiology > Variant 1A (2020/21) > Flashcards

Variant 1A (2020/21) Flashcards

1
Q

In the diagnosis of brainstem death:

A. Spinal reflexes may be present
B. An EEG must be flat for 24 hours
C. Consultation with a neurologist is needed
D. Blood must be sent for drug screening

A

A. Spinal reflexes may be present

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2
Q

Each of the following drugs causes
enhanced activity of the gamma-aminobutyric acid receptor except:

A. Etomidate
B. Midazolam
C. Ketamine
D. Propofol

A

C. Ketamine

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3
Q

What is the primary purpose of
denitrogenation prior to anesthetic induction?

A. Improving matching of ventilation and
perfusion

B. Increasing oxygen reserve in the functional residual capacity

C. Increasing contribution of second gas effect to rate of induction

D. Maximizing arterial oxygen content

A

B. Increasing oxygen reserve in the functional residual capacity

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4
Q

Increased Alveolar–arterial oxygen gradient can be caused by:

A. Endotracheal intubation
B. Decreased cardiac output
C. Atelectasis
D. Second gas effect

A

B. Decreased cardiac output

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5
Q

A patient with diabetic ketoacidosis is
scheduled for an emergent laparotomy.

Which of the following best explains the decrease in serum potassium concentration that occurs in this patient following administration of insulin?

A. Dilutional hypokalemia follows free water retention from decreased osmotic diuresis

B. Extracellular potassium is actively transported with glucose into cells

C. Insulin enhances renal excretion of potassium

D. Intracellular potassium is exchanged for extracellular glucose

A

B. Extracellular potassium is actively transported with glucose into cells

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6
Q

Lung compliance is increased in:

A. Idiopathic pulmonary fibrosis
B. The presence of intra-alveolar fluid
C. Emphysema
D. Fibrosing alveolitis

A

C. Emphysema

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7
Q

A patient with a head injury becomes
unconscious and develops signs of raised ICP.
Management in the acute phase includes:

A. Performing an immediate lumbar puncture
B. Obtaining an electroencephalogram
C. Treatment with mannitol
D. Ordering a digital subtraction angiogram

A

C. Treatment with mannitol

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8
Q

Maternal hypotension in the supine position during pregnancy is most often due to:

A. Compression of the vena cava
B. Decreased peripheral vascular resistance
C. Decreased hematocrit
D. Decreased blood volume

A

A. Compression of the vena cava

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9
Q

Which one of the following best describes
the reason for the rapid offset of effect of the induction agents?

A. Ester hydrolysis
B. Liver metabolism
C. Renal excretion
D. Redistribution

A

D. Redistribution

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10
Q

In the oxygen dissociation curve, causes of
a right shift include:

A. Low-molecular-weight dextran
B. Metabolic acidosis
C. Digitalis
D. Respiratory alkalosis

A

B. Metabolic acidosis

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11
Q

In septic shock:

A. peripheral hypothermia is associated with a good prognosis

B. the patients usually have an increased cardiac output

C. the patients usually have a depleted circulating volume

D. the causative organisms are always Gram-negative

E. antibiotics should not be given before
blood culture results are available.

A

B. the patients usually have an increased cardiac output

C. the patients usually have a depleted circulating volume

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12
Q

Causes of prolonged postoperative recovery of consciousness are:

A. acromegaly
B. intraoperative intracerebral event
C. myxoedema
D. prolonged action of muscle relaxants
E. hypoventilation

A

ALL answers are correct!

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13
Q

Blood pressure measured by an automatic non-invasive method:

A. may over-read at high pressure
B. may over-read at low pressure
C. is affected by arrhythmias
D. may cause ulnar nerve damage
E. cuff width does not affect the measurement.

