Palliative Extras

Question 1

Patient is breathless + pain eg due to end stage COPD. What do you give

Answer 1

Morphine PO - reduces resp rate + helps with pain
start small dose then titrate up

Question 2

how does ASA rankings work for surgery

Answer 2

ASA score of 1 would be awarded to a healthy patient who does not smoke and has no or low alcohol intake
2 –with mild systemic disease
score of 3 is for patients with severe systemic disease and functional limitations
score of 4 is for patients with systemic disease severe enough to constantly threaten life
score of 5 are unlikely to survive if surgery does not go ahead

Question 3

if using more than 2 doses of breakthrough pain medication eg if He takes modified-release morphine sulphate tablets (MST) 20 mg twice daily. He also takes 4–6 doses daily of oramorph 10 mg/5 ml for breakthrough pain, what should you do

Answer 3

increase dose of longer acting analgesia

Question 4

what must be given the day before colonoscopy

Answer 4

laxatives

Question 5

diabetes control in major surgery/poorly controlled diabetes into surgery

Answer 5

variable rate insulin

Question 6

what is used for the neuromuscular relaxation part of rapid sequence induction

Answer 6

suxamethonium

Question 7

how do you calculate breakthrough dose of morphine

Answer 7

1/6th of daily morphine dose

Question 8

what type of airway intervention can you not use in basal skull fractures

Answer 8

nasopharyngeal airways

Question 9

what are the opioid of choice for pain management in severe renal impairment

Answer 9

buprenorphine or fentanyl

Question 10

what are features of malignant hyperthermia

Answer 10

happens after anaesthetics
hyperpyrexia and muscle rigidity
susceptibility is inherited in autosomal dominant fashion

Question 11

what drugs cause malignant hyperthermia

Answer 11

halothane
suxamethonium

Question 12

what investigations do you do in malignant hyperthermia

Answer 12

CK raised

Question 13

what is the management of malignant hyperthermia

Answer 13

dantrolene

Question 14

what are indications and contraindications for cyclizine use

Answer 14

indication -
movement related nausea/vomiting
bowel obstruction

Question 15

what are indications and contraindications for dexamethasone use

Answer 15

indications -
intracranial disease eg metastases
bowel obstruction

Question 16

what are indications and contraindications for domperidone use

Answer 16

useful in gastric stasis
can be used in parkinsons/not cross BBB
Contraindication - bowel obstruction

Question 17

what are indications and contraindications for metaclopramide use

Answer 17

useful in gastric stasis
contraindication - not in parkinsons
not in bowel obstruction

Question 18

treatment for anxiety related nausea/vomiting

Answer 18

lorazepam

Question 19

treatment for chemotherapy related nausea/vomiting

Answer 19

ondansetron

Question 20

when should you start LMWH after surgery

Answer 20

6-12 hours after

Question 21

when can you have clear fluids until before surgery

Answer 21

until 2 hours before

Question 22

when can you have non clear liquids/food until before surgery

Answer 22

6 hours before

Question 23

decreased oxygen saturation 10 minutes after intubation

Answer 23

intubation was done in oesophagus

Question 24

what are the things that are checked before induction of anaesthesia

Answer 24

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

Question 25

what analgesia is given in mild-moderate renal impairment

Answer 25

oxycodone

Question 26

how should wounds be cleaned post surgery up to 48 hours

Answer 26

sterile saline

Question 27

when can a patient shower after surgery

Answer 27

after 48 hours

Question 28

what BMI is ASA 2 and 3

Answer 28

BMI 30-40 = 2 BMI 40+ = 3

Question 29

how do you manage secretions at end of life eg patient makes gargling noises, dullness to percussion

Answer 29

Hyoscine hydrobromide or hyoscine butylbromide subcut

Question 30

what treatment is given for reducing discomfort in a painful mouth eg due to ulcers

Answer 30

Benzydamine hydrochloride mouthwash or spray

Question 31

how can multiple intubations lead to increased infections

Answer 31

formation of a Tracheo-oesophageal fistula

Question 32

how do you convert morphine to diamorphine

Answer 32

/3

Question 33

what would you give for bowel colic eg abdominal pain in bowel cancer

Answer 33

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

Question 34

how would you treat local anaesthetic toxicity eg due to lidocaine

Answer 34

IV 20% lipid emulsion

Question 35

what changes to prednisolone are made prior to surgery

Answer 35

supplement with hydrocortisone

Question 36

isolated fever in a patient 24 hours after surgery

Answer 36

physiological reaction to operation

Question 37

What is given for the actual induction agent in rapid sequence induction

Answer 37

sodium thiopentone

Question 38

What drugs slow down wound healing

Answer 38

Non steroidal anti inflammatory drugs Steroids Immunosupressive agents Anti neoplastic drugs

Question 39

if patients temp is <36 degrees before operation, can you do operation

Answer 39

No unless urgent -> must warm up

Question 40

Causes of post operative fever pneumonic

Answer 40

Day 1-2: 'Wind' - Pneumonia, aspiration, pulmonary embolism Day 3-5: 'Water' - Urinary tract infection (especially if the patient was catheterised) Day 5-7: 'Wound' - Infection at the surgical site or abscess formation Day 5+: 'Walking' - Deep vein thrombosis or pulmonary embolism Any time: Drugs, transfusion reactions, sepsis, line contamination.

Question 41

for hip replacement, what VTE prophylaxis is used and when

Answer 41

TED stockings once admitted and LMWH 6 hours after surgery

Question 42

treatment for hiccups in palliative care

Answer 42

chlorpromazine or haloperidol

Question 43

When would you use total parenteral nutrition

Answer 43

when the intestines dont work

Question 44

what vessel is TPN given through

Answer 44

subclavian line

Question 45

codeine to morphine conversion

Answer 45

/10

Question 46

what anaesthetic agent would you use if the patient is haemodynamically unstable

Answer 46

ketamine

Question 47

What drug can be given to reverse neuromuscular blockade

Answer 47

neostigmine

Question 48

oral morphine to subcut morphine conversion

Answer 48

/2

Question 49

what is the risk of giving hypotonic (0.45%) fluid in paediatric patients

Answer 49

risk of hyponatraemic encephalopathy

Question 50

what is central pontine myelinolysis

Answer 50

rapid correction of hyponatraemia

Question 51

what is a contraindication for suxamethonium

Answer 51

penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure