Anaesthetic Viva Stems Flashcards
22.1 VIVA 1
Pass Rate 76.5%
A 30-year old man booked for an emergency laparoscopic cholecystectomy for a gangrenous gallbladder. He has a past medical history of juvenile idiopathic arthritis (formerly juvenile rheumatoid arthritis).
He appears unwell and is vomiting.
Vital signs
Blood pressure 100/60 mmHg
Heart rate 120 bpm
SpO2 93% (room air)
Respiratory rate 20 per minute
T 38.5°C
Based on the provided history and findings, describe your initial assessment of this patient.
TOPICS:
1. Assessment of complicated airway in context of urgent surgery
2. Induction and intubation of a septic vomiting patient with an unstable spine
3. Management of an Oxygen supply wall failure alarm
22.1 VIVA 2
Pass rate 83.7%
You are on-call at a tertiary hospital and receive a theatre booking from a surgeon at 23:00 hours for an urgent endoscopic retrograde cholangiopancreatography (ERCP).
The patient is a 30-year-old male (weight 60 kg) who presented with a three-day history of vomiting and jaundice and has been diagnosed with ascending cholangitis due to choledocholithiasis.
He is febrile at 38.5°C and tachycardic at 110 bpm.
His past medical history includes stage III testicular cancer diagnosed 12 years ago, for which he underwent radical orchidectomy followed by 18 months of chemotherapy with bleomycin and cisplastin.
During his latest surveillance review with oncology he was sent for some further investigations to assess progressive shortness of breath. His pulmonary function tests and chest X-ray are shown below.
What further information would you like to obtain?
TOPICS:
1. Assess and plan for patient management including bleomycin exposure
2. Management of intraoperative hypoxaemia and raised airway pressures
3. Postoperative management of analgesia for pancreatitis
22.1 VIVA 3
Pass rate 77.6%
You are the on-call consultant in a regional hospital. The anaesthesia registrar calls you at 22:30 hours reporting that there is a 14-month-old child in the emergency department with a foreign body in the mid-oesophagus visible on chest X-ray. There is an ENT consultant available to take the child to theatre.
How would you assess the urgency of this case?
TOPICS:
1. Planning anaesthesia for removal of a foreign body (Li battery) 2. Management of lack of IV access in time pressured situation 3. Management of postintubation issues relating to shared airway
22.1 VIVA 4
Pass rate 90.8%
You are the anaesthetist on-call in a large regional hospital. You have been asked to provide epidural analgesia to a 32-year-old parturient (gravida 1, para 0, 41+1 weeks gestation) after commencement of induction of labour for prolonged pregnancy.
Her past medical history includes mild asthma (no regular treatment required).
When you attend the patient, she is noted to be in established labour with some distress due to contraction pain. She is 148 cm tall and weighs 55 kg.
The midwife informs you that the patient moved from Mongolia two years ago and is not fluent in
English, although her husband in fluent in English. She has had an unremarkable antenatal
course.
How will you obtain consent for this patient’s labour epidural?
TOPICS:
1. Management of assessment and consent with husband as translator
2. Total spinal leading to perimortem LUSCS
3. Assessment and management of post dural puncture headache
22.1 VIVA 5
Pass rate 65.3%
A 76-year-old man with infected pacing wires has been scheduled for removal of his entire pacing system under general anaesthesia. The procedure is to be performed in a hybrid theatre in the cardiology department.
Current medications aspirin 100 mg daily atorvastatin 40 mg daily flucloxacillin 2g qid IV perindopril 1 mg daily
His chest X-ray is displayed.
Considering your clinical assessment of this man, what are your main areas of concern?
TOPICS:
1. Assessment of sick patient with pacemaker
2. Conduct of anaesthesia for lead extraction
3. Management of major haemorrhage from lead removal injury
22.1 VIVA 6
Pass rate 80.6%
You are the duty anaesthetist in a small regional hospital and have been called urgently to assist the anaesthesia registrar in the emergency theatre.
The registrar is anaesthetising a previously well 25-year-old man (75 kg, ASA I) who is undergoing open reduction and internal fixation of a fractured tibia and fibula sustained in a skiing accident two days ago. The registrar has noted progressive desaturation and increasing tachycardia over last 15 minutes. The surgeons have deflated the torniquet and are closing the wound.
