Fellowshiop - periop general

Question 1

“The following are the areterial blood gas (ABG) results of a patient with chronic liver disease:
pH 7.49
PaCO2 25mmHg
PaO2 55mmHg
HCO3 24.8
SpO2 88%
Interpret this ABG
List the causes of hypoxia in patients with chronic liver disease
Describe how you would differentiate between the causes of hypoxia in patients with chronic liver disease”

Question 2

“PH 7.01, PCO2 50mmHg, PO291mmHg, SaO2 91%, HCO3 12.2 mmol/L. Interpret this arterial blood gas (ABG). Justify any additional information you would require to complete your interpretation.
Describe a clinical situation which may explain this ABG”

Question 3

“A patient with diabetes mellitus presents fasted on today’s list for elective ileo-femoral bypass surgery.
His biochemistry results from this morning are as follows:
Na 142 mmol/L (135-145 mmol/L)
K 6.0 mmol/L (3.5-5 mmol/L)
HCO3 18 mmol/L (20-29 mmol/L)
Cl 105 mmol/L (97-107 mmol/L)
urea 12 mmol/L (3.0-6.5 mmol/L)
creatinine 300 mmol/L (60-125 mmol/L)
eGFR 30 mL/min/1.73m2 (>90mL/min/1.73m2)
Interpret these results. List the most likely differential diagnoses. Justify any additional information you require in order to make your diagnosis.”

Question 4

“pH 7.01, PCO2 50mmHg, PO291mmHg, SaO2 91%, HCO3 12.2 mmol/L. Interpret this arterial blood gas (ABG). Justify any additional information you would require to complete your interpretation.
Describe a clinical situation which may explain this ABG”

Question 5

a) Outline the principles of cardiopulmonary exercise testing (50%) b) Evaluate the role of cardiopulmonary exercise testing in a patient who is scheduled for oesophagectmony (50%)

Question 6

A patient’s arterial blood gases include pH 7.1 pCO2 27 mmHg HCO3 <15 A. What is the acid-base status of this patient and briefly justify your differential diagnosis list. B. Describe how other biochemical parameters would help identify the cause

Question 7

“A patient is undergoing femoro-popliteal artery bypass grafting for intermittent claudication under spinal anaesthesia with no sedation.Discuss this patient’s intraoperative arterial blood gas result.
FiO2 0.5
Patient temperature 36.5oC
pH 7.235 (7.35 – 7.45)
PaO2 145 mmHg (80 – 100 mmHg)
PaCO2 50 mmHg (35 – 45 mmHg)
HCO3⁻ 15 mmol/L (22 – 26 mmol/L)
Base Excess -6 mmol/L (-2 – +2 mmol/L)
Lactate 3.5 mmol/L (0.5 – 2 mmol/L)”

Question 8

“A patient is undergoing femoro-popliteal artery bypass grafting for intermittent claudication under spinal anaesthesia with no sedation.Discuss this patient’s intraoperative arterial blood gas result.
FiO2 0.5
Patient temperature 36.5oC
pH 7.235 (7.35 – 7.45)
PaO2 145 mmHg (80 – 100 mmHg)
PaCO2 50 mmHg (35 – 45 mmHg)
HCO3⁻ 15 mmol/L (22 – 26 mmol/L)
Base Excess -6 mmol/L (-2 – +2 mmol/L)
Lactate 3.5 mmol/L (0.5 – 2 mmol/L)”

Question 9

Discuss the preoperative elements of an Enhanced Recovery After Surgery (ERAS) program for a patient requiring major colorectal surgery

Question 10

A patient presents on the day of surgery with a blood pressure of 180/110mmHg. Justify your decision to proceed with or postpone surgery for this patient.

Question 11

Describe the role of the anaesthetist in minimising surgical site infection (45.8%)

Question 12

Outline the factors relevant to selection of a perioperative antibiotic prophylaxis regimen for a surgical patient. (50%) Discuss strategies to ensure appropriate implementation of antibiotic prophylaxis regimens. (50%)

Question 13

A patient on the morning endoscopy list lives alone and is planning to return home in a taxi. She has already taken her colonoscopy preparation solution. What are the considerations for discharge planning for this patient?

Question 14

As a perioperative physician, what strategies can you offer to assist a patient to cease smoking tobacco and how will you best communicate them?

Question 15

An adult patient is scheduled for a major operation during which significant blood loss is expected. Describe strategies you would consider peri-operatively when planning to minimise blood loss and transfusion requirement.

Question 16

a. Describe the principles behind an “Enhanced Recovery After Surgery (ERAS)” programme for colorectal surgery. (50%) b. Outline the key steps you would take in setting up this programme in your hospital (50%)

Question 17

A 68-year-old man is scheduled for total knee replacement next week. He has hypertension, for which he is prescribed enalapril, and type 2 diabetes, for which he is prescribed metformin.Justify your perioperative management of his medications.

Question 18

“The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and the Surgical Outcome Risk Tool (SORT) are examples of risk scoring systems used for predicting post-operative morbidity and mortality.
Evaluate the strengths and weaknesses of these types of risk scoring systems in clinical practice.”

Question 19

A 30-year-old male is scheduled to undergo complex lower limb reconstructive surgery expected to last 18 hours. Discuss the issues associated with this prolonged procedure.

Question 20

Discuss the consequences of perioperative hypothermia.

Question 21

Justify strategies used to mitigate postoperative delirium in an elderly patient requiring hip fracture fixation

Question 22

An 80-year-old manis in the post anaesthesia care unit (PACU) following a transurethral resection of prostate under spinal anaesthesia. He is restless, saturating poorly on air and refusing to keep an oxygen mask on. List the likely differential diagnoses and describe your management.

