Randomised SAQs 06-24.1 (No Answers) Flashcards
Revise SAQs
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%)
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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%)
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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.
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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%)
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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%)
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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
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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
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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%)
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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.
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Describe the clinical features and treatment of fat embolism syndrome
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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.
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The T-Piece is obsolete in modern anaesthesia practice. Discuss.
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List the risks associated with the placement of a central venous catheter? Discuss the ways in which these risks may be modified.
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List the risk factors for postoperative nausea and vomiting (PONV) (30%) Evaluate methods to minimise PONV (70%)
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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.
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How do you assess an otherwise well patient with regard to difficulty of intubation at the bedside? How accurate is such an assessment?
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Describe the pathophysiological effects associated with the use of a pneumatic limb tourniquet and how they can be minimised.
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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.
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Discuss the management of cerebral vasospasm following coiling of a cerebral aneurysm
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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%)
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A 45-year-old woman with a large anterior mediastinal mass is scheduled for mediastinoscopy and biopsy. Discuss your preoperative assessment of this patient.
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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
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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?
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Describe the management of a patient who has a total thyroidectomy and develops respiratory distress in the recovery room.
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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.
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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%)
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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
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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.
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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%).
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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%)
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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%)
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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.
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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%)
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Describe the pathophysiology of hypertrophic cardiomyopathy and how this is affected by pregnancy, labour, and vaginal delivery.
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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
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Describe the clinical features of trigeminal neuralgia (50%) b. Discuss the efficacy of the treatment modalities available for this condition. (50%)
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An otherwise well 60-year-old man is having a radical prostatectomy. List and briefly evaluate strategies to prevent peri-operative thromboembolism
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Describe the anatomy of the orbit in relation to performing a peribulbar block for cataract surgery.
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Describe how the safety of anaesthetised patients undergoing surgery is ensured in the event of a power failure to the hospital.
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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%)
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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.
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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
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(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%)
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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%)
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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)
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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
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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
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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%)
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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
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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%)
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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
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Outline the features and clinical management of amniotic fluid embolism
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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?
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List the indications and contra-indications for the use of an intra-aortic balloon pump. Describe how its performance is optimised.
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(a) What are the complications associated with residual neuromuscular blockade? (30%) (b) Evaluate the methods available to assess residual neuromuscular blockade. (70%)
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Outline the steps you would take to ensure safe introduction of elective paediatric surgery at your local private hospital.
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Outline the steps necessary to diagnose brain death in a 38 year old woman who is comatose following a subarachnoid haemorrhage.
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How could you modify your anaesthetic technique to minimise hypoxia at induction. (70%)
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(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%)
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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%)
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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%)
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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?
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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.
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(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%)
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What do you understand by the term “Universal Precautions”? (40%) b. Describe how you apply these precautions in your daily anaesthesia practice. (60%)
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Discuss the principles underlying the management of a general anaesthetic for carotid endarterectomy.
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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%)
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Discuss the role of non steroidal anti-inflammatory drugs for post operative analgesia in adult day surgery patients.
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Outline the principles of an initial management plan for diabetic ketoacidosis, having regard to the physiological derangements involved
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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.
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How and why is cardiopulmonary resuscitation modified for the pregnant patient at term compared with the non-pregnant patient
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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%)
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A two-year-old boy scheduled for hypospadias repair is found to have a praecordial murmur. Justify your decision to proceed.
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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%)
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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%)
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What are the principles of ventilatory management of patients with acute respiratory distress syndrome (ARDS)?
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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%)
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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%)
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How does a residual current device (RCD) work? (30%) Evaluate its usefulness to protect patients from injury. (70%)
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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
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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%)
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Outline your approach to the perioperative management of a patient who gives a strong family history of von Willebrand disease.
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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%)
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A clinical trial is planned to evaluate a new analgesic. Discuss the ethical considerations in having a placebo group in the trial.
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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%)
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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.
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Discuss the preoperative elements of an enhanced recovery after surgery (ERAS) Programme for a patient requiring major colorectal surgery.
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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?
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Discuss the usefulness of the ASA grading as a measure of perioperative risk.
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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.
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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.