What will you do when you enter the operating room?
TOPICS:
1. Diagnosis and management of hypoxaemia from pulmonary embolus 2. Management of PEA arrest in CT Scanner
3. Exploration of issues in post arrest management
22.1 VIVA 7
Pass rate 77.6%
You are the anaesthetist on-call in a major trauma centre. The orthopaedic registrar has booked a 45-year-old woman for an urgent C3 – C7 decompression and fusion for C5/6 bilateral facet joint fracture-dislocations. She has an incomplete spinal cord injury.
The patient sustained the injury jumping off a cliff in an act of deliberate self-harm. She has had a prolonged extraction time due to difficult terrain.
Past medical history
- anxiety and depression with multiple previous suicide attempts
- polysubstance use disorder with previous intravenous drug use
Medications
clonazepam 0.5 – 1.0 mg PRN for anxiety methadone 100mg mane
quetiapine 300mg nocte
Please comment on her chest X-ray.
TOPICS:
1. Assessment of complicated polytrauma with poor IV access 2. Management of high airway P with hypoxia when prone
3. Management of intraoperative VT when prone
22.1 VIVA 8
Pass rate 81.6%
A 75-year-old woman presented to the emergency department following a fall in which she sustained a fractured right hip. She has no other injuries and is cognitively intact. She has been scheduled for a right hemiarthroplasty as the first case on the operating list tomorrow morning.
Past medical history
Polymyalgia rheumatica
Chronic alcohol consumption (60 g per day)
Previous deep vein thrombosis with pulmonary embolism Chronic kidney disease
Height: 162cmWeight: 61kg
Medications
Fluoxetine 40 mg mane Perindopril/indapamide 5 mg/1.25 mg mane Prednisolone 15 mg mane
Rivaroxaban 15 mg mane Rosuvastatin 20 mg mane
Blood test results on admission to the emergency department:
Haemoglobin 82 g/L
Platelets 117 x10^9/L
Na+ 127 mmol/L
K+ 4.2 mmol/L
Cl- 103 mmol/L
HCO3- 20 mmol/L
Urea12 mmol/L
Creatinine145 mmol/L
eGFR 30 mL/min/1.73m2
Albumin 26 g/L
A cardiac rhythm strip was printed in the Emergency Department, as shown below:
How will you assess if this patient is suitable for surgery tomorrow morning?
TOPICS:
1. Preoperative assessment of complex patient with sick sinus syndrome and adrenal
insufficiency
2. Management of general anaesthesia for total hip arthroplasty
3. Assess and manage delayed recovery secondary to hyponatraemia
22.1 VIVA 9
Pass rate 72.2%
You are running the emergency theatre in a regional hospital on a Sunday morning when you receive a phone call from the emergency department (ED) consultant.
A 23-year-old man with an intellectual disability has presented with a productive cough and haemoptysis after a choking episode the previous evening whilst eating dinner.
The ED consultant asks you to provide assistance with sedation for a CT chest due to the patient’s non-compliance with lying still.
What would you like to know from the ED consultant when she calls you?
TOPICS:
1. Assess suitability and methods for sedation
2. Anaesthesia for rigid bronchoscopy
3. Management of upper airway obstruction in PACU
22.1 VIVA 10
Pass rate 75.6%
A 74-year-old woman presents to the preanaesthesia clinic for review ahead of a laparoscopic right hemicolectomy for colorectal cancer. She is a smoker and has a background of longstanding bronchial carcinoid tumours.
How would you assess this woman?
TOPICS:
1. Assess and optimise a patient with carcinoid syndrome
2. Conduct of GA and management of intraoperative bronchospasm from carcinoid
3. Management of rapid AF in PACU
22.1 VIVA 11
Pass rate 74.4%
You have been asked to take over an elective list at a tertiary paediatric hospital as the regular anaesthetist is delayed in the postanaesthesia care unit by a postoperative airway event.
The next patient is a five-year-old First Nations boy (weight 28 kg) from a regional centre who is accompanied by his grandmother who is his legal guardian. He is booked for adenotonsillectomy for the management of obstructive sleep apnoea. His surgery was previously cancelled three months ago. The anaesthetist had just administered ketamine and midazolam premedication to this child when he was called away.
What further information do you require to proceed with this case.
TOPICS:
1. Perioperative assessment and planning
2. Induction strategies for severe OSA
3. Management of PONV and the exclusion of haemorrhage as a cause
22.1 VIVA 12
Pass rate 74.4%
You are the anaesthetist covering the obstetric theatre at a large regional hospital. A 30-year-old primiparous woman at 38 weeks gestation is booked for a category 2 caesarean section for a non- reassuring cardiotocograph (CTG).
The patient has pre-eclampsia with a blood pressure of 160/100 mmHg while on antihypertensive treatment. She is not currently in labour. She is morbidly obese with a BMI of 58 (height 168 cm, weight 164 kg).
When you review the patient, she tells you that she is needle-phobic and wants to “be asleep” for the procedure.
Current medications Labetalol 40 mg q30 min IV Magnesium 1g / hour IV Methyldopa 500 mg PO QID Nifedipine IR 10 mg PO
There are no known drug allergies.
How will you approach this situation?
TOPICS:
1. Management of patient with complex problems and demands to allow consent for safest
practice
2. Failed spinal and conversion to general anaesthesia
3. Management of a patient fall on transfer off the operating table
22.1 VIVA 13
Pass rate 76.7%
A 28-year-old male is booked on your list for resection of a large right-sided posterior mediastinal tumour. This was diagnosed after he presented with increased breathlessness and cough. He has no other significant comorbidities.
How will you assess this patient preoperatively?
TOPICS:
1. Assessment of a mediastinal mass
2. Anaesthesia for prone one lung ventilation
3. Management of postoperative haemorrhage requiring reintubation›
22.1 VIVA 14
Pass rate 80%
You are the on-call consultant anaesthetist at a small regional hospital. At 09:00 hours on a Saturday morning you receive a call from the surgical registrar regarding a 69-year-old man who presented to the emergency department with a 24-hour history of worsening abdominal pain. An erect chest X-ray demonstrates free gas under the diaphragm.
The surgical registrar would like to bring the patient to theatre for a laparotomy.
Past medical history
Current smoker – 50 pack-years
Ischaemic heart disease – non-obstructive, medical management Abdominal aortic aneurysm – 4 cm diameter, currently under surveillance
Medications
Aspirin 100 mg daily Atenolol 50 mg daily Ibuprofen 400 mg tds PRN Perindopril 5 mg daily Rosuvastatin 20 mg daily
Height 175 cm
Weight 80 kg
BMI 26.1 kg/m2
(ideal body weight 70 kg)
Outline how you would respond to this request.
TOPICS:
1. Assessment and resuscitation of shocked patient in ED
2. Induction and management of GA with severe circulatory failure
3. Recognition and management of multiorgan failure with acute lung injury
22.1 VIVA 15
Pass rate 75.6%
As the duty anaesthetist in a tertiary hospital, you are asked to attend the emergency department for the impending arrival of a 38-year-old male who has been struck on the head while working on a building site. On arrival with the paramedics he is unconscious with a laryngeal mask airway in situ. He has a compression bandage applied to his head and severe right periorbital and midface swelling
The initial observations from the paramedics are as follows:
Heart rate 76 bpm
Blood Pressure 167/90 mmHg
SpO2 90% spontaneous ventilating on a T-piece with oxygen at 15 L/min Respiratory rate 28/min
Left pupil size 4 and non-reactive
Right pupil size 2 and sluggishly reactive
What are your priorities in the management of this patient?
TOPICS:
1. Airway management of trauma with inadequate airway and unstable spine.
2. Recognise and manage cardiovascular collapse from intracerebral haemorrhage
3. Management of poorly performing registrar
22.1 VIVA 16
Pass rate 73.3%
You are seeing a 72-year-old man in the preanaesthesia clinic of your tertiary hospital. He is booked for a wide local excision of a sarcoma of the right latissimus dorsi muscle in ten days time. The surgeon requests that he is positioned in the left lateral decubitus position. The surgery is anticipated to take two to three hours.
