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Anaesthesiology > Variant 3 (2021/22) > Flashcards

Variant 3 (2021/22) Flashcards

1
Q

What is the appropriate emergent treatment
for tension pneumothorax?

A. Endotracheal intubation
B. Needle decompression
C. Intravenous fluid bolus
D. Oxygen supplementation via face mask

A

B. Needle decompression

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2
Q

Which of the following intravenous
induction agents is more suitable for day care
surgery?

A. Morphin
B. Ketamine
C. Propofol
D. Diazepam

A

C. Propofol

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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. Maximizing arterial oxygen content

C. Increasing oxygen reserve in the functional residual capacity

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

A

C. Increasing oxygen reserve in the functional residual capacity

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4
Q

The following medication should be
discontinued prior to surgery and anesthesia:

A. Anticonvulsants
B. Monoamine-oxidase inhibitors
C. Thyroid replacement
D. Antihypertensives

A

B. Monoamine-oxidase inhibitors

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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. Intracellular potassium is exchanged for extracellular glucose

C. Extracellular potassium is actively transported with glucose into cells

D. Insulin enhances renal excretion of potassium

A

C. Extracellular potassium is actively transported with glucose into cells

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6
Q

Which of the following anesthetic agents
does NOT trigger malignant hyperthermia?

A. Halothane
B. Isoflurane
C. Suxamethonium
D. Thiopental

A

D. Thiopental

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7
Q

After head injury, increased intracranial
pressure (ICP) is indicated by:

A. a fall in systemic blood pressure
B. a reduction of the Glasgow coma score
C. an increase in heart rate
D. small pupils.

A

B. a reduction of the Glasgow coma score

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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

Regarding myasthenia gravis:

A. Muscle weakness is worsened by gentamicin
B. Muscle weakness improves with exercise
C. IgE antibodies are found in 85% of patients
D. Thymectomy is the treatment of choice in
patients over 50

A

A. Muscle weakness is worsened by gentamicin

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10
Q

A 21-year-old man is brought into the
trauma room by EMS after a head-on cycling
accident. His eyes are closed, but open to
command. He can move his arms and legs on
command. When asked questions, he is
disoriented but able to converse. What is this
patient’s GCS score?

A. 10
B. 13
C. 12
D. 11

A

B. 13

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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

In patients with hemorrhagic shock:

A. Antidiuretic hormone (ADH) secretion is increased

B. Renal blood flow is decreased

C. The oxygen dissociation curve is shifted to the left

D. Physiological dead-space is increased

E. Oxygen delivery is decreased.

A

A. Antidiuretic hormone (ADH) secretion is increased

B. Renal blood flow is decreased

D. Physiological dead-space is increased

E. Oxygen delivery is decreased.

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13
Q

A pregnant patient complains of difficulty
breathing and tingling in the arms soon after a
spinal with heavy bupivacaine for Caesarean
section. Actions to perform include:

A. Place the patient head down
B. Give oxygen and be ready to control the airway
C. Speed the iv infusion up
D. Place a pillow under the head and shoulders
E. Continue scrubbing up for surgery

A

B. Give oxygen and be ready to control the airway

C. Speed the iv infusion up
D. Place a pillow under the head and shoulders

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14
Q

Postoperative hypoxia at 15 minutes may
be due to:

A. mild hypercapnia
B. nitrous oxide diffusion
C. central depression
D. increased V/Q scatter
E. shivering.

A

A. mild hypercapnia
C. central depression
D. increased V/Q scatter
E. shivering.

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15
Q

Which of the following criteria are part of
the qSOFA (Quick SOFA) Score?

A. Altered mental status
B. SpO2 < 92%
C. Leucocytes > 11G/L
D. Systolic blood pressure < 100mmHg
E. Respiratory rate > 22 bpm

A

A. Altered mental status
D. Systolic blood pressure < 100mmHg
E. Respiratory rate > 22 bpm

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16
Q

Which of the following can cause Acute
respiratory distress syndrome (ARDS)?

A. Acute Pancreatitis
B. Sepsis
C. Pneumonia
D. Acute heart failure
E. Massive blood transfusion

A

A. Acute Pancreatitis
B. Sepsis
C. Pneumonia
E. Massive blood transfusion

17
Q

The following are associated with difficult
intubations:

A. Rheumatoid arthritis
B. Marfan’s syndrome
C. Ankylosing spondylitis
D. Sickle cell anaemia
E. Acromegaly.

A

A. Rheumatoid arthritis
B. Marfan’s syndrome
C. Ankylosing spondylitis
E. Acromegaly.

18
Q

Treatment of an anaphylactic reaction
includes:

A. norepinephrine
B. corticosteroids
C. crystalloid solutions
D. antihistamines
E. antibiotics

A

B. corticosteroids
C. crystalloid solutions
D. antihistamines

19
Q

Recognised effects of PEEP include:

A. Sodium retention
B. Fall in cardiac output
C. Rise in closing volume
D. Rise in FRC
E. Fall in CVP

A

A. Sodium retention
B. Fall in cardiac output
D. Rise in FRC

20
Q

Hypokalaemia

A. causes ST segment depression on the ECG
B. may precipitate muscle paralysis
C. precipitates digoxin toxicity
D. causes mental depression
E. occurs in untreated hyperosmolar non-ketotic diabetic coma

A

A. causes ST segment depression on the ECG
B. may precipitate muscle paralysis
C. precipitates digoxin toxicity

21
Q

[CASE 1]

A 40-year-old previously healthy 90-kg man (ideal body weight of 80kg) walks into the Emergency Department (ED) complaining of 5 days of myalgias, fevers, rhinorrhea, and dry cough.
Over the last day, he has become short of breath walking across the room.

In the ED, he is febrile, hypotensive requiring vasopressors, with a respiratory rate of 40 and SpO2 88% on a non rebreather face mask.

He receives 30 mL/kg crystalloid and develops worsening work of breathing requiring endotracheal intubation 2 hours after arrival in ED.

Endotracheal tube placement is confirmed by end-tidal CO2 and bilateral breath sounds.

His SpO2 nadir is 75% but despite 5 minutes of bagging his SpO2 remains in the mid-80s.

His chest X-ray is shown below:

A) What is the Clinical Diagnosis in this Case?

B) What kind of Additional Diagnostic Assessment do you need to perform?

C) Explain your treatment Strategy in this case.

A

A) ARDS with Compensatory Resp ACIDOSIS, possibly DUE to Viral Pneumonia (COVID-19)

B) Perform CBC, Urine Output, Blood Culture, CT and Sputum Test

C) Treatment Strategy
- For Resp Distress = Mechanical Ventilation
- For Hypotension = Vasopressor
- Fluid Replacement
- Empirical Antibiotics

22
Q

[CASE 2]

The recovery nurse reports a BP of 100/40 mmHg and pulse rate of 90 following a spinal anaesthetic for open prostatectomy in a 70-year-old man.

She feels that he is a bit confused but appears
well perfused.

His preoperative BP was 150/90 and he was stable when you handed him over 15 minutes before.

A) What are the possible causes?

B) What other information do you require immediately?

C) Suggest a treatment plan.

A

A) Either be:
- Spinal Anaesthesia Complication
- Hypokalemia
- Inadequate Fluid Replacement

B) Need to Require:
- Urine Output
- Level of Consciousness, according to Glasgow Coma Scale
- ICP (Intracranial Pressure)
- Papillary Reflex
- CBC
- Monitor 02 Saturation

C) Treatment:
- ABCDE
- IV Bolus CRYSTALLOID Solution = TO INCREASE the Cardiac Preload
- Prescribe PHENYLEPHRINE

23
Q

[WRITING I] - GENERAL Anaesthesia - Definition; Components; Types

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

24
Q

[WRITING II] SYSTEMIC TOXICITY of LOCAL Anaesthetics - Clinical Picture; Treatment

A

CLINICAL PICTURE
- Tinnitus
- Light-Headedness / Drowsiness
- Visual Disturbances
- Slurred Speech

** Convulsions resembling Temporal Lobe Epilepsy DUE to INTOXCITY of Blood LIGNOCAINE / BUPIVACAINE Levels

** Ventricular ARRs is ALSO to do w/ HIGH BUPIVACAINE Levels

TREATMENT
- Maintain Airway + Give 100% 02
- Intubate + Ventilate

  • FOR Convulsions = IV THIOPENTONE 50mg / DIAZEPAM 2.5mg
  • FOR Hypotension = IV EPHEDRINE 5mg + IV Fluids
  • For Cardiac Arrest = IV BRETYLIUM 400-700mg
25
Q

[WRITING III] SEPSIS & SEPTIC SHOCK - Diagnostic Criteria; Rating Scales

A

SEPSIS = Life-threatening Organ Dysfunction, DUE to DYSREGULATED HOST RESPONSE to Infx

SEPTIC SHOCK = SUBSET of Sepsis w/ Circulatory + Metabolic Dysfunction, associated with HIGHER RISK of MORTALITY

DIAGNOSTIC CRITERIA
- Sepsis is diagnosed w/ BOTH Clinical + Lab info = make sure Px has infection

  • SIRS Criteria = Temp is LESS than 36 / MORE than 38; HR is MORE than 90bpm; RR is MORE than 20
  • qSOFA = +ve if 2/3 of criteria are present:
    1. RR MORE than 22
    2. GCS is LESS than 15
    3. Systolic BP is LESS than 100 mmHg
26
Q

[WRITING IV] CHEST TRAUMA - Diagnosis & Treatment of Life-Threatening Complications - TENSION Pneumothorax

A

TENSION PNEUMOTHORAX = Collection of Air WITHIN PLEURAL SPACE - BTW Lung + Chest Wall, DUE to one-way valve mechanism; where air can enter PS via inspiration, but CANNOT leave

DIAGNOSIS = Chest X-Ray
- Shows MEDIASTINAL Shift TOWARDS Contralateral Side
- IPSILATERAL Diaphragmatic FLATTENING

TREATMENT
- FOR Resp Support = Supplement 02
- FOR Emergency Chest Decompression = NEEDLE Thoracostomy at 4-5th ICS; FINGER Thoracostomy

Anaesthesiology (16 decks)

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