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Flashcards in ANAESTHETICS Deck (106)
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1

does smoking make you hyper-coagulable or hypo-coagulable?

hyper

2

does alcohol make you hyper-coagulable or hypo-coagulable?

hypo

3

what are the components of an anaesthetic pre-assessment?

social history
current health
physical examination
drug history
past medical/surgical hx
blood tests
hospital anxiety & depression scale

4

what are the 3 different types of anaesthetic?

general
regional
local

5

which of these is not a component of general anaesthesia?
a) amnesia
b) analgesia
c) apyrexia
d) akinesis

c) apyrexia

6

what is the CEPOD classification in surgery?
a) urgency
b) anaesthesia
c) open vs keyhole
d) morbidity

a) urgency

7

which of these is NOT a classification under the CEPOD urgency of surgery system?
a) immediate
b) urgent
c) expedited
d) elective
e) non-urgent

e) non-urgent

8

which of these is NOT a form of cardiovascular monitoring used whilst a patient is under general anaesthetic?
a) central venous catheter
b) ECG
c) NIBP

a) central venous catheter

9

which of these is NOT an air gas regularly monitored when a patient is under general anaesthetic?
a) O2
b) Nitrogen
c) CO2
d) vapour
e) pressure

b) Nitrogen

10

which of these is the largest IV venflon cannula?
a) 14G
b) 24G

a) 14G

11

how long do induction agents take to induce loss of consciousness?
a) 2-5secs
b) 10-20secs
c) 30-40secs
d) 1 min

b) 10-20secs

12

how long do induction agents' effects last?
a) 1-2 mins
b) 4-10 mins
c) 15-30 mins
d) 30mins - 1 hour

b) 4-10 mins

13

what is the most common induction agent used?

propofol

14

what is an added bonus of propofol as an induction agent?
a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-secretions

a) suppresses airway reflexes

15

fill in the gap:
propofol causes a _____ in heart rate and _____ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop

a) drop; drop

16

which is the fastest induction agent to use?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

b) thiopentone

17

which induction agent is used in rapid sequence induction?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

b) thiopentone

18

what is an added bonus of thiopentone as an induction agent?
a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-epileptic properties

d) anti-epileptic properties

19

fill in the gap:
thiopentone causes a _____ in heart rate and _____ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop

d) raise; drop

20

true or false:
propofol is painful on injection

true

21

why can thiopentone result in a rash and/or bronchospasm?
a) dopamine release
b) bradykinin release
c) histamine release
d) choline release

c) histamine release

22

which induction agent is contraindicated in porphyria?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

b) thiopentone

23

which induction agent has the slowest onset (around 90secs)
a) propofol
b) thiopentone
c) ketamine
d) etomidate

c) ketamine

24

fill in the gap:
ketamine causes a _____ in heart rate and _____ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop

b) raise; raise

25

which induction agent is the most haemo-dynamically stable?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

d) etomidate

26

what is the benefit of etomidate being haemo-dynamically stable?

useful in patient's with heart failure

27

which induction agent has the lowest incidence of hypersensitivity?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

d) etomidate

28

which induction agent has the lowest incidence of nausea & vomiting?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

a) propofol

29

which induction agent has the highest incidence of nausea & vomiting?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

d) etomidate

30

true or false:
thiopentone is painful on injection

false

31

true or false:
ketamine is painful on injection

false

32

true or false:
etomidate is painful on injection

true

33

which induction agent causes adreno-cortical suppression?
a) propofol
b) thiopentone
c) ketamine
d) etomidate

d) etomidate
the patient may need to be given supplementary cortisol following 'stress' periods e.g. bleeding

34

give an example of an amnesic vapour

isoflurane
sevoflurane
desflurane

35

which amnesic vapour affects organ blood flow THE LEAST?
a) isoflurane
b) sevoflurane
c) desflurane

a) isoflurane

36

which amnesic vapour has the lowest MAC?
a) isoflurane
b) sevoflurane
c) desflurane

a) isoflurane

37

what does MAC stand for (in terms of amnesic agents?)
a) maximum arterial concentration
b) my ass is candy
c) minimum alveolar concentration
d) maximum affected cells

c) minimum alveolar concentration

38

which amnesic vapour has a sweet smell?
a) isoflurane
b) sevoflurane
c) desflurane

b) sevoflurane

39

which amnesic vapour is most suitable for long operations?
a) isoflurane
b) sevoflurane
c) desflurane

c) desflurane

40

give an examples of a short acting analgesic used in patients under general anaesthetic

fentanyl
alfentanyl
(sometimes remifentanil)

41

give an example of a long-acting analgesic used intra and post-operatively for patients under general anaesthetic

morphine
oxycodone

42

diclofenac, parecoxib (IV) and ketorolac (IV) are examples of what type of analgesic?