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Evaluate the merits of large multicentre randomised controlled trials compared with the merits of single-centre observational studies in guiding clinical practice
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Describe the clinical features and management of bupivacaine toxicity.
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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
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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?
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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.
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List the methods of assessing intracranial pressure (ICP) (30%) b. Evaluate the role of ICP monitoring in the setting of traumatic brain injury (70%)
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Describe the blood supply to the spinal cord. Explain the determinants of spinal cord perfusion.
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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.
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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%)
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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%)
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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)
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A 25-year-old female with longstanding C5-6 quadriplegia requires ureteric stent insertion. Outline the implications for anaesthesia.
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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.
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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%)
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Justify your choice and dosing of drugs when providing anaesthesia for electroconvulsive therapy (ECT).
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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%)
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A drug has been unintentionally administered through a radial arterial line in an awake patient. Describe your management of this situation.
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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%)
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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%)
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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%)
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Outline extubation strategies for anticipated difficult extubation of an adult.
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A 30YO patient is scheduled for laser resection of a subglottic mass to relieve mild stridor. Justify your intraoperative anaesthetic management of this case
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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.
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Describe the requirements for establishing an anaesthetic service for a neurosurgical theatre with a magnetic resonance imaging scanner
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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.
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As a perioperative physician, what strategies can you offer to assist a patient to cease smoking tobacco and how will you best communicate them?
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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?
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Discuss the advantages and disadvantages of non-invasive ventilation methods in the intensive care unit.
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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
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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
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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%)
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Describe the physiological effects of pneumoperitoneum with CO2 for laparoscopic surgery
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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.
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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%)
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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?
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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%)
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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
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An otherwise well 60-year-old man is having a radical prostatectomy List and briefly evaluate strategies to prevent peri-operative thromboembolism
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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.
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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%)
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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.
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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%)
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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.
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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.
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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%)
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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%)
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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
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A 60-year-old patient is scheduled for stenting of a tracheobronchial mass. Outline your perioperative management.
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Evaluate the role of tramadol in acute and chronic pain management.
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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.
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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.
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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.
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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%)
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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%)
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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
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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%)
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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?
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List the hazards to the patient associated with the prone position under general anaesthesia. (60%) How can these hazards be minimised? (40%)
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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.
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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%)
.x.
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%)
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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.
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Discuss the consequences of perioperative hypothermia.
.x.
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.
.x.
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%)
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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%
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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
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What are the issues associated with jet ventilation?
.x.
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%)
.x.
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.
.x.
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
.x.
Discuss the perioperative implications for a patient known to use methamphetamine.
.x.
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
.x.
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%)
.x.
Evaluate the role of gabapentin in acute and chronic post surgical pain management
.x.
Outline the key steps in gaining informed consent for anaesthesia in a competent ASA 1 adult undergoing minor elective surgery
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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.
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Discuss how Marfan syndrome influences your anaesthetic management for a patient requiring an urgent laparoscopic appendicectomy.
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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
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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%)
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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.
.x.
Define frailty and discuss the role of prehabilitation for patients with frailty.
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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%)
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Considering the indications and limitations, compare the rationale for the use of: —Hudson masks —Non-rebreathing masks —Nasal prongs
.x.
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
.x.
Describe the pathophysiological effects of carbon dioxide pneumoperitoneum during a surgical procedure.
.x.
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%)
.x.
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%)
.x.
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
.x.
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%)
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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%)
.x.
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%)
.x.
Discuss in detail the technique of rapid sequence induction with cricoid pressure in a child. Include the reasons for your choice of relaxant.
.x.
Discuss the elements you consider important when obtaining consent for epidural analgesia in labour.
.x.
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%)
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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
.x.
Describe the clinical presentation of venous carbon dioxide embolism during laparoscopic surgery and outline your management
.x.
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%)
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What are the considerations when anaesthetising a patient for a complex laparoscopic ultra-low colonic resection?
.x.
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%)
.x.
Describe the indications for referral for an antenatal anaesthetic assessment.
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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%)
.x.
Compare and contrast first-generation and second-generation laryngeal mask airways
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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%)
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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%)
.x.
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.
.x.
Critically evaluate the role of recombinant factor VIIa in blood loss requiring massive transfusion in the trauma patient
.x.