Past medical history Coronary artery stent Type 2 diabetes mellitus Hypertension
Transient ischaemic attack two years ago
Medications
Clopidogrel 75 mg daily Metformin 500 mg twice daily Perindopril 8 mg daily Rosuvastatin 20 mg daily
Observations performed in clinic Blood pressure 165/95 mmHg Heart rate 85 bpm
SpO2 98% on room air
Random blood glucose 8.5 mmol/L Height 1.78m Weight 95 kg BMI 30
How will you assess this patient’s cardiovascular system?
TOPICS:
1. Preoperative planning for prolonged surgery in extreme position
2. Management of request for induced hypotension for bleeding
3. Development of intraoperative ST changes and postoperative neurological defecits
21.2 VIVA 1 PASS RATE: 69.9%
You review a 67-year-old man in the Preadmission Clinic (PAC) for a left hemihepatectomy via a roof- top incision for metastatic colon cancer.
He underwent a right hemicolectomy four months ago for primary cancer resection. The procedure was complicated by an extended stay in hospital due to suboptimal pain management.
Past medical history:
* Hypertension
* Lower limb peripheral neuropathy secondary to chemotherapy * Ex-smoker with 30 pack-year history
Medications & allergies
* perindopril 5 mg daily
* amitriptyline 25 mg nocte
Nil known allergies
Outline your concerns regarding the patient’s fitness for surgery.
T opics:
VIVA 2
Assessment and evaluation including assessing altered liver function tests and functional assessment
Intraoperative management of bleeding and portal pressure
Postoperative neuropathy and neuralgia management
21.2 VIVA 2
Postoperative neuropathy and neuralgia management
PASS RATE: 86.0%
You are on call at the Children’s Hospital. At 1730 hours you are asked to review a 7-year-old girl with Down syndrome in the Emergency Department (ED) who sustained a supracondylar fracture of the left humerus whilst playing on a trampoline at a birthday party. She is booked on the emergency list for closed reduction and percutaneous pinning of the fracture.
On your arrival in ED you are informed that the girl has received intranasal fentanyl 50 mcg following one unsuccessful attempt to gain IV access.
The dose of fentanyl was based on a weight of 31 kg which had been documented in the girl’s case notes at a recent outpatient clinic appointment.
How will you approach your anaesthetic assessment of this girl?
Topics:
1. Preoperative assessment and discussion re fasting
2. Induction management with an uncooperative parent
3. Management of intraoperative hypoxia from Right Upper Lobe collapse
21.2 VIVA 3 PASS RATE: 73.1%
You attend the subacute Coronary Care Unit to review a 52-year-old man with a six week history of increasing dyspnoea who has been scheduled for revision aortic valve replacement +/- mitral annuloplasty tomorrow.
His past history includes a bioprosthetic aortic valve replacement eight years ago.
On admission his echocardiogram showed severe aortic regurgitation and moderate mitral regurgitation, with an estimated left ventricular ejection fraction of 35% and a moderately dilated left ventricle.
His only regular medication prior to this admission was aspirin 100 mg daily, but during this admission he has been commenced on:
* furosemide (frusemide) 80 mg bd orally
* perindopril 6 mg mane orally
* dobutamine infusion 2.5 mcg/kg/min intravenously.
When you attend the ward you find him walking around with his IV pole. He weighs 80 kg.
Outline how you would determine if this patient is optimised for his surgery.
Topics:
1. Medical assessment and management of induction focused on haemodynamics and
implication of redo sternotomy
2. Management of postoperative increased drain output on transfer
3. Return to theatre with low Haemaglobin and acute Left Ventricular Failure
21.2 VIVA4
PASS RATE: 83.9%
A 32-year-old woman attends the obstetric anaesthetic assessment clinic, having been referred by the obstetric registrar.
She is 24 weeks into her first pregnancy, and has a history of multiple sclerosis. She uses a walking stick. Her other medical history includes anxiety.
There are no other relevant obstetric, medical or anaesthetic issues. She had an uneventful general anaesthetic for an appendicectomy at this hospital last year for which you have the anaesthetic record. There were no airway issues.
