HKCA Final MCQ flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

MAC definition

The minimum alveolar concentration of an inhaled anaesthetic producing immobility in 50% of patients in response to a standard surgical stimulus.

Suxamethonium contraindications

Avoid in hyperkalaemia, burns or denervation beyond 24-72 hours, prolonged immobility, and pseudocholinesterase deficiency because of the risk of life-threatening hyperkalaemia.

Malignant hyperthermia treatment

Dantrolene 2.5 mg/kg IV repeated to a cumulative 10 mg/kg, stop triggering agents, hyperventilate with 100% oxygen, and cool the patient actively.

Cricoid force in RSI

Apply 10-30 N in adults (30 N for the cricoid pressure manoeuvre) during rapid sequence induction to reduce aspiration risk; release if intubation is difficult.

Apfel PONV risk factors

Female sex, non-smoker, history of postoperative nausea and vomiting, and postoperative opioids; each factor adds roughly 20% to baseline risk.

Intralipid for LAST

For local anaesthetic systemic toxicity, give 20% lipid emulsion 1.5 mL/kg bolus followed by 0.25 mL/kg/min infusion while continuing resuscitation.

Spinal anaesthesia hypotension

Sympathectomy causes vasodilation and reduced venous return; treat with vasopressors (phenylephrine or ephedrine) and judicious fluids, monitoring for bradycardia.

Sepsis-3 definition

Suspected infection with an acute rise in SOFA score of ≥2 points; septic shock adds vasopressor requirement for MAP ≥65 mmHg and lactate >2 mmol/L.

ARDS Berlin criteria

Acute onset within 1 week, bilateral opacities, PEEP ≥5 cmH2O, and PaO2/FiO2 ≤300 not fully explained by cardiac failure; severity graded by PaO2/FiO2.

Lung-protective ventilation

Tidal volume 6 mL/kg predicted body weight, plateau pressure ≤30 cmH2O, PEEP titration, and permissive hypercapnia reduce mortality in ARDS.

Prone positioning in ARDS

Prone positioning for ≥16 hours per day reduces mortality in moderate-severe ARDS with PaO2/FiO2 <150; monitor for pressure injury and tube dislodgement.

Initial sepsis fluid bolus

Give 30 mL/kg crystalloid within the first 3 hours for sepsis-induced hypoperfusion, then start noradrenaline to maintain MAP ≥65 mmHg.

KDIGO AKI staging

Stage 1: creatinine ≥26.5 micromol/L rise or 1.5-1.9 times baseline; stage 2: 2.0-2.9 times; stage 3: ≥3 times or dialysis initiation.

Hyperkalaemia first-line treatment

Calcium gluconate 10 mL 10% IV stabilises the myocardium; insulin-dextrose and nebulised salbutamol shift potassium intracellularly; dialysis removes it.

CAM-ICU

A validated screening tool for delirium in ventilated and non-ventilated ICU patients assessing acute onset, inattention, altered consciousness, and disorganised thinking.

Ventilator-associated pneumonia

Pneumonia developing after 48 hours of mechanical ventilation; diagnosed with new infiltrate plus clinical signs and treated with empirical broad-spectrum antibiotics then de-escalation.

SOFA score

Sequential Organ Failure Assessment scoring respiration, coagulation, liver, cardiovascular, CNS, and renal function; a rise of ≥2 points defines sepsis.

Noradrenaline first-line vasopressor

First-line vasopressor in septic shock, titrated to MAP ≥65 mmHg; add vasopressin or adrenaline if target is not achieved with high doses.

WHO analgesic ladder

A three-step approach: non-opioids for mild pain, weak opioids for moderate pain, strong opioids for severe pain, with co-analgesics added at any step.

Neuropathic pain first line

Gabapentinoids (gabapentin, pregabalin), tricyclic antidepressants (amitriptyline), duloxetine, or topical lidocaine/capsaicin are first-line; opioids are second line.

Oral morphine equivalence

Oral morphine 30 mg ≈ oral oxycodone 20 mg ≈ oral hydromorphone 6 mg ≈ subcutaneous morphine 10 mg; use these ratios when switching opioids.

Fentanyl patch conversion

Fentanyl transdermal 25 micrograms/h is approximately equivalent to oral morphine 60-90 mg per day; titrate the patch slowly and avoid in opioid-naive patients.

Breakthrough pain dosing

Use a short-acting opioid dose of 10-15% of the total daily opioid requirement for breakthrough pain; reassess after 15-30 minutes and adjust the regular dose.

NSAID contraindications

Avoid in eGFR <30, active peptic ulcer disease, decompensated heart failure, and third-trimester pregnancy due to renal, gastrointestinal, and cardiovascular risks.

Paracetamol dose cap

Maximum 4 g/day in healthy adults; reduce to 2-3 g/day in hepatic impairment, low body weight, chronic alcohol use, or prolonged fasting.

Nociceptive versus neuropathic pain

Nociceptive pain arises from tissue injury and responds to simple and opioid analgesics; neuropathic pain arises from nerve injury and responds to gabapentinoids, tricyclics, and SNRIs.

Opioid-induced constipation

A predictable adverse effect of opioids; prevent with a stimulant laxative plus an osmotic agent, and consider peripherally acting mu-opioid antagonists if refractory.

Opioid rotation

Switching opioids to improve analgesia and reduce toxicity; use equianalgesic tables and reduce the calculated dose by 25-50% to account for incomplete cross-tolerance.

Multimodal analgesia

Combining paracetamol, NSAIDs, regional blocks, and opioid-sparing agents to improve pain control and reduce opioid requirements after surgery.

Caudal anaesthesia in children

A common paediatric regional technique using bupivacaine 0.25% at 1 mL/kg for sacral block or 1.25 mL/kg for lumbar block, often combined with general anaesthesia.

Post-dural puncture headache

Occurs after dural puncture, worse on standing and relieved by lying flat; treat with hydration, caffeine, and an epidural blood patch if persistent.