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

Variant 1C (2020/21) Flashcards

1
Q

A 17-year-old boy develops pulmonary
edema after resolution of postoperative
laryngospasm. While breathing 100% oxygen,
SpO2 is 80%.

Which of the following is the most appropriate management?

A. Administration of albuterol
B. Positive-pressure ventilation
C. Infusion of nitroglycerin
D. Administration of furosemide

A

D. Administration of furosemide

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2
Q

Which one of the following conditions is
NOT associated with upregulation of the
postjunctional acetylcholine receptors at the
neuromuscular junction?

A. Myasthenia gravis
B. Burn injuries
C. Prolonged bed rest
D. Prolonged use of neuromuscular blocking
agents

A

A. Myasthenia gravis

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3
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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4
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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5
Q

Oxygen consumption

A. When increased, causes a decrease in the mixed venous PO2 (assume oxygen delivery remains constant)

B. In health, is critically dependent on oxygen
delivery

C. Is approximately 2L/min in the resting adult
D. Is increased under general anaesthesia

A

A. When increased, causes a decrease in the mixed venous PO2 (assume oxygen delivery remains constant)

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6
Q

Which one of the following receptors is NOT
targeted in the treatment or prevention of post-operative nausea and vomiting?

A. GABA
B. Histamine
C. Serotonin
D. Dopamine

A

A. GABA

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7
Q

Regarding the comparative considerations of
epidural and spinal anesthesia, which one of the
following is correct?

A. A postdural puncture headache is a potential complication that occurs with both spinal and epidural techniques

B. The epidural space is identified by puncture
of the dura and free flow of cerebral spinal fluid

C. The lumbar puncture for a spinal anesthetic
should be performed above L1 to avoid trauma
to the cauda equina

D. Epidural anesthesia is usually faster in onset
than spinal anesthesia

A

A. A postdural puncture headache is a potential complication that occurs with both spinal and epidural techniques

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8
Q

The use of epidural analgesia for labour is
likely to result in which one of the following:

A. Prolonged second stage
B. Increased risk of operative delivery
C. Neonatal depression
D. Maternal sedation

A

A. Prolonged second stage

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9
Q

Suitable anaesthetic techniques for patients
with raised intracranial pressure are:

A. Nitrous oxide, oxygen and fentanyl; controlled ventilation
B. Ketamine
C. Halothane, nitrous oxide and oxygen;
spontaneous ventilation
D. Premedication with Morphine.

A

A. Nitrous oxide, oxygen and fentanyl; controlled ventilation

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10
Q

Which one of the following structures is NOT
encountered during direct laryngoscopy?

A.Vallecula
B. Cricoid cartilage
C. Epiglottis
D. Arytenoid cartilage

A

B. Cricoid cartilage

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11
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

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12
Q

In patients with increased ICP requiring a
general anaesthetic, the following are
especially dangerous:

a) fentanyl, nitrous oxide/oxygen and
controlled ventilation

b) ketamine

c) spontaneous ventilation with nitrous
oxide/oxygen and halothane

d) thiopentone/atracurium/ nitrous
oxide/oxygen

e) a total intravenous technique using propofol
and remifentanil

A

b) ketamine

c) spontaneous ventilation with nitrous
oxide/oxygen and halothane

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13
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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14
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

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15
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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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

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

18
Q

Concerning postoperative nausea and
vomiting:

a) it is more common in women than men

b) the incidence is 80% with general
anaesthesia

c) it is more common with thiopentone than
with propofol

d) butyrophenones can decrease the incidence

e) it is more common with ear surgery

A

a) it is more common in women than men

c) it is more common with thiopentone than
with propofol

d) butyrophenones can decrease the incidence

e) it is more common with ear surgery

19
Q

Propofol:

a) is suspended in an emulsion of soyabean oil
and egg phosphatide
b) can produce green urine
c) has little effect on the cardiovascular system
d) impairs ventilatory response to CO2
e) has no effect on intraocular pressure.

A

a) is suspended in an emulsion of soyabean oil
and egg phosphatide

b) can produce green urine

d) impairs ventilatory response to CO2

20
Q

If 50% nitrous oxide is inhaled for 3 days:

a) the lymphocyte count falls
b) methionine synthetase activity is reduced
c) megaloblastic bone marrow changes occur
d) B12 deficiency anaemia develops
e) peripheral neuropathy develops.

A

b) methionine synthetase activity is reduced
c) megaloblastic bone marrow changes occur

21
Q

[CASE 1]

A 36-year-old woman is receiveing general anesthesia for a diagnostic laparoscopy in the
Trendelenburg position with carbon dioxide insufflation.

