Basics

Question 1

What is pain?

Answer 1

Sensation associated with actual or potential injury

Question 2

What neurones transmit sharp pain from pain receptor?

Answer 2

A-delta fibres

Question 3

What fibres carry touch?

Answer 3

A-beta fibres

Question 4

How does rubbing a painful area help with the pain?

Answer 4

A-beta fibres throw branches to inhibitory interneurones to dampen pain

Question 5

What tracts transmit pain?

Answer 5

Lateral Spinothalamic tract

Question 6

What is allodynia?

Answer 6

Pain to a stimulus that’s not actually there

Question 7

What are some analgesics?

Give in form of pain ladder?

Answer 7

Moderate - severe pain (Morphine, fentanyl)
Mild - moderate pain (Codein, tramadol)
Mild (paracetamol, ibuprofen)

Question 8

What is the max dosing of paracetamol?

Answer 8

1g up to 4 times a day

Question 9

What are some side effects of paracetamol?

Answer 9

Rash
Idiopathic thrombocytopenia

If given rapidly IV can get hypotension and bradycardia

Question 10

What is the principle of a paracetamol overdose?

How is it treated?

Answer 10

NAPQI is conjugated by GSH to prevent its toxicity . (NAPQI is toxic metabolite from paracetamol)

Acetylcysteine given to regenerate GSH

Question 11

How long should a woman cease taking her COCP or HRT prior to surgery?

Answer 11

4 weeks

Question 12

When should a patient cease taking their ACE inhibitor prior to surgery?

Answer 12

Morning of

Question 13

Which anaesthetic agent has good anti-emetic properties?

Answer 13

Propofol

Question 14

What anaesthetic is useful in cases of trauma since it doesn’t cause hypotension?

Answer 14

Ketamine

Question 15

What are some drugs that impair wound healing?

Answer 15

NSAIDs
Corticosteroids
Immunosuppressants
Anti-neoplastic drugs

Question 16

What are the 3 components to GCS?

Answer 16

Eye movements
Verbal responses
Motor responses

EVM

Question 17

What is the total score for GCS?

Answer 17

15

Question 17

What are the 3 components to GCS?

Answer 17

Eye movements
Verbal responses
Motor responses

EVM

Question 18

What is the max score for eye opening?

Answer 18

4

Question 19

What is the max score for verbal responses?

Answer 19

5

Question 20

What is the max score for motor responses?

Answer 20

6

Question 21

What are the scores for eye opening in GCS?

Answer 21

4 - spontaneous
3- to speech
2 - to pain
1 - no response

Question 22

What are the scores for verbal responses in GCS?

Answer 22

5 - orientated / fully aware
4 - confused conversation
3 - inappropriate words
2 - incomprehensible sounds
1 - no response

Question 23

What are the scores for motor responses for GCS?

Answer 23

6 - obeys commands 5 - localises to pain 4 - withdraws from pain 3 - abnormal Flexion 2 - abnormal extension 1 - no response

Question 24

What is the lowest score you can get with GCS?

Answer 24

3

Question 25

When should warfarin be stopped before surgery?

Answer 25

5 days before

Question 26

When should DOACs be stopped before surgery?

Answer 26

48-72hrs depending on procedure and renal function

Question 27

When should LMWHs be stopped before surgery?

Answer 27

12 hrs if its prophylactic 24hrs if its therapeutic

Question 28

When should ADP antagonists like clopidogrel, Ticagrelor and Prasugrel be stopped prior to surgery (unless it’s coronary stenting)?

Answer 28

5-7days before

Question 29

When should NSAIDs be stopped prior to surgery?

Answer 29

2-3 days

Question 30

When should Metformin be stopped prior to surgery?

Answer 30

Omit on the day

Question 31

When should SGLT-2 inhibitors be stopped prior to surgery?

Answer 31

3 days before (risk euglycemic DKA)

Question 32

When should sulfonyl urea’s like gliclazide be stopped before surgery?

Answer 32

Morning of