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C. Year 3: Elderly Medicine > Surgery in Older People > Flashcards

Surgery in Older People Flashcards

1
Q

What does perioperative care relate to?

1 - time prior to surgery
2 - time during surgery
3 - time following surgery
4 - time around surgery (pre, during and post)

A

4 - time around surgery (pre, during and post)
- essentially includes everything until the patient is back home functioning or until the patient passes away

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2
Q

While surgery is safe, older adults experience the greater proportion of perioperative complications therefore careful planning is required to ensure positive patient outcomes. Which of the following is NOT typically one of the stages of managing the patients?

1 - Pre-operative care
2 - Pre-clinical research care
3 - Intra-operative care
4 - Post-operative care

A

2 - Pre-clinical research care

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3
Q

What % of all operations are in those aged >65 y/o?

1 - 10%
2 - 30%
3 - 55%
4 - 75%

A

3 - 55%

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4
Q

Which of the following is NOT a high risk surgery patient?

1 - Elderly
2 - Fractured ankle
3 - Co-morbid disease/multimorbidity
4 - Major surgery
5 - Emergency surgery

A

2 - Fractured ankle

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5
Q

Intra-cavity surgery puts a major stress on the body, causing a systemic inflammatory response. Does this increase or decrease the oxygen demand of the body?

A
  • increases
  • aprox 110 to 170ml/min/m2 at rest
  • essentially body needs an additional 50% of oxygen in an older already stressed body
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6
Q

96% of patients who die within 30 days of surgery have what?

1 - significant medical comorbidities
2 - family history of dyeing within 30 days of surgery
3 - poor response to anaesthesia
4 - all of the above

A

1 - significant medical comorbidities
- cardiovascular accounts for 76%
- respiratory pathology accounts for 56%
- peri-operative MI has a mortality of up to 70%

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7
Q

Perioperative medicine relates to the practice of patient-centred, multidisciplinary, and integrated medical care of patients from the moment of contemplation of surgery until full recovery.” Which of the following is part of perioperative medicine as part of the comprehensive geriatric assessment?

1 - Optimise physical function – nutrition, exercise, frailty
2 - Optimise mental health and improve mood
Identification of specific risks, risk assessment and shared decision making
3 - Plan for immediate and individualised perioperative management –anaesthetic technique, ward or HDU, analgesia
4 - Comprehensive plan for discharge including social care at home or respite care
5 - all of the above

A

5 - all of the above

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8
Q

Post-operative complications are common in older patients. Which of the following is NOT a common complication?

1 - Increased length of stay – multifactorial
2 - Deconditioning
3 - Delirium
4 - Fractures

A

4 - Fractures
- could happen if patient falls, but far less likely than the others

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9
Q

Post-operative complications are common in older patients. Which of the following common complications of infections?

1 - Poor wound healing
2 - Urinary
3 - Pneumonia
4 - all of the above

A

4 - all of the above

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10
Q

Post-operative complications are common in older patients. Which of the following common complications is NOT a pulmonary complication?

1 - Pneumonia
2 - Need for ventilation
3 - DVT/PE
4 - Atelectasis
5 - AKI

A

5 - AKI

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11
Q

Post-operative complications are common in older patients. Which of the following common complications is NOT a cardiac complication?

1 - infarction/ischaemia
2 - congestive heart failure
3 - arrhythmia, heart block/cardiac arrest
4 - PE/DVT

A

4 - PE/DVT

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12
Q

Does frailty impact upon recovery?

A
  • yes
  • older patients can sustain an initial stressor, but the 2nd stressor is often what makes them go from independent to dependent
  • patients essentially struggle to get back to their original baseline
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13
Q

In patient following surgery, we can use the mnemonic DREAM. Which of the following is NOT part of the DREAM mnemonic?

1 - DR = DRink
2 - R = Rest
3 - E = Eat
4 - A = And
5 - M = Move

A

2 - R = Rest
- patients aim to mobilise asap where possible

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14
Q

Prior to surgery, do all patients having elective surgery require going to an anaesthetist clinic?

A
  • no
  • only high risk patients
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15
Q

What is the name of the Anaesthetist led services that is a national programme combining organisation of care and clinical management throughout the surgical patient pathway with the aim of improving postoperative outcomes, and is now part of standard care?

