Randomised SAQs 06-24.1 (No Answers)

Question 1

Outline the principles of cardiopulmonary exercise testing (50%) b) Evaluate the role of cardiopulmonary exercise testing in a patient who is scheduled for oesophagectmony (50%)

Answer 1

.x.

Question 2

In a patient who complains of post operative pain, which features of the history and examination suggest a diagnosis of acute neuropathic pain? (50%) b. How would the diagnosis affect your postoperative pain management plan? (50%)

Answer 2

.x.

Question 3

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.

Answer 3

.x.

Question 4

With regard to oxygen therapy for patients in a general postoperative ward a. Describe the options available (30%) b. What are the justifications for your choice for a particular patient? (70%)

Answer 4

.x.

Question 5

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%)

Answer 5

.x.

Question 6

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

Answer 6

.x.

Question 7

A 75-year-old man is scheduled for elective endovascular repair of a thoraco-abdominal aortic aneurysm. List the potential complications of this procedure in this patient and discuss your strategies to mitigate these complications

Answer 7

.x.

Question 8

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%)

Answer 8

.x.

Question 9

While performing an epidural for labour analgesia in an otherwise healthy primigravida in first stage you inadvertently cause a dural puncture with the Touhy needle. Describe and justify your management of this complication.

Answer 9

.x.

Question 10

Describe the clinical features and treatment of fat embolism syndrome

Answer 10

.x.

Question 11

You are asked to assess and anaesthetise a 54-year-old patient for a laparoscopic cholecystectomy. They received a heart transplant ten years ago. Discuss the issues relevant for this patient.

Answer 11

.x.

Question 12

The T-Piece is obsolete in modern anaesthesia practice. Discuss.

Answer 12

.x.

Question 13

List the risks associated with the placement of a central venous catheter? Discuss the ways in which these risks may be modified.

Answer 13

.x.

Question 14

List the risk factors for postoperative nausea and vomiting (PONV) (30%) Evaluate methods to minimise PONV (70%)

Answer 14

.x.

Question 15

A 60-year-old woman is having breast reconstruction surgery using a deep inferior epigastric perforator free flap six months following a mastectomy for breast cancer. Discuss the issues of anaesthetic management relevant for this procedure.

Answer 15

.x.

Question 16

How do you assess an otherwise well patient with regard to difficulty of intubation at the bedside? How accurate is such an assessment?

Answer 16

.x.

Question 17

Describe the pathophysiological effects associated with the use of a pneumatic limb tourniquet and how they can be minimised.

Answer 17

.x.

Question 18

A 2 year old child has burns to lower body from immersion into a hot bath. Describe your assessment and management of pain and fluid requirements in the first 2 hours following injury.

Answer 18

.x.

Question 19

Discuss the management of cerebral vasospasm following coiling of a cerebral aneurysm

Answer 19

.x.

Question 20

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%)

Answer 20

.x.

Question 21

A 45-year-old woman with a large anterior mediastinal mass is scheduled for mediastinoscopy and biopsy. Discuss your preoperative assessment of this patient.

Answer 21

.x.

Question 22

In a large clinical trial, patients were randomised into two groups to study the impact of using a nitrous oxide (N2O) anaesthetic on the incidence of death and other major cardiovascular events.The table below shows the results 70% N2O w 30% O2 Size 3500 Cases 283 Air in 30% O2 size 3500 number 296. Data analysis found that the difference in the incidence of death and major cardiovascular events had a p value of 0.64. The study reported that 70% N2O anaesthesia had a relative risk of death and major cardiovascular events of 0.96 (95% CI 0.82-1.13). Define the following terms and explain their meaning in relation to this study: P-value, Risk reduction, Confidence interval, Odds ratio

Answer 22

.x.

Question 23

Why is the radial artery a common site for arterial cannulation? What complications may occur from radial artery cannulation and how may they be minimised?

Answer 23

.x.

Question 24

Describe the management of a patient who has a total thyroidectomy and develops respiratory distress in the recovery room.

Answer 24

.x.

Question 25

The anaesthetic machine is designed to deliver gases and anaesthetic vapours to patients via a breathing circuit. Outline the safety features of an anaesthetic machine.

Answer 25

.x.

Question 26

A 35-year-old female is booked for thyroidectomy. Her blood results are as follows Thyroid stimulating hormone (TSH, thyrotropin) 0.1 (N 0.3 – 3 mIU/l) Total Thyroxine (Total T4) 20 (N 4 – 11 µg/dl) Free Thyroxine (Free T4) 4 (N 0.7 – 1.8 ng/dl) Free Tri-iodothyronine (Free T3) 120 (N 60 – 175 ng/dl) Interpret the thyroid function tests (10%) b. Justify when you would proceed to thyroidectomy in this patient (50%) c. What is the management of an intraoperative thyrotoxic crisis? (40%)

Answer 26

.x.

Question 27

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

Answer 27

.x.

Question 28

A patient with diabetes mellitus presents fasted on today’s list for elective ileo-femoral bypass surgery. His biochemistry results from this morning are as follows: Na 142 K 6 HCO3 18 C; 105 Urea 12 Cr 300 GFR 30 Interpret these results. List the most likely differential diagnoses. Justify any additional information you require in order to make your diagnosis.

Answer 28

.x.

Question 29

A 65 year old female patient is two hours into debridement and skin grafting for a 40% burn to her thorax and legs. She is intubated and paralysed. An arterial blood gas now shows: pH 7.12 PaO2 150 PaCO2 45 HCO3 15 K 6.3 Outline the potential causes for this patient’s hyperkalaemia. (30%) b. Describe your management of this hyperkalaemia. (70%).

Answer 29

.x.

Question 30

What are the prerequisites for separation from standard cardiopulmonary bypass after uneventful coronary artery bypass surgery? (50%) 2. What are the likely causes of hypotension in the immediate post-separation period? (50%)

Answer 30

.x.

Question 31

What is the role of dexamethasone in the management of postoperative nausea and vomiting? (70%) (b) What are the potential problems associated with its use? (30%)

Answer 31

.x.

Question 32

A 55-year-old male with severe steroid-dependent rheumatoid arthritis requires spinal surgery in the prone position. Discuss your considerations for patient positioning for the procedure.

Answer 32

.x.

Question 33

A patient with a previous spinal cord injury presents for ureteric stenting. Discuss the pathophysiology of autonomic dysreflexia. (50%) Describe the intra-operative manifestations and subsequent management of autonomic dysreflexia. (50%)

Answer 33

.x.

Question 34

Describe the pathophysiology of hypertrophic cardiomyopathy and how this is affected by pregnancy, labour, and vaginal delivery.

Answer 34

.x.

Question 35

Draw a diagram illustrating the bronchial anatomy to level of the lobar bronchi and describe how you would use a fibreoptic bronchoscope to correctly position a right sided double lumen tube

Answer 35

.x.

Question 36

Describe the clinical features of trigeminal neuralgia (50%) b. Discuss the efficacy of the treatment modalities available for this condition. (50%)

Answer 36

.x.

Question 37

An otherwise well 60-year-old man is having a radical prostatectomy. List and briefly evaluate strategies to prevent peri-operative thromboembolism

Answer 37

.x.

Question 38

Describe the anatomy of the orbit in relation to performing a peribulbar block for cataract surgery.

Answer 38

.x.

Question 39

Describe how the safety of anaesthetised patients undergoing surgery is ensured in the event of a power failure to the hospital.

Answer 39

.x.

Question 40

You are called to see a 30 year old man with bilateral fractured femurs. He has been diagnosed with Fat Embolism Syndrome.a. Outline the pathophysiology of Fat Embolism Syndrome? (50%) b. Describe the principles of management of Fat Embolism Syndrome? (50%)

Answer 40

.x.

Question 41

Discuss the implications of anticoagulation as well as an appropriate anticoagulation management strategy for a 25 year old with a mechanical aortic valve for the duration of pregnancy, delivery, and the postpartum period.

Answer 41

.x.

Question 42

An infant born at 30 weeks gestation is booked for repair of bilateral inguinal herniae at 46 weeks post-conceptual age. Discuss the important issues when providing perioperative care for this infant

Answer 42

.x.

Question 43

(a) Describe the arterial blood supply of the spinal cord. (50%) (b) Why is spinal cord function at risk during open repair of a thoracic aortic aneurysm and what measures are available to reduce this risk? (50%)

Answer 43

.x.

Question 44

A 25-year-old man with recurrent pneumothorax and persistent air leak is scheduled for video-assisted thoracoscopic pleurodesis. a. Outline the considerations involved in induction of anaesthesia in a patient with a persistent air leak (50%) b. Outline the management of an intraoperative deterioration of oxygen saturation in this patient (50%)

Answer 44

.x.

Question 45

A 58 year old man presents for tonsillectomy for a tonsillar tumour. He has a 2 year history of intermittent palpitations. His electrocardiogram at diagnosis shows the following (WPW) a. What is the diagnosis? Describe the electrocardiographic changes that support your diagnosis. (30%) Following the administration of neostigmine and atropine for reversal of neuromuscular blockade, you see the following rhythm on your monitor. b. What is this rhythm? How would you manage this situation? (70%) (VF)

Answer 45

.x.

Question 46

A patient’s arterial blood gases include pH 7.1 pCO2 27 HCO3 < 15 What is the acid-base status of this patient and briefly justify your differential diagnosis list. Describe how other biochemical parameters would help identify the cause

Answer 46

.x.

Question 47

A 14-year-old with severe autism is rescheduled for dental surgery. The operation was previously abandoned due to their poor cooperation with the team. Justify your perioperative management plan

Answer 47

.x.

Question 48

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%)

Answer 48

.x.

Question 49

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

Answer 49

.x.

Question 50

A 7-year-old nonverbal girl with severe spastic cerebral palsy is scheduled for cystoscopy. a. Describe the important features of cerebral palsy relevant to planning anaesthesia for this procedure. (70%) b. What are the advantages and disadvantages of inhalational induction in this child? (30%)

Answer 50

.x.

Question 51

Define persistent post surgical pain Outline the interventions that are efficacious in reducing the transition of acute post surgical pain to persistent post surgical pain

Answer 51

.x.

Question 52

Outline the features and clinical management of amniotic fluid embolism

Answer 52

.x.

Question 53

Describe the function of a three-chamber underwater seal chest drainage system. (a diagram may be useful) (50%) b. Evaluate the use of this system in the management of haemopneumothorax secondary to blunt chest trauma?

Answer 53

.x.

Question 54

List the indications and contra-indications for the use of an intra-aortic balloon pump. Describe how its performance is optimised.

Answer 54

.x.

Question 55

(a) What are the complications associated with residual neuromuscular blockade? (30%) (b) Evaluate the methods available to assess residual neuromuscular blockade. (70%)

Answer 55

.x.

Question 56

Outline the steps you would take to ensure safe introduction of elective paediatric surgery at your local private hospital.

Answer 56

.x.

Question 57

Outline the steps necessary to diagnose brain death in a 38 year old woman who is comatose following a subarachnoid haemorrhage.

Answer 57

.x.

Question 58

How could you modify your anaesthetic technique to minimise hypoxia at induction. (70%)

Answer 58

.x.

Question 59

(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%)

Answer 59

.x.

Question 60

An elderly patient has collapsed with a bleed into a known brain tumour and is unable to communicate. An advance health directive has been produced stating she would not wish to receive treatment if the most likely outcome was a significant permanent neurological deficit. Define advance health directive, including its scope and legal status (50%) How would this advance health directive influence decision making around treatment options. (50%)

Answer 60

.x.

Question 61

A child with active upper respiratory tract infection presents for general anaesthesia. a. Outline the factors that increase the rate of adverse respiratory events during anaesthesia. (50%) b. How can you reduce the risk of an adverse event occurring? (50%)

Answer 61

.x.

Question 62

An otherwise well 35-year-old woman is scheduled for ablation of an accessory atrioventricular pathway in the Cardiac Electrophysiology laboratory. What are the implications for anaesthesia and how would you manage them?

Answer 62

.x.

Question 63

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.

Answer 63

.x.

Question 64

(a) List the predisposing factors for pain persisting for more than three months postoperatively. (50%) (b) Outline the interventions that have been demonstrated to be efficacious in the prevention of persistent postoperative pain. (50%)

Answer 64

.x.

Question 65

What do you understand by the term “Universal Precautions”? (40%) b. Describe how you apply these precautions in your daily anaesthesia practice. (60%)

Answer 65

.x.

Question 66

Discuss the principles underlying the management of a general anaesthetic for carotid endarterectomy.

Answer 66

.x.

Question 67

A 70-year-old man has undergone radical prostatectomy under general anaesthesia. On emergence he has crushing central chest pain, is restless, and has cold, clammy skin. His blood pressure is 90/50 mm Hg, pulse rate 110/minute and SpO2 is 95% on oxygen via a Hudson mask. A twelve-lead ECG shows widespread ST segment elevation across the anterior chest leads. a. Describe your immediate management. (50%) b. What are the treatment priorities for this patient? (50%)

Answer 67

.x.

Question 68

Discuss the role of non steroidal anti-inflammatory drugs for post operative analgesia in adult day surgery patients.

Answer 68

.x.

Question 69

Outline the principles of an initial management plan for diabetic ketoacidosis, having regard to the physiological derangements involved

Answer 69

.x.

Question 70

You wish to investigate the effects of a new anaesthesia technique on postoperative patient outcomes. Describe the stages of study design that are important to consider when planning this trial.

Answer 70

.x.

Question 71

How and why is cardiopulmonary resuscitation modified for the pregnant patient at term compared with the non-pregnant patient

Answer 71

.x.

Question 72

A 30-year-old woman at full term collapses in early labour and is unresponsive. List the most likely causes of her collapse. (30%) A presumptive diagnosis of amniotic fluid embolism is made. Describe the immediate and ongoing management of this patient. (70%)

Answer 72

.x.

Question 73

A two-year-old boy scheduled for hypospadias repair is found to have a praecordial murmur. Justify your decision to proceed.

Answer 73

.x.

Question 74

Intensive care patients may be at risk of ventilator-associated pneumonia (VAP). a. Describe the likely aetiology of, and risk factors for, VAP. (50%) b. Outline prevention strategies that reduce the incidence of VAP. (50%)

Answer 74

.x.

Question 75

Describe the differences between biphasic and monophasic manual external cardiac defibrillators. (50%) and What is the “synchronize” button for? When would you use it? (20%) List the potential hazards of defibrillation. (30%)

Answer 75

.x.

Question 76

What are the principles of ventilatory management of patients with acute respiratory distress syndrome (ARDS)?

Answer 76

.x.

Question 77

Four hours after multi-level laminectomy with instrumentation, your patient complains of unilateral visual loss. a. What is your differential diagnosis? (40%) b. How can you minimise the risk of visual complications in the prone patient? (60%)

Answer 77

.x.

Question 78

You are called to see a 30-year-old woman who has collapsed 2 hours post normal vaginal delivery. What is the differential diagnosis?(30%)Outline the clinical features andinvestigations that would support a diagnosis of postpartum haemorrhage. (70%)

Answer 78

.x.

Question 79

How does a residual current device (RCD) work? (30%) Evaluate its usefulness to protect patients from injury. (70%)

Answer 79

.x.

Question 80

A patient is admitted to hospital following a diagnosis of intrauterine fetal death (IUFD) at 35 weeks gestation. Discuss your considerations for the anaesthetic management of her labour and delivery

Answer 80

.x.

Question 81

A 49-year-old woman has just arrived in the Recovery Room following a total abdominal hysterectomy under general anaesthesia. She is agitated and complaining of difficulty breathing. 1. List your differential diagnoses. (40%) 2. How would you determine if this was caused by residual neuromuscular blockade? (40%) 3. What is the role of sugammadex in the treatment of residual neuromuscular blockade? (20%)

Answer 81

.x.

Question 82

Outline your approach to the perioperative management of a patient who gives a strong family history of von Willebrand disease.

Answer 82

.x.

Question 83

A 65-year-old man is on your list for an arthroscopic acromioplasty that is to be performed in the beachchair position. a. List the complications associated with this position (30%) b. Describe how the risk of these complications can be minimised (70%)

Answer 83

.x.

Question 84

A clinical trial is planned to evaluate a new analgesic. Discuss the ethical considerations in having a placebo group in the trial.

Answer 84

.x.

Question 85

Outline the principles of stroke volume variation (SVV) measurement. (50%) b. Describe how SVV measurement can be used to assist haemodynamic optimisation in a patient undergoing major elective abdominal surgery. (50%)

Answer 85

.x.

Question 86

The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and the Surgical Outcome Risk Tool (SORT) are examples of risk scoring systems used for predicting post-operative morbidity and mortality. Evaluate the strengths and weaknesses of these types of risk scoring systems in clinical practice.

Answer 86

.x.

Question 87

Discuss the preoperative elements of an enhanced recovery after surgery (ERAS) Programme for a patient requiring major colorectal surgery.

Answer 87

.x.

Question 88

A patient on the morning endoscopy list lives alone and is planning to return home in a taxi. She has already taken her colonoscopy preparation solution. What are the considerations for discharge planning for this patient?

Answer 88

.x.

Question 89

Discuss the usefulness of the ASA grading as a measure of perioperative risk.

Answer 89

.x.

Question 90

List the patterns of peripheral nerve stimulation that may be used to monitor non-depolarising neuromuscular blockade during anaesthesia and describe how each is used in clinical practice.

Answer 90

.x.

Question 91

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.

Answer 91

.x.

Question 92

Evaluate the merits of large multicentre randomised controlled trials compared with the merits of single-centre observational studies in guiding clinical practice

Answer 92

.x.

Question 93

Describe the clinical features and management of bupivacaine toxicity.

Answer 93

.x.

Question 94

A 3 week old male infant who was born by uncomplicated vaginal delivery at term presents with projectile vomiting for 2 weeks. His weight is now 2.8 kg from a birth weight of 3.1kg. His presumed diagnosis is pyloric stenosis. His blood chemistry results are: Na 129 K 3 Cl 84 HCO3 36 Cr 69 BGL 3. Describe an appropriate fluid resuscitation regime for this infant and list the lab criteria where you would consider him sufficiently resuscitated for surgery

Answer 94

.x.

Question 95

A new randomised controlled trial suggests therapy A is better than therapy B in the treatment of condition X. How would you evaluate this trial before changing your clinical practice?

Answer 95

.x.

Question 96

Outline the steps to ensure the safe storage, handling and administration of blood to a patient once the packed red blood cells (RBC’s) have arrived in the theatre suite.

Answer 96

.x.

Question 97

List the methods of assessing intracranial pressure (ICP) (30%) b. Evaluate the role of ICP monitoring in the setting of traumatic brain injury (70%)

Answer 97

.x.

Question 98

Describe the blood supply to the spinal cord. Explain the determinants of spinal cord perfusion.

Answer 98

.x.

Question 99

You have been asked to provide anaesthesia for a lower uterine segment caesarean section (LUSCS) in a woman at 38 weeks gestation. She has a pacemaker-defibrillator implanted for a known cardiomyopathy. Her current echocardiogram demonstrates an ejection fraction of 35% with mild to moderate left ventricular global hypokinesis. Clinically, the patient feels very well. 1. What additional preparations with respect to her cardiovascular system would you make to ensure the safe management of this patient during her Caesarean Section? 2. Outline the relative benefits and risks of a regional technique compared with general anaesthesia in this patient.

Answer 99

.x.

Question 100

A 25-year-old boilermaker is scheduled for repair of a penetrating eye injury on the emergency list. a. List the determinants of intraocular pressure in general. (30%) b. Discuss the perioperative measures available to minimise increases in intraocular pressure in this patient. (70%)

Answer 100

.x.

Question 101

A 3-year-old presents to the emergency department with a recent onset of stridor. a. List the differential diagnoses (30%) b. How do you differentiate between the potential causes of this stridor? (70%)

Answer 101

.x.

Question 102

The electrolyte results below were taken from a 38 year old woman found obtunded 30 hours after abdominal hysterectomy She had no intercurrent illnesses prior to surgery Explain how these electrolyte abnormalities are most likely to have arisen and describe how you would correct them: Na 110 K 3 Cl 80 HCO3 25 BGL 5 Urea 3 Cr 0.06 (RR 0.06-0.12) OSM 225 (RR 280-295)

Answer 102

.x.

Question 103

A 25-year-old female with longstanding C5-6 quadriplegia requires ureteric stent insertion. Outline the implications for anaesthesia.

Answer 103

.x.

Question 104

Describe the strengths and weaknesses of the the fascia iliaca and femoral blocks for the provision of analgesia during surgery for repair of a fractured neck of femur.

Answer 104

.x.

Question 105

A six-week-old term baby weighing 4.0 kg requires pyloromyotomy for pyloric stenosis. How would you assess the baby’s hydration status? (50%) Detail and justify your resuscitation regimen. (50%)

Answer 105

.x.

Question 106

Justify your choice and dosing of drugs when providing anaesthesia for electroconvulsive therapy (ECT).

Answer 106

.x.

Question 107

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%)

Answer 107

.x.

Question 108

A drug has been unintentionally administered through a radial arterial line in an awake patient. Describe your management of this situation.

Answer 108

.x.

Question 109

List the advantages and disadvantages of opioid-free approaches for laparoscopic sleeve gastrectomy. (50%) Justify your choice of opioid-free technique for this procedure. (50%)

Answer 109

.x.

Question 110

Describe the aims of a quality assurance program. (40%) b. Outline the steps you would take to set up a quality assurance program for your anaesthesia department. (60%)

Answer 110

.x.

Question 111

Outline the anatomical relations of the internal jugular veins highlighting how the left internal jugular vein differs from the right. (70%) Describe how the anatomy relates to complications that may arise at the time of central venous cannulation. (30%)

Answer 111

.x.

Question 112

Outline extubation strategies for anticipated difficult extubation of an adult.

Answer 112

.x.

Question 113

A 30YO patient is scheduled for laser resection of a subglottic mass to relieve mild stridor. Justify your intraoperative anaesthetic management of this case

Answer 113

.x.

Question 114

A 60 year old man develops a large haemo/pneumothorax following attempted insertion of a haemodialysis catheter via the left subclavian route. Describe your technique of chest tube insertion to drain this and the features of the pleural drainage system you would connect to it.

Answer 114

.x.

Question 115

Describe the requirements for establishing an anaesthetic service for a neurosurgical theatre with a magnetic resonance imaging scanner

Answer 115

.x.

Question 116

A 75-year-old lady scheduled for total knee replacement is currently using a fentanyl patch (75 µg/hour) for analgesia to manage her knee pain. Discuss how this influences your perioperative pain management.

Answer 116

.x.

Question 117

As a perioperative physician, what strategies can you offer to assist a patient to cease smoking tobacco and how will you best communicate them?

Answer 117

.x.

Question 118

You are asked to give a practical tutorial on paediatric airway management to Emergency Department registrars at a large hospital. What are the important aspects of paediatric airway management that you would present to them?

Answer 118

.x.

Question 119

Discuss the advantages and disadvantages of non-invasive ventilation methods in the intensive care unit.

Answer 119

.x.

Question 120

An elderly patient has previously declined an above knee amputation for a gangrenous leg. She becomes acutely unwell, confused and no longer competent to make decisions. At the request of the family, the surgeon has approached you to discuss whether to proceed with surgery or not. She is likely to die without the surgery. Outline the ethical considerations you would discuss with the surgeon

Answer 120

.x.

Question 121

A 34 year old woman presents at 36 weeks with an anterior placenta previa and Caesarean section is scheduled She has no intercurrent health problems She has a history of two previous Caesarean sections under regional anaesthesia Describe and justify the changes this history would make to your routine preoperative and intra operative management plan for caesarean section

Answer 121

.x.

Question 122

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. (30%)

Answer 122

.x.

Question 123

Describe the physiological effects of pneumoperitoneum with CO2 for laparoscopic surgery

Answer 123

.x.

Question 124

A 40-year-old woman presents having been trampled on by a horse. She has a compound fracture of her arm requiring surgery and bruising over the centre of the chest with a fractured sternum. List the injuries to the heart that may be caused by this blunt trauma. If she had no signs or symptoms of cardiac injury list and justify any screening investigations for cardiac injury you would perform prior to anaesthesia.

Answer 124

.x.

Question 125

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%)

Answer 125

.x.

Question 126

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?

Answer 126

.x.

Question 127

A 34 year old, opioid-dependant woman is complaining of severe pain on the day after a first metatarsal osteotomy. The nurses are concerned she is drug-seeking. a. How would you assess this patient? (60%) b. Outline your pain management plan. (40%)

Answer 127

.x.

