Fellowship - gsurg/gynae/urol

Question 1

Discuss the preoperative assessment for a patient who presents for thyroidectomy.

Question 2

Describe the pathophysiological effects of carbon dioxide pneumoperitoneum during a surgical procedure.

Question 3

An otherwise well patient presents for a laparoscopic right hemicolectomy. What are the issues related to the carbon dioxide pneumoperitoneum? How would your intra operative management address these issues?

Question 4

Describe your preoperative assessment of a patient with oesophageal cancer scheduled for an oesophagectomy and justify your strategy to optimise them before surgery

Question 5

Describe the clinical presentation of venous carbon dioxide embolism during laparoscopic surgery and outline your management.

Question 6

“A patient with chronic liver disease requires gastroscopy for investigation of chronic anaemia.
A preoperative arterial blood gas (ABG) on room air demonstrates:
pH 7.49 (7.36-7.44)
PaCO2 29 mmHg/ 3.9 kPa (36-44 mmHg/ 4.8-5.9 kPa)
PaO2 56 mmHg/ 7.5 kPa (85-100 mmHg/ 11.3-13.3 kPa)
HCO3 22.6 mmol/l (22-28 mmol/l)
SBE -0.4
SaO2 89%
Interpret this ABG and list possible causes of hypoxia in this patient. (50%) Justify your anaesthetic technique for gastroscopy in this patient. (50%)”

Question 7

List the advantages and disadvantages of opioid-free approaches for laparoscopic sleeve gastrectomy. (50%) Justify your choice of opioid-free technique for this procedure. (50%)

Question 8

What are the considerations when anaesthetising a patient for a complex laparoscopic ultra-low colonic resection?

Question 9

Describe the physiological effects of pneumoperitoneum with CO2 for laparoscopic surgery.

Question 10

An otherwise well 60-year-old man is having a radical prostatectomy. List and briefly evaluate strategies to prevent peri-operative thromboembolism.

Question 11

Discuss ways in which the risk of deep venous thrombosis can be minimised in adult patients having intra-abdominal surgery.

Question 12

Describe and justify your usual anaesthetic technique for colonoscopy in an otherwise uncompromised patient

Question 13

An 85 year old female presents with a 3 day history of bowel obstruction. The duty surgeon wants to perform a laparotomy as soon as possible. Discuss the main factors determining the optimal time for anaesthesia and surgery.

Question 14

“A morbidly obese patient (160kg, 165cm) with sleep apnoea requiring the use of CPAP mask develops actue cholecystitis. He is febrile and sweaty, with warm peripheries. Blood pressure is 110/70. Heart rate is 110/min. He is scheduled for urgent cholecystectomy. His saturation on arrival in the operating theatre is 93% on O2 (nasal prongs 2l/min). Discuss the advantages and disadvantages of an awake intubation in this patient.

Outline the implications of this operation being performed as an open rather than a laparoscopic procedure in this patient.

Justify your plan for postoperative respiratory care of this patient following an open procedure.”

Question 15

“A patient is referred to see you six weeks before her scheduled cholecystectomy. The significant features of her history and exam are: Age 42, weight 140kg, height 171cm. Medication: oral contraceptive pill. Allergies: peanuts (severe asthma); some cosmetics; penicillin (itchy rash). Smokes 60 cigs per day for 20 years. Discuss the anaesthetic related risks associated with laparoscopic as compared to open surgery in this patient.

What will you advise her regarding the risks of continuing to smoke prior to the operation?

Discuss premedication in this patient.
“

Question 16

“A 52 yo man, height 1.75m weighing 130kg presents for laparoscopic cholecystectomy under GA. History and examination reveal no other abnormality. How does this patients obesity influence your anaesthetic management up to the time of the first incision?

Explain the physiological effects of a carbon dioxide pneumoperitoneum in this man. Open cholecystectomy becomes necessary.

The surgeon requests that you place an epidural catheter for postoperative analgesia. Outline the issues which should be considered in responding to this request.
“

Question 17

You are asked to review a patient in the recovery room who had a transurethral resection of prostate an hour ago.

He is complaining of severely altered vision.

Describe how you would assess this patient and the possible causes of his altered vision?

Question 18

Discuss the perioperative anaesthetic management considerations of a patient with inoperable pancreatic cancer causing obstructive jaundice who requires endoscopic retrograde cholangiopancreatography (ERCP) intervention

Question 19

Discuss the elements of perioperative management that improve outcomes in patients undergoing emergency laparotomy.

Question 20

Discuss the potential complications associated with hysteroscopy and their anaesthetic management.

Question 21

What are the peri-operative considerations when anaesthetising a patient for complex laparoscopic ultra-low colonic resection?

Question 22

A 75 year old man is having a transurethral resection of prostate under a general anaesthetic. 30 minutes into the procedure your registrar takes a blood gas and the results are as follows
pH 7.35
pCO2 43
pO2 189
Hb 100
Na+ 119
K+ 5.6
Cl- 89
What are the possible causes of this result? (30%)
How will you manage the most likely cause of this result? (70%)

Question 23

A 23 year old man is booked for a retroperitoneal lymph node dissection. He has a testicular tumour and has been treated with chemotherapy including bleomycin, etoposide and cisplatin.
a. What is your approach to intra-operative management of this patient?
b. The operation proceeds uneventfully. In the recovery room, the patient is becoming increasingly tachycardic. What are the possible causes of the tachycardia?