Question 23

Describe your responsibilities as the anaesthetist before you leave your patient in the post anaesthesia care unit (PACU). (50%) Your patient has been in the PACU for an hour. The nurse asks you to change the discharge criteria so the patient can be discharged to the ward. Discuss your decision making process following this request. (50%)

Question 24

An elderly patient in the recovery unit is confused and agitated following surgery. Describe your management.

Question 25

A patient in the post anaesthesia care unit is suspected of having residual neuromuscular blockade. List ways to assess this patient for the presence of residual neuromuscular blockade. (30%) Discuss methods to reduce the risk of residual neuromuscular blockade. (70%)

Question 26

A 55-year-old male is in the post-anaesthesia care unit after nasal surgery. He is conscious, dyspnoeic, and is coughing up frothy secretions. List your differential diagnosis AND how this would direct subsequent management.

Question 27

“An obese 55-year-old female has undergone sleeve gastrectomy which concluded one hour earlier. The post anaesthetic care unit has called to report a blood pressure of 190/110 mmHg. Discuss your approach to the evaluation and management
of the hypertension. “

Question 28

Discuss the usefulness of the ASA grading as a measure of perioperative risk.

Question 29

“An apparently healthy 71 yo woman presents with a fractured neck of femur requiring internal fixation. She smokes 15 cigarettes each day and drinks approximately 30 gm of alcohol daily. She takes no medications.
Justify the blood tests you would request when making your pre-anaesthetic visit. How would you interpet a pre-operative serum potassium of 3.2 mmol/L in this woman if the laboratory normal range is 3.5-5.0 mmol/L?
If her pre-operative serum potassium had been 5.7 mmol/L, how would this influence your anaesthetic management?”

Question 30

What are the indications for prophylaxis against perioperative bacterial endocarditis? Justify your choice of antibiotics. (50%)

Question 31

What do the terms decontamination, disinfection and sterilisation mean? (30%) What measures should be in place to minimise the risk of transmission of infection to the respiratory tract of patients via anesthetic equipment (70%)

Question 32

Discuss the management options for an epidural abscess.

Question 33

Outline the diagnostic criteria for an epidural abscess

Question 34

Discuss the indications for peri-operative antibiotic prophylaxis. Include consideration of the appropriate class of antibiotic for each indication.

Question 35

A 35 yo man had a heart transplant 4 years ago. He now requires elective hip surgery. He is on cyclosporine, azathioprine and prednisolone. What are the implications of his immunosuppressive treatment for perioperative anaesthesia care?

Question 36

How may the spread of blood borne viral infectious agents from patient to health care worker be minimised in anaesthesia?

Question 37

“A 35 yo man had a heart transplant 4 years ago. He is now troubled by pain from avascular necrosis of the head of the femur, and requires surgery. He is on cyclosporin, azathioprine and prednisolone.
What are the implications of his immunosuppressive treatment for perioperative anaesthesia care?
How does the history of him having a heart transplant influence your anaesthetic management?
Describe the strategies which should be employed to minimise the risk of sepsis associated with his periperhal venous cannula.”

Question 38

How should a laryngeal mask airway be processed to avoid cross infection between patients.

Question 39

How would you diagnose a clinically significant latex allergy occurring intra-operatively?

Question 40

Describe the precautions that should be taken to prevent a patient with known latex allergy from having a reaction to latex in the peri-operative period.

Question 41

Discuss serum tryptase as an investigation in current medical practice.

Question 42

(a) What are the clinical consequences of hypothermia to 34⁰C in adults? (50%) (b) How can you manage body temperature in a multi-trauma patient? (50%)

Question 43

How does anaesthesia alter temperature homeostasis?

Question 44

Discuss the advantages and disadvantages of the methods used to avoid hypothermia in the operating theatre.

Question 45

How may physiological control of temperature regulation in adults by altered by general anaesthesia?

Question 46

A 70 yo woman is scheduled for colectomy under GA. Compare the effectiveness of the methods you would use to prevent her becoming hypothermic by the completion of surgery.

Question 47

Describe the adverse effects of a core temperature of 34.0 degrees centigrade at emergence from general anaesthesia.

Question 48

A 14 year old girl, 130 cm tall, with idiopathic scoliosis is scheduled for corrective fixation via thoracotomy. Controlled hypotension will be used. At the time of skin closure her core temperature is 34.1C. How would you manage this?

Question 49

An 18 year old otherwise healthy female is to have 2 impacted wisdom teeth surgically removed as a day stay patient. Describe and justify features of your anaesthetic technique that may help prevent the common postoperative problems you would anticipate in this patient.

Question 50

A 35 year old female is found to have a small pneumothorax following removal of a breast lump under local anaesthesia in a day surgery facility. How would you manage this?

Question 51

Desflurane should be used only for day case procedures. Discuss this statement.

Question 52

A healthy 34 yo man requires colonoscopy under intravenous sedation because of a strong family history of bowel cancer. Describe the composition and effects of bowel preparation solutions commonly used before colonoscopy. Soon after colonoscopy begins his pulse rate falls to 40 beats/min and blood pressure to 60/40 mmHg. Describe your management. What criteria would need to be met before he can be discharged home from the day procedure unit?

Question 53

What criteria would need to be met before he can be discharged home from the day procedure unit?

Question 54

A healthy 34 yo man requires colonoscopy under intravenous sedation because of a strong family history of bowel cancer. Describe the composition and effects of bowel preparation solutions commonly used before colonoscopy. Soon after colonoscopy begins his pulse rate falls to 40 beats/min and blood pressure to 60/40 mmHg. Describe your management. What criteria would need to be met before he can be discharged home from the day procedure unit?

Question 55

Outline the criteria you would use in determining a patient’s suitability for discharge from a day surgery unit.