Fellowship - periop cardio

Question 1

List the branches of the coronary arteries and the myocardial territories and structures they supply. Outline the ECG leads that correspond to the blood supply. Describe the ECG changes in a non-ST elevation myocardial infarct (NSTEMI)

Question 2

“A patient presenting for surgery has a DDDR pacemaker
A) Explain the NASPE/BPEG Generic (NBG) pacemaker classification system
b) Describe the assessment and preoperative management of this DDDR device. “

Question 3

A 25-year-old male scheduled for elective surgery is found to have a systolic murmur on the day of surgery a. What are the clinical features and ECG findings in this patient that would prompt you to postpone the case to allow further investigation? (70%) b. What are the likely causes of this murmur? (30%)

Question 4

Outline your peri-operative management of a patient with mitral stenosis scheduled for a laparoscopic inguinal hernia repair.

Question 5

A patient with an implantable cardioverter defibrillator pacemaker is scheduled for a left mastectomy. Discuss how the presence of this device affects your management of this patient.

Question 6

Discuss how Marfan syndrome influences your anaesthetic management for a patient requiring an urgent laparoscopic appendicectomy

Question 7

A 25-year-old male is scheduled for an elective inguinal hernia repair. He has a ventricular septal defect and was recently diagnosed with Eisenmenger syndrome. Discuss your preoperative assessment and how this affects your anaesthesia plan

Question 8

List the risk factors for perioperative stroke. (50%) Discuss the measures you use to minimise perioperative stroke in high-risk patients undergoing major orthopaedic surgery. (50%)

Question 9

A 77-year-old patient is admitted to hospital with a fractured neck of femur requiring total hip arthroplasty. Physical examination on admission reveals signs of congestive cardiac failure. Outline how congestive cardiac failure influences the perioperative risk for this patient. (30%) Discuss how the finding of congestive cardiac failure influences your perioperative management of this patient. (70%)

Question 10

A 63-year-old patient presents for urgent cancer surgery three weeks following myocardial infarction. Discuss the risk assessment of this patient for this surgery. (50%) How would you optimise this patient for surgery? (50%)

Question 11

A 60-year-old female patient with known hypertrophic cardiomyopathy requires semi- urgent surgery for a femoral fracture. Describe the perioperative haemodynamic goals and justify your anaesthetic technique.

Question 12

A 70-year-old man scheduled for major surgery presents to the pre-anaesthesia assessment clinic. He has a history of ischaemic heart disease and coronary stent insertion, and is on aspirin and clopidogrel. Outline the considerations when managing his antiplatelet therapy.

Question 13

“A 50 year old patient has received an orthotopic heart transplant 10 years ago. He now presents for elective non-cardiac surgery. Outline the issues a prior heart transplant may present for the anaesthetist AND describe how these will affect
anaesthetic management.”

Question 14

A 75-year-old man presents for right hemicolectomy for an obstructing lesion of the ascending colon that has failed to settle with conservative management. He had a drug-eluting stent placed eight months ago, and is currently on clopidogrel and aspirin. Discuss and justify your plan for perioperative management of his antiplatelet therapy?

Question 15

1. What is the natural history of aortic stenosis? (30%) 2. What are the key echocardiographic features in haemodynamically significant aortic stenosis? (70%)

Question 16

a. List the risk factors for perioperative stroke (50%)b. Describe how you would minimise the risk in a high-risk patient having major orthopaedic surgery (50%)

Question 17

A 40 year old man with hypertrophic obstructive cardiomyopathy (HOCM) presents for elective laparoscopic cholecystectomy. a. Describe the principles of intraoperative haemodynamic management for this patient. (40%) b. How would you manage hypotension post induction of general anaesthesia in this patient? (60%)

Question 18

Evaluate the methods for detection of myocardial ischaemia in the anaesthetised patient

Question 19

A patient presents for an elective inguinal hernia repair and his preoperative electrocardiogram shows trifascicular block. What implications might this have for this patient in the perioperative period and how will you manage those implications?

Question 20

A patient is complaining of central chest pain in the post anaesthesia care unit (PACU) following femoro-popliteal artery bypass surgery.Outline the diagnostic criteria for acute myocardial ischaemia on an ECG? (30%) Describe your management of acute myocardial ischemia in PACU in this patient. (70%)