NSAIDS

43

true or false
tramadol can be used with morphine

true

44

fill in the gaps:
muscle contraction occurs when ______ enters the ___-_______ junction. ___ is released at the _________ junction leading to depolarisation of _________ receptors

potassium, calcium, sodium, ACh, ACh-esterase
pre-synaptic, post-synaptic, inter-synaptic, neuromuscular, nicotinic

calcium
pre-synaptic
ACh
neuromuscular
nicotinic

45

how do depolarising muscle relaxants work?

act like ACh but are broken down more slowly by ACh-esterase
this leads to extended muscle contraction and fatigue (as calcium needed for contraction is used up). the muscle relaxes

46

is suxamethonium an example of a depolarising or non-depolarising muscle relaxant?

depolarising

47

true or false:
suxamethonium is used in rapid sequence induction

true (rapid onset of 30-60secs)

48

how long does suxamethonium last?
a) 1-2 mins
b) 6-10 mins
c) 20-30 mins
c) 60 mins

b) 6-10 mins

49

which of these is NOT a side effect of suxamethonium?
a) fasciculations
b) hyperkalaemia
c) rise in OCP/IOP/gastric pressure
d) hearing loss

d) hearing loss - that's gentamicin bro

50

how can use of suxamethonium lead to hyperkalaemia?

potassium released if muscle fibres break

51

how do non-depolarising muscle relaxants work?

block nicotinic receptors leading to muscle relaxation

52

is atracurium an example of a depolarising or non-depolarising muscle relaxant?

non-depolarising

53

true or false:
atracurium is used in rapid sequence induction

false - all non-depolarising muscle relaxants have a slow onset

54

which group of muscle relaxants have LESS side effects?
a) depolarising
b) non-depolarising

b) non-depolarising

55

give an example of a short acting muscle relaxant (30 mins)

atracurium
mivacurium

56

give an example of an intermediate acting muscle relaxant (60 mins)

vecuronium
rocuronium

57

give an example of an long acting muscle relaxant (90 mins)

pancuronium

58

name a drug used to reverse non-depolarising muscle relaxants and it's mechanism

neostigmine - ACh inhibitor
glycopyrrolate - muscarinic antagonist (protects against bradycardia)

59

put the following drugs in order of administration in the general anaesthetic process:
muscle relaxant
short-acting analgesic
amnesic vapour
induction agent
long-acting analgesic

short-acting analgesic
induction agent
muscle relaxant
amnesic vapour
long-acting analgesic

60

what percentage of patients experience PONV?
a) 5-10%
b) 20-30%
c) 50-60%
d) 80-90%

b) 20-30%

61

name the most commonly used anti-emetic for PONV

ondansetron
(then dexamethasone, then cyclizine)

62

name a type of surgery which pre-disposes to PONV

ENT
eye
laparotomy
gynae

63

name a demographic factor which can predispose to PONV

female
previous PONV
motion sickness
non-smoker
obese

64

give an indication for rapid sequence induction

emergency situation when there is a full stomach

65

how long should you pre-oxygenate the patient before rapid sequence induction
a) you don't need to
b) 1 min
c) 3 mins
d) 7 mins

c) 3 mins

66

what 3 drugs are used in rapid sequence induction?

thiopentone
propofol
suxamethonium

67

fill in the blanks:
cardiac output = ____ ____ x ____ ____

stroke volume
heart rate

68

fill in the blanks:
mean arterial pressure = ____ ____ x ____ ____ _____

cardiac output
systemic vascular resistance

69

which 2 of these spinal regions does the sympathetic nervous system NOT originate from?
a) cranial
b) cervical
c) thoracic
d) lumbar

a) cranial
d) lumbar

70

which of these is NOT a receptor used by the sympathetic nervous system?
a) ACh
b) nicotinic
c) dopaminergic

c) dopaminergic

71

true or false:
the sympathetic nervous system is associated with 'fight or flight'

true

72

do alpha 1 receptors act pre- or post- synaptically?

