Anaesthetics Flashcards
(46 cards)
Regarding migraines which is incorrect in its treatment a) Chlorpromazine can have a success rate of up to 95% b) Metoclopramide has extrapyramidal side effects in approx. 1% of patients c) Promethazine, chlorpromazine and prochlorperazine can have extrapyramidal effects in up to 45% of patients d) Opioids have good performance for acute migraine treatments
D (Opioids have poor performance for migraines)
Which is incorrect about analgesia in children a) Adolescence: behaviors can regress when anxious or in pain b) Stranger anxiety is no longer an issue in primary school aged children c) Children less than 9 months will adversely react to subsequent painful procedures after the initial exposure to pain d) Toddlers should always be examined initially with a parental presence
C
Which is an appropriate dose for analgesia in children a) Sucrose 3 ml orally for neonates b) Intranasal fentanyl 1.5 mcg/kg c) Morphine 0.5 mg/kg intravenous d) Oxycodone 0.5 mg/kg orally
B
(sucrose 0.1 to 0.5 ml orally max 5ml, IN fentanyl 1.5 mcg/kg up to 3 mcg/kg, morphine IV and oxycodone 0.1 to 0.2 mg/kg max 10mg. (RCH analgesia and sedation guidelines 2016)
Which of the following is correct regarding procedural sedation of children in the ED a) Aspiration risk is 5% in a non-fasted child receiving procedural sedation outside theater b) Vomiting is more likely in the recovery phase than during sedation phase c) The risk of vomiting cannot be decreased with pre-treatment including use of ondansetron d) Laryngospasm cannot be overcome with airway manipulation maneuvers including pressure at ‘Larson’s point’
B
(Aspiration risk is 1 in 30,000 in a non-fasted pediatric sedation outside ED, risk of vomiting may be decreased with ondansetron depending on sedation drugs used, laryngospasm can be overcome with pressure at Larson’s point bilaterally whilst performing a jaw thrust. LITFL laryngospasm 2016)
Regarding local anaesthetics which is correct
a) Prilocaine can cause oxidation of haemaglobin and create methemoglobin
b) The use of local anaesthesia with adrenaline often cause problems when given in end arterial fields such as fingers, toes
c) True allergic reactions to local anaesthetics is common
d) Ropivocaine has significantly more cardiotoxicity compared to lignocaine and bupivocaine
A
LA with adrenaline appears to be safe for use in end arteries but should be avoided in the presence of vascular diseases such as Raynaulds or Bergers and in vascular surgery, true allergy is uncommon and usual allergy is to preservatives: alternatives to amides and esters are
diphenhydramine and benzyl alcohol with adrenaline. Ropivocaine has significantly less
cardiotoxicity compared to lignocaine and bupivocaine
Which maximal safe dose of local anaesthetic is incorrect
a) Bupivacaine 3 mg/kg
b) Ligocaine 4 mg/kg
c) Ropivacaine 3 mg/kg
d) Prilocaine 7 mg/kg
D (Prilocaine 5 mg/kg)
Regarding median nerve blocks which is correct
a) It passes between flexor digitorum profundus and palmaris longis at the proximal wrist crease.
b) It provides sensation to the palmar and dorsum of thumb, index, long and half of ring fingers
c) It provides innervation to the thenar muscles as well as 1 st and second lumbricals
d) The palmar cutaneous branch lies deep to the recurrent branch of the median nerve
C
It lies between palmaris longis and flexor carpi radialis, it does not provide sensation to dorsum of thumb, the palmar cutaneous branch lies superficial to the recurrent nerve and to the flexor retinaculum so is spared in carpal tunnel syndrome.
Radial nerve innervates which of the following
a) Medial two Lumbricals
b) All of the extensor muscles of the forearm
c) Sensation of dorsum thumb, index, middle and ring fingers
d) All of the interossei muscles
B
Radial nerve provides sensation to dorsum thumb, index and half of middle fingers, innervates all of the extensor muscles of posterior forearm.
