OCSE

Question 1

What you can’t forget when asking about diabetes? History of micro/macrovascular complicatoons

Answer 1

Micro/Macro vascular complications
When it was diagnosed
Hba1c levels
What have been sugars
Treatment Regimes
If Hba1c% is greater than 8% it is worth to liase with doctors

Question 2

What are the micro vascular complications?

Answer 2

Nephropathy
Retinopathy
Neuropathy
-peripheral neuropathy
-autonomic neuropathy
Macrovascular complications:
- IHD, CVD: hypertension, hyperlipidarmia, nephropathy

Question 3

Ophthalmologic surgery

Answer 3

1. Opthalamic surgery: previous surgery or retinal detachment is contradicted
   2.

Question 4

What questions you should ask if someone had Mi?

Answer 4

Stents

Question 5

What are the pertinent questions to ask when patient present for knee/hip/orthopaedic surgery?

Answer 5

Ask about previous general/regional anaesthesia and patient experience of them!

Question 6

What questions to ask to patient who is hypertensive?

Answer 6

Any ankle sweeping
Orthopnea
Chest pain
SOB

Question 7

What is a poor predictor of outcome in COPD?

Answer 7

FEV less than 1 is poor prognostic sign in terms of respiratory secretions and increased likehood of requiring respiratory support post operatively?

Question 8

What are the side effects of blood patch

Answer 8

Seizure
Infections
Another rural puncture
Arrhythmia
Nerve pain (radiculaitis)

Question 9

What is the lesson learned from analgesia for ex-intravenous drug user?

Answer 9

Patients might not want to have morphine because of the risk of addiction coming back.
Offer epidural/spinal analgesia and that you will discuss with consultant team and other members of the team

Question 10

What do you offer to patients who’s operation has already been cancelled once?

Answer 10

That they operation would be prioritised as it has already been cancelled once.

Question 11

If angry patient wants to talk to surgeon what would you say?

Answer 11

• say you have discussed
• say that someone from surgical team will come over and discuss it with her
• offer to have a senior colleague talking to her

Question 12

What are the indications for awake fibre optic?

Answer 12

• anticipated or difficult airway
  -difficult face mask ventilation
• to reduce risk of aspiration
  -to prevent cardiovascular collapse
• minimise mobilisation of the c-spine

Question 13

What are the absolute contradictions?

Answer 13

Patient refusal/coagulopathy/obstructed airway/allergy to local anaesththethiscs

Question 14

What are the merications?

Answer 14

Nebulisers
Pastes
Sprays
Superior Laryngeal Nerve Block

Anti-sligagoguse such as glyopyrollate

Question 15

What are the complications?

Answer 15

TCI propofol and fentanyl
Failure
Bleeding
Harmatoma
Laryngospasm
Local Anaesthethic toxicity

Question 16

What are the complications?

Answer 16

Failure
Bleeding
Haematoma
Local Anaesthethic Toxicity

Question 17

What is important to ask when asking about emergence?

Answer 17

-induction
-intraoperative
- emergence
-feeling pain
- any discussion with anaesthetists

Question 18

What would you explain to patient presenting with awareness?

Answer 18

That this is:
- emergency situation]-obstetric anaesthesia
-difficult airway

Question 19

What is the difference between EXPLICIT vs IMPLICIT

Answer 19

EXPLICIT - recollection of events
IMPLICIT - poor sleep

Question 20

Child Refusing Surgery points to remember

Answer 20

• offer anxiolytics
• surgery in the morning
• if child is uncooperative postpone the surgery
• restraining might be traumatic for the child and scar them long-term

Question 21

Can child refuse surgery?

Answer 21

A child can consent to surgery if having a full capacity that is in his best interest. A child can’t refuse surgery that is in person best interest.

Question 22

What to do if patient refuses needles?

Answer 22

• canula is not a needle
• for big operations we would need to be checking blood groups

Question 23

Jehowa’s witness blood products?

Answer 23

Clarify: - fractions, plasma, red blood cells, platelets

ask if factor VII would be ok?it is used for treatment of haemophilia
cell salvage

Question 24

what you need to clarify with Jehowa witness?

Answer 24

Would day in life/death situation would they rather die than accept blood products

Do they have advance directive?

Question 25

How would you pre-optimise patient who is Jehowa’s witness and anemic?

Answer 25

the need to treat anemia prior to operation
oral iron if ineffective
EPO should be considered

Question 26

What are the strategises for minimising blood loss?

Answer 26

• hypotensive anaesthesia
• acute hypervolemic haemodilution
• regional anaesthesia