A

B. may over-read at low pressure
C. is affected by arrhythmias
D. may cause ulnar nerve damage

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14
Q

In patients with haemorrhagic shock:

A. physiological dead-space is increased

B. renal blood flow is decreased

C. antidiuretic hormone (ADH) secretion is increased

D. the oxygen dissociation curve is shifted to the left

E. oxygen delivery is decreased

A

A. physiological dead-space is increased

B. renal blood flow is decreased

C. antidiuretic hormone (ADH) secretion is increased

E. oxygen delivery is decreased

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15
Q

Oxygen toxicity to the lung is due to:

A. inspired oxygen (FiO2) above 0.6
B. prolonged exposure
C. increased arterial partial pressure of oxygen
D. the effect of oxygen on pulmonary vessels
E. unhumidified oxygen.

A

A. inspired oxygen (FiO2) above 0.6
B. prolonged exposure
D. the effect of oxygen on pulmonary vessels

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16
Q

Pulmonary hypertension is caused by:

A. multiple pulmonary emboli
B. mitral stenosis
C. chronic obstructive airways disease
D. volatile anaesthetic agents
E. ascent to high altitude

A

A. multiple pulmonary emboli
B. mitral stenosis
C. chronic obstructive airways disease
E. ascent to high altitude

17
Q

Suitable anaesthetic techniques for patients
with raised intracranial pressure are:

A. nitrous oxide, oxygen and fentanyl; controlled ventilation

B. nitrous oxide, oxygen, thiopentone and
atracurium

C. ketamine

D. halothane, nitrous oxide and oxygen; spontaneous ventilation

E. premedication with morphine.

A

A. nitrous oxide, oxygen and fentanyl; controlled ventilation

B. nitrous oxide, oxygen, thiopentone and
atracurium

18
Q

Contraindications to the use of NSAIDs (non-steroidal anti-inflammatory drugs) for the control of pain include:

A. renal failure
B. all asthmatic patients
C. patients actively bleeding
D. old and frail patients
E. patients with peptic ulcer

A

A. renal failure
B. all asthmatic patients
C. patients actively bleeding
E. patients with peptic ulcer

19
Q

An increased alveolar–arterial (A–a) gradient is associated with:

A. an increased FiO2
B. a decreased FiO2
C. a decreased FRC
D. an increased V/Q ratio
E. an increased shunt.

A

A. an increased FiO2
C. a decreased FRC
D. an increased V/Q ratio
E. an increased shunt.

20
Q

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. a short thick neck
B. limited mouth opening
C. dental abscess
D. limited neck movements

21
Q

[CASE 1]

A 72-year-old man who has just received midazolam for an endoscopic procedure of the
upper gastrointestinal tract. Sedation is easily antagonized by FLUMAZENIL.

A) Although the endoscopist asks to send the patient home in one hour, is it appropriate?

B) What are the possible complications?

C) Why?

A

A) NO, it’s INAPPROPRIATE! Midazolam has a LONGER&raquo_space; Duration of Action, than Flumazenil

B) Possible Complications include DECREASING the Level of Consciousness

  • since Midazolam is a Benzodiazepine, which INHIBITS the CNS Depressive Effect
  • VIA INCREASING GABAergic Neurotransmission in the brain, resulting in this

C) INAPPROPRIATE since Midazolam can induce symptoms - Ataxia / Resp Depression
- Putting the px AT RISK of Car Crash / Traumatic Injury en route home

22
Q

[CASE 2]

A 23-year-old man is brought in by ambulance after falling off a roof.

He is moaning and has sonorous respirations; he will not open his eyes to pain but withdraws to pain when tested.

A) Could you describe the pathogenesis of the condition?

B) What is the patient’s Glasgow Coma Scale score?

C) What would be your initial treatment?