Regarding Ulnar nerve blocks which is incorrect
a) The ulnar nerve travels deep to the flexor carpi ulnaris
b) It innervates flexor pollicis brevis, adductor pollicis and all digiti minimi muscles except extensor, medial two lumbricals and all interossei.
c) It innervates the medial two lumbricals and all of the interossei muscles
d) Skin innervation includes all of the 4 th and 5 th digit as well as the hypothenar eminence
D
Ulnar skin innervation: hypothenar, all of 5 th digit and medial half of 4 th digit.
Muscle innervations: flexor pollicis brevis, adductor pollicis, palmaris brevis, all digiti minimi except
extensor, medial two lumbricals and all interossei)
Which is not a branch of the sciatic nerve that is anaesthetized in a full ankle block
a) Saphenous nerve
b) Peroneal nerves
c) Tibial nerve
d) Sural nerve
A (Saphonous nerve a branch of the femoral)
Regarding ankle blocks which is not true.
a) The deep nerves are posterior tibial and deep peroneal
b) The superficial nerves need to be blocked by depositing local anaestheisa as a field block in subcutaneous space.
c) A complete ankle block anaesthetizes four individual nerves that innervate the foot
d) The landmarks for performing an ankle block includes extensor halluces longis, tibialis anterior tendon, Achilles and the malleoli.
C
A complete ankle block anaesthetizes five nerves: superficial and deep peroneal, posterior tibial, sural and saphenous.
Which is correct regarding skin innervation of the ankle nerves
a) 1 st web space is innervated by superficial peroneal nerve
b) Majority of plantar surface is innervated by sural nerve
c) Saphenous nerves innervates the lateral aspect of the ankle
d) Posterior tibial nerve innervates the heel
D
Saphenous nerve innervates medial aspect of ankle.
Posterior tibial innervates heel and majority of plantar.
Sural nerve innervates lateral plantar and lateral ankle.
Superficial peroneal innervates majority of dorsum of foot.
Deep peroneal innervates 1 st web space.
Which of these is not one of the 6 ‘A’s of anaesthesia.
a) Anaesthesia
b) Amnesia
c) Analgesia
d) Anxiolysis
e) Airway control
E
The 6 A’s are:
Anaesthesia
Anxiolysis
Amnesia
Areflexia (muscle relaxation - not always required)
Autonomic stability
Analgesia
Which of the following is part of the LEMON evaluation when assesing for a difficult airway?
a) Look
b) Enlarged tongue
c) Mouth opening
d) Obvious airway swelling
e) Nasty dentition
A
Look - obesity, beard, dental/facial abnormalities, neck and facial trauma.
Evaluate 3-3-2 rule
Mallampati score
Obstruction - stridor, foreign bodies
Neck mobility
When considering the 3-3-2 rule during the evaluation of a difficult airway. Which of the following statements is true?
a) 3 applies to mouth opening, if the patient can not fit 3 of their own fingers in their mouth it will be a difficult intubation.
b) 1 finger breadth is the thyromental distance.
c) The thyromental distance is the distance of the lower mandible in midline from the mentum to the base of the thyroid.
d) 2 fingers should fit from the base of the mouth to the thyroid notch.
e) The hyoid bone to the base of the mouth should fit at least 2 fingers.
A
3 - of the patients fingers should fit vertically between the incisors (any less could be a difficult airway)
3 - of the patients fingers should fit horizotally from the tip of the chin to the hyoid bone (this is the thyromental distance, from the mentum to the thyroid notch - or hyoid bone)
2 - of the patients fingers should fit from the top of the hyoid bone to the top of the thyroid cartilage.
A difficult bag valve mask can be remembered by the mneumonic BONES. Which of the following is correct?
a) Bad teeth
b) Overbite
c) No sedation
d) Elderly
e) Short chin
D
Beard
Obese
No teeth
Elderly
Sleep apnoea / snoring
Which of the following is included in the ‘RODS’ mneumonic for a difficult LMA?
a) Restricted mouth opening
b) Restricted tongue protrusion
c) Restricted anterior jaw dislocation
d) Systolic BP <80
e) Salivation (excess)
A
Restricted mouth opening
Obstruction
Distorted Airway
Stiff lungs or c-spine
Which of the following is included in the mneumonic ‘SHORT’ for a difficult surgical airway?
