Fellowship - periop haem Flashcards
A 30-year-old woman requires a laparoscopic appendicectomy. She reports a “severe allergic reaction” during a laparoscopy five years ago. Outline your strategy for managing this case, given her history.
“These are the blood results of a 65-year-old man scheduled for a revision total hip replacement. Interpret these results (30%) and how would you manage this patient pre-operatively (70%)
Hb 120 g/l MCV 78 fL WCC 5.5 x 103/l Plt 250 x 109/l
Na 136 mmol/l K 4.0 mmol/l Urea 5.5 mmol/l Cr 100 mmol/
Iron 8 Transferrin 3.2 Transferrin saturation12 Ferritin40 CRP 8”
In preadmission clinic you are assessing a patient who is concerned about the risk of developing venous thromboembolism (VTE) perioperatively. Outline the patient factors that increase the risk of VTE. (50%) Describe measures that may reduce the risk of perioperative VTE (50%)
Explain your approach to thromboprophylaxis in the patient undergoing total knee replacement.
A 56-year-old male with haemophilia A is scheduled to undergo a total knee replacement. Describe the pathogenesis of haemophilia A and its complications (50%). Discuss how the presence of haemophilia A influences you perioperative management of this patient (50%)
Discuss the options for anticoagulation management in the perioperative period for a patient taking warfarin for atrial fibrillation who requires a laparotomy for ischaemic bowel.
A patient on an organ transplantation waiting list is taking rivaroxaban for recurrent pulmonary emboli. Discuss your perioperative anticoagulation plan
Outline your approach to the perioperative management of a patient who gives a strong family history of von Willebrand disease.
A 40-year-old patient who is scheduled for elective total abdominal hysterectomy has a haemoglobin level of 80 g/l. Describe your preoperative assessment and optimisation of this patient’s anaemia.
“A patient scheduled for transurethral resection of the prostate is seen in the pre-admission clinic. He has non-valvular atrial fibrillation and was commenced on dabigatran 150 mg bd when he had a minor stroke three months ago.
a) Outline briefly the advantages and disadvantages of dabigatran as compared to warfarin for stroke prevention in elective surgical patients. (30%)b) Describe and justify your plan for the perioperative management of this patient’s
anticoagulation. (70%)”
A patient with chronic atrial fibrillation on warfarin is scheduled for elective surgery. Outline how you decide if bridging therapy is needed? (70%) Describe how you would bridge anticoagulation if necessary. (30%)
“A female patient scheduled requiring a total knee replacement is seen in clinic. A date has not yet been scheduled for surgery.On investigation she has a haemoglobin of 105 g/L1. What are the most likely causes of this result, and how would
confirm this? (50%)2. What preoperative treatment would you undertake and why? What advice would you give for scheduling time of surgery? (50%)”
a. Describe the pathophysiological changes associated with a haemoglobin of 75 g/L. (50%) b. Outline the patient factors that would indicate the need for a perioperative red blood cell transfusion in a patient with a haemoglobin of 75 g/L. (50%)
“A fit 37-year-old female presents for laparoscopic appendicectomy. She reports a “severe allergic reaction” during her a laparoscopy 5 years ago. There were no tests performed and the records are not available.a. Outline your strategy for
managing this case. (70%)b. List the investigations that are recommended following any suspected anaphylaxis and when they should be performed. (30%)”
