SELF ASSESSMENT SECTION (2)
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Multiple Choice Questions (Dr Beth Newstead, Exeter, UK)
Please answer True or False to the following statements
1. With regards to fasting (T or F):
a. Clear fluids will usually empty from an adult stomach in 3- 4 hours
b. Solids will usually empty from the stomach in 6 hours
c. Milk empties from the stomach at the same rate as other fluids
d. ASA guidelines recommend a minimum fast of 4 hours for breast milk
e. At least 100mls of gastric fluid needs to be aspirated to cause pulmonary damage
Answer
a. F - it takes about 2 hours for clear fluids to empty from the stomach
b. T
c. F - milk thickens when mixed with gastric juice and should be regarded as a solid
d. T
e. F - aspiration of as little as 30-40 mls can result in lung damage
2. The following apply to pre-operative steroids:
a. 10mg prednisolone is equivalent to 40mg hydrocortisone
b. A patient on a maintenance dose of 6mg prednisolone requires additional intra-operative steroids
c. It is estimated that adults secrete 75-100mg of cortisol in response to a major surgical procedure
d. 10mg prednisolone is equivalent to 2mg dexamethasone
e. For a patient who is on 12mg prednisolone daily, a suitable dose of intra-operative hydrocortisone for a hernia repair is 100mg
Answer
a. T - (see below)
b. F - current recommendations are that supplementary steroids are only needed if the patient is on a dose of 10mg prednisolone (or more)/ day
c. T
d. F - 10mg prednisolone is equivalent to 1.5 mg dexamethasone
e. F - a dose of 25mg hydrocortisone on induction is considered sufficient
Prednisolone 10mg is equivalent to:
_ Dexamethasone 1.5mg
_ Hydrocortisone 40mg
_ Methylprednisolone 8mg
_ Betamethasone 1.5mg
_ Cortisone acetate 50mg
3. With regard to Aortic Stenosis:
a. Severe aortic stenosis will always be symptomatic
b. A gradient of >80mmHg across the aortic valve is considered to be severe aortic stenosis
c. Spinal anaesthesia is safe in patients with aortic stenosis
d. With increasing severity of aortic stenosis, the louder the murmur becomes
e. If a vasoconstrictor is required in a patient with aortic stenosis, ephedrine is the agent of first choice
Answer
a. F - whilst severe aortic stenosis can present with chest pain,breathlessness and syncope, it can also be entirely asymptomatic (and may present for the first time with sudden death).
b. T
|
Degree of severity of aortic stenosis |
Gradient across aortic valve |
|
Mild |
< 40mmHg |
|
Moderate |
40-80 mmHg |
|
Severe |
>80 mmHg |
c. F - a spinal anaesthetic leads to a sympathetic block leading to
a fall in blood pressure. This is clearly something to be avoided in patients with a relatively fixed cardiac output.
d. F - the loudness of the murmur bears no relation to the severity of the aortic stenosis. In fact, in very severe stenosis the murmur is often very quiet (due to falling cardiac output).
e. F - Metaraminol (or similar) would be first choice as it does not cause a tachycardia (and thus avoids stressing the heart any further).
4. With regards to Trans-urethral resection of the prostate (TURP):
a. Most TURP surgery is done under a general anaesthetic
b. TUR syndrome is estimated to occur in 1-2% of cases
c. Treatment of TUR syndrome is with rapid correction of the hyponatraemia
d. Severe blood loss in TURP occurs in <1% of cases
e. Most patients will require no routine pre-operative investigations
Answer
a. F - TURP is often done under a spinal anaesthetic. This avoids the risk of a general anaesthetic in an often frail population. It also enables TUR syndrome to be picked up earlier (through regular conversation with the patient).
b. T
c. F - Hyponatraemia should not be corrected at a rate faster than 1mmol/L/hour
d. T
e. F - most patients are elderly and often have significant comorbidity. A minimum of FBC/ U&E/ G&S and an ECG is recommended.
(SELF ASSESSMENT - Answers to MCQ Dr B Newstead, Dr U Schroeter)
(ที่มา : http://www.nda.ox.ac.uk/wfsa/html/u17/u1716_01.htm
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Issue 19 (2005) Article 8: Page 1 of 1 |
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