1 - Enhanced Risk Assessment (ERA)
2 - Enhanced Recovery Programme (ERP)
3 - Enhanced Rehabilitation Programme (ERP)
4 - Enhanced Rational Surgery (ERS)

A

2 - Enhanced Recovery Programme (ERP)

  • Preoperatively = consent, planning
    and nutrition
  • Intraoperatively = fluid balance, normothermia, least invasive procedures,
  • Postoperative = early mobilisation, resume normal diet asap, innovative analgesic techniques, proactive discharge planning
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16
Q

Is the amount of anaesthetic given during surgery associated with outcomes in older patients?

A
  • yes
  • higher levels of anaesthetics are linked with poorer outcomes
17
Q

Following surgery, does oliguria (<400ml urine output/day) occur?

A
  • yes
  • stress on body requires the retention of electrolytes such as Na+ and K+
18
Q

Which drugs commonly used in surgery should be reduced as much as possible for their association with delirium?

1 - opioids
2 - sedatives
3 - oxycodone
4 - all of the above

A

4 - all of the above

19
Q

What is the definition of silver trauma?

1 - major trauma in >65 y/o
2 - major trauma requiring surgery in >65 y/o
3 - hospitalisation >65 days following trauma
4 - major trauma causing hospitalisation >100 days

A

1 - major trauma in >65 y/o

20
Q

Is the number of older patients with major trauma increasing or decreasing?

A
  • increasing
  • likely to be due to older population
21
Q

Which of the following is now the major cause of trauma in >65 y/o?

1 - road traffic accident
2 - penetrating injury
3 - fall from >2m
4 - fall from <2m

A

4 - fall from <2m
- typically 3-4 stairs

22
Q

The most common cause of silver trauma, major trauma in >65 y/o is a fall from <2m. What is the most common injury from the following?

1 - abdomen
2 - head
3 - thorax
4 - spine
5 - pelvis
6 - limbs

A

2 - head
- by far the most common
- thorax is 2nd most common

23
Q

The Abbreviated Injury Scale (AIS) can be used to standardise the trauma of injury to patients. The scoring includes all of the following, EXCEPT which one?

1 - Head
2 - Face
3 - Cognitive function
4 - Chest
5 - Abdomen
6 - Extremities (inc. pelvis)
7 - External

A

3 - Cognitive function
- may be assessed later though

24
Q

The Abbreviated Injury Scale (AIS) can be used to standardise the trauma of injury to patients. What score indicates that the trauma is a major trauma?

1 - >5
2 - >10
3 - >15
4 - >20

A

3 - >15
- typically polytrauma = multiple body parts affected

25
Q

The Abbreviated Injury Scale (AIS) can be used to standardise the trauma of injury to patients. Is the AIS used in emergency departments?

A
  • no
  • typically it is used for audits and research
26
Q

Are silver trauma patients (>65 y/o) with major trauma more or less likely to be triaged than younger patients?

A
  • less likely to be triaged
  • less likely to be identified as a major trauma patient
  • less likely to be seen by the trauma team
  • high morbidity and mortality
27
Q

Higher GCS are not always a good indicator of traumatic injury, even more so in silver trauma. What has been identified as a major cause of this?

1 - slower bleeding in the brain due to polypharmacy
2 - thicker skull so slower bleeds
3 - cortex atrophy so larger space for bleeding to fill
4 - all of the above

A

3 - cortex atrophy so larger space for bleeding to fill
- bleeding takes longer to put pressure on brain and elicit cognitive deficits that cause a lower GCS

28
Q

Which of the following classes of medications is most likely to increase the risk of bleeding following silver trauma?

1 - anti-epileptics
2 - SSRI
3 - anticoagulants
4 - anti-hypertensives

A

3 - anticoagulants
- significantly increase risk of bleeding following head injury
- always need a head CT scan
- imaging of neck is important as well

29
Q

Hypotension is a low BP. Does hypotension have the same risk of mortality in >65 y/o as younger patients?

A
  • no
  • SBP < 110mmHg equal to mortality as SBP < 90mmHg in a younger person
30
Q

Is a chest X-ray sufficient to rule out chest wall injuries?

A
  • no
  • 50% of rib fractures are missed on chest X-ray
  • 1 rib is dangerous in elderly, buy in older patients 1 is dangerous
31
Q

Which of the following injuries are associated with rib fractures?

1 - pneumonia
2 - pulmonary contusions
3 - sepsis
4 - VTE
5 - Acute respiratory distress syndrome (ARDS)
6 - increased hospital stay
7 - death
8 - all of the above

A

8 - all of the above

C. Year 3: Elderly Medicine (18 decks)

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