Question 128

A 9-year-old girl with cerebral palsy is scheduled to undergo bilateral femoral varus derotation osteotomy and adductor lengthening. Outline the challenges of providing effective postoperative analgesia for her surgery and discuss the analgesia options available

Answer 128

.x.

Question 129

An otherwise well 60-year-old man is having a radical prostatectomy List and briefly evaluate strategies to prevent peri-operative thromboembolism

Answer 129

.x.

Question 130

A 68-year-old man is scheduled for total knee replacement next week. He has hypertension, for which he is prescribed enalapril, and type 2 diabetes, for which he is prescribed metformin. Justify your perioperative management of his medications.

Answer 130

.x.

Question 131

Why can hypoxaemia occur after changing from two lung to one lung ventilation? 50% b. Describe the treatment of hypoxaemia in one lung ventilation (50%)

Answer 131

.x.

Question 132

A 16-year-old girl has failed to wake from anaesthesia following posterior instrumentation for severe idiopathic scoliosis. Discuss the potential causes and management of her failure to wake.

Answer 132

.x.

Question 133

An elderly patient is scheduled for total hip replacement and has been taking oxycodone 40mg twice daily in the last six months for severe hip pain. What issues do you anticipate with regard to her oxycodone use? (50%) How do these issues influence your postoperative management? (50%)

Answer 133

.x.

Question 134

A 55-year-old patient with atrial fibrillation (AF) requires general anaesthesia in the cardiac catheter laboratory for electrophysiological (EP) study and catheter ablation. Discuss the principles of remote location anaesthesia relevant to this case.

Answer 134

.x.

Question 135

A 40 year old, otherwise healthy male presents following a subarachnoid haemorrhage. He is scheduled for clipping of the middle cerebral artery aneurysm. Outline the major issues in providing anaesthesia for this patient and describe how you would address them.

Answer 135

.x.

Question 136

You are asked to evaluate a 35-year-old patient who has been scheduled for mediastinoscopy to biopsy a symptomatic anterior mediastinal mass a. Discuss the features specific to this condition that need to be considered when planning an anaesthetic for this patient. (50%) b. Describe how you may need to adapt your anaesthetic plan in response to each of these features. (50%)

Answer 136

.x.

Question 137

An adult patient from the intensive care unit with severe adult respiratory distress syndrome (ARDS) requires a laparotomy for an acute abdomen. a. What are the features of ARDS? (30%) b. Explain your perioperative ventilation strategy (70%)

Answer 137

.x.

Question 138

A previously well 80kg, 19 year old male is anaesthetised for an open reduction, internal fixation of a fractured tibia and fibula. He has a rapid sequence induction including suxmethonium and is intubated and ventilated via circle system at 12 breaths per minute and a tidal volume of 700ml with an FiO 2 of 0.5. He has had 500mcg of Fentanyl and anaesthesia is maintained with 1.5 MAC Sevo. He develops and increasing sinus tachycardia to 160/min with frequent ventricular extopic beats (VEBs) and his end tidal CO2 rises to 60mmHg despite increasing his ventilation. There is no rebreathing evident on capnography. ABG shows: pO2 105 mmHg pCO2 65mmHg pH 7.12 HCO3 20.7 BE -10 Outline the steps you would follow to manage this situation

Answer 138

.x.

Question 139

A 60-year-old patient is scheduled for stenting of a tracheobronchial mass. Outline your perioperative management.

Answer 139

.x.

Question 140

Evaluate the role of tramadol in acute and chronic pain management.

Answer 140

.x.

Question 141

A sixty-five year old woman presents for a total abdominal hysterectomy. She has non-insulin dependent diabetes mellitus that is normally controlled with an oral hypoglycaemic agent. Describe your perioperative management of her blood sugar.

Answer 141

.x.

Question 142

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.

Answer 142

.x.

Question 143

A patient with myasthenia gravis presents for emergency laparotomy for small bowel obstruction. Discuss your perioperative management of this patient including your choice of anaesthetic.

Answer 143

.x.

Question 144

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%)

Answer 144

.x.

Question 145

Describe the anatomy relevant to performing a femoral nerve block at the level of the inguinal ligament (50%) 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%)

Answer 145

.x.

Question 146

This is the standard 12-lead electrocardiogram (ECG) of a 56-year-old man in the post-anaesthesia care unit (PACU) two hours after an emergency laparotomy for bowel obstruction. He is complaining of shortness of breath, abdominal pain and has a blood pressure of 160/110mmHg t-wave inversions in II, III avf with ST depression in V5 and V6. He has a history of hypertension controlled with atenolol and hydrochlorothiazide. The preoperative ECG is missing. The anaesthetic assessment only notes that it showed sinus rhythm. Considering all the clinical information, interpret this ECG and outline the appropriate management of this patient in PACU

Answer 146

.x.

Question 147

A 6-month-old boy presents with an acute abdomen. He is diagnosed with intussusception and booked for laparotomy after a failed attempt at reduction. His heart rate is 160bpm and BP is 75/45 mmHg. His electrolyte profile is as shown: Na 132 K 2.7 Cl 106 Urea 3.3 (RR 3.5-8.5) Cr 86 (RR 60-110) Lac 4.5 (RR 1-1.8) (a) How would you determine his degree of dehydration and how severe is it likely to be? (40%) (b) Describe your perioperative fluid management. (40%) (c) When would you proceed to surgery and why? (20%)

Answer 147

.x.

Question 148

You are asked to provide anaesthesia for cardioversion for a 60-year-old male with atrial fibrillation. Which factors influence the success of the cardioversion, and a safe outcome?

Answer 148

.x.

Question 149

List the hazards to the patient associated with the prone position under general anaesthesia. (60%) How can these hazards be minimised? (40%)

Answer 149

.x.

Question 150

A 75-year-old patient presents for lower limb angioplasty and stenting for peripheral vascular disease. Discuss the challenges in providing anaesthesia for this patient.

Answer 150

.x.

Question 151

A patient has smoked 20 cigarettes a day for over 25 years. 1. What are the expected physiological changes that would occur in the first 3 months following cessation of smoking? Include a time frame for the changes you describe. (60%) 2. What are the clinical benefits, with regard to anaesthesia, of smoking cessation in this patient? (40%)

Answer 151

.x.

Question 152

A patient with known primary pulmonary hypertension is scheduled to undergo elective umbilical hernia repair. How will you assess the severity of this patient’s pulmonary hypertension? (50%) How does this diagnosis affect your perioperative management of this patient? (50%)

Answer 152

.x.

Question 153

While performing an epidural for labour analgesia in an otherwise healthy primigravida during the first stage of labour you inadvertently cause a dural puncture with the Tuohy needle. Discuss your management of this complication.

Answer 153

.x.

Question 154

Discuss the consequences of perioperative hypothermia.

Answer 154

.x.

Question 155

The Mallampati test is a commonly used bedside screening tool to assess the probability of a difficult intubation. Explain the terms sensitivity, specificity, positive predictive value, and negative predictive value when applied to this test.

Answer 155

.x.

Question 156

A patient takes a 60mg slow-release morphine tablet twice daily for chronic low back pain. They have been appropriately investigated and there is no surgically treatable pathology. In relation to this patient List the risks of long-term opioid therapy. (30%) Justify the appropriate treatment of chronic low back pain. (70%)

Answer 156

.x.

Question 157

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%

Answer 157

.x.

Question 158

You are asked to provide assistance to resuscitate a baby one minute after the birth The baby is apneic grey blue all over floppy and unresponsive to stimulation with a pulse felt In the umbilical cord stump at 60 per minute What is this, babies APGAR score? Describe your resuscitation of the baby

Answer 158

.x.

Question 159

What are the issues associated with jet ventilation?

Answer 159

.x.

Question 160

Describe the factors that influence emergence delirium in children. (50%) b. How would you manage emergence delirium in a 3 year old child having had myringotomy tubes inserted under general anaesthesia? (50%)

Answer 160

.x.

Question 161

Outline the advantages and disadvantages of using the paediatric circle system and the Jackson-Rees modification of Ayre’s T-piece (Mapleson F) for anaesthesia in a 15 kg child.

Answer 161

.x.

Question 162

You are covering ICU in your local district hospital when a 14-year-old boy presents to your emergency department obtunded and hypotensive with a rash suggestive of meningococcal sepsis Describe your resuscitation

Answer 162

.x.

Question 163

Discuss the perioperative implications for a patient known to use methamphetamine.

Answer 163

.x.

Question 164

A patient is scheduled on your list for arthroscopic shoulder surgery. The surgery is to be performed in the beach chair position. List the problems associated with this position and describe how you could minimise them

Answer 164

.x.

Question 165

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%)

Answer 165

.x.

Question 166

Evaluate the role of gabapentin in acute and chronic post surgical pain management

Answer 166

.x.

Question 167

Outline the key steps in gaining informed consent for anaesthesia in a competent ASA 1 adult undergoing minor elective surgery

Answer 167

.x.

Question 168

An 18 year old otherwise healthy female is to have 2 impacted wisdom teeth surgically removed as a day stay patient. Describe and justify features of your anaesthetic technique that may help prevent the common postoperative problems you would anticipate in this patient.

Answer 168

.x.

Question 169

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

Answer 169

.x.

Question 170

A patient is undergoing femoro-popliteal artery bypass grafting for intermittent claudication under spinal anaesthesia with no sedation. Discuss this patient’s intraoperative arterial blood gas result: FiO2 0.5 Temp 36.5 pH 7.235 PaO2 145 PaCO2 50 HCO3 15 BE -6 Lact 3.5

Answer 170

.x.

Question 171

You are asked to anaesthetise an 80-year-old lady with dementia and a fractured neck of femur. She is on no other medication. 1. What are the issues in assessing pain in this patient? (50%) 2. What would you prescribe for postoperative analgesia and why? (50%)

Answer 171

.x.

Question 172

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.

Answer 172

.x.

Question 173

Define frailty and discuss the role of prehabilitation for patients with frailty.

Answer 173

.x.

Question 174

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%)

Answer 174

.x.

Question 175

Considering the indications and limitations, compare the rationale for the use of: —Hudson masks —Non-rebreathing masks —Nasal prongs

Answer 175

.x.

Question 176

A 70 year old female had a cardiac arrest after arriving in the Recovery Room following open fixation of a femoral fracture. This arterial blood gas was taken after intubation and several minutes of CPR. The ABG shows a mixed severe respiratory and metabolic acidosis. Describe your management and differentials for this ABG

Answer 176

.x.

Question 177

Describe the pathophysiological effects of carbon dioxide pneumoperitoneum during a surgical procedure.

Answer 177

.x.

Question 178

A 30 year old patient with myasthenia gravis presents for orthopaedic procedure and refuses a regional anaesthetic technique a.What are the signs and symptoms of myasthenia gravis? (30%) b.How does the disease affect your anaesthetic management?(70%)

Answer 178

.x.

Question 179

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%)

Answer 179

.x.

Question 180

Outline how oxygen is stored at the hospital and delivered to operating theatres up to and including the wall outlet. In your answer include features that ensure the safety of the system

Answer 180

.x.

Question 181

A 22-year-old primigravida at 31 weeks gestation is admitted to hospital with a diagnosis of severe pre-eclampsia. Her blood pressure is 180/115 mmHg. Describe the symptoms and signs she may have due to her pre-eclampsia. (50%) Outline the appropriate immediate management of this patient. (50%)

Answer 181

.x.

Question 182

Discuss the significance of anticipated changes in blood pressure during anaesthesia and in the post anaesthesia care unit in a patient undergoing carotid endarterectomy. (50%) Outline strategies to manage these changes. (50%)

Answer 182

.x.

Question 183

As the on-duty specialist anaesthetist, you are asked to see a previously well 64 year-old man in the PACU with SpO2 of 85% two hours after laparoscopic right partial nephrectomy during which he lost 1 litre of blood. a) List the likely causes of the desaturation? (30%) b) Outline your approach to managing the patient’s hypoxaemia. (70%)

Answer 183

.x.

Question 184

Discuss in detail the technique of rapid sequence induction with cricoid pressure in a child. Include the reasons for your choice of relaxant.

Answer 184

.x.

Question 185

Discuss the elements you consider important when obtaining consent for epidural analgesia in labour.

Answer 185

.x.

Question 186

A 30-year-old patient with myotonic dystrophy is scheduled for surgery for acute appendicitis. Outline the important factors in the preoperative assessment of this patient. (50%) Describe how this patient’s myotonic dystrophy will affect your anaesthetic management.(50%)

Answer 186

.x.

