T/F liver failure can result in hypoglycaemia due to limited / absent – (i) glycogen storage and (ii) gluconeogenesis
T/F liver disease can result in coagulopathy, because the liver produces all of the clotting factors
T/F Kupffer cells are macrophages which line the hepatic sinusoids – with severe liver disease these may be absent, placing the patient at risk of sepsis from GIT flora
T/F biliverdin (from haem breakdown) undergoes active transport into hepatocytes where it is metabolised to bilirubin – this is why liver disease can produce jaundice
T/F one cause of hepatic encephalopathy is high ammonia levels – this results from impaired conversion of nitrogenous compounds (derived from protein), to urea. Lactulose is used in patients with encephalopathy because it decreases intestinal ammonia production.
T/F portal hypertension leads to intestinal wall oedema, which reduces the absorptive capacity of the GIT
T/F (not in the primary exam) gynaecomastia occurs in men with chronic liver disease because the free oestrogen : testosterone ratio is altered by a reduction in sex-hormone binding globulin
1. Miller 8th edition, Chapter 22
2. Kam and Power 3rd edition, Chapter 6
T/F patients being actively warmed during anaesthesia must have their core temperature continually monitored (see ANZCA PS 18)
T/F a simple layer of insulation can reduce heat loss by approximately 30% – there is no clinically important difference between insulation types (cotton blanket, surgical drapes, plastic sheet, ‘space’ blanket)
T/F mattresses containing circulating warm water are nearly ineffective, because there is very little capillary blood flow through the posterior skin surface
T/F compared with an obese adult, in a frail thin adult, there is a greater risk of intraoperative hypothermia, and a greater risk of over-heating with forced air warming devices
T/F forced air warmers cannot cause skin burns because the maximum air temperature is 43 degrees C
T/F forced air warmers should not be turned on until after surgical draping is complete, because they blow germs around the theatre **
T/F ‘space’ blankets are highly flammable (click here)
The UK National Audit Projects have provided us with some invaluable information courtesy of their size and widespread buy in by the UK anaesthetic community. This is particularly helpful when you look at important adverse outcomes which are quite uncommon. NAP6 looked at perioperative anaphylaxis and the results came out earlier this year. If you don’t look at anything else look at the one page infographic summary. NAP7 will look at perioperative cardiac arrest. Our College’s ANZAAG have developed an online module which can be done to complete the anaphylaxis activity for the emergency CPD module.
Although NAP6 is undoubtedly important it hasn’t made its way to any of the textbooks yet- but it will. I am going to be proactive and ask a few questions relating to its findings as well as the content of the ANZAAG module.
T/F anaphylaxis is the leading cause of death directly related to anaesthesia
T/F the incidence of anaphylaxis in NAP6 was 1 in 10,000 anaesthetics
T/F the single worst offender for causing anaphylaxis in the UK was teicoplanin
T/F IM adrenaline should be administered as first line therapy for low grade anaphylaxis responses
T/F tryptases should be taken at 1, 2 and 4 hours post event.
T/F Noradrenaline, vasopressin and glucagon are recommended for use in refractory anaphylaxis
The top three causes of anaphylaxis in Australasia are antibiotics, muscle relaxants and what?
T/F oxygen and carbon dioxide are exchanged on a 1:1 basis across the alveolar-capillary membrane *
T/F the diffusion of oxygen from alveoli to blood occurs down an average partial pressure gradient of approximately 110 mmHg (150 – 40)
T/F the diffusion gradient for oxygen is greater in basal alveoli, compared with apical
T/F carbon dioxide diffuses less readily than oxygen through the alveolar-capillary membrane, because its molecular weight is higher
T/F at altitude, or with lung disease, the transfer of oxygen can become diffusion limited when the cardiac output increases
T/F If an aircraft at 36,000 ft depressurised, the alveolar PO2 would be below mixed venous PO2 (i.e. the diffusion gradient for O2 would be reversed), so breathing would actually excrete oxygen from the body. Therefore, you should hold your breath until your oxygen mask is on.
* this statement was confidently made by an SRMO at an ALS course I attended