During a 15-minute period after induction,
her SpO2 decreases from 99% to 90% and PETCO2 increases from 38 to 43 mmHg. FiO2 is 0.3; all ventilator settings have been constant.

A) Which are the possible causes for the decrease in SpO2?

B) Explain the pathogenesis?

C) What would be your initial management?

A

A) Cause for DECREASED Sp02 is DUE to DECREASED Diaphragmatic Movement

B) PATHOGENESIS:
1. Place Px into CEPHALAD Position, which PUTS PRESSURE onto Abdo Viscera, thereby DISPLACING the Diaphragm + impairing it’s Fx

  1. DECREASED Pulmonary Compliance + FRC means, FAILURE of ALVEOLI to ELIMINATE C02 / INCREASE 02
  2. Resulting in HYPERCAPNIA + HYPOXEMIA

C) TREATMENT PLAN:
- Administer 02 = TO MAINTAIN Sp02 ABOVE 90%
- CORRECT the DECREASED Sp02
- NON-INVASIVE Ventilatory Support
- MOVE the Px in REVERSE TRENDELENBURG Position

22
Q

[Case 2]

A 69-year-old woman is brought to the emergency department by her husband 45 minutes after she had sudden onset of dyspnea and severe pain in the left side of the chest. The patient underwent right total hip replacement three weeks ago.

Temperature is 37.3°C (99.2°F), pulse rate is
120/min, respirations are 22/min and labored, and blood pressure is 140/88 mmHg in the left arm with the patient supine. The patient seems anxious. Physical examination shows persistent cough.

Auscultation of the chest shows accentuation of the pulmonary component of S2, unilateral crackles, and wheezing.

A) What is the most likely cause for this condition?

B) Do you require additional information?

C) What would be your initial treatment

A

A) Most likely cause for this condition is, PULMONARY THROMBOEMBOLISM

B) ADDITIONAL INFO REQUIRED:
- ABG Analysis = Shows MILD Hypoxemia w/ Resp ALKALOSIS

  • Chest X-Ray = Shows WEDGE-Shaped Density w/ INFARCT ATELECTASIS ; With ELEVATED Diaphragm; ASYMMETRICALLY ENLARGED Proximal Pulmonary Artery w/ Acute Pulmonary HT
  • CT Pulmonary Angiogram is GOLD STANDARD
  • Lab Test = Check for D-Dimer / BNP + Troponin

C) INITIAL TREATMENT:
- FIBRINOLYSIS = IV BOLUS of TPA / Streptokinase

  • UNFRACTIONED Heparin, 5000U SUBCUT, every 12h
  • Check aPTT levels, and make sure it’s DOUBLED!
23
Q

[CASE 3]

An otherwise healthy 61-year-old man receives a spinal anesthetic for transurethral resection
of the prostate (TURP).

Forty-five minutes after the start of the procedure, he suddenly develops
nausea, diaphoresis, and sharp pain in the left shoulder.

A) Which is the most likely cause?
B) Do you need additional information?
C) What would be your initial treatment?

A

A) Most likely cause would be, BLADDER PERFORATION

B) ADDITIONAL INFO:
- Volume of IRRIGATION FLUID returning from Bladder

  • Whether there’s RETROPUBIC / LOWER Abdo Pain Present
  • MONITOR Abdo DISTENSION
  • MONITOR Blood Pressure = Extra/Intra-peritoneal PERFORATIONS tend to present w/ Hypo/Hypertension

C) INITIAL TREATMENT:
- Blood Transfusion
- NOREPINEPHRINE
- IMMEDIATE Laparotomy
- REMOVAL of PERITONEAL FLUID / Placing a Suprapubic CYSTOMY Catheter

24
Q

[WRITING I] INTRAVENOUS Anesthesia - definition. Advantages and disadvantages. Intravenous anesthesia techniques.

A

DEF = IVA is used to INDUCE a state of REVERSIBLE loss of consciousness, characterised w/ amnesia, hypnosis, muscle relaxation + analgesia - done GENERALLY / LOCALLY

EXAMPLES incl = Barbiturates / Propofol / Ketamine

ADV = Easy + Quick Admin / Precise control of Dose / RAPID Onset / NO Dependence on Breathing / IMPROVED V/Q Matching!

DISADV = Rate of Elimination depends on Organ + Enzyme Function / Risk of Allergies / Risk of Systemic Infections / Anaphylaxis / Risk of Hypotension

25
Q

[WRITING II] SYSTEMIC TOXICITY of the LOCAL Anaesthetics – clinical picture, treatment

A

CLINICAL PICTURE
- Tinnitus
- Light-Headedness / Drowsiness
- Visual Disturbances
- Slurred Speech
- Metallic Taste in Mouth

** 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
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

  1. 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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