Anaesthetics

Question 1

What is the MOA of suxamethonium and when is it used clinically?

Answer 1

A depolarising neuromuscular block (nAchR) used to generate a brief period of muscular relaxation for, e.g. intubation

Question 2

What are the contraindications to Suxamethonium?

Answer 2

Penetrating eye injuries/narrow angle glaucoma (causes raised IOP)
Hyperkalaemia
Burn injuries

Question 3

What are the side effects of suxamethonium?

Answer 3

Hyperkalaemia

Malignent hyperthermia

Question 4

What cardiovascular complication might an anastomotic leak precipitate after GI surgery?

Answer 4

AF

Question 5

How long post op would an anastomotic leak present?

Answer 5

5-7 days

Question 6

What is a contraindication to nasopharyngeal airway insertion?

Answer 6

Skull base fracture

Question 7

What are the features of a keloid scar?

Answer 7

Dark shiny tissue which extends beyond the limits of the incision

Question 8

What are the features of a hypertrophic scar?

Answer 8

Excessive collagen resulting in nodules and parallel fibre formation which remains confined to the boundaries of the wound

Question 9

What are the causes of early post op pyrexia (0-5 days)?

Answer 9

Blood transfusion
Cellulitis
UTI
Physiological SIRS
Atelectasis

Question 10

What are the causes of late post op pyrexia (>5 days)?

Answer 10

VTE
Pneumonia
Wound infection
Anastomotic leak

Question 11

What is the ASA classification and outline its grades

Answer 11

Used to determine a prospective surgical patient’s current health

ASA1 - Normal healthy
ASA2 - Mild systemic disease
ASA3 - Severe systemic disease
ASA4 - Severe systemic disease that is a constant threat to life (inc <3month hx of e.g. MI/CVA)
ASA5 - Moribund, not expected to survive without the procedure
ASA6 - Braindead

Question 12

What is thge mechanism of lidocaine?

Answer 12

Blockage of axonal Na channels, disrupting action potential

Question 13

What is a Hickmann line and when is it commonly used?

Answer 13

A tunneled line inserted into the IJV used for patients with long term therapeutic requirements, e.g. chemotherapy

Question 14

What effect does intra-operative hypothermia have on bleeding during surgery?

Answer 14

May cause bleeding levels to increase due to defunctioning of clotting factors etc.

Question 15

Which anaesthetic agent has anti-emetic properties?

Answer 15

Propofol

Question 16

What is the use of propofol?

Answer 16

Used especially for maintaining sedation on ITU, total IV anaesthesia, and for daycase surgery

Question 17

What is the use and beneficial effect of ketamine?

Answer 17

Used for induction of anaestheaia

Strong analgesic properties

Question 18

What is a contraindication to LMA insertion?

Answer 18

Non-fasted patients due to risk of aspiration

Question 19

What agent is given as an antidote to benzodiazepine toxicity?

Answer 19

Flumazenil

Question 20

Which anaesthetic agent is hepatotoxic?

Answer 20

Halothane

Question 21

What metabolic disturbance would excessive administration of 0.9% saline cause?

Answer 21

Hyperchloraemic acidosis

Question 22

What are the timings for NBM for theatre?

Answer 22

Foods/solids >6 hours before

Clear fluids >2 hours before

Question 23

How long post op should prophylactic LMWH be started?

Answer 23

6-12 hours

Question 24

What is the management of local anaesthetic toxicity?

Answer 24

20% lipid emulsion IV

Question 25

What is used to reverse a heparin overdose/

Answer 25

IV PROTAMINE SULFATE

Question 26

What is the underlying abnormality in AD inherited suxamethonium apnoea?

Answer 26

Pesudocholinesterase deficiency

Question 27

What is a potentially fatal complication of poor post operative pain management?

Answer 27

Pneumonia

Question 28

What type of feeding aid should be used in a patient who has just undergone oesophagectomy?

Answer 28

Feeding jejunostomy

Question 29

What is the antidote for malignant hyperthermia secondary to suxamethonium hypersensitivity?

Answer 29

IV dantrolene

Question 30

What should be used for wound cleansing up to and after 48 hours post op?

Answer 30

Up to - sterile saline | After - shower

Question 31

How long before surgery should the COCP be stopped?

Answer 31

4 weeks prior

Question 32

How shouyld TPN be administered?

Answer 32

Via a central line

Question 33

What is a cvomplication of long term mechanical ventilation in trauma patients, and how might it present?

Answer 33

Tracheo-oesophageal fistula formation which would present with abdominal distension on ventilation

Question 34

Should you cannulate the foot of a known diabetic?

Answer 34

No

Question 35

What are the different cannula colour, sizes and flow rates?

Answer 35

``` Orange - 14G - 270ml/min Grey - 16G - 180ml/min Green - 18G - 80ml/min Pink - 20G - 54ml/min Blue - 22G - 33ml/min ```

Question 36

What are the risk factors for post op urinary retention?

Answer 36

``` TWOC Constipation Immobility Opiate analgesia Infection Haematuria BPH ```

Question 37

What imaging modality would you use to diagnose an anastomotic leak?

Answer 37

Abdo CT

Question 38

What should be given to patients taking prednisolone before surgery?

Answer 38

Hydrocortisone - as pred suppresses the HPA axis such that the adrenal response to the stress of surgery would be impaired

Question 39

What should be given in the event of DIC?

Answer 39

FFP

Question 40

What should be done to manage post op paralytic ileus?

Answer 40

Drip and suck

Question 41

Which drugs slow the wound healing process?

Answer 41

NSAIDs Steroids Immunosuppressive/cancer therapy

Question 42

What bowel prep should be given before colonoscopy?

Answer 42

Laxatives the day before and dont eat for 24 hours before the exam