Question 187

A 6-year-old girl with severe spastic cerebral palsy presents for major orthopaedic surgery to correct lower limb deformities Outline the implications of cerebral palsy for anaesthesia management for this operation

Answer 187

.x.

Question 188

Describe the clinical presentation of venous carbon dioxide embolism during laparoscopic surgery and outline your management

Answer 188

.x.

Question 189

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%)

Answer 189

.x.

Question 190

What are the considerations when anaesthetising a patient for a complex laparoscopic ultra-low colonic resection?

Answer 190

.x.

Question 191

A 60-year-old lung cancer patient is planned to undergo an open thoracotomy, involving possible rib resection. List the regional techniques available for post-operative pain management and justify your choice of regional technique for this patient. (50%) Outline your management plan if pain is still present at the operative site 14 days later. (50%)

Answer 191

.x.

Question 192

Describe the indications for referral for an antenatal anaesthetic assessment.

Answer 192

.x.

Question 193

A 30-year-old woman who is 28 weeks pregnant has been referred to your tertiary high-risk obstetric clinic. She has complex cyanotic heart disease and now functions with a Fontan circulation. How would you stratify her cardiovascular risk? (30%) What are the relevant anaesthetic issues for this patient? (70%)

Answer 193

.x.

Question 194

Compare and contrast first-generation and second-generation laryngeal mask airways

Answer 194

.x.

Question 195

A. List the clinical features that support a diagnosis of malignant hyperthermia in an anaesthetised patient. (30%) B. Describe your immediate management of suspected malignant hyperthermia. (70%)

Answer 195

.x.

Question 196

Describe the pathophysiological changes associated with a haemoglobin of 75 g/L. (50%) 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%)

Answer 196

.x.

Question 197

Draw flow volume loops associated with a) Fixed upper airway obstruction b) Variable extrathoracic airway obstruction c) Variable intrathoracic airway obstruction Explain briefly the physiological reasons for the shape of these loops.

Answer 197

.x.

Question 198

Critically evaluate the role of recombinant factor VIIa in blood loss requiring massive transfusion in the trauma patient

Answer 198

.x.

Question 199

Outline the clinical features, differential diagnoses, and management of serotonin syndrome in the perioperative period.

Answer 199

.x.

Question 200

Describe the principles of cerebral protection in a patient with an isolated closed head injury.

Answer 200

.x.

Question 201

Critically evaluate the use of Beta blockers in the perioperative period to prevent myocardial infarction.

Answer 201

.x.

Question 202

Outline the physiological implications of brainstem death following subarachnoid haemorrhage in a patient listed for organ donation.

Answer 202

.x.

Question 203

List methods to prevent hypothermia in paediatric patients during anaesthesia and surgery, commenting on the effectiveness of each.

Answer 203

.x.

Question 204

Describe the principles that are important in making clinical research ethical.

Answer 204

.x.

Question 205

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%)

Answer 205

.x.

Question 206

A developmentally delayed, unco-operative adult requires a magnetic resonance imaging scan (MRI) for investigation of deteriorating control of seizures. What issues do you foresee in terms of providing general anaesthesia in the MRI suite for this patient

Answer 206

.x.

Question 207

Operating theatres starting late have been identified as a problem in your hospital. How would you design and implement a quality improvement program to assess and improve operating theatre starting times in your hospital?

Answer 207

.x.

Question 208

A 78-year-old female presents for fixation of a displaced femoral fracture. She has longstanding mitral regurgitation and is known to have a mean pulmonary artery pressure of 60mmHg. She reports orthopnoea but is not short of breath at rest. (a) What are the issues of concern in your preoperative assessment? (50%) (b) How would you manage pulmonary vascular resistance perioperatively? (50%)

Answer 208

.x.

Question 209

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?

Answer 209

.x.

Question 210

Outline the circumstances where the dosing of paracetamol requires modification 50% Described the management principles of paracetamol toxicity 50%.

Answer 210

.x.

Question 211

Describe the pathophysiological effects of an inhalational injury following a house fire. (60%) b. What implications would this have for anaesthesia one week after the injury? (40%)

Answer 211

.x.

Question 212

You are the anaesthetist at a Children’s Hospital A 3 year old child scheduled for dental restoration and extractions is found to have a systolic murmur during your preoperative assessment on the day of surgery They have been on a waiting list for six months and have had a dental abscess that settled with antibiotics Describe how you would evaluate the significance of this murmur and how this evaluation would affect your decision to proceed or not with surgery

Answer 212

.x.

Question 213

Describe the cardiovascular changes which occur during clamping and unclamping of the supra-renal aorta during repair of an abdominal aortic aneurysm in a patient with normal ventricular function and outline your strategies to maintain critical organ perfusion during these times

Answer 213

.x.

Question 214

Describe the physiological effects of a high-flow nasal cannula device (HFNC) e.g. OptiflowTM or AirvoTM. (50%) Justify its use in an adult endoscopy suite. (50%)

Answer 214

.x.

Question 215

A patient presents on the day of surgery with a blood pressure of 180/110mmHg. Justify your decision to proceed with or postpone surgery for this patient.

Answer 215

.x.

Question 216

Discuss your considerations when anaesthetising a patient for functional endoscopic sinus surgery.

Answer 216

.x.

Question 217

Why is consent for a medical procedure necessary? What makes consent for a medical procedure valid?

Answer 217

.x.

Question 218

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

Answer 218

.x.

Question 219

Outline the considerations for successful weaning from cardiopulmonary bypass after coronary artery graft surgery.

Answer 219

.x.

Question 220

Discuss the usefulness of the continuous measurement of mixed venous oxygen saturation in the intensive care patient

Answer 220

.x.

Question 221

The first patient on your orthopaedic list tomorrow is scheduled for left total hip replacement. He has an implanted (permanent) cardiac pacemaker. Discuss the relevant factors in your pre-anaesthetic assessment of this patient.

Answer 221

.x.

Question 222

Describe the anatomy relevant to cannulation of the subclavian vein via the infraclavicular approach.

Answer 222

.x.

Question 223

(a) Describe the clinical pharmacology of codeine including an outline of its therapeutic use. (70%) (b) Describe the influence of pharmacogenetics on the variability of patient response to codeine. (30%)

Answer 223

.x.

Question 224

Describe the rationale for the use of deep hypothermic circulatory arrest and outline the pathophysiological consequences of this technique.

Answer 224

.x.

Question 225

What symptoms and signs suggest the presence of sleep apnoea in a patient presenting for preoperative assessment? How does the presence of sleep apnoea alter your anaesthetic plan?

Answer 225

.x.

Question 226

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

Answer 226

.x.

Question 227

Define the terms ‘train-of-four’ (TOF) and ‘double burst stimulation’ (DBS) with respect to a peripheral nerve stimulator (PNS). (30%)

Answer 227

.x.

Question 228

A woman who is 10 weeks pregnant presents to the Emergency Department with a closed tibial shaft fracture. 1. Classify the drugs used in pain management according to their safety to use at this stage of pregnancy. (40%) 2. What are the options available for perioperative pain management for this patient? (30%) 3. What would you recommend? Justify your choice. (30%)

Answer 228

.x.

Question 229

Explain the professional attributes of an anaesthetist in specialist practice.

Answer 229

.x.

Question 230

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

Answer 230

.x.

Question 231

Describe the anatomy relevant to performing a caudal block in a two-year-old male.

Answer 231

.x.

Question 232

A 24-year-old female with cystic fibrosis is scheduled to undergo elective breast surgery. How does the presence of cystic fibrosis affect your perioperative management of this patient for this procedure?

Answer 232

.x.

Question 233

Evaluate the use of 10% povidone−iodine compared to 0.5% chlorhexidine/70% isopropyl alcohol as skin preparation prior to the institution of lumbar epidural analgesia.

Answer 233

.x.

Question 234

Outline the features of the anaesthetic machine that ensure safe gas delivery to the patient.

Answer 234

.x.

Question 235

Outlined the problems in providing general anaesthesia for an adult in the MRI suite

Answer 235

.x.

Question 236

Describe your technique to provide caudal epidural anaesthesia for an infant weighing 10 kilograms undergoing hypospadias surgery.

Answer 236

.x.

Question 237

(a) How would you clinically assess a patient complaining of leg numbness the day after a spinal anaesthetic for an emergency caesarean section? (70%) (b) How would you manage the situation? (30%)

Answer 237

.x.

Question 238

A patient is anaesthetised for video-assisted thoracoscopic resection of the left upper lobe. At the completion of surgery, the double-lumen tube is in situ and the patient has persistent hypoxia. List the potential causes of hypoxia in this situation. (30%) How will you manage this? (70%)

Answer 238

.x.

Question 239

What are the benefits and limitations of red blood cell salvage? (50%) How would you justify its introduction into your institution? (50%)

Answer 239

.x.

Question 240

List the signs of malignant hyperthermia. (30%) Outline the immediate management of a patient where malignant hyperthermia is suspected. (70%)

Answer 240

.x.

Question 241

Discuss the key areas of concern in your preoperative assessment of a patient for excision of a large tonsillar mass.

Answer 241

.x.

Question 242

For the following devices, describe the design features that ensure the safe delivery of oxygen during anaesthesia: a) cylinders b) pipeline oxygen delivery systems c) anaesthesia machines

Answer 242

.x.

Question 243

What are the advantages and disadvantages of general versus local anaesthesia for carotid endarterectomy?

Answer 243

.x.

Question 244

Discuss the perioperative management of a previously well patient presenting for transphenoidal resection of a non-secreting pituitary macroadenoma

Answer 244

.x.

Question 245

Evaluate the use of intravenous lignocaine infusions for perioperative analgesia.

Answer 245

.x.

Question 246

A 24-year-old woman requires urgent manual removal of placenta due to ongoing bleeding following a vaginal delivery (estimated blood loss 1500ml). Outline your initial management prior to her arrival in theatre. (50%) Discuss the options available for managing persistent uterine atony in theatre. (50%)

Answer 246

.x.

Question 247

List the factors associated with increased mortality following rib fractures. (30%) Describe a comprehensive rib fracture management plan. (70%)

Answer 247

.x.

Question 248

Define circulatory shock Categorise the causes of circulatory shock and give an example in each category.

Answer 248

.x.

Question 249

A young adult male is assaulted and sustains a maxillary fracture. He is scheduled for an open reduction and internal fixation (ORIF) of the maxillary fracture on the emergency list. Outline the relevant anaesthetic considerations

Answer 249

.x.

Question 250

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%)

Answer 250

.x.

Question 251

You are asked to anaesthetise a two-year-old child for an eight-hour craniotomy. The child is susceptible to developing malignant hyperthermia. Outine your strategies for obtaining intravenous access in this child. (50%) Discuss the issues of using a total intravenous technique in this situation. (50%)

Answer 251

.x.

Question 252

Discuss the role of desflurane in current anaesthesia practice

Answer 252

.x.

Question 253

List the risk factors for the development of chronic pain following a surgical procedure. Outline possible mechanisms for the progression of acute to chronic pain

Answer 253

.x.

Question 254

A patient with known idiopathic pulmonary fibrosis (fibrosing alveolitis) presents for an open right hemicolectomy. (a) What are the respiratory issues facing this patient with regard to their general anaesthetic? (70%) (b) Explain your intraoperative ventilation strategy. (30%)

Answer 254

.x.

Question 255

Describe your immediate assessment and management of the airway in a patient with smoke inhalation injury.

Answer 255

.x.

Question 256

Identify the axes A & B (with units) and the points labelled C to H on a standard spirometry loop. Outline healthy spirometry parameters change in - Chronic obstructive pulmonary disease - Idiopathic pulmonary fibrosis - Extrathoracic tracheal obstruction

Answer 256

.x.

Question 257

Outline the pharmacological features of remifentanil. (50%) Describe how these features can be utilised when using remifentanil in clinical practice. (50%)

Answer 257

.x.

Question 258

Describe a technique of peribulbar block for cataract surgery. Describe how you would minimise complications of this block.

Answer 258

.x.

Question 259

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%)

Answer 259

.x.

Question 260

A trauma patient presents thirty minutes after a significant crush injury, with an estimated 40% blood loss. He was previously well. 1. Explain the coagulation abnormalities you would expect in this patient at this stage. (60%) 2. Discuss the current evidence for treatment of these abnormalities. (40%)

Answer 260

.x.