A

A) PATHOGENESIS:
- Possibility Px has suffered a Traumatic Brain Injury, resulting in Primary Brain Injury

1. MEDIATOR Release, causing changes in BBB Permeability, causing CEREBRAL EDEMA + INCREASED ICP

2. Haemorrhage can cause IMPAIRED Autoregulation + INCREASED ICP

3. There’s a SYMPATHETIC SURGE, which can DECREASE the Consciousness, presenting with symptoms

B) GCS could be:
- Eyes = 1 (No Response)
- Speech = 2 (Incomprehensible)
- Movement = 4 (Flexion Withdrawal) == GCS 7

C) INITIAL TREATMENT
- Ventilation with 100% 02
- Fluid Resuscitation with 0.9% SALINE
- CSF Drainage
- Treatment with MANNITOL

23
Q

[CASE 3]

A 22-year-old man comes to the emergency department because he has had fever, elevated blood glucose level, and confusion during the past three hours.

Pulse rate is 140/min, respirations are 30/min, and blood pressure is 80/50 mmHg.

Physical examination shows dry mucous membranes and delayed capillary refill.

Laboratory studies show serum potassium level of 3.2 mmol/L and serum glucose level of 26 mmol/L.

Arterial blood gas analysis shows pH of 7.0.

A) Which is the possible cause?

B) Do you need additional information?

C) What would be your initial treatment?

A

A) Possible causes could be:

  • SEPTIC SHOCK, such as Pneumonia
  • HYPERGLYCEMIA, due to Diabetes which causes Ketoacidosis, from LACK of Insulin

B) ADDITIONAL INFO:
- ABG
- p02
- Lactic Acid
- HR, Cardiac Output (CO)
- Urine Output
- Blood Culture = For Sepsis

C) INITIAL TREATMENT
- Insulin WITH Potassium = Monitor Hb1Ac + K+ Levels
- Administer ISOTONIC CRYSTALLOID FLUID
- Empiric Antibiotic Treatment = For Septic Shock

24
Q

[WRITING I] GENERAL ANAESTHESIA – definition, components.

A

DEF = GENERAL Anaesthesia is the CONTROLLED + REVERSIBLE Induction of a State of Unconsciousness

Characterised by
- Analgesia / Amnesia / Hypnosis / Muscle Relaxation + STABLE Autonomic Regulation

3 COMPONENTS
1) TOTAL INHALATION Anaesthesia = Volatile Compounds, which are HIGHLY Lipid Soluble

2) TOTAL INTRAVENOUS Anaesthesia (TIVA) = Non-Volatile

3) BALANCE Anaesthesia

25
Q

[WRITING II] Complications of EPIDURAL and SPINAL anaesthesia – prophylaxis and treatment.

A

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
26
Q

[WRITING III] Definition and classification of ALKALOSIS.

A

DEF = An EXTREMELY ALKALINE Condition of the Body Fluids / Tissues

CLASSIFICATION

1. Respiratory Alkalosis = pC02 is LESS than 35mmHg
- DUE to = Hypoxemia / High Altitudes / Congestive HF / SALICYLATE Intoxication

2. Metabolic Alkalosis = Bicarbonate (HC03-) is MORE than 26 mmol / L
- DUE to = Vomiting / Diuretics / Cushing’s Syndrome

27
Q

[WRITING IV] Acute Respiratory Distress Syndrome in adults (ARDS) – diagnostic criteria, treatment.

A

ARDS = State of Resp Distress, which can beb DUE to Trauma, Acute Pancreatitis or Obstetric Complications

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

  1. Chest X-Ray shows BILATERAL Opacities
  2. Resp Failure NOT DUE to HF
  3. pa02/ / Fi02 Ratio is LESS than 300 mmHg

TREATMENT
- Tx Underlying = Fluid Management / Broad-Spec Abs
- Oxygenation = FOR Hypoxemia
- Positive (+ve) Pressure Ventilation (Non-Invasive)

  • Intubation, Corticosteroids + Prone Position = FOR MODERATE ARDS
  • ECMO + Alternative Ventilator Settings = For SEVERE ARDS

Anaesthesiology (16 decks)

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