Exam 2020

Question 1

Complications related to TEVAR?

Answer 1

Device-related issue - graft failure to deploy
- Thorough imaging to ensure anatomical suitability.

Systemic complications
- Spinal cord ischaemia
- Renal failure
- Cerebrovascular event
- Cardiovascular event
- Bleeding, anticoagulation during surgery.

Question 2

Common dose of sux for ECT?

Answer 2

0.5mg/kg
- rapid onset, offset
- Visual cues of effect
- Higher dose in patients with cachexia, osteoporosis

Question 3

Gold standard of hypnotic agent for ECT

Why don’t we use it?

Answer 3

methohexital - respiratory and myocardial depression.

Not readily available. Other agents with greater familiarity.

Question 4

Euglycaemic DKA diagnosis?

Answer 4

Ketone >3.0 mmol/L
pH < 7.30 +/- HCO3 - < 15mmol/L
Typically with blood glucose level (BGL) < 14 mmol/L.

Question 5

Glycemic management targets for euDKA

Answer 5

Commence 5% dextrose at 1L over 12 hours when BSL < 14mmol/L

Aim BSL 8-12 mmol/L

If BSL < 5.6mmol, give 30ml of 50% dextrose

Question 6

Criteria for ICU deposition for euDKA

Answer 6

pH <7.0
Bicarb <5.0
Ketone > 6.0
Significant electrolyte abnormalities
Altered mental status when awake

Question 7

How do myasthenia graves patients react to muscle relaxants?

Answer 7

Resistant to sux - need high dose, high risk of hyper K+

Reduced dose of rocuronium - titrate to nerve stimulator

Question 8

Drugs to avoid in patients with MG?

Answer 8

aminoglycoside
Beta blockers
Magnesium
Procainamide

Question 9

60mg of PO pyridostigmine = ? IV = ?IV neo

Answer 9

1/30 to IV conversion = 2mg IV pyrido

= 500mcirog of neostigmine

Question 10

What are the departmental strategies to minimise fatigue?

Answer 10

Establish safe working hours
- No more than 16hours per shift.
- 10 hours between night shift to day shift.

Only life or limb emergency surgeries after 10pm

Provision of private sleeping facilities for on call.