Question 261

Describe the elements of informed consent for anaesthesia. (50%) Discuss the informed consent process in the context of the following clinical situations: (50%) a). A 20-year-old primigravida in late first stage of labour requests epidural analgesia. b). A 15-year-old is scheduled for posterior spinal instrumentation for severe idiopathic scoliosis

Answer 261

.x.

Question 262

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.

Answer 262

.x.

Question 263

Explain the features of the electrical power supply to operating theatres that protect patients from marcoshock.

Answer 263

.x.

Question 264

43 year old female with a Grade 1 subarachnoid haemorrhage is scheduled for coiling of her middle cerebral artery in the radiology suite. Discuss the important issues to consider when providing anaesthesia for this patient

Answer 264

.x.

Question 265

You will be anaesthetising a 63-year-old man with severe Parkinson’s disease who is booked for an inguinal hernia repair. Discuss the issues that are relevant to providing perioperative care for this patient

Answer 265

.x.

Question 266

Ambulance officers performing CPR with bag and mask ventilation. She has been rescued from a swimming pool. (1) Describe how basic life support should be provided in the emergency department. She has no pulse and her ECG shows ventricular fibrillation. (2) Outline the advanced life support algorithm you would now follow

Answer 266

.x.

Question 267

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

Answer 267

.x.

Question 268

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.

Answer 268

.x.

Question 269

Discuss the preoperative assessment for a patient who presents for thyroidectomy.

Answer 269

.x.

Question 270

Describe the principles behind an “Enhanced Recovery After Surgery (ERAS)” programme for colorectal surgery. (50%) b. Outline the key steps you would take in setting up this programme in your hospital

Answer 270

.x.

Question 271

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

Answer 271

.x.

Question 272

A 40 year old requires a laparotomy ten days after an isolated traumatic spinal cord transection at C6. Outline the key anaesthetic issues. (50%) How would these influence your anaesthetic management? (50%)

Answer 272

.x.

Question 273

A patient is undergoing revision parathyroidectomy. At the surgeon’s request, you have placed a Nerve Integrity Monitor (NIM) tube for monitoring recurrent laryngeal nerve function. The surgeon is unable to elicit a response from the monitor when stimulating the recurrent laryngeal nerve. a. Explain how the NIM tube monitors nerve function? (30%) b. Outline the possible causes of being unable to elicit a response and how you would manage them? (70%)

Answer 273

.x.

Question 274

Describe the role of the anaesthetist in minimising surgical site infection.

Answer 274

.x.

Question 275

How is the need for manual in-line stabilisation of the neck determined? (50%) b. What are the implications of inline stabilisation for endotracheal intubation of the airway (50%).

Answer 275

.x.

Question 276

Discuss the safe use of arterial tourniquets for orthopaedic procedures.

Answer 276

.x.

Question 277

You are the consultant who has been tasked with introduction of the WHO SSCL (surgical safety checklist) to your hospital. 1. What are the principles behind the checklist that enhance patient safety, with reference to each component? (70%) 2. What do you expect the barriers to its effective implementation to be? (30%)

Answer 277

.x.

Question 278

A 25 year old man with a history of blunt trauma to the right side of his head has a fixed and dilated right pupil. He has been intubated and ventilated in the emergency department after an initial Glasgow Coma Score (GCS) of 15 on admission had fallen to 3. Evaluate the pharmacological and non-pharmacological methods to manipulate this patient’s intracranial pressure?

Answer 278

.x.

Question 279

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.

Answer 279

.x.

Question 280

List the advantages and disadvantages of tight glycaemic control perioperatively in a diabetic patient on insulin. (30%) How would you manage the glycaemic control for such a patient having a minor procedure under general anaesthesia? (70%)

Answer 280

.x.

Question 281

A patient who is 6 weeks post cardiac surgery has a pericardial effusion requiring treatment. Outline the symptoms and signs of this condition. (70%) Which of these features would trigger an urgent intervention? (30%)

Answer 281

.x.

Question 282

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.

Answer 282

.x.

Question 283

A patient is scheduled for posterior fossa surgery in the sitting position. (a) Outline the precautions you would take to minimise the risk of venous air embolism. (70%) (b) How would you recognise an air embolism intraoperatively? (30%)

Answer 283

.x.

Question 284

What is evidence based medicine. (30%) b. Describe the features of a systematic review, indicating how it may influence your practice of anaesthesia. (70%)

Answer 284

.x.

Question 285

A 30-year-old male is scheduled to undergo complex lower limb reconstructive surgery expected to last 18 hours. Discuss the issues associated with this prolonged procedure.

Answer 285

.x.

Question 286

Your patient is midway through a laparoscopic cholecystectomy. You smell smoke and can see flames in the room adjacent to your theatre. Describe your management of this situation

Answer 286

.x.

Question 287

This is the standard 12-lead electrocardiogram (ECG) of a 76-year-old woman in the postanaesthesia care unit following a total knee replacement (AF). She has hypertension and type 2 diabetes, and her preoperative ECG showed sinus rhythm with a rate of 82 /minute. Interpret the ECG. Outline your initial management and develop a plan in the event of the rhythm disturbance persisting

Answer 287

.x.

Question 288

A patient with chronic liver disease requires gastroscopy for investigation of chronic anaemia. A preoperative arterial blood gas (ABG) on room air demonstrates: pH 7.49 PCO2 29 O2 52 HCO3 22.6 BE -/04 SaO2 89% Interpret this ABG and list possible causes of hypoxia in this patient. (50%) Justify your anaesthetic technique for gastroscopy in this patient. (50%)

Answer 288

.x.

Question 289

Describe your responsibilities as the anaesthetist before you leave your patient in the post anaesthesia care unit (PACU). (50%) Your patient has been in the PACU for an hour. The nurse asks you to change the discharge criteria so the patient can be discharged to the ward. Discuss your decision making process following this request. (50%)

Answer 289

.x.

Question 290

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

Answer 290

.x.

Question 291

A patient is scheduled to undergo prolonged steep head-down surgery. Outline the potential anaesthetic implications of this position in this situation. (50%) .Describe how you would modify your anaesthetic plan to minimise these.(50%)

Answer 291

.x.

Question 292

Nitrous oxide should not be used routinely as a component of general anaesthesia. Discuss.

Answer 292

.x.

Question 293

A 36-year-old with a history of opioid dependence is booked for spinal surgery. The patient is no longer on opioids and is maintained on 50mg of oral naltrexone daily. Discuss the implications of the history of opioid dependence and current naltrexone treatment for the provision of effective analgesia, including an analgesia plan upon hospital discharge.

Answer 293

.x.

Question 294

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

Answer 294

.x.

Question 295

Describe how the ECG should be used to monitor for intraoperative myocardial ischemia in a patient with ischemic heart disease.

Answer 295

.x.

Question 296

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%)

Answer 296

.x.

Question 297

A 65 year old female who weighs 85 kilogrammes and is 165 centimetres tall. BMI 31 is scheduled for total knee replacement surgery. She has no other health problems. Discuss the pros and cons of intra-thecal morphine for postoperative analgesia in this patient.

Answer 297

.x.

Question 298

What are the perioperative concerns for the anaesthetist managing a patient with epilepsy?

Answer 298

.x.

Question 299

A 25 year old woman at 28 weeks gestation, with a body mass index (BMI) of 45 attends the high risk obstetric clinic Outline the pathophysiology of morbid obesity affecting pregnancy and describe the implications for obstetric anaesthetic care

Answer 299

.x.

Question 300

An elderly patient in the recovery unit is confused and agitated following surgery. Describe your management.

Answer 300

.x.

Question 301

In what circumstances is it permissible to permanently hand over responsibility for an anaesthetic to a colleague and how would you ensure that this handover occurs safely?

Answer 301

.x.

Question 302

A patient is due to have intramedullary reaming and nailing of a pathological fracture of the femur secondary to metastatic renal cell carcinoma. Outline the key issues this case presents. (50%) Describe how you would manage these issues. (50%)

Answer 302

.x.

Question 303

List the methods of analgesia that can be used for patients undergoing open liver resection surgery. (30%) Justify your perioperative pain management strategy. (70%)

Answer 303

.x.

Question 304

You are covering ICU in your local district hospital when a 14-year-old boy presents to your emergency department obtunded and hypotensive with a rash suggestive of meningococcal sepsis. Describe your resuscitation.

Answer 304

.x.

Question 305

What do the terms decontamination, disinfection and sterilisation mean? 30%. What measures should be in place to minimise the risk of transmission of infection to the respiratory tract of patients via anaesthetic equipment 70%.

Answer 305

.x.

Question 306

Discuss the anaesthetic considerations for an adult patient with rheumatoid arthritis presenting for wrist surgery.

Answer 306

.x.

Question 307

A patient scheduled for transurethral resection of the prostate is seen in thepre-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. Outline briefly the advantages and disadvantages of dabigatran as compared to warfarin for stroke prevention in elective surgical patients.(30%) Describe and justify your plan for the perioperative management of this patient’s anticoagulation.(70%)

Answer 307

.x.

Question 308

Outline the coagulation changes you would expect in a patient with a ruptured liver from a blunt abdominal trauma requiring massive transfusion and describe how you would minimise them.

Answer 308

.x.

Question 309

Outline the factors that determine oxygen delivery to the tissues. (30%) How might you increase the oxygen delivery to the tissues in an anaesthetised patient. (40%) How does a hyperbaric chamber influence oxygen delivery to the tissues? (30%)

Answer 309

.x.

Question 310

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%)

Answer 310

.x.

Question 311

List the predisposing factors for aspiration of gastric contents in a patient undergoing general anaesthesia. Discuss the measures you would take to prevent this complication.

Answer 311

.x.

Question 312

What would make you suspect venous gas embolism occurring during a surgical procedure? Briefly outline the principles of management of venous gas embolism causing haemodynamic compromise

Answer 312

.x.

Question 313

Evaluate the role of tranexamic acid in primary hip arthroplasty.

Answer 313

.x.

Question 314

You are asked to assess a 35-year-old woman on labour ward. She has uncontrolled hypertension at 34 weeks’ gestation. Her blood pressure is 180/110 mmHg and urinalysis shows 3+ of protein. Her obstetrician wants to deliver her by caesarean section as soon as feasible. Outline your management to optimise her status prior to transfer to theatre.

Answer 314

.x.

Question 315

Describe the physiological responses to electroconvulsive therapy (ECT). (50%) Discuss how these affect your anaesthetic management of a patient undergoing ECT. (50%)

Answer 315

.x.

Question 316

A patient in the post anaesthesia care unit is suspected of having residual neuromuscular blockade. List ways to assess this patient for the presence of residual neuromuscular blockade. (30%) Discuss methods to reduce the risk of residual neuromuscular blockade. (70%)

Answer 316

.x.

Question 317

You are called to anaesthetise a 70-year-old man with a perforated bowel for laparotomy, three days after colonoscopy. Outline the measures you will take to reduce the likelihood of this patient developing acute lung injury.

Answer 317

.x.

Question 318

Discuss the role of ketamine in current anaesthesia practice.

Answer 318

.x.

Question 319

You are asked to assess a 4-year-old child who is scheduled for a strabismus (squint) correction as a day case procedure. 1. What are the issues relevant to anaesthesia? (70%) 2. What would prevent you from discharging this patient home after surgery? (30%)

Answer 319

.x.

Question 320

Describe the advantages and disadvantages of multicenter clinical trials in anaesthetic research

Answer 320

.x.

Question 321

An otherwise fit 30 year old man is having microvascular reimplantation of his forearm. Describe methods available to optimise the perfusion of the reimplanted limb in the post-operative period.

Answer 321

.x.

Question 322

Justify your strategies for managing severely elevated intracranial pressure.

Answer 322

.x.

Question 323

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%)

Answer 323

.x.

Question 324

What is the physiological basis of preoxygenation? Describe your method of preoxygenation including how you assess its adequacy.

Answer 324

.x.

Question 325

Outline risk factors for spinal cord ischaemia in a patient undergoing endovascular repair of a thoraco-abdominal aortic aneurysm. (50%) Discuss your approach to minimising spinal cord ischaemia in this setting. (50%)

Answer 325

.x.

Question 326

You are concerned about the possibility of substance abuse by a consultant colleague. Describe the signs that are suggestive of substance abuse in a colleague. (50%) Outline the steps that should be followed if this is suspected. (50%)

Answer 326

.x.

Question 327

A 56 year old diabetic is scheduled for laparoscopic nephrectomy. This is his pre-operative 12 lead ECG. Ten minutes into the procedure his BP is 70/30 and his ECG lead 2 monitor looks like this. What does ECG 1 show? What Does ECG2 show? Outline your management of the situation associated with ECG 2.

