Fellowship - regional

Question 1

A 65-year-old patient with type 2 diabetes is unable to dorsiflex her left foot 24 hours after undergoing a left total knee joint replacement under spinal anaesthesia and a left femoral nerve block. Discuss the possible causes of this problem. (50%) Outline how you would manage this situation. (50%)

Question 2

You perform multiple intercostal blocks using 300mg ropivavcaine for flail chesta. What features would make you suspect systemic local anaesthetic toxicity? (50%)b. How would you manage the situation? (50%)

Question 3

Describe the anatomy relevant to siting an epidural catheter for postoperative analgesia following open abdominal surgery. (50%) Outline the limitations and complications of providing epidural analgesia for this type of surgery. (50%) - (70.2%)

Question 4

Outline the factors influencing spread of intrathecal local anaesthetic.

Question 5

“A patient has a mid-thoracic epidural inserted preoperatively prior to anaesthesia for open AAA repair. Describe the relevant anatomy including surface landmarks for insertion of a mid-thoracic epidural. Use of diagram(s) may be helpful (50%) List
reasons for persistent leg weakness 4 hours after emergence from anaesthesia in this case (50%)”

Question 6

a. Describe the anatomy of the epidural space (50%)b. What are the clinical implications of the anatomical differences between thoracic and lumbar epidural spaces in the placement and management of epidural analgesia? (50%)

Question 7

Describe the anatomy relevant to performing an adductor canal block (50%). Outline the indications, limitations and technique of performing an adductor canal block (50%)

Question 8

Describe the sensory and motor innervation of the airway relevant for topicalisation for an awake nasal fibreoptic intubation

Question 9

Describe the nerve supply to the breast. (30%) Describe an appropriate regional technique to provide perioperative analgesia for a patient undergoing a total mastectomy and justify your choice. (70%)

Question 10

Evaluate the use of five (5) of the following additives that may be combined with local anaesthetics for neural blockade. adrenaline clonidine dexamethasone glucose hyaluronidase midazolam morphine neostigmine sodium bicarbonate

Question 11

Outline the anatomy relevant to performing a brachial plexus block using the axillary approach. (70%) Describe the limitations of this block when used for upper limb surgery.

Question 12

“Describe the cross-sectional anatomy of the femoral triangle and identify where local anaesthetic would be placed for a  
femoral nerve block  
fascia iliaca block
Describe the strengths and weaknesses of these two blocks for the provision of analgesia during surgery for repair of a fractured neck of femur.”

Question 13

Describe (and/or draw) the anatomy in the optimal ultrasound view when performing a supraclavicular brachial plexus block. (50%). List the possible complications and limitations of this block. (50%)

Question 14

Describe the innervation of the foot relevant to an ankle block.

Question 15

“A 65 year old female patient requires open reduction and internal fixation (ORIF) of her fractured distal radius and ulna. She has no other injuries and is otherwise well but is keen to avoid general anaesthesia. a. List the options for nerve block to
provide regional anaesthesia in this patient (30%) b. Describe the advantages and disadvantages of each of these options (70%)”

Question 16

Describe the anatomy relevant to performing a thoracic paravertebral block. (50%) List the advantages and complications of performing this block for a patient undergoing radical mastectomy (50%)

Question 17

“a. Describe the anatomy relevant to performing a femoral nerve block at the level of the inguinal ligament (50%)b. Outline the advantages and disadvantages of performing a femoral nerve block at this site as part of an analgesia plan for a patient
undergoing total knee arthroplasty. (50%)”

Question 18

An adult patient is scheduled for formation of an arterio-venous fistula at the wrist.a. Describe the nerve supply relevant to this surgery. (30%)b. Discuss the suitability of an interscalene block in this situation. (70%)

Question 19

Describe the anatomy of the Transversus Abdominis Plane (TAP) relevant to regional analgesia. (70%) List the complications associated with TAP block. (30%)

Question 20

a. Which peripheral nerve/s need to be blocked for complete analgesia following repair of a tibial plateau fracture? (30%) b. Describe your technique for blockade of these nerve/s (EXCLUDING central neuraxial blockade). (70%)

Question 21

Draw a cross section of the arm at the level of the axilla illustrating the anatomy relevant to performing a brachial plexus block for surgery on the forearm (50%). List the advantages and disadvantages of a block at this level compared to a supraclavicular block (50%).