a) Shotgun wound
b) Hair
c) Obvious infection at site
d) Raised / extended neck
e) Tumour
E
Apart from the extended neck all the others would technically make things trickier. However, the mnuemonic is:
Surgery
Haematoma
Obesity
Radiation distortion or other deformity
Tumour
Which one of the following is correct from the Mallampati classification?
a) IV only the base of the uvula can be seen
b) II All the tonsillar pillars are seen
c) I Base of uvula is seen
d) IV Only the tongue and hard palate is visable
e) III partial view of the tonsillar pillars
D
I - Everything is seen (Uvula - body and base, tonsils and tonsilar pillars)
II - Uvula is seen but you start losing site of the tonsils and tonsilar pillars
III - Only the base of the uvula is seen
IV - Only the hard palate can be seen
In relation to the American Society of Anesthesiology Classification (ASA) which one of the following is correct?
a) ASA 6 is declared brain dead.
b) ASA 2 is a fit person but not fasted.
c) ASA 4 is a moribound patient not expected to survive 24 hours without surgery.
d) ASA 3 a patient with mild systemic disease.
e) ASA 5 a patient with incapacitating disease this is a constant threat to life.
A
ASA 1 = a healthy fit person
ASA 2 = a patient with a mild systemic disease (T2DM, controlled HTN)
ASA 3 = a patient with severe systemic disease that limits activity e.g. stable CAD, COPD
ASA 4 = a patient with incapacitating disease this is a constant life threat e.g. unstable angina
ASA 5 = a moribund patient not expected to survivie 24 hours without surgery e.g. ruptured AAA
ASA 6 = declared brain dead, a patient whose organs are being removed for donation purposes.
For emergency operation, add the letter E after the classification (e.g. ASA 3E)
Regarding facial nerve blocks which is correct?
a) Supraorbital nerve blocks will anaesthetize forehead and bridge of nose.
b) Infraorbital nerve blocks can be done through mucosa superior to maxilla canine.
c) Mental nerve block also anaesthetizes the teeth.
d) Auricular field blocks need only to infiltrate the area superior to the external ear.
B (Supraorbital nerve only supplies forehead, supratrochlear nerve supplies bridge of nose, mental nerve innovates gingiva but not teeth, auricular field block needs both superior and
inferior injections around the external ear)
Regarding intercostal nerve blocks which is correct?
a) The scapula and rhomboid muscles will only make blocking to ribs 1 to 3 difficult
b) The order from superior to inferior within the subcostal groove of a rib goes: nerve, artery, vein)
c) Blocking posterior to the midaxillary line ensures analgesia to the lateral cutaneous and anterior branch of the intercostal nerve
d) Pneumothorax occurs in 20% of patients or about 5% for each individual intercostal block
C (Scapula and rhomberg muscles make blocking ribs 1 to 6 difficult, subcostal groove of rib from superior to inferior runs vein – artery – nerve, pneumothorax rate is 8-9% or about 1.4%
for each individual intercostal block)
With respect to femoral nerve blocks and fascia iliaca blocks which is incorrect?
a) “3 in 1” blocks target the femoral, obturator and sciatic nerves
b) Ideal injuries for these blocks are neck of femur and proximal femur fractures
c) Fascia iliaca block technique will have two “pops” where the needle infiltrates the fascia lata and fascia iliaca
d) Ropivocaine 0.75% is used as it is less cardiotoxic and usual dose should be 1-3 mg/kg maximal dose of 300mg (40ml)
- *A** (3 in 1: femoral, lateral fem cutaneous and obturator. Ozemed and ASEM websites 2016: http://www.ozemedicine.com/wiki/doku.php?id=fasciailiacusblock. AND
http: //www.asem.org.au/document.php/gbcokgx/Guidelines+for+use+in+the+ED.pdf.)
Which is not a typical contraindication for Bier’s Blocks
a) Sickle cell disease
b) Raynaud’s disease
c) Poorly controlled epilepsy
d) Children
- *D** (contraindicated for children under 5 yo, RCH and RCEM websites 2016 and 2014:
http: //www.rch.org.au/clinicalguide/guideline_index/Biers_Block/. AND
secure. rcem.ac.uk/code/document.asp?ID=5360.)