Answer 327

.x.

Question 328

A patient with an automatic implanted cardiac defibrillator with BI ventricular pacing presents for elective surgery Describe how the presence of this device influences your Peri operative management of this patient

Answer 328

.x.

Question 329

Describe the sensory innervation of the respiratory passage from the nostrils to, and including, the vocal cords (50%) and List the indications and contraindications for nasal intubation (50%).

Answer 329

.x.

Question 330

A 50-year-old patient presents for urgent craniotomy and decompression of a subdural haematoma. Two days ago he was well, but now has a Glasgow Coma Scale score of 11. He is combative and has pulled out his intravenous line. On inspection there are no obvious veins for cannulation. a. List the options available for induction and intubation. (30%) b. Describe and justify your preferred approach. (70%)

Answer 330

.x.

Question 331

You see a 28-year-old woman at the pre-admission clinic who is 32 weeks pregnant. She weighs 150kg and has gestational diabetes. She is hoping to have a normal vaginal delivery at term. 1. What are the issues you would discuss with her during the appointment? (50%) 2. What would you recommend for her management when she goes in to labour? (50%)

Answer 331

.x.

Question 332

A 65 year old male presents to your preadmission clinic. He is scheduled for femoral popliteal bypass surgery for peripheral vascular disease in four days time. He has ischemic rest pain in his leg. Evaluate the usefulness of initiating therapy with. Beta blockers to reduce the incidence of perioperative myocardial infarction in this man.

Answer 332

.x.

Question 333

Describe the physiological principles underlying preoxygenation prior to the induction of anaesthesia. (50%) Discuss the advantages and disadvantages of using a high inspired oxygen concentration (>80%) during maintenance of anaesthesia. (50%)

Answer 333

.x.

Question 334

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.

Answer 334

.x.

Question 335

A fifty year old man taking corticosteroid and pyridostigmine for myasthenia gravis is to have an elective right hemicolectomy under general anaesthesia. Discuss your management of his myasthenia pre and post operatively.

Answer 335

.x.

Question 336

A thirty-year-old man has sustained a penetrating eye injury requiring surgery. What are the key anaesthetic issues? (30%) Outline your plan of perioperative management and justify your choices. (70%)

Answer 336

.x.

Question 337

Outline the mechanisms that may contribute to visual loss associated with spinal surgery in the prone position. (50%) Describe strategies that may reduce the risk of visual loss in this situation. (50%)

Answer 337

.x.

Question 338

Justify your use of perioperative prophylactic antiemetics.

Answer 338

.x.

Question 339

Describe your assessment of a four-year-old child who has been rescued from a house fire.

Answer 339

.x.

Question 340

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%)

Answer 340

.x.

Question 341

A 27 year old male presents with a glioblastoma for a craniotomy. As part of your anaesthetic technique, you decide to use a remifentanil infusion. 1. Discuss the characteristics of remifentanil with respect to its use as an infusion. (50%) 2. What are the advantages and disadvantages of using effect site calculations to guide remifentanil infusions? (50%)

Answer 341

.x.

Question 342

A 50-year-old man presents with confusion and the following electrolyte profile: Na 155 K 4 HCO3 15 Cr 120 Hb 200 a. What are the possible causes of this abnormality? (30%) b. How can they be distinguished? (70%)

Answer 342

.x.

Question 343

A 40-year-old 100 kg patient presents with septicaemia of unknown cause. After receiving two litres of 0.9% NaCl (Normal Saline) as initial resuscitation the patient has the following observations: HR 126 bpmBP 80/40 mmHg Outline your initial resuscitation goals. (30%) Evaluate options for ongoing fluid resuscitation at this time. (70%)

Answer 343

.x.

Question 344

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

Answer 344

.x.

Question 345

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

Answer 345

.x.

Question 346

A healthy 28-year-old primigravida is scheduled for elective lower segment caesarean section for breech presentation at 39 weeks gestation. You have performed a spinal anaesthetic using 0.5% bupivacaine 2.2 ml and fentanyl 15 µg (total volume 2.5 ml). a. Describe the issues in assessing adequacy of the block for the planned surgery (50%) b. Describe the options for managing an inadequate block recognised prior to commencement of surgery (50%)

Answer 346

.x.

Question 347

A 24-year-old with a breech presentation at 35 weeks gestation has severe preeclampsia and requires delivery by lower segment caesarean section. You witness her having a short selflimiting generalised seizure in the delivery suite. Outline the key points of her management prior to theatre. (50%) Describe the changes you would make to your usual general anaesthetic technique for her lower segment caesarean section. (50%)

Answer 347

.x.

Question 348

Outline the pathophysiological insults that exacerbate a primary brain injury following head trauma and indicate how can they be minimised.

Answer 348

.x.

Question 349

A patient on an organ transplantation waiting list is taking rivaroxaban for recurrent pulmonary emboli. Discuss your perioperative anticoagulation plan.

Answer 349

.x.

Question 350

A 68-year-old man in hospital awaiting definitive surgery for a supraglottic squamous cell carcinoma of the larynx has worsening stridor at rest. (a) How might his symptoms be improved in the preoperative period? (30%) (b) Describe your evaluation of his airway and how this will influence your intraoperative airway management plan. (70%)

Answer 350

.x.

Question 351

List the branches of the coronary arteries and the myocardial territories and structures they supply. Also please outline the ECG leads that correspond to the blood supply and describe corresponding ECG changes in an NSTEMI

Answer 351

.x.

Question 352

A 25-year-old primigravida patient presents to the delivery suite at 38 weeks gestation complaining of a headache and difficulty with her vision Her BP is 180/115 and she has clonus Cardiotocograph monitoring shows no indication of foetal distress Outline your initial management of her preeclampsia

Answer 352

.x.

Question 353

How is an appropriate sample size for a clinical trial determined (50%), and what are the ethical implications of using an inappropriate sample size in a clinical trial?

Answer 353

.x.

Question 354

Describe the anatomy of the orbit relevant to a peribulbar eye block.

Answer 354

.x.

Question 355

An adult is brought to your district hospital after a house fire. They have sustained burns to 75% of their total body surface area (TBSA). Discuss your management prior to their transfer to a Burns Unit

Answer 355

.x.

Question 356

A 65 year old man with a 40 pack a year history of smoking is scheduled for right pneumonectomy for carcinoma. Describe your preoperative evaluation of his respiratory system to decide his capacity to undergo this operation.

Answer 356

.x.

Question 357

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%)

Answer 357

.x.

Question 358

Three days after a patient has undergone hemiarthroplasty under general anaesthesia, his relatives ask to see you because of concerns that the patient does not recognise family members. This was not present preoperatively. a. What features would distinguish between delirium and dysfunction in this setting? (50%) b. What you would advise the family to be the expected outcome? (50%)

Answer 358

.x.

Question 359

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%)

Answer 359

.x.

Question 360

(a) Describe the anatomy, including surface landmarks, relevant to performing cricothyroidotomy. (50%) (b) What are the complications of this procedure? (50%)

Answer 360

.x.

Question 361

Outline methods available to minimise intraoperative drug errors

Answer 361

.x.

Question 362

Describe the factors that contribute to intravenous drug errors in anaesthesia practice. Discuss the methods available to reduce the incidents of such errors.

Answer 362

.x.

Question 363

You have rated a workplace based assessment for a trainee as unsatisfactory. The trainee has now written to the head of the department complaining that you have been bullying him. Define the following (50%) -Bullying -Feedback Outline your approach to this complaint. (50%)

Answer 363

.x.

Question 364

List and explain the typical electrolyte abnormalities of chronic renal failure.

Answer 364

.x.

Question 365

What are the indications for prophylaxis against perioperative bacterial endocarditis? (50%) 2. Justify your choice of antibiotics. (50%)

Answer 365

.x.

Question 366

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.

Answer 366

.x.

Question 367

A 50-year-old man with a base of tongue cancer is scheduled for elective tracheostomy immediately followed by tumour resection. Discuss the issues involved with his airway management.

Answer 367

.x.

Question 368

“It is no longer justifiable to use aprotinin during cardiac surgical procedures”. Discuss

Answer 368

.x.

Question 369

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

Answer 369

.x.

Question 370

Outline the major considerations for organ donation after circulatory death. (DCD)

Answer 370

.x.

Question 371

One of your anaesthetic colleagues is prescribing fentanyl patches as discharge medication for patients following total hip joint replacement. Evaluate this practice.

Answer 371

.x.

Question 372

Discuss the principles of damage control resuscitation in severe trauma

Answer 372

.x.

Question 373

A 20 year old patient has been successfully resuscitated from suspected anaphylaxis. Describe your immediate and longer term post crisis management.

Answer 373

.x.

Question 374

A 70-year old male with a 10 year history of parkinsons disease presents for a total knee replacement. He is on levodopa/carbidopa 5 times per day. Outline the main issues to consider in relation to his Parkinsons disease in planning their perioperative management

Answer 374

.x.

Question 375

A three year old child requires an adenotonsillectomy for obstructive sleep apnoea. Outline and justify your peri-operative management plan

Answer 375

.x.

Question 376

A 40 year-old male is scheduled for elective bariatric surgery. For this patient: List the important features of history and examination that may identify a potentially difficult airway. (30%)

Answer 376

.x.

Question 377

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?

Answer 377

.x.

Question 378

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%)

Answer 378

.x.

Question 379

An otherwise well patient presents for a laparoscopic right hemicolectomy. What are the issues related to the carbon dioxide pneumoperitoneum? How would your intra operative management address these issues?

Answer 379

.x.

Question 380

You have just intubated a patient who has respiratory failure due to severe bacterial pneumonia. They remain hypoxaemic with an SpO2 of 82%. Describe your immediate actions and justify your strategies to improve oxygenation whilst awaiting the patient’s retrieval to a tertiary centre.

Answer 380

.x.

Question 381

What are the hazards of the prone position for patients under general anaesthesia and how can they be minimized?

Answer 381

.x.

Question 382

Outline the factors relevant to selection of a perioperative antibiotic prophylaxis regimen for a surgical patient. (50%) Discuss strategies to ensure appropriate implementation of antibiotic prophylaxis regimens. (50%)

Answer 382

.x.

Question 383

You are asked to initiate an opioid patient-controlled analgesia service in your hospital. a. How would you ensure patient safety? (70%) b. What are the key components to include in designing an order form? (30%)

Answer 383

.x.

Question 384

Evaluate the use of available neuromuscular blocking agents when performing a rapid sequence induction.

Answer 384

.x.

Question 385

A 25 year old, 65kg woman with acute severe asthma requires intubation and ventilation. Explain the problems associated with initiating ventilatory support in this patient and describe how you would overcome them.

Answer 385

.x.

Question 386

You are asked to anaesthetise an adult patient for a left pneumonectomy. Describe the different methods for lung isolation in this patient, including the advantages and disadvantages of each

Answer 386

.x.

Question 387

What do the terms decontamination, disinfection and sterilisation mean? (30%) b. What measures should be in place to minimise the risk of transmission of infection to the respiratory tract of patients via anaesthetic equipment? (70%)

Answer 387

.x.

Question 388

List the causes of acute atrial fibrillation in the perioperative period. Describe your management of acute atrial fibrillation which occurs in the PACU (Post-anaesthesia Care Unit) in a patient who has had a total hip replacement.

Answer 388

.x.

Question 389

A previously healthy 28 year old male has persistent pain 12 weeks after a compound fracture to his lower leg and is on slow release. Oxycodone 80 mg twice daily and an immediate release oxycodone 20 mg 4 hourly. Discuss the advantages and disadvantages of switching his opioid to methadone in this situation and how this may be achieved safely.

Answer 389

.x.

Question 390

1. Classify the possible causes for patient awareness under general anaesthesia. (70%) 2. Evaluate the evidence for the use of Bispectral Index monitoring in reducing the risk of awareness. (30%)

Answer 390

.x.

Question 391

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%)

Answer 391

.x.

Question 392

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

Answer 392

.x.

Question 393

(a) Describe the common classification code for permanent pacemakers. (30%) (b) Outline the principles involved in the perioperative management of patients with a permanent pacemaker. (70%)

Answer 393

.x.

Question 394

List the complications associated with the use of limb tourniquets during surgery. (60%) How can these complications be minimised? (40%)

Answer 394

.x.