post-synamptically

73

which intracellular messanger do alpha 1 receptors increase when activated?
a) sodium
b) calcium
c) potassium
d) noradrenaline

b) calcium

74

which of these actions is NOT increased by alpha-1 receptors?
a) heart rate
b) vasoconstriction
c) peripheral resistance
d) systemic arterial pressure

a) heart rate

75

do alpha 2 receptors act pre- or post- synaptically?

pre-synaptically

76

which intracellular messenger do alpha 2 receptors inhibit when activated?
a) sodium
b) calcium
c) potassium
d) noradrenaline

d) noradrenaline (inhibition results in inhibition of caMP)

77

what is the result of beta 1 receptor activation?
a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)

a) increased contractility and heart rate
also increase cAMP formation

78

what is the result of beta 2 receptor activation?
a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)

b) smooth muscle relaxation (vascular & non-vascular)
also increase cAMP formation

79

what type of receptor does the parasympathetic nervous system act on?

muscarinic

80

ephedrine, phenyephrine, metaraminol, methoxamine, xylometazoline, oxymetalozine, adrenaline and noradrenaline are examples of drugs which act on which receptors?

alpha 1
VASOCONSTRICTION
phenyephrine can cause reflex bradycardia

81

clonidine is an example of a drug which works on which receptors?

alpha 2 - sedative

82

isoprenaline, salbutamol and adrenaline are examples of drugs which act on which receptors?

beta
adrenaline = beta 1
isoprenaline = beta 1 & 2
salbutamol = beta 2

83

give an example of an alpha blocker and a beta blocker

doxazocin
labetalol

84

give an example of an ACh inhibitor

neostigmine

85

give some examples of muscarinic receptor antagonists

atropine
glycopyrrolate
ipatropium

86

what is the name of this law?
as a myocyte stretches, its contractility increases, therefore the greater the volume of blood in the heart during diastole, the more forceful the cardiac contraction (up to a point e.g. HF)

starling's law

87

what do you give in the occurence of local anaesthetic toxicity?

intralipid IV

88

what is the difference in location between the epidural and spinal anaesthetics?

epidural is in epidural space LOL
spinal is in subarachnoid

89

why is the epidural needle curved?

to allow fitting of catheter
makes a 'pop' sound after it pierces ligamentum flavum so you know you're in the right place

90

what is recommended treatment for post epidural/spinal/LP headache?

lie on back, drink caffeine - conservative
if still not working can do spinal tap - blood clot to block hole

91

are amide or ester LAs used most commonly nowadays?

amides

92

give an example of a short, medium and long acting LA

short - prilocaine (ester)
med - lignocaine (amide) long - bupivicaine (amide)

93

what is the dose of lignocaine, prilocaine & bupivicane with and withut adrenaline

lignocaine = 3ml/kg or 7 w adrenaline
prilocaine = 6ml/kg or 9 w adrenaline
bupivicaine = 2ml/kg or 2 w adrenaline

94

why would you give adrenaline with LAs?

causes vasoconstriction
reduces systemic absorption
increases conc in area injected

95

which ASA grade is this?
healthy patient, no co-morbidities or significant PMHx

ASA 1

96

which ASA grade is this?
mild systemic disease

ASA 2

97

which ASA grade is this?
severe systemic disease

ASA 3

98

which ASA grade is this?
severe systemic disease that is a constant threat to life

ASA 4

99

which ASA grade is this?
moribund, won't survive without this operation

ASA 5

100

which ASA grade is this?
brain dead, organs being removed (cheerful thought)

ASA 6

101

what is the most common patient position

supine

102

when would yu tilt a supine patient to the left?

risk of SVC compression e.g. pregnancy, obese

103

what is the trendelenburg position?

45' head down
reverse trendelenburg equals opposite duh (e.g. for raised ICP or GORD)

104

what is the lloyd davis/lithotomy position?

legs in stirrups

105

what is a major complication of the lloyd davis/lithotomy position?

calf compression - DVT and compartment syndrome

106

what is the lateral position

patient laid on side
one lung is underventilated compared to the other