Fellowship - periop endo/GIT/renal

Question 1

A 45-year-old man with a longstanding history of alcoholism is booked for upper gastrointestinal endoscopy and banding of oesophageal varices following an episode of haematemesis. (a) How is the severity of this patient’s liver disease assessed? (50%) (b) How do these findings influence your evaluation of this patient’s perioperative risk? (50%)

Question 2

(a) What factors contribute to acute kidney injury in the perioperative period? (70%) (b) Outline the efficacy of perioperative strategies to reduce acute kidney injury. (30%)

Question 3

A 56-year-old patient with a phaeochromocytoma is scheduled for a laparoscopic adrenalectomy. Justify your preoperative investigations for this patient (30%). Discuss your goals for preoperative optimisation and how to achieve them (70%).

Question 4

A patient with Type 1 diabetes mellitus is scheduled for a laparoscopic cholecystectomy. Outline your perioperative management of their diabetes.

Question 5

Discuss the perioperative management of a patient on haemodialysis who is to undergo a renal transplant

Question 6

Discuss how a diagnosis of Addison’s disease would influence your perioperative management of a patient who requires an urgent laparotomy for bowel obstruction.

Question 7

Explain your strategies to minimise the risk of hypoxia during induction, maintenance and emergence from anaesthesia in a morbidly obese patient undergoing a laparoscopic total hysterectomy.

Question 8

A patient with type 2 diabetes mellitus requires urgent lower limb arterial bypass surgery. Their medications include dapagliflozin (a sodium-glucose cotransporter 2 inhibitor). Outline your specific concerns and management of this patient for this procedure

Question 9

List the causes of increased perioperative morbidity and mortality in surgical patients with type 2 diabetes mellitus. (30%) Outline the principles of perioperative management of these patients (70%)

Question 10

A 61-year-old man presents with a large haematemesis. He has known alcoholic liver disease and sedation is requested for an urgent gastroscopy. Outline your peri-procedural concerns

Question 11

“A patient scheduled for trans-sphenoidal pituitary surgery is noticed to have greater than normal urine output. How would you determine if this patient has diabetes insipidus? (30%) How would you manage diabetes insipidus in the
perioperative period? (70%) “

Question 12

Discuss your perioperative management of a patient with carcinoid syndrome presenting for small bowel resection.

Question 13

“An 80-year-old man is admitted to the high dependency unit following laparotomy for relief of a large bowel obstruction. He has a urinary catheter in situ. Three hours later he remains oliguric. What are the potential causes of oliguria in this
patient? (50%) How would you differentiate between these causes? (50%) “

Question 14

A 45-year-old man with insulin treated type 2 diabetes is undergoing a gastrectomy on the afternoon list. How will you manage his diabetes perioperatively?

Question 15

“A 45-year-old male with longstanding diabetes is scheduled to undergo elective laparoscopic cholecystectomy. 1. In the pre-anaesthesia assessment clinic, how would you assess this patient for the presence of diabetic autonomic neuropathy?(50%)
2.Discuss the anaesthetic implications of his autonomic neuropathy.(50%) “

Question 16

A 53 year-old man with acromegaly presents for a transphenoidal resection of his pituitary tumour. Outline the features of acromegaly. (50%) How does this diagnosis influence your anaesthetic management? (50%)

Question 17

(a) How would you identify a patient with autonomic neuropathy associated with diabetes? (50%)(b) What are the anaesthetic implications from a cardiovascular perspective? (50%)

Question 18

A 20 year old female with a body mass index of 48 kg/m2 presents for an elective diagnostic laparoscopy for endometriosis. She has no other medical conditions. Describe the potential problems associated with anaesthetising this patient.

Question 19

“A 60-year-old man is admitted to the high dependency unit following laparotomy for relief of a large bowel obstruction. He has a urinary catheter in situ. Three hours later he remains oliguric.a. Define oliguria (10%)b. What are the potential
causes of oliguria in this patient? (40%)c. How would you differentiate between these causes? (50%)”