Question 395

A 25 year old woman who is 30 weeks pregnant has been referred to your tertiary high risk obstetric clinic. She has complex cyanotic congenital heart disease and now functions with a Fontan circulation. a) How would you stratify the cardiovascular risk? (30%) b)What are the issues relevant to anaesthetic care that will need to be managed for this patient? (70%)

Answer 395

.x.

Question 396

26 year old woman with subclinical myotonic dystrophy presents to the high risk obstetric clinic. She is 25 weeks pregnant in her first pregnancy and otherwise well. She hopes for a normal vaginal delivery. Describe and justify your recommendations for the management of her analgesia for labour and the perioperative management of any potential operative delivery.

Answer 396

.x.

Question 397

Evaluate the options for managing a confirmed postdural puncture headache in an obstetric patient.

Answer 397

.x.

Question 398

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

Answer 398

.x.

Question 399

An 82 year old patient is booked for an excision of a floor of mouth squamous cell carcinoma and neck dissection with radical free forearm flap reconstruction. Discuss the issues relevant to the intraoperative anaesthetic management for this procedure.

Answer 399

.x.

Question 400

These are the blood results of a 65-year-old man scheduled for a revision total hip replacement. Interpret these results. (30%) How would you manage this patient preoperatively? (70%) (CRP 8 Fe 8 TF 3.2 TF Sat 12% Ferr 40)

Answer 400

.x.

Question 401

A patient dies soon after induction of anaesthesia. As a senior clinician you are asked to arrange a debriefing.

Answer 401

.x.

Question 402

A 47 year old man presents to the emergency department with acute abdominal pain requiring a laparotomy. He is known to have chronic high intake of alcohol. Describe how chronic alcohol misuse will affect your perioperative management of this patient.

Answer 402

.x.

Question 403

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%)

Answer 403

.x.

Question 404

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

Answer 404

.x.

Question 405

A patient requires vascular access for three weeks. a. List the advantages and disadvantages of a peripherally inserted central catheter (PICC line) compared to a percutaneous central venous catheter (CVL). (50%) b. Outline the methods by which you would minimize the risks associated with the placement of a PICC line. (50%)

Answer 405

.x.

Question 406

A 68 year-old male with severe Parkinson’s Disease presents for elective right hemicolectomy. Current medications include levodopa/benserazide and selegiline (monoamine oxidase inhibitor). What clinical features of Parkinson ’s disease affect anaesthesia? (50%) Justify your perioperative drug management plan. (50%)

Answer 406

.x.

Question 407

Outline the factors influencing spread of intrathecal local anaesthetic.

Answer 407

.x.

Question 408

An 8 week old baby is scheduled for an inguinal hernia repair on your list at a local general hospital tomorrow.a)Outline the important issues when providing anaesthesia care for this baby.(70%)b)Justify your decision to proceed with surgery at the local general hospital.(30%)

Answer 408

.x.

Question 409

Describe the process of intraoperative cell salvage. (50%) Discuss the indications and contraindications for intraoperative cell salvage. (50%)

Answer 409

.x.

Question 410

An elderly patient is to undergo operative fixation of a fractured neck of femur. A radial arterial line is inserted prior to induction, and when transduced, the trace appears damped a. What are the possible causes for the trace to appear damped in this patient? (50%) b. Outline the steps you would take to ensure the accuracy of your arterial line (50%)

Answer 410

.x.

Question 411

Describe the factors that determine the maximum achievable rate of intravenous fluid administration. (50%) Outline the issues associated with the use of rapid infusion devices. (50%)

Answer 411

.x.

Question 412

Outline the risk factors for, possible mechanisms of, and methods to prevent, postoperative ulnar neuropathy.

Answer 412

.x.

Question 413

Evaluate the use of human albumin in perioperative volume replacement.

Answer 413

.x.

Question 414

A 55-year-old patient is undergoing emergency laparotomy for acute bowel obstruction. Intraoperative blood tests include the following result: Mg 0.20 a) Outline the potential causes for this result and the effects it may produce. (70%) b) Describe the management of this abnormality. (30%)

Answer 414

.x.

Question 415

A 70-year-old patient wearing a transdermal buprenorphine slow release patch (Norspan®) (5μg/h) presents for knee arthroscopy. a. Describe the mechanism of action and pharmacokinetic profile of this patch. (50%) b. What are the implications for perioperative pain management? (50%)

Answer 415

.x.

Question 416

Compare and contrast oxygen delivery by nasal prongs, simple facemask and Venturi mask.

Answer 416

.x.

Question 417

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

Answer 417

.x.

Question 418

How would you critically appraise a paper published in a journal?

Answer 418

.x.

Question 419

Outline the operating principles and safety features of a modern variable bypass out of circuit vaporiser

Answer 419

.x.

Question 420

You are asked to provide epidural pain relief for a woman in labour. She is having primigravida, and is 3cm dilated. Describe and justify both you choice of drugs for and the mode of administration of epidural analgesia in this situation

Answer 420

.x.

Question 421

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

Answer 421

.x.

Question 422

An adult patient who was intubated for tonsillectomy is noted to have an upper central incisor tooth missing in the Recovery Room after extubation. (a) List the predisposing factors for perioperative dental damage. (50%) (b) What is your management of this situation? (50%)

Answer 422

.x.

Question 423

What are the key objectives of ethical review of a research project?

Answer 423

.x.

Question 424

A seventy five year old man having a transurethral resection of the prostate under spinal anaesthesia which has been uneventful, becomes restless 70 minutes into the procedure. He had 2 milligrams of midazolam at the start of the case and no further sedation. Describe your assessment and management of this problem.

Answer 424

.x.

Question 425

Describe the features you require of a transport ventilator for a patient with severe ventilator-dependent acute respiratory distress syndrome.

Answer 425

.x.

Question 426

Explain your approach to thromboprophylaxis in the patient undergoing total knee replacement.

Answer 426

.x.

Question 427

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.

Answer 427

.x.

Question 428

How does soda lime work? List the hazards associated with its use.

Answer 428

.x.

Question 429

Discuss the non-technical skills required for management of an intraoperative crisis

Answer 429

.x.

Question 430

Discuss the perioperative strategies you would use to mitigate the risks of prolonged surgery in the prone position

Answer 430

.x.

Question 431

A 60-year-old man is anaesthetised for a rigid cystoscopy. You notice bile stained fluid in his classic laryngeal mask airway (LMA) during the procedure. Describe your management.

Answer 431

.x.

Question 432

Insertion of a central venous line may result in cardiac tamponade. a. How would you recognise this complication? (50%) b. How could you minimise the risk of this complication? (50%)

Answer 432

.x.

Question 433

How do you determine if a patient with known obstructive sleep apnoea is suitable for day surgery?

Answer 433

.x.

Question 434

There is a 70-year-old female on your emergency list for an urgent laparotomy. She was involved in a motor vehicle accident this morning and sustained multiple trauma. Her medications include clopidogrel to cover the insertion of bare metal stents into her coronary arteries 2 months ago. 1. Describe the mechanism and duration of action of clopidogrel. (30%) 2. What are the major considerations for the perioperative period in view of the patient’s stent? (70%)

Answer 434

.x.

Question 435

An adult patient is scheduled for a major operation during which significant blood loss is expected. Describe strategies you would consider peri-operatively when planning to minimise blood loss and transfusion requirement.

Answer 435

.x.

Question 436

Explain the terms sensitivity, specificity, positive predictive value and negative predictive value when applied to a diagnostic test

Answer 436

.x.

Question 437

Outline the physiological determinants of blood flow through a myocutaneous free flap? (50%) Evaluate the use of vasoconstrictors for support of blood pressure following reanastamosis of a myocutaneous free flap? (50%)

Answer 437

.x.

Question 438

A 60-year-old man is booked for plating of a fractured ankle. He arrests on induction. His ECG shows ventricular fibrillation. Outline the immediate management of his cardiac arrest with particular reference to current resuscitation guidelines

Answer 438

.x.

Question 439

What are the clinical consequences of hypothermia to 34⁰ C in adults? (50%) and How can you manage body temperature in a multi-trauma patient? (50%)

Answer 439

.x.

Question 440

You are inserting a central venous line (CVL) as part of your anaesthetic management for a laparotomy. Outline the perioperative measures you should consider to minimise central venous line sepsis.

Answer 440

.x.

Question 441

What are the essential safety requirements for delivery of gases via anaesthetic machines and their associated breathing circuits in use in Australia and NZ. Do not include ventilators or scavenging in your answers.

Answer 441

.x.

Question 442

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/L 1. 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%)

Answer 442

.x.

Question 443

What is the physiological basis of preoxygenation? (50%) b. Describe your method of preoxygenation including how you assess its adequacy. (50%)

Answer 443

.x.

Question 444

What are the signs that may make you suspect opioid abuse in a colleague? If you had suspicions of opioid abuse in a colleague outline the principles that should guide intervention.

Answer 444

.x.

Question 445

Describe how you would determine the usefulness of a published paper for your own practice.

Answer 445

.x.

Question 446

You are on the interview panel appointing new Assistants for the Anaesthetist. What are the educational requirements and the practical responsibilities expected of the applicants?

Answer 446

.x.

Question 447

This table displays the pulmonary function test results for a 67-year-old male. Define the following: FEV1, FVC, VC and DLCO. (50%) Interpret these results and discuss this patient’s possible diagnoses (FEV1: 1.19, 34% Predicted, FVC: 4.231, 95% predicted, FER: 23%, 29% VC 5.111 115% DLCO 11.7 37% PEF 3.91 44%)

Answer 447

.x.

Question 448

You are asked to provide local anaesthesia for awake craniotomy. Describe the innervation of the scalp, including the landmarks for nerve blockade.

Answer 448

.x.

Question 449

An obese 55-year-old female has undergone sleeve gastrectomy which concluded one hour earlier. The post anaesthetic care unit has called to report a blood pressure of 190/110 mmHg. Discuss your approach to the evaluation and management of the hypertension.

Answer 449

.x.

Question 450

A 55-year-old male is in the post-anaesthesia care unit after nasal surgery. He is conscious, dyspnoeic, and is coughing up frothy secretions. List your differential diagnosis AND how this would direct subsequent management.

Answer 450

.x.

Question 451

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%)

Answer 451

.x.

Question 452

A 44-year-old male is booked for debulking of a large intracranial tumour. Describe the physiological aims during this case. (50%) Justify your anaesthetic technique to achieve these aims. (50%)

Answer 452

.x.

Question 453

Discuss the issues relevant to the perioperative care of a seven-year-old child with Down Syndrome who has sustained a supracondylar fracture of the humerus.

Answer 453

.x.

Question 454

In regard to serotonin syndrome a. What are the risk factors? (20%) b. What are the clinical manifestations? (40%) c. What is the treatment for an acute episode of serotonin syndrome? (40%)

Answer 454

.x.

Question 455

Identify the structures labeled A to H on this normal chest X-ray. (40%) Describe the arterial blood supply and venous drainage of the myocardium. (60%) (A. Ascending aorta, trachea, superior vena cava, tracheobronchus, right paratracheal stripe (NOT carina) B. Right pulmonary artery branch, right pulmonary vessels/trunk/vasculature C. Right atrium D. Left subclavian artery, left innominate artery, left brachiocephalic artery, (NOT brachiocephalic trunk) E. Aortic knob/arch/notch F. Left pulmonary artery G. Atrial appendage H. Left ventricle)

Answer 455

.x.

Question 456

A new hospital is setting up its pain service and you have been asked to write the administration guidelines for ketamine infusions on the ward. Outline the information you would include in these guidelines.

Answer 456

.x.

Question 457

Forty minutes after a laparoscopic appendicectomy has been completed, a 55 year old patient has failed to regain consciousness. List the potential causes. (30%) Describe your management (70%)

Answer 457

.x.

Question 458

You are planning a trial to evaluate the efficacy of a new drug on reducing post-laparotomy pain.Describe potential sources of bias and indicate how these can be minimised.

Answer 458

.x.

Question 459

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.

Answer 459

.x.

Question 460

Outline the issues involved in the preoperative assessment specific to a patient presenting for transsphenoidal hypophysectomy for acromegaly

Answer 460

.x.

Question 461

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 supraclavicular block

Answer 461

.x.

Question 462

A 50 year old, 110kg builder is on your list for an arthroscopic acromioplasty which is to be performed in the beach chair position. List the problems associated with this position and describe how you could minimise them.

Answer 462

.x.

Question 463

List the indications for hyperbaric oxygen therapy. (30%) Discuss the problems with providing this treatment. (70%)

Answer 463

.x.

