Anaesthetics

Question 1

ASA Grades

Answer 1

1: Normal healthy patient
2: Mild diseases (smoker, pregnant, controlled DM, BMI 30-40)
3: Severe (DM, BMI over 40, HTN)
4: Severe threat to life
5: not expected to survive without operation e.g. AAA
6: declared brain dead

Question 2

Which anaesthetic has anti-emetic properties

Answer 2

Propofol

Question 3

Malignant hyperthermia inheritance

Answer 3

Autosomal dominant

Question 4

VTE propjylaxis in hip replacement

Answer 4

TED stockings and dalteparin 6 hrs AFTER surgery

Question 5

Depolarising muscle relaxant MOA and example

Answer 5

Suxamethonium

fasiculations - not reversible

Question 6

What is malignant hyperthermia

Answer 6

tachycardia, fever and muscle rigidity

often caused by suxamethonium

Question 7

Contraindication for suxamethonium

Answer 7

increased intra-ocular pressure so not in glaucoma or eye injury
burns patients as it causes hyperkalaemia

Question 8

Calcium channel blockers during surgery

Answer 8

Safe

Question 9

Side effect of etomidate

Answer 9

Adrenal suppression

Question 10

Caution with nitrous oxide

Answer 10

Pneumothorax

Question 11

Oral intake before surgery

Answer 11

Food/solids > 6 hours beforehand and clear fluids > 2 hours beforehand

Question 12

Risk of excessive infusions - abg

Answer 12

hyperchloraemic acidosis

Question 13

Surgery and insulin

Answer 13

once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery

Question 14

Imaging for anastomotic leak

Answer 14

CT abdo

Question 15

muscle relaxant of choice for rapid sequence induction for intubation

Answer 15

Suxamethonium

Question 16

TPN vein

Answer 16

Central e..g subclavian

Question 17

Hypothermia during an operation can lead to excess bleeding

Question 18

Ileus occurs in the few days following surgery and can cause hypovolaemia and electrolyte disturbances BEFORE nausea and vomiting becomes apparent

Question 19

Intraosseous access

Answer 19

Proximal tibia

Question 20

All oral antidiabetic medications should be taken as normal the day before surgery

Question 21

Isolated fever in well patient in first 24 hours following surgery?

Answer 21

Think physiological reaction to operation

Question 22

Loop ileostomy

Answer 22

Normal feeding

Question 23

Oesophagectomy

Answer 23

Feeding jejunostomy

Question 24

ICU feeding

Answer 24

NG tube

Question 25

Pneumonia can be a complication of poor post-operative pain management

Question 26

Laparoscopic approach reduces adhesions

Question 27

Right upper quadrant tenderness and bilious fluid in the intra-abdominal drain would suggest a bile leak following the cholecystectomy

Question 28

Hydrocortisone supplementation is required prior to surgery for patients taking prednisolone

Question 29

metformin on day of surgery:

Answer 29

OD or BD: take as normal
TDS: miss lunchtime dose
assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

Question 30

Risk of halothane

Answer 30

Hepatotoxicity

Question 31

Which agent reverses midazzolam

Answer 31

Flumazenil

Question 32

OD or BD: take as normal
TDS: miss lunchtime dose
assumes only one meal will be missed during surgery, eGFR > 60 and no contrast during procedure

Answer 32

Skin mottling and diaphoresis

Question 33

What medication slows bone healing

Answer 33

NSAIDS

Question 34

Long term chemo - access

Answer 34

hickman line

Question 35

Anaesthetic with the strongest analgesic effect

Answer 35

Ketamine

Question 36

Nasopharyngeal airways are contraindicated in suspected are known base of skull fractures