She takes escitalopram and has monthly ocrelizumab infusions, which have been withheld in pregnancy. She has no allergies.
She wishes to discuss analgesia in labour and anaesthesia should a caesarean or other operative intervention be required.
What further information do you require to address the patient’s concerns?
Topics:
1. Prelabour plan for analgesia and anaesthesia
2. Obstructed labour with epidural in. Progress to instrumental delivery and LUSCS with
patchy block
3. Assess leg weakness postoperatively – foot drop
21.2 VIVA5
PASS RATE: 76.3%
Your next patient on the emergency list is a 24-year-old man scheduled for a laparoscopic appendicectomy. His only past medical history is that of occasional self-limiting palpitations on exertion. He has been sick for three days with severe abdominal pain, nausea and vomiting.
He weighs 70 kg.
His vital signs are:
* temperature 38.5° C
* heart rate
* blood pressure 100/71 mmHg
The surgeon suspects a perforated appendix. He has an electrocardiogram (ECG) in his notes.
Please describe this ECG:
106 bpm
Topics:
VIVA 6
Preoperative and intraoperative management of Wolff Parkinson White Syndrome.
Manage broad complex tachyarrhythmia in recovery including cardioversion
Low saturation secondary to cardioversion from aspiration
21.2 VIVA 6
PASS RATE: 72.0%
You are assessing a patient on the neurosurgical ward who is booked on your list tomorrow for coiling of cerebral aneurysms in the hospital’s interventional radiology suite.
The 56-year-old woman presented earlier in the day with a two day history of severe headache, vomiting and malaise that was unresponsive to paracetamol. There has been no change to her level of consciousness or focal neurological deficits.
Cranial CT revealed five intracerebral aneurysms, the largest in the anterior communicating artery.
There is evidence of diffuse subarachnoid haemorrhage, Fisher grade 2.
Her vital signs are:
* blood pressure 145/75 mmHg MAP 88 mmHg
* pulse 85/min sinus rhythm
Past medical history
Polycystic kidney disease
* renal transplant 10 years ago
* end-stage renal disease treated with haemodialysis for two years prior to
transplantation Hypertension
Medications
atorvastatin 20mg daily
enalapril 5mg BD
mycophenolate 1g BD
prednisone 5mg daily
tacrolimus 5mg BD
trimethoprim / sulphamethoxazole one tab BD
What specific information do you require about this patient’s medical problems to ensure optimisation for the coiling procedure?
T opics:
1. Assess patient and prepare in a nonhybrid theatre setting
2. Management of rupture after coil insertion
3. Planning and management of transfer to definitive care
21.2VIVA7
PASS RATE: 83.9%
A 50-year-old woman has been transferred to your tertiary referral centre for a total thyroidectomy for a massive goitre with associated recent voice change.
You review her on the ward as she is booked on your list for the following day.
Medications: carbimazole 15 mg bd propranolol 40 mg bd rosuvastatin 10 mg daily
Weight Height BMI
120 kg 165 cm 44 kg/m2
How will you assess her airway preoperatively?
Topics:
Preoperative assessment of endocrine disease and airway
Airway management with no front of neck access and an airway described as poor on ENT nasendoscopy
Stridor post extubation from bilateral recurrent laryngeal nerve palsy
21.2 VIVA 8
PASS RATE: 73.1%
You are the on-call anaesthetist for a regional base hospital. It is 2030 hours and you have just arrived in the carpark to review a patient for tomorrow’s elective operating list, when you receive a request for assistance from the ED consultant. He is busy resuscitating a sick patient and cannot attend a new category 1 trauma patient that has just arrived by ambulance.
The new arrival is a 45-year-old man who has been assaulted at a local hotel. He has been struck in the neck with a broken beer bottle and was found by paramedics lying on the floor of the public bar.
They noticed profuse bleeding from an anterior neck wound before applying some gauze.
He is restless, irritable and combative.
How are you going to manage this situation?
Topics:
Management of urgent airway in the Emergency Department.
