Fellowship - pain

Question 1

Outline the circumstances where the dosing of paracetamol requires modification (50%). Describe the management principles of paracetamol toxicity (50%).

Question 2

Discuss the intraoperative and postoperative pain management of a trauma patient who requires a semi-elective below knee amputation for an isolated injury

Question 3

Describe the factors that ensure the safety and quality of a ward-based postoperative epidural analgesia service

Question 4

Outline your management of a patient with chronic daily headache

Question 5

One of your anaesthetic colleagues is prescribing fentanyl patches as discharge medication for patients following total hip joint replacement. Evaluate this practice.

Question 6

Evaluate the use of intravenous lignocaine infusions for perioperative analgesia.

Question 7

List the methods of analgesia that can be used for patients undergoing open liver resection surgery. (30%) Justify your perioperative pain management strategy. (70%)

Question 8

A 75-year-old lady scheduled for total knee replacement is currently using a fentanyl patch (75 μg/hour) for analgesia to manage her knee pain. Discuss how this influences your perioperative pain management.

Question 9

“An elderly patient is scheduled for total hip replacement and has been taking oxycodone 40mg twice daily in the last six months for severe hip pain. What issues do you anticipate with regard to her oxycodone use? (50%) How do these issues influence
your postoperative management? (50%)”

Question 10

Define persistent post surgical pain. Outline the interventions that are efficacious in reducing the transition of acute post surgical pain to persistent post surgical pain

Question 11

Evaluate the role of tramadol in acute and chronic pain management.

Question 12

“A 70-year-old patient wearing a transdermal buprenorphine slow release patch (Norspan®) (5μg/h) presents for knee arthroscopy.a. Describe the mechanism of action and pharmacokinetic profile of this patch. (50%)b. What are the implications for
perioperative pain management? (50%)”

Question 13

(a) Describe the clinical pharmacology of codeine including an outline of its therapeutic use. (70%) (b) Describe the influence of pharmacogenetics on the variability of patient response to codeine. (30%)

Question 14

(a) List the predisposing factors for pain persisting for more than three months postoperatively. (50%) (b) Outline the interventions that have been demonstrated to be efficacious in the prevention of persistent postoperative pain. (50%)

Question 15

A patient takes a 60mg slow-release morphine tablet twice daily for chronic low back pain. They have been appropriately investigated and there is no surgically treatable pathology. In relation to this patient List the risks of long-term opioid therapy. (30%) Justify the appropriate treatment of chronic low back pain. (70%)

Question 16

Discuss the perioperative implications for a patient known to use methamphetamine

Question 17

“A 36-year-old with a history of opioid dependence is booked for spinal surgery. The patient is no longer on opioids and is maintained on 50mg of oral naltrexone daily.
Discuss the implications of the history of opioid dependence and current naltrexone treatment for the provision of effective analgesia, including an analgesia plan upon hospital discharge.”

Question 18

a. Describe the clinical features of trigeminal neuralgia (50%) b. Discuss the efficacy of the treatment modalities available for this condition. (50%)

Question 19

a. In a patient who complains of post operative pain, which features of the history and examination suggest a diagnosis of acute neuropathic pain? (50%) b. How would the diagnosis affect your postoperative pain management plan? (50%)

Question 20

A 34 year old, opioid-dependant woman is complaining of severe pain on the day after a first metatarsal osteotomy. The nurses are concerned she is drug-seeking. a. How would you assess this patient? (60%) b. Outline your pain management plan. (40%)

Question 21

“A 60-year-old lung cancer patient is planned to undergo an open thoracotomy, involving possible rib resection.
List the regional techniques available for post-operative pain management and justify your choice of regional technique for this patient. (50%)
Outline your management plan if pain is still present at the operative site 14 days later. (50%)”

Question 22

List the factors associated with increased mortality following rib fractures. (30%) Describe a comprehensive rib fracture management plan. (70%)

Question 23

“You are asked to anaesthetise an 80-year-old lady with dementia and a fractured neck of femur. She is on no other medication. 1. What are the issues in assessing pain in this patient? (50%) 2. What would you prescribe for postoperative analgesia and
why? (50%)”

Question 24

A woman who is 10 weeks pregnant presents to the Emergency Department with a closed tibial shaft fracture. 1. Classify the drugs used in pain management according to their safety to use at this stage of pregnancy. (40%) 2. What are the options available for perioperative pain management for this patient? (30%) 3. What would you recommend? Justify your choice. (30%)

Question 25

A previously healthy 28-year-old male has persistent pain 12 weeks after compound fracture to his lower leg and is on slow-release oxycodone 80mg twice daily and immediate release oxycodone 20mg 4 hourly. Discuss the advantages and disadvantages of switching his opioid to methadone in this situation and how this may be achieved safely.

Question 26

List the risk factors for the development of chronic pain following a surgical procedure. Outline possible mechanisms for the progression of acute to chronic pain.

Question 27

A 65 yo female who weighs 85kg and is 165cm tall (BMI 31) is scheduled for TKR surgery. Discuss the pros and cons of intrathecal morphine for post operative analgesia in this patient.

Question 28

Evaluate the role of gapapentin in acute and chronic post surgical pain management.

Question 29

Discuss the features and management of phantom limb pain.

Question 30

Discuss the role of non steroidal anti-inflammatory drugs for post operative analgesia in adult day surgery patients.

Question 31

Discuss the requirements for and limitation of the use of patient-controlled analgesia (PCA) as a technique.

Question 32

A 71 year old man presents with acute herpes zoster involving the ophthalmic division of his left trigeminal nerve. He complains of severe unrelenting facial and eye pain which started 3 days ago. Discuss the pharmacological treatment options. Include information about the relevant efficacy of the treatments you prescribe.

Question 33

A 27 year old male presents with a glioblastoma for a craniotomy. As part of your anaesthetic technique, you decide to use a remifentanil infusion. Discuss the characteristics of remifentanil with respect to its use as an infusion. (50%) What are the advantages and disadvantages of using effect site calculations to guide remifentanil 
infusions? (50%)

Question 34

Nitrous oxide should not be used routinely as a component of general anaesthesia. Discuss.

Question 35

Discuss the role of ketamine in current anaesthesia practice.

Question 36

Describe the clinical features and management of bupivacaine toxicity.

Question 37

You are asked to review a healthy 20-year-old patient for severe post-operative pain in a stand-alone day surgery unit. Describe your assessment and justify your management

Question 38

Discuss the advantages and disadvantages of the different analgesic options for a patient undergoing an open liver resection for excision of colorectal metastasis.

Question 39

Discuss potential strategies for postoperative analgesia following shoulder rotator cuff repair

Question 40

Outline the principles of opioid stewardship

Question 41

Evaluate the use of long-acting opioids in the treatment of acute pain

Question 42

Evaluate the role of tramadol in acute and chronic pain management.