Fellowship - GA/sedation

Question 1

Evaluate the use of available neuromuscular blocking agents when performing a rapid sequence induction.

Question 2

Define the terms ‘train-of-four’ (TOF) and ‘double burst stimulation’ (DBS) with respect to a peripheral nerve stimulator (PNS). (30%) Evaluate the use of a quantitative peripheral nerve stimulator when using neuromuscular blocking agents in anaesthetic practice. (70%)

Question 3

Justify your use of perioperative prophylactic antiemetics.

Question 4

Outline the pharmacological features of remifentanil. (50%) Describe how these features can be utilised when using remifentanil in clinical practice. (50%)

Question 5

List the risk factors for postoperative nausea and vomiting (PONV) (30%) Evaluate methods to minimise PONV (70%)

Question 6

(a) What is the role of dexamethasone in the management of postoperative nausea and vomiting? (70%)(b) What are the potential problems associated with its use? (30%)

Question 7

(a) What are the complications associated with residual neuromuscular blockade? (30%)(b) Evaluate the methods available to assess residual neuromuscular blockade. (70%)

Question 8

A 16-year-old girl has failed to wake from anaesthesia following posterior instrumentation for severe idiopathic scoliosis. Discuss the potential causes and management of her failure to wake. (61.8%)

Question 9

“A 61 year old woman is scheduled for total laparoscopic hysterectomy. She has had an episode of awareness under anaesthesia during previous laparoscopic surgery. a. What are the risk factors for awareness? (30%) b. How would you minimise this patient’s
risk of awareness during her operation? (70%) “

Question 10

Forty minutes after a laparoscopic appendicectomy has been completed, a 55 year old patient has failed to regain consciousness. List the potential causes. (30%) Describe your management (70%)

Question 11

Three days after a patient has undergone hemiarthroplasty under general anaesthesia, his relatives ask to see you because of concerns that the patient does not recognise family members. This was not present preoperatively.a. What features would distinguish between delirium and dysfunction in this setting? (50%)b. What you would advise the family to be the expected outcome? (50%)

Question 12

1. Classify the possible causes for patient awareness under general anaesthesia. (70%)2. Evaluate the evidence for the use of Bispectral Index monitoring in reducing the risk of awareness. (30%)

Question 13

Describe the anatomy relevant to cannulation of the subclavian vein via the infraclavicular approach.

Question 14

A drug has been unintentionally administered through a radial arterial line in an awake patient. Describe your management of this situation.

Question 15

“A patient requires vascular access for three weeks. a. List the advantages and disadvantages of a peripherally inserted central catheter (PICC line) compared to a percutaneous central venous catheter (CVL). (50%) b. Outline the methods by which you would
minimize the risks associated with the placement of a PICC line. (50%) “

Question 16

You are inserting a central venous line (CVL) as part of your anaesthetic management for a laparotomy. Outline the perioperative measures you should consider to minimise central venous line sepsis.

Question 17

Insertion of a central venous line may result in cardiac tamponade.a. How would you recognise this complication? (50%) b. How could you minimise the risk of this complication? (50%)

Question 18

Describe the process of intraoperative cell salvage. (50%) Discuss the indications and contraindications for intraoperative cell salvage. (50%)

Question 19

“Describe the factors that determine the maximum achievable rate of intravenous fluid administration. (50%)
Outline the issues associated with the use of rapid infusion devices. (50%)”

Question 20

a. Outline the principles of stroke volume variation (SVV) measurement. (50%)b. Describe how SVV measurement can be used to assist haemodynamic optimisation in a patient undergoing major elective abdominal surgery. (50%)

Question 21

An elderly patient is to undergo operative fixation of a fractured neck of femur. A radial arterial line is inserted prior to induction, and when transduced, the trace appears dampeda. What are the possible causes for the trace to appear damped in this patient? (50%)b. Outline the steps you would take to ensure the accuracy of your arterial line (50%)

Question 22

What are the benefits and limitations of red blood cell salvage? (50%) How would you justify its introduction into your institution? (50%)

Question 23

Evaluate the use of human albumin in perioperative volume replacement.

Question 24

Discuss the role of desflurane in current anaesthesia practice.

Question 25

The hospital pharmacist notifies you as Director of Anaesthesia that Thiopentone is to be withdrawn from the hospital formulary due to minimal usage. Outline and justify your response.

Question 26

Compare the relative merits of gelatin-based intravenous solutions and dextran intravenous solutions. & 2000B8

Question 27

What significant side-effects are associated with the use of anti-emetic agents?

Question 28

Discuss the problems of clopidogrel for the perioperative period

Question 29

What are the relative merits of sodium nitroprusside and glyceryl trinitrate in the control of blood pressure in anaesthetised patients?

Question 30

Compare and contrast thiopentone and propofol for use in rapid sequence induction of anaesthesia.

Question 31

Outline the issues to be considered when a patient wishes to continue self-prescribed herbal preparations in the peri-operative period.

Question 32

Outline the pharmacology of naltrexone relevant to providing anaesthesia and postoperative care for a patient on naltrexone undergoing major abdominal surgery?

Question 33

Use of at least 30% O2 in the inspired gas has been traditional practice in anaesthesia for healthy adults. Is this practice valid?

Question 34

Outline the undesirable effects of intravenous protamine sulphate.

Question 35

What are the advantages and disadvantages of the use of propofol for sedation of intensive care patients?

Question 36

Describe both the surface anatomy and anatomical relations of the internal jugular vein relevant to central venous cannulation

Question 37

Evaluate the use of a processed electroencephalogram (EEG) as a routine monitor during general anaesthesia

Question 38

Evaluate the practice of deliberately-induced intraoperative hypotension

Question 39

Outline the assessment and immediate management of a patient in the post anaesthesia care unit (PACU) with respiratory failure after emergency open abdominal surger

Question 40

Outline the functional elements of an intraoperative cell salvage system. (30%)Discuss the indications, advantages and disadvantages of intraoperative cell salvage. (70%)