Question 22

Describe the anatomy of the brachial plexus relevant to performing and interscalene block under ultrasound guidance. Include a drawing of the real or sono-anatomy you would see in a transverse view of the brachial plexus at the point of needle insertion.

Question 23

Describe the anatomy of the ulnar nerve, relevant to supplementation of an interscalene brachial plexus block which is inadequate for an operation on the hand.

Question 24

Describe the anatomy of the brachial plexus relevant to risks associated with the interscalene block.

Question 25

Describe the anatomy of the brachial plexus relevant to risks associated with the supraclavicular block.

Question 26

Describe the anatomy relevant to an interscalene block for post-operative analgesia.

Question 27

Describe and justify an appropriate strategy for the use of low molecular weight heparin in a patient undergoing knee replacement surgery with an epidural block.

Question 28

Describe the anatomy of the epidural space.

Question 29

Outline guidelines you think should be in place for reducing both the incidence and the morbidity of epidural space infections as a complication of epidural analgesia.

Question 30

Describe the anatomy of the trigeminal nerve relevant to local anaesthesia for dental extraction.

Question 31

Describe the anatomy of the trigeminal nerve and its branches relevant to providing anaesthesia of the teeth and gums.

Question 32

Describe the anatomy relevant to providing an ankle block for surgery on the big toe.

Question 33

Describe the anatomy relevant to providing an ankle block for amputation (surgery on) of the great toe

Question 34

A 60 yo woman presents for elective right bunion surgery. She is hypertensive, controlled on medication, and would like the procedure to be performed under spinal anaesthesia. The surgeon requests this procedure be done under tourniquet control. How would you apply the tourniquet, what pressures would you choose, and what precautions would you take? Three weeks following the surgery, the patient contacts you as she has persistent numbness in her big toe. Describe your management of this situation. Describe in detail how you would perform and ankle block for this patient if spinal anaesthesia was contra-indicated and a tourniquet was not required.

Question 35

Describe a technique of neural blockade in the popliteal fossa for surgery on the foot and ankle including a description of the relevant anatomy.

Question 36

Describe the relevant anatomy and technique for field block for inguinal hernia repair.

Question 37

“A 4 year old boy weighing 15 kg presents for day surgery repair of a left inguinal hernia for which you plan general anaesthesia and a caudal block. He has no significant past history, and is well.
If his parents express concern about caudal analgesia, what alternative analgesia options would you offer? Include a brief comment on their particular advantages and disadvantages.”

Question 38

Describe your technique for performing a continuous paravertebral block in a 50 year old man with fractured 5th – 10th left ribs. Include possible complications and relevant anatomy.

Question 39

Describe the anatomy of the 6th intercostal space at the angle of the rib, relevant to an intercostal nerve block.

Question 40

Describe the anatomy of the penis relevant to providing regional anaesthesia for circumcision in an adult.

Question 41

Describe the anatomy of the penis relevant to providing regional anaesthesia for circumcision in an adult.

Question 42

An otherwise well 20 yo requires circumcision. Describe the anatomy of the penis relevant to providing regional anaesthesia for circumcision in an adult. The patient becomes unconscious after injection of a total of 10 mls of bupivacaine 5mg/ml for penile block. Describe your initial assessment. The patient is found to be in ventricular fibrillation. Describe your management of this situation.

Question 43

Describe the innvervation of the lower abdominal wall from the umbilicus to the pubis symphysis. Describe a technique of peripheral nerve block (not wound infiltration) to provide post-operative analgesia for a low transverse abdominal incision.

Question 44

Give reasons for your choice of local anaesthetic agent to provide intravenous regional anaesthesia for a reduction of a Colle’s fracture in an 80 year old woman weighing 95kg.

Question 45

“An 83 year old woman slips and sustains a left Colles’ fracture after a birthday lunch, and is booked for manipulation and plaster of her fracture.
Discuss the benefits and drawbacks of intravenous regional anaesthesia in this patient. Give reasons for your choice and dose of local anaesthetic agent for intravenous regional anaesthesia.
What hazards does the use of a tourniquet present in this situation, and how might they be minimised.”

Question 46

Describe the anatomy relevant to a digital nerve block of the ring (4th) finger