Test_C

Question 1

T/F:

1. During sepsis, there is 30% temporary depression of the myocardial contractility.
2. During sepsis the lung water is increased
3. During SIRS, the WBCC is more that 12000 or less than 4000.
4. Viral infection can cause SIRS

Answer 1

All true

Question 2

Name an example of a benzodiazepine?

List 4 effects of benzos that are usefull in premedication?

Answer 2

Midazolam

Anxiolysis - amnesia
Sedative hypnotic
Anticonvulsant
Midazolam can be used to induce anesthesia

Question 3

List 3 sfx of benzos?

Answer 3

CNS depression - APNOEA in overdose
Tolerance and dependance
AGITATION/CONFUSION in elderly
Impaired motor function (coordination)

Question 4

What is the mechanism of action of benzos?

Answer 4

GABA agonist - incr the inhibitory stimulation of CNS

Question 5

Name 5 ways to confirm the correct placement of the ETT?

Answer 5

Auscultate : bilat breathing
Visualization: chest mvment, also ETT thru vocal cords
Water vapour in mask, O2 sats normal, CXR
Capnography
Regular, sustained, non declining

Question 6

Re to:
Cerebral metabolic rate
Cerebral blood flow
ICP

What affects will the following drugs have:

1. Thiopentone
2. Ketamine
3. Isoflurane
4. N2O

Answer 6

1. All decr
2. All incr
3. Decrease met rate, incr other
4. All incr.

Question 7

4 groups of pt at high risk for PONV?

Answer 7

Females
Non-smoking
Opioids use
Prev Hx / motion sickness

Question 8

Name 5 neurotransmitters involved in in N and V an give pharmacological antagonist.

Answer 8

Serotonin (5HT) - ondansetron
Histamine (h2) - promethazine, cyclizine
Dopamine.   - droperidol, metoclopromide
Ach - hyoscine hydrobromide
Substance P - antineurkinin 1 - aprepitant

Question 9

Which two a/w problems can obese pt get?

Answer 9

Limited mvmnt of atlanto-occipital joint -/+ TMJ

Decr thyromental distance

Question 10

List 5 effects with re to effects/ actions of IAA ass with aging?

Answer 10

MAC decr by 4 % / decade after 40
Onset of action
- accelerates - CO depressed
- decreases- VQ abnormalities
Myocardial depression due to drugs accelerted
Prolonged recovery time ( incr volume of distribution and decr. gass exchange)
Halothane metabolism decr by liver thus longer acting

Question 11

Name al IAA in increasing order acc to their Min Alv Concentration?

Answer 11

Halothan
Isoflurane
Enflurane
Sevoflurane
Desflurane
N2O

Question 12

How do local anesthetics work?

Answer 12

Prevent the flow of Na through the Na channels, thus preventing action potentials

Question 13

Which 2 organ system are particularly affected by LA?

Answer 13

CNS and CVS

Question 14

What are the precautions to prevent Sfx of LA?

Answer 14

Dont exceed prescribed dose
Limit dose used in vascular areas of body
Always aspirate before injecting to exclude IV placement
Test dose - which contains adrenaline as a intravascular marker should be given before main bolus dose : helps ID the intravascular placement of needle

Question 15

T/F: RSI

1. Is routinely used in elective surgery.
2. Indicated in elective surgery when stomach in full
3. Indicated in emergency surgery when stomach suspected to be full
4. Indicated during elective C/S where the mom refuses regional anesthesia and mother has been starved for 8hours
5. Is contraindicated in children who have full stomach - because they have difficult a/w.

Answer 15

1. False
2. True, aspiration risk
3. True
   4.
4. False

Question 16

T/F: recognition of a difficult a/w

1. Mallampati score I
2. Thyromental distance is 6cm
3. Mandibular teeth cannot slide anteriorly to reach the maxilary teeth
4. Pts head cannot extend sothat the chin is higher than the occiput in a standing/ sitting position.

Answer 16

1. False only 3 and 4
2. True (normal > 6.5 cm)
3. True
4. True (delikans signs)

Question 17

Nb concept:

Raised BP in pt with cardiac failure must first be Rx before anesthesia - why?

Answer 17

Normal heart is insensitive to afterload,
A myopaths heart is extremely sensitive to this.

THUS
A rise in BP increases the afterload, increased afterload will decrease the SV
CO = SV x HR thus CO will also decr

NB SV determined by
Preload, after load and contractility

Question 18

T/F: re drug interactions in anesthesia
1. Synergistic drug rxns are those where one drug counters the effect of the other drug

2. Anesthetic drug interactions can be beneficial to the pt.
3. Opioids antagonizes the effect of induction agents by up to 65%.
4. The interaction bw N2O and IAA is synergistic
5. Interaction bt thiopentone an midazolam is synergistic.

Answer 18

1. False
2. True
3. False
4. True
5. True

Question 19

Name the CVS CI for spinal anesthesia?

Answer 19

Hypovoleamia
Stenotic valves
Constrictive pericarditis
Abnormal clotting profile

Question 20

What is the average blood volume of an adult?

Answer 20

75 ml/kg

Question 21

How would you manage more than 40 % blood loss?

Answer 21

Replace the blood loss with equal volume of transfused blood (as for 20-40% loss)
Add platelets and clotting factors

Question 22

Name 5 factors that affect the liver blood flow during anesthesia? LBF

What 2 IAA preserves LBF?

Even though GA and extensive regional anesthesia cause a fall in O2 consumption the fall in LBF is much more and of grave importance.