Outline the clinical features, differential diagnoses, and management of serotonin syndrome in the perioperative period.
.x.
Describe the principles of cerebral protection in a patient with an isolated closed head injury.
.x.
Critically evaluate the use of Beta blockers in the perioperative period to prevent myocardial infarction.
.x.
Outline the physiological implications of brainstem death following subarachnoid haemorrhage in a patient listed for organ donation.
.x.
List methods to prevent hypothermia in paediatric patients during anaesthesia and surgery, commenting on the effectiveness of each.
.x.
Describe the principles that are important in making clinical research ethical.
.x.
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%)
.x.
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
.x.
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?
.x.
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%)
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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?
.x.
Outline the circumstances where the dosing of paracetamol requires modification 50% Described the management principles of paracetamol toxicity 50%.
.x.
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%)
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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
.x.
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
.x.
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%)
.x.
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.
.x.
Discuss your considerations when anaesthetising a patient for functional endoscopic sinus surgery.
.x.
Why is consent for a medical procedure necessary? What makes consent for a medical procedure valid?
.x.
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%)
.x.
Outline the considerations for successful weaning from cardiopulmonary bypass after coronary artery graft surgery.
.x.
Discuss the usefulness of the continuous measurement of mixed venous oxygen saturation in the intensive care patient
.x.
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.
.x.
Describe the anatomy relevant to cannulation of the subclavian vein via the infraclavicular approach.
.x.
(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%)
.x.
Describe the rationale for the use of deep hypothermic circulatory arrest and outline the pathophysiological consequences of this technique.
.x.
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?
.x.
Describe the anatomy of the Transversus Abdominis Plane (TAP) relevant to regional analgesia. (70%) List the complications associated with TAP block. (30%)
.x.
Define the terms ‘train-of-four’ (TOF) and ‘double burst stimulation’ (DBS) with respect to a peripheral nerve stimulator (PNS). (30%)
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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%)
.x.
Explain the professional attributes of an anaesthetist in specialist practice.
.x.
What is the natural history of aortic stenosis? (30%) 2. What are the key echocardiographic features in haemodynamically significant aortic stenosis? (70%)
.x.
Describe the anatomy relevant to performing a caudal block in a two-year-old male.
.x.
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?
.x.
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.
.x.
Outline the features of the anaesthetic machine that ensure safe gas delivery to the patient.
.x.
Outlined the problems in providing general anaesthesia for an adult in the MRI suite
.x.
Describe your technique to provide caudal epidural anaesthesia for an infant weighing 10 kilograms undergoing hypospadias surgery.
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(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%)
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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%)
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What are the benefits and limitations of red blood cell salvage? (50%) How would you justify its introduction into your institution? (50%)
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List the signs of malignant hyperthermia. (30%) Outline the immediate management of a patient where malignant hyperthermia is suspected. (70%)
.x.
Discuss the key areas of concern in your preoperative assessment of a patient for excision of a large tonsillar mass.
.x.
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
.x.
What are the advantages and disadvantages of general versus local anaesthesia for carotid endarterectomy?
.x.
Discuss the perioperative management of a previously well patient presenting for transphenoidal resection of a non-secreting pituitary macroadenoma
.x.
Evaluate the use of intravenous lignocaine infusions for perioperative analgesia.
.x.
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%)
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List the factors associated with increased mortality following rib fractures. (30%) Describe a comprehensive rib fracture management plan. (70%)
.x.
Define circulatory shock Categorise the causes of circulatory shock and give an example in each category.
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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
.x.
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%)
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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%)
.x.
Discuss the role of desflurane in current anaesthesia practice
.x.
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
.x.
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%)
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Describe your immediate assessment and management of the airway in a patient with smoke inhalation injury.
.x.
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
.x.
Outline the pharmacological features of remifentanil. (50%) Describe how these features can be utilised when using remifentanil in clinical practice. (50%)
.x.
Describe a technique of peribulbar block for cataract surgery. Describe how you would minimise complications of this block.
.x.
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%)
.x.
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%)
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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
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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.
.x.
Explain the features of the electrical power supply to operating theatres that protect patients from marcoshock.
.x.
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
.x.
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
.x.
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
.x.
