Anaesthetics

Question 1

assessment scale of n+v

Answer 1

0 = no n or v 
1 = n only 
2 = v once 
3 = v more than once

Question 2

Mx of n+v in intracranial tumours

Answer 2

dexamethasone

Question 3

mechanism and use of metoclopramide in n+v

Answer 3

D2-antagonist (anti-dopaminergic)

• prokinetic/promotes bowel motility
• 1st line in low risk chemo induced n+v

Question 4

mechanism and use of ondansetron in n+v

Answer 4

5HT3 antagonist

- chemotherapy induced nausea (high risk pts)

Question 5

mechanism and use of cyclizine in n+v

Answer 5

anti-histamine

- inner ear induced nausea

Question 6

mechanism and use of haloperidol in n+v

Answer 6

typical antipsychotic

- used in palliative care n+v

Question 7

rating pain scale

Answer 7

0 = no pain rest, no pain movement 
1 = no pain rest, slight pain movement 
2 = slight pain rest, moderate pain movement 
3 = pain at rest, severe pain movement

Question 8

1st step in WHO pain ladder

Answer 8

pain score 0-1

non-opioid e.g. paracetamol 1g 6hrly

Question 9

2nd step in WHO pain ladder

Answer 9

pain score 1-2
non-opioid
+
mild opioid (e.g. codeine or tramadol)

Question 10

3rd step in WHO pain ladder

Answer 10

non-opioid
+
strong opioid (e.g. morphine)

Question 11

how is oramorph usually given

Answer 11

10mg/5mls

Question 12

what is MST

Answer 12

modified release morphine

- given bd

Question 13

dose of breakthrough analgesia

Answer 13

1/6th of total daily dose of morphine

Question 14

standard PCA prescription

Answer 14

1mg morphine bolus / 5 min lockout

Question 15

conversion codeine to morphine

Answer 15

divide by 10

Question 16

conversion morphine to oxycodone

Answer 16

divide by 2

Question 17

order for opening airway

Answer 17

head tilt 
chin lift
jaw thrust 
oropharyngeal airway
nasopharyngeal airway 
laryngeal airway (guedel)

Question 18

what airway device is not used in patients with GORD

Answer 18

laryngeal airway
- poor control against gastric reflux
(use endotracheal tube)

Question 19

when is nasopharyngeal airway contraindicated

Answer 19

BOS #

Question 20

how to size an oropharyngeal airway

Answer 20

between incisor teeth and angle of mandible

Question 21

how long should warfarin be with-held for pre-op

Answer 21

5d

Question 22

what is INR target pre-surgery for someone on warfarin

Answer 22

<1.5

Question 23

if INR high in someone on warfarin pre-op, what do u give

Answer 23

oral vit K

Question 24

when do u restart warfarin post op

Answer 24

on the same day of the procedure, if there is no bleeding

Question 25

normal urine output

Answer 25

0.5ml/kg/hr

Question 26

for a 70kg man - daily water requirement

Answer 26

2000-2500ml/day

Question 27

daily Na requirement

Answer 27

1-2 mmol/kg

Question 28

daily K requirement

Answer 28

1-2 mmol/kg

Question 29

Na, K, Cl and Ca levels in plasma

Answer 29

Na - 135-147 K - 3.5-5 Cl - 92-109 Ca - 1.9-2.3

Question 30

contents of 0.9% saline

Answer 30

``` Na 154 Cl 154 K 0 Ca 0 Lactate 0 ```

Question 31

contents of 5% glucose

Answer 31

``` Na 0 Cl 0 Ca 0 K 0 Lactate 0 ``` used for pure dehydration

Question 32

contents of hartmann's

Answer 32

``` Na 131 Cl 110 K 5 Lactate 29 Ca 0 ```

Question 33

contents of colloid

Answer 33

``` Na 154 Cl 154 K 0 Lactate 0 Ca 0 ```

Question 34

what 3 things should be considered when prescribing fluids

Answer 34

1. basal requirements 2. existing deficit 3. predicted losses

Question 35

when are maintenance fluids given

Answer 35

if pt isnt drinking enough | must match daily requirements of Na, K and water over 24h

Question 36

replacing fluid loss - how is this given

Answer 36

as a stat bolus - hartmanns

Question 37

presentation paracetamol overdose

Answer 37

non-specific - vomiting - fever - ringing in ears - unconsciousness

Question 38

what is the toxic metabolite of paracetamol and what detoxifies it

Answer 38

NAPQI | detoxified by glutathione

Question 39

when to do paracetamol OD blood test

Answer 39

4h - if 100% paracetamol at this time they get Tx

Question 40

how long does paracetamol take to be absorbed - what things affect this time

Answer 40

30mins | substances that delay gastric emptying - opiates, alcohol

Question 41

when checking paracetamol level, what also always gets checked

Answer 41

aspirin level

Question 42

Mx paracetamol Od

Answer 42

N-acetylcysteine (Parvolex) - replenishes glutathione - gvien in 3 stages

Question 43

Mx opiate OD

Answer 43

naloxone

Question 44

Mx TCA OD

Answer 44

sodium bicarbonate

Question 45

presentation TCA OD

Answer 45

``` large pupils tachy urinary retention arrhythmia hypotension dry skin ```

Question 46

If pt having seizures in TCA OD, what do u give

Answer 46

lorazepam + muscle relaxant + barbituate infusion

Question 47

Mx BZD OD

Answer 47

flumazenil

Question 48

why is flumazenil only given in iatrogenic OD

Answer 48

flumazenil can cause seizures which are then untreatable.

Question 49

Mx tetanus

Answer 49

IVIG

Question 50

prophylaxis following injury: | Mx if tetanus immune status complete and any wound

Answer 50

none required

Question 51

prophylaxis following injury: | Mx if tetanus status inadequate and clean wound

Answer 51

none required

Question 52

prophylaxis following injury: | Mx if tetanus status inadequate and tetanus prone site

Answer 52

immediate reinforcing dose of vaccine

Question 53

prophylaxis following injury: | Mx if tetanus status inadequate and high risk tetanus prone site

Answer 53

immediate reinforcing dose of vaccine + IVIG at diff site

Question 54

prophylaxis following injury: | Mx if no immune tetanus status and clean wound

Answer 54

immediate reinforcing dose of vaccine

Question 55

prophylaxis following injury: | Mx if no immune tetanus status and tetanus prone site

Answer 55

immediate reinforcing dose of vaccine + IVIG at diff site