Answer 22

Intra abdominal surgery -fall a further 50%
Incr venous pressure - decr. Venous outflow
PEEP and IPPV -decr CO and invr venous press.
Incr PaCO2, incr in Symp stimulation, incr symp tone.
All IAA
NB : halothane, nitrous and enflurane cause arterial resistance incr (hepatic and mesenteric) AND dcr in portal venous outflow

Sevoflurane and isoflurane - prserves hepatic artery inflow

Question 23

How to manage MH:
Specific
Non- specific

C SSHHARP D

Answer 23

Specific:
 - Dantroline sodium 2-3 mg/kg bolus every 5 min
    Untill sx revert
  - max dose = 10mg/kg
  - SFx : muscle weakness, phlebitis

Non-specific:
 -stop IAA (trigger) admin 100%OXYGEN
 - sedation /TIVA
 - cooling measures: cold IV, NG lavage, 
   Bladder lavage, abdominal lavage
 -hypercarbia (incr. minute ventilation)
 - asidosis : Rx and monitor (bloodgas)
 - hyperK
 - renal damage:  prevent (fluids for duiresis)
 - postop : ICU/ HCU

Question 24

Choose IV induction agent best suited and CI in following pts:

1. Shocked pt
2. Hypertrophic cardiomyopathy
3. Porphyria
4. Asthma attack

Answer 24

Best; CI

1. Ketamine ; thiopentone
2. Etomidate; ketamine
3. Propofol ; thiopentone
4. Ketamine ; thiopentone

Question 25

Consider IAA: Halothane, sevoflurane , N2O, isoflurane 1. Highest MAC 2. Best in children 3. CI in pt with possible pneumothorax 4. CI in pt with fam Hx of MH 5. CI in pt with liver disease

Answer 25

1. N2O 2. Sevoflurane 3. N2O 4. All 5. Halothane

Question 26

How are the effects of suxamethonium terminated?

Answer 26

Plasma pseudocholinesterases

Question 27

Name two conditions that can lead to prolonged action of sux?

Answer 27

Burns | Pregnancy, previous dx

Question 28

Why should GA be avoided in child with previous URTI?

Answer 28

``` Incr risk of desaturation Apnoeic spells Broncospasm Laryngospasm Excessive coughing ```

Question 29

List two rx modalities for LA toxicity?

Answer 29

Intralipid (1.5ml/kg followed by infusion ) Rescuss (ABC) Continue CPR (one of the reversible causes) Terminate convulsion (benzo/thiopentone)

Question 30

4 levels of sedation | Also what stimuli necessary to arouse pt.

Answer 30

Level 1: anxiolysis - no stim req Level 2: conscious sedation - verbal and tactile Level 3: deep sedation - painful Level 4: GA - pt cannot be aroused

Question 31

6 medical conditions ass with obesity?

Answer 31

``` HTN IHD NIDDM Gallstones OA DVT Peripheral vascualr disease (embolus) Cerebrovascular disease (stroke) ```

Question 32

What factors determine end tidal CO2?

Answer 32

Body temp Cardiac status Pulmonary disease Normal capnograph trace If all stable the end tidal should = that of PaCO2

Question 33

4 ways to decrease venpus pressure in brain?

Answer 33

``` 15 deg head up position Neutral head position No jugular compression Limit intrathoracic pressure Limit PEEP, avoid coughing, avoid aw obstuction Avoid, rx pneumothorax ```

Question 34

What does an increase in PaCO2 do to cerebral blood flow?

Answer 34

It increase it

Question 35

What an increase in PaO2 do to cerebral bloodflow?

Answer 35

Decreases it

Question 36

Where does ach act as neurotransmitter in PNS | Also mention the receptor

Answer 36

NMJ - nicotinic Autonomic ganglia - nicotinic Postsynaptic para$ - muscurinic Sweat gland -muscurinic

Question 37

How will you know that your rescuss effort is creating a reasonable circulation?

Answer 37

Using a capnograph | Reading needs to be > 1% and needs to be maintained

Question 38

Explain diffusion hypoxia? | How is it remedied?

Answer 38

30 min after Pa N2O breathing -large potions dissolved in blood and tissues even tho solubility is low (HISND) If pt suddenly switched to room air - a sequence of events dilute the oxygen leading to hypoxia ( as PaN2O decr rapid diffusion from pulm veins to alveoli will take place- thus filling lungs) Administer oxygen enrished mixtures (50-100%) first few minutes after admin N2O

Question 39

When would you administer steroid for post op management?

Answer 39

Steroid therapy currently> 2/52 Steroid therapy in last year > 1/12 Steroid therapy high dose inhaled (Beclamethasone) Known adrenal insuff Inadeq response to testing of axis (ACTH / stress) Adrenal of pituitary surgery

Question 40

What is the trendellenberg position? Conseq Dangers

Answer 40

When pts head is lower that feet during laproscopic surgery. Conseq: Increased : venous return, right arterial pressure, central blood vol, and CO. Reduction in: FRC and lung compliance - pulm atelectasis Dangers Hypoxeamia Nerve compression (brachial plexus inj) Atelectasis

Question 41

T/F: 1. A max decr in BP of 35% (compared to preop pressure) can be tolerated by HTN pt. 2. Intravascular volume in a pt with HTN is 15% greater than that of the normotensive pt. 3. The higher resistance to bloodflow in the HTN pt is because of generalized arterial vasospasm. 4. Beta adrenergic blockers will control/ prevent HTN ass with ETT in the HTN pt.

Answer 41

1. False, 25% 2. False, less 3. False - due to smaller internal diameter, due to muscular changes 4. False - alpha blockers will