What factors contribute to acute kidney injury in the perioperative period? (70%) & Outline the efficacy of perioperative strategies to reduce acute kidney injury. (30%)
.x.
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.
.x.
Discuss the preoperative assessment for a patient who presents for thyroidectomy.
.x.
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
.x.
Discuss how a diagnosis of Addison’s disease would influence your perioperative management of a patient who requires an urgent laparotomy for bowel obstruction.
.x.
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%)
.x.
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%)
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Describe the role of the anaesthetist in minimising surgical site infection.
.x.
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%).
.x.
Discuss the safe use of arterial tourniquets for orthopaedic procedures.
.x.
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%)
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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?
.x.
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.
.x.
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%)
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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%)
.x.
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.
.x.
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%)
.x.
What is evidence based medicine. (30%) b. Describe the features of a systematic review, indicating how it may influence your practice of anaesthesia. (70%)
.x.
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.
.x.
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
.x.
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
.x.
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%)
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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%)
.x.
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%)
.x.
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%)
.x.
Nitrous oxide should not be used routinely as a component of general anaesthesia. Discuss.
.x.
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.
.x.
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
.x.
Describe how the ECG should be used to monitor for intraoperative myocardial ischemia in a patient with ischemic heart disease.
.x.
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%)
.x.
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.
.x.
What are the perioperative concerns for the anaesthetist managing a patient with epilepsy?
.x.
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
.x.
An elderly patient in the recovery unit is confused and agitated following surgery. Describe your management.
.x.
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?
.x.
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%)
.x.
List the methods of analgesia that can be used for patients undergoing open liver resection surgery. (30%) Justify your perioperative pain management strategy. (70%)
.x.
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.
.x.
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%.
.x.
Discuss the anaesthetic considerations for an adult patient with rheumatoid arthritis presenting for wrist surgery.
.x.
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%)
.x.
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.
.x.
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%)
.x.
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%)
.x.
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.
.x.
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
.x.
Evaluate the role of tranexamic acid in primary hip arthroplasty.
.x.
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.
.x.
Describe the physiological responses to electroconvulsive therapy (ECT). (50%) Discuss how these affect your anaesthetic management of a patient undergoing ECT. (50%)
.x.
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%)
.x.
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.
.x.
Discuss the role of ketamine in current anaesthesia practice.
.x.
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%)
.x.
Describe the advantages and disadvantages of multicenter clinical trials in anaesthetic research
.x.
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.
.x.
Justify your strategies for managing severely elevated intracranial pressure.
.x.
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%)
.x.
What is the physiological basis of preoxygenation? Describe your method of preoxygenation including how you assess its adequacy.
.x.
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%)
.x.
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%)
.x.
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.
.x.
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
.x.
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%).
.x.
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%)
.x.
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%)
.x.
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.
.x.
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%)
.x.
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.
.x.
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.
.x.
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%)
.x.
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%)
.x.
Justify your use of perioperative prophylactic antiemetics.
.x.
Describe your assessment of a four-year-old child who has been rescued from a house fire.
.x.
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%)
.x.
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%)
.x.
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%)
.x.
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%)
.x.
Discuss your perioperative management of a patient with carcinoid syndrome presenting for small bowel resection.
.x.
Outline your peri-operative management of a patient with mitral stenosis scheduled for a laparoscopic inguinal hernia repair.
.x.
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%)
.x.
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%)
.x.
Outline the pathophysiological insults that exacerbate a primary brain injury following head trauma and indicate how can they be minimised.
.x.
A patient on an organ transplantation waiting list is taking rivaroxaban for recurrent pulmonary emboli. Discuss your perioperative anticoagulation plan.
.x.
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%)
.x.
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
.x.
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
.x.
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?
.x.
Describe the anatomy of the orbit relevant to a peribulbar eye block.
.x.
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
.x.
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.
.x.
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%)
.x.
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%)
.x.
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%)
.x.
(a) Describe the anatomy, including surface landmarks, relevant to performing cricothyroidotomy. (50%) (b) What are the complications of this procedure? (50%)
.x.
Outline methods available to minimise intraoperative drug errors
.x.
Describe the factors that contribute to intravenous drug errors in anaesthesia practice. Discuss the methods available to reduce the incidents of such errors.