Question 464

A 61 year old woman is scheduled for total laparoscopic hysterectomy. She has had an episode of awareness under anaesthesia during previous laparoscopic surgery. a. What are the risk factors for awareness? (30%) b. How would you minimise this patient’s risk of awareness during her operation? (70%)

Answer 464

.x.

Question 465

Discuss your strategy for the management of coagulopathy in the multitrauma patient

Answer 465

.x.

Question 466

Describe the features and management of phantom limb pain.

Answer 466

.x.

Question 467

You are developing an anaesthetic department policy for acute endovascular stroke intervention. Outline the issues to be considered in your policy.

Answer 467

.x.

Question 468

Discuss the risks and benefits associated with intermittent positive pressure ventilation through proseal ® laryngeal mask airway for a patient undergoing laparoscopic cholecystectomy.

Answer 468

.x.

Question 469

A 43-year-old man with Down Syndrome is booked for an inguinal hernia repair. Discuss the issues that are relevant in providing anaesthesia for this patient having this surgery.

Answer 469

.x.

Question 470

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.

Answer 470

.x.

Question 471

Data regarding the conduct and outcomes of anaesthesia are now widely collected. (e.g. National Anaesthesia, Clinical Outcomes Registry, (NACOR)) Outline the benefits and the potential errors that can occur when using this data for research.

Answer 471

.x.

Question 472

Evaluate the equipment available for the delivery of oxygen to postoperative patients on a general surgical ward.

Answer 472

.x.

Question 473

A 30-year-old female at term requires a general anaesthetic for lower uterine segment caesarean section for significant antepartum haemorrhage. Discuss how significant antepartum haemorrhage affects your perioperative management.

Answer 473

.x.

Question 474

A 50-year-old woman with systemic sclerosis (scleroderma) presents for laparoscopic appendicectomy. She is currently treated with folate supplements and weekly methotrexate. Describe how your anaesthetic plan is modified by the presence of scleroderma in this patient

Answer 474

.x.

Question 475

Interpret this arterial blood gas (ABG) b) Justify any additional information you would require to complete your interpretation c) Describe a clinical situation which may explain this ABG (pH 7.1 CO2 50 O2 91 SaO2 91 HCO3 12.2

Answer 475

.x.

Question 476

Describe the complications that can occur post carotid endarterectomy and how these may present in the post anaesthesia care unit (PACU).

Answer 476

.x.

Question 477

a. Define quality assurance. (30%) b. How would you design and implement a Quality Improvement programme to assess patient satisfaction with the preoperative visit? (70%)

Answer 477

.x.

Question 478

Describe the anatomy of the eye relevant to a sub-Tenon’s eye block. (40%) b. Discuss the potential advantages and disadvantages of this technique for providing regional anaesthesia for eye surgery. (60%)

Answer 478

.x.

Question 479

In a large clinical trial, patients were randomised into two groups to study the impact of BIS monitoring on the incidence of awareness. The table below shows the results: BIS - Size 1250 Aware 2 & Routine - Size 1250 Aware 11. Data analysis found that the difference in the incidence of awareness had a p value of 0.022. The study reported that BIS guided anaesthesia reduced the risk of awareness by 82% (95% CI 17-98%) with an odds ratio of 0.2 and a NNT of 140. Define the following terms and explain their meaning in relation to this study • P value • Risk reduction • Confidence interval • Odds ratio • Number needed to treat

Answer 479

.x.

Question 480

(a) What systems would you put in place to reduce the likelihood of a power failure? (50%) (b) Outline a protocol for dealing with power failures. (50%)

Answer 480

.x.

Question 481

Outline the immediate management of an unconscious trauma patient in the ED who has suspected C-Spine injury

Answer 481

.x.

Question 482

You hear a cardiac murmur in a two-year-old child presenting for elective minor surgery. (a) What are the features of the murmur that would differentiate an innocent from a pathological murmur? (50%) (b) How would you evaluate this child’s fitness for anaesthesia from the cardiac perspective? (50%)

Answer 482

.x.

Question 483

Your department has exceeded its drug budget for the last financial year. You have been asked to develop a departmental policy document for the rational use of sugammadex. Discuss the issues to be considered.

Answer 483

.x.

Question 484

List the essential equipment currently recommended to manage a difficult airway in an adult patient. (50%) Justify supplementary items you would recommend. (50%)

Answer 484

.x.

Question 485

This is the standard 12-lead electrocardiogram (ECG) of a 68-year-old man in the post-anaesthesia care unit (PACU) following a revision total hip replacement. He has a history of hypertension controlled with candesartan and hydrochlorothiazide. His preoperative ECG showed sinus rhythm with a rate of 82 per minute. a) Interpret this ECG and provide differential diagnoses (SVT) b) List the likely causes of the rhythm disturbance in this patient. c) Outline the appropriate immediate management.

Answer 485

.x.

Question 486

Describe the principles of cerebral protection in a patient with an isolated closed head injury.

Answer 486

.x.

Question 487

A 25 year old man is to have laser surgery for a vocal cord papilloma What are the hazards associated with the use of a laser in this situation and how can they be minimised?

Answer 487

.x.

Question 488

In regard to total parenteral nutrition: 1. What are the indications? (30%) 2. What are the complications? (70%)

Answer 488

.x.

Question 489

A 20-year-old female presents to the emergency department in an agitated state. A. Interpret her blood gas (taken on room air) pH 7.25 pCO2 24 pO2 82 HCO3 11 BE -15 K 4.5 Na 135 Cl 100 (50%) B. List the most likely differential diagnoses. (50%)

Answer 489

.x.

Question 490

Evaluate the use of cerebral oximetry monitoring in non-cardiac surgery.

Answer 490

.x.

Question 491

23.1
List the branches of the coronary arteries and the myocardial territories and
structures they supply.
Outline the electrocardiograph (ECG) leads that correspond to the blood
supply.
Describe the ECG changes in a non-ST-elevation myocardial infarct (NSTEMI).

Question 492

23.1
Outline the immediate management of an unconscious trauma patient in the
emergency department who has a suspected cervical spine injury.

Question 493

23.1
A 30-year-old patient is scheduled for laser resection of a subglottic mass to
relieve mild stridor.
Justify your intraoperative anaesthetic management of this case.

Question 494

23.1
Discuss the perioperative management of a previously well patient presenting
for transsphenoidal resection of a non-secretory pituitary macroadenoma.

Question 495

23.1
An 82-year-old patient is booked for excision of a floor of mouth squamous cell
carcinoma and neck dissection, with radial forearm free flap reconstruction.
Discuss the issues relevant to the intraoperative anaesthetic management for
this procedure.

Question 496

23.1
Discuss the implications of anticoagulation as well as an appropriate
anticoagulant management strategy for a 25-year-old with a mechanical aortic
valve for the duration of pregnancy, delivery and the postpartum period.

Question 497

23.1
Describe your technique to provide caudal epidural analgesia for an infant
weighing 10 kg undergoing hypospadias surgery.

Question 498

23.1
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

Question 499

23.1
Justify strategies used to mitigate postoperative delirium in an elderly patient
requiring hip fracture fixation.

Question 500

23.1
Describe the innervation relevant to the stages of labour (30%).
Evaluate the regional analgesia options for each stage (70%).

Question 501

23.1
Outline the major considerations for organ donation after circulatory death
(DCD).

Question 502

23.1
Outline the circumstances where the dosing of paracetamol requires
modification (50%).
Describe the management principles of paracetamol toxicity (50%).

Question 503

23.1
Data regarding the conduct and outcomes of anaesthesia are now widely
collected (e.g. National Anesthesia Clinical Outcomes Registry (NACOR)).
Outline the benefits and the potential errors that can occur when using this
data for research.

Question 504

23.1
Discuss the preoperative elements of an Enhanced Recovery After Surgery
(ERAS) program for a patient requiring major colorectal surgery.

Question 505

23.1
A) Identify the axes A and B (with units), and the points labelled C through H
on the following spirometry loop:

B) Outline how these spirometry parameters change in:
* Chronic obstructive pulmonary disease
* Idiopathic pulmonary fibrosis
* Extrathoracic tracheal obstruction

Question 506

23.2
Evaluate the use of long-acting opioids in the treatment of acute pain.

Question 507

23.2
Describe a perioperative pathway for hip replacement surgery with an expected in-
hospital length of stay of less than 24 hours.

Question 508

23.2
Discuss the management of a patient with life-threatening haemorrhage from major
pelvic trauma.

Question 509

23.2
Evaluate the usage of the pulmonary artery catheter in anaesthesia.

Question 510

23.2
Evaluate the use of each of the following for preoperative cardiac risk stratification:
* plasma biomarkers (chose ONE of natriuretic peptides OR troponin)
* Duke Activity Status Index (DASI) stair-climbing test
* cardiopulmonary exercise testing (CPX/CPET).

Question 511

23.2
Outline the treatment strategies for chronic heart failure.

Question 512

23.2
List the clinical features that suggest a diagnosis of pulmonary embolism under
general anaesthesia. (30%)
Outline your immediate management of intraoperative pulmonary embolism. (70%)

Question 513

23.2
Discuss the elements of perioperative management that improve outcomes in patients undergoing emergency laparotomy.

Question 514

23.2
Outline your preoperative assessment of a 1-year-old patient requiring a
ventriculoperitoneal shunt revision.

Question 515

23.2
Discuss the potential benefits and risks of supranormal oxygen levels in the
perioperative setting.

Question 516

23.2
Outline the sensory innervation of the hip. (30%)
Describe one motor-sparing regional anaesthesia technique to provide analgesia to a
patient undergoing surgery for a fractured neck of femur. (70%)

Question 517

23.2
Describe the benefits and limitations of meta-analyses.

Question 518

23.2
Discuss the perioperative management of a patient undergoing urgent thyroidectomy
following failed medical therapy for thyrotoxicosis.

Question 519

23.2
You have been called to the emergency department to see a patient with a post-
tonsillectomy haemorrhage.
Discuss your initial assessment and management of this patient (50%).
Describe your anaesthesia management for the return to theatre for exploration of
haemorrhage (50%).

Question 520

23.2
Discuss the potential complications associated with hysteroscopy and their anaesthetic
management.

Question 521

24.1
You are asked to review a healthy 20-year-old patient for severe post-operative pain in
a stand-alone day surgery unit. Describe your assessment and justify your
management.

Question 522

24.1
Describe both the surface anatomy and anatomical relations of the internal jugular vein
relevant to central venous cannulation.

Question 523

24.1
Describe the mechanism of action of tranexamic acid and evaluate its use in obstetric
anaesthesia practice.

Question 524

24.1
Discuss the strategies you would use to mitigate the risk of a fire in the operating
room. (50%)
Outline the steps to take in the event of fire in the operating room. (50%)

Question 525

24.1
Discuss the preoperative assessment and risk stratification of an adult patient with a
repaired congenital cardiac lesion, scheduled for an elective laparoscopic
cholecystectomy.

Question 526

24.1
Evaluate the use of a processed electroencephalogram (EEG) as a routine monitor
during general anaesthesia.

Question 527

24.1
Discuss the anaesthetic considerations for a patient requiring cerebral aneurysm
coiling.

Question 528

24.1
List the risk factors for the development of a bronchopleural fistula. (30%)
Justify your airway management plan for a bronchopleural fistula repair. (70%)

Question 529

24.1
Discuss your perioperative analgesic management plan for a 20 kg, four-year-old child
undergoing elective adenotonsillectomy.

Question 530

24.1
Evaluate the practice of deliberately-induced intraoperative hypotension.

Question 531

24.1
Discuss the anaesthetic considerations for a patient with myotonic dystrophy
presenting for an emergency laparotomy.

Question 532

24.1
Outline the physiological changes associated with carotid artery clamping and
unclamping during carotid endarterectomy. (50%
Outline intra-operative protection strategies to minimise harm from these manoeuvres.
(50%)

Question 533

24.1
Discuss the requirement for, and potential barriers to, open disclosure in the following
intraoperative scenarios:
A) drug administration error
B) vagally-induced asystole necessitating a brief episode of chest compressions

Question 534

24.1
List the limitations of awake fibreoptic intubation. (30%)
Discuss the options for securing the airway following unsuccessful awake fibreoptic
intubation for an adult presenting with acute epiglottitis. (70%)

Question 535

24.1
Describe the assessment and management of a patient with a suspected
pneumothorax in the post anaesthesia care unit (PACU) following a paravertebral
block for a mastectomy.