Transfer to OT for further exploration. Sudden fall in BIS and implications Management of occult injury from noncompleted primary survey
21.2 VIVA 9
PASS RATE: 81.2%
A 45-year-old man presents to your Preadmission Clinic for a review ahead of an open left adrenalectomy for phaeochromocytoma in four weeks time.
He currently takes the following medications:
* Bio Magnesium supplements 2 capsules daily
* dapagliflozin 10 mg mane
* enalapril 40 mg mane
* frusemide 20 mg mane
* metoprolol 100 mg BD
How would you assess a patient with a phaeochromocytoma who is to undergo surgical resection?
Topics:
1. Assessment and management of phaeochromocytoma preoperatively and at
induction
2. Management of intraoperative BP changes and especially hypotension post ligation
adrenal vein
3. Postoperative brachial plexus injury with diagnosis and management
21.2 VIVA 11 PASS RATE: 82.5%
You are seeing a 64-year-old man in the Preadmission Clinic who is booked for a left lower lobectomy for non-small cell carcinoma.
He is on your list in two weeks’ time.
Past Medical History:
* hypertension
* type II diabetes mellitus
* paroxysmal atrial fibrillation
Medications
perindopril 2mg bd
rivaroxaban 20 mg daily
metoprolol 50mg bd
empagliflozin 10mg daily
He currently smokes 1 packet cigarettes per day and has a 42 pack-year history. Height - 177cm Weight - 74 kg BMI 23.6 kg/m2
His chest CT scan is displayed below.
How will you assess this patient’s suitability to undergo a lobectomy?
Topics:
1. Preoperative assessment including plan for GA and analgesia
2. Management of intraoperative lung reinflation (unintended)
3. Development of hypotension in Postanaesthesia Care Unit from Atrial Fibrillation
21.2 V IVA 14 PASS RATE: 88.8%
You are reviewing a 44-year-old man for revision ventriculoperitoneal shunt for congenital aqueductal stenosis which was first diagnosed at age 13. This operation will be his fourth revision. He is an inpatient on the neurosurgical ward.
His current medications are:
* dexamethasone 4 mg bd orally
* omeprazole 20 mg mane orally
* levetiracetam (Keppra) 250 mg bd orally
Please comment on the CT scan and explain what specific information you would like in your assessment of this patient.
T opics:
1. Assess shunt failure and hydrocephalus. Discuss management of induction.
2. Develops Left sided neck swelling from vascular injury. Discuss diagnosis and management
3. Patient combative in recovery. Discuss management of delirium
Viva 3
22.2 You are currently providing anaesthesia for the transoesophageal echocardiogram and cardioversion list. The cardiology registrar informs you that he has added a 65-year-old man to the end of the list. The patient presented to the emergency department two hours ago with severe shortness of breath. He has a history of multiple admissions to the Coronary Care Unit for management for his cardiac amyloid disease.
Medications on admission:
* atorvastatin 40 mg daily
* bisoprolol 2.5 mg daily
* furosemide (frusemide) 40 mg twice daily
* potassium chloride 1500 mg twice daily
* prednisone 10 mg daily
* rivaroxaban 20 mg daily
* spironolactone 25 mg daily
(SEE ECG. Note ECG was flipped and reverse in actual exam report - ?attempted deception)
What are the key issues concerning your management of this patient?
- Assessment and planning for cardioversion in a patient with little reserve
- Management of bradycardia post successful cardioversion resulting in cardiogenic shock
- Management of cardiac arrest when a not for resuscitation order discovered in chart
Pass 76%
Viva 9
22.2 You are an anaesthetist at a metropolitan private hospital. A 22-year-old woman requires surgery for an acute abdomen. She is day 4 post-laparoscopic sleeve gastrectomy that was performed for obesity. The ICU specialist has called you with her blood results
Usual medications:
* empagliflozin 10 mg daily
* escitalopram 20 mg daily
* lansoprazole 30 mg bd
* metformin 500 mg bd
* vitamin D 1000 IU daily
Outline your preoperative assessment and preparation of this patient for surgery.
- Assess and optimise a shocked patient including assessment of ABG and electrolytes.
- Intraoperative loss of IV access leads to volatile anaesthesia and then temp increase – Differential diagnosis and management.
- Assessment of confusion and hypoxaemia in PACU
Pass 78%
Viva 11
22.2 A 63-year-old woman is booked for a pulmonary vein isolation for atrial fibrillation today. She is scheduled to be the first case on your afternoon list in the cardiac catheter laboratory.
She describes episodic palpitations lasting 30 to 40 minutes up to five times a day with associated fatigue and exertional limitation.
Past medical history:
* Ischaemic heart disease – drug-eluting stent (DES) to proximal LAD 12 weeks ago for stable angina symptoms
* Hypertension
* Type 2 diabetes mellitus
* Obstructive sleep apnoea requiring nocturnal CPAP
* Elevated BMI (41 kg/m2)
* Chronic kidney disease - baseline eGFR 65 mL/min/1.73m2
Current medications:
* apixaban 5 mg bd
* aspirin 100 mg daily
* clopidogrel 75 mg daily
* dapagliflozin 5 mg daily
* bisoprolol 2.5 mg bd
* insulin glargine 20 units nocte subcutaneously
* irbesartan/hydrochlorothiazide 150 mg/12.5 mg daily
* pantoprazole 40 mg daily
* rosuvastatin 10 mg nocte
An ECG has been taken this morning. Her blood pressure is 118/79 mmHg and SpO2 98% (room air).
What additional information would you like to obtain from the patient prior to commencing anaesthesia?
- Anaesthesia plan for pulmonary vein isolation.
- Management of postinduction tachyarrhythmia
- Development of chest pain in PACU leading to the diagnosis of a pericardial collection
Pass 70%
Viva 13
22.2 A 62-year-old woman has just arrived by ambulance to your burns centre emergency department and you have been called to assist as part of the trauma team. She was caught in a house fire where she was trapped indoors for ten minutes before firefighters were able to free her. Forty-five minutes have lapsed since rescue.Past medical history:
* Smoking 40 pack-year history
* Mechanical mitral valve replacement
* Chronic kidney disease
Medications:
* warfarin 5 mg daily
Examination findings:
Approximate weight 70 kg
SpO2 99% (oxygen via Hudson mask at 10 L/min)
HR 120 bpm (sinus rhythm)
BP 100/70 mmHg
RR 21/min, shallow breathing and coughing intermittently
Chest auscultation: mild diffuse wheeze.
Her burn injuries have been documented by the paramedic in the diagram overleaf (hashed areas). The burnt skin is a blotchy red or dark pink colour and has large blisters. Capillary refill is sluggish (> 2 seconds) and there is loss of sensation in some areas.
She is confused about the events, visibly distressed and in pain. She has been administered 10 mg of morphine intravenously.
How do you assess her burn injuries?
- Immediate assessment and management of major burn
- Plan for first major debridement including consideration of blood loss and temperature management
- Analgesic options for wards based dressing changes
Pass 66%
Viva 14
22.2 You are asked to review a 40-year-old man in the emergency department who has trismus secondary to a dental abscess. He has severe intellectual impairment and is nonverbal. His caregiver is with him.
The maxillofacial surgeon wishes to bring him to theatre urgently to remove a lower molar tooth and incise and drain his submandibular abscess
How will you assess this man’s airway?
AREAS COVERED:
1. Assessment and management of transfer to theatre including requirement for sedation/analgesia.
2. Management of trismus after induction
3. Assessment and management of a circuit leak after successful intubation
Pass 76%
Viva 16
22.2 You are an anaesthetist working in a major hospital which includes neurosurgery.
You are currently in the preanaesthetic assessment clinic reviewing a 52-year-old man for his suitability to undergo awake craniotomy for tumour resection.
He presented with a headache and right-sided weakness two weeks ago.
Since diagnosis, his oral medications are:
* dexamethasone 4 mg TDS
* levetiracetam 500 mg BD
Weight 110 kg, height 182 cm (BMI 33kg/m2).
What does this scan show and how will you assess this patient’s suitability for awake craniotomy
- Anaesthesia for regional approach to stereotactic surgery
- Management of unco-operative awake patient in pins
- Management of intraoperative seizure in pins with loss of airway and open head.
Pass 78%