.x.
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%)
.x.
List and explain the typical electrolyte abnormalities of chronic renal failure.
.x.
What are the indications for prophylaxis against perioperative bacterial endocarditis? (50%) 2. Justify your choice of antibiotics. (50%)
.x.
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.
.x.
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.
.x.
“It is no longer justifiable to use aprotinin during cardiac surgical procedures”. Discuss
.x.
Describe a technique of neural blockade in the popliteal fossa for surgery on the foot and ankle including a description of the relevant anatomy.
.x.
Outline the major considerations for organ donation after circulatory death. (DCD)
.x.
One of your anaesthetic colleagues is prescribing fentanyl patches as discharge medication for patients following total hip joint replacement. Evaluate this practice.
.x.
Discuss the principles of damage control resuscitation in severe trauma
.x.
A 20 year old patient has been successfully resuscitated from suspected anaphylaxis. Describe your immediate and longer term post crisis management.
.x.
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
.x.
A three year old child requires an adenotonsillectomy for obstructive sleep apnoea. Outline and justify your peri-operative management plan
.x.
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%)
.x.
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?
.x.
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%)
.x.
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?
.x.
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.
.x.
What are the hazards of the prone position for patients under general anaesthesia and how can they be minimized?
.x.
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%)
.x.
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%)
.x.
Evaluate the use of available neuromuscular blocking agents when performing a rapid sequence induction.
.x.
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.
.x.
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
.x.
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%)
.x.
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.
.x.
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.
.x.
- 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%)
.x.
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%)
.x.
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
.x.
(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%)
.x.
List the complications associated with the use of limb tourniquets during surgery. (60%) How can these complications be minimised? (40%)
.x.
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%)
.x.
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.
.x.
Evaluate the options for managing a confirmed postdural puncture headache in an obstetric patient.
.x.
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%).
.x.
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.
.x.
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)
.x.
A patient dies soon after induction of anaesthesia. As a senior clinician you are asked to arrange a debriefing.
.x.
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.
.x.
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%)
.x.
Describe the relevant anatomy and technique for field block for inguinal hernia repair.
.x.
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%)
.x.
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%)
.x.
Outline the factors influencing spread of intrathecal local anaesthetic.
.x.
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%)
.x.
Describe the process of intraoperative cell salvage. (50%) Discuss the indications and contraindications for intraoperative cell salvage. (50%)
.x.
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%)
.x.
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%)
.x.
Outline the risk factors for, possible mechanisms of, and methods to prevent, postoperative ulnar neuropathy.
.x.
Evaluate the use of human albumin in perioperative volume replacement.
.x.
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%)
.x.
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%)
.x.
Compare and contrast oxygen delivery by nasal prongs, simple facemask and Venturi mask.
.x.
Describe the innervation of the foot relevant to an ankle block.
.x.
How would you critically appraise a paper published in a journal?
.x.
Outline the operating principles and safety features of a modern variable bypass out of circuit vaporiser
.x.
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
.x.
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
.x.
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%)
.x.
What are the key objectives of ethical review of a research project?
.x.
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.
.x.
Describe the features you require of a transport ventilator for a patient with severe ventilator-dependent acute respiratory distress syndrome.
.x.
Explain your approach to thromboprophylaxis in the patient undergoing total knee replacement.
.x.
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.
.x.
How does soda lime work? List the hazards associated with its use.
.x.
Discuss the non-technical skills required for management of an intraoperative crisis
.x.
Discuss the perioperative strategies you would use to mitigate the risks of prolonged surgery in the prone position
.x.
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.
.x.
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%)
.x.
How do you determine if a patient with known obstructive sleep apnoea is suitable for day surgery?
.x.
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%)
.x.
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.
.x.
Explain the terms sensitivity, specificity, positive predictive value and negative predictive value when applied to a diagnostic test
.x.
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%)
.x.
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
.x.
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%)
.x.
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.
.x.
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.
.x.
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%)
.x.
What is the physiological basis of preoxygenation? (50%) b. Describe your method of preoxygenation including how you assess its adequacy. (50%)
.x.
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.
.x.
Describe how you would determine the usefulness of a published paper for your own practice.
.x.
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?
.x.
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%)
.x.
You are asked to provide local anaesthesia for awake craniotomy. Describe the innervation of the scalp, including the landmarks for nerve blockade.
.x.
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.
.x.
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.
.x.
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%)
.x.
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%)
.x.
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.
.x.
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%)
.x.
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)
.x.
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.
.x.
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%)
.x.
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.
.x.
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.
.x.
Outline the issues involved in the preoperative assessment specific to a patient presenting for transsphenoidal hypophysectomy for acromegaly
.x.
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
.x.
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.
.x.
List the indications for hyperbaric oxygen therapy. (30%) Discuss the problems with providing this treatment. (70%)
.x.
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%)
.x.
Discuss your strategy for the management of coagulopathy in the multitrauma patient
.x.
Describe the features and management of phantom limb pain.
.x.
You are developing an anaesthetic department policy for acute endovascular stroke intervention. Outline the issues to be considered in your policy.
.x.
Discuss the risks and benefits associated with intermittent positive pressure ventilation through proseal ® laryngeal mask airway for a patient undergoing laparoscopic cholecystectomy.
.x.
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.
.x.
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.
.x.
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.
.x.
Evaluate the equipment available for the delivery of oxygen to postoperative patients on a general surgical ward.
.x.
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.
.x.
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
.x.
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
.x.
Describe the complications that can occur post carotid endarterectomy and how these may present in the post anaesthesia care unit (PACU).
.x.
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%)
.x.
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%)
.x.
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
.x.
(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%)
.x.
Outline the immediate management of an unconscious trauma patient in the ED who has suspected C-Spine injury
.x.
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%)
.x.
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.
.x.
List the essential equipment currently recommended to manage a difficult airway in an adult patient. (50%) Justify supplementary items you would recommend. (50%)
.x.
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.
.x.
Describe the principles of cerebral protection in a patient with an isolated closed head injury.
.x.
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?
.x.
In regard to total parenteral nutrition: 1. What are the indications? (30%) 2. What are the complications? (70%)
.x.
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%)
.x.
Evaluate the use of cerebral oximetry monitoring in non-cardiac surgery.
.x.
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).
23.1
Outline the immediate management of an unconscious trauma patient in the
emergency department who has a suspected cervical spine injury.
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.
23.1
Discuss the perioperative management of a previously well patient presenting
for transsphenoidal resection of a non-secretory pituitary macroadenoma.
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.
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.
23.1
Describe your technique to provide caudal epidural analgesia for an infant
weighing 10 kg undergoing hypospadias surgery.
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
23.1
Justify strategies used to mitigate postoperative delirium in an elderly patient
requiring hip fracture fixation.
23.1
Describe the innervation relevant to the stages of labour (30%).
Evaluate the regional analgesia options for each stage (70%).
23.1
Outline the major considerations for organ donation after circulatory death
(DCD).
23.1
Outline the circumstances where the dosing of paracetamol requires
modification (50%).
Describe the management principles of paracetamol toxicity (50%).
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.
23.1
Discuss the preoperative elements of an Enhanced Recovery After Surgery
(ERAS) program for a patient requiring major colorectal surgery.
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
23.2
Evaluate the use of long-acting opioids in the treatment of acute pain.
23.2
Describe a perioperative pathway for hip replacement surgery with an expected in-
hospital length of stay of less than 24 hours.
23.2
Discuss the management of a patient with life-threatening haemorrhage from major
pelvic trauma.
23.2
Evaluate the usage of the pulmonary artery catheter in anaesthesia.
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).
23.2
Outline the treatment strategies for chronic heart failure.
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%)
23.2
Discuss the elements of perioperative management that improve outcomes in patients undergoing emergency laparotomy.
23.2
Outline your preoperative assessment of a 1-year-old patient requiring a
ventriculoperitoneal shunt revision.
23.2
Discuss the potential benefits and risks of supranormal oxygen levels in the
perioperative setting.
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%)
23.2
Describe the benefits and limitations of meta-analyses.
23.2
Discuss the perioperative management of a patient undergoing urgent thyroidectomy
following failed medical therapy for thyrotoxicosis.
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%).
23.2
Discuss the potential complications associated with hysteroscopy and their anaesthetic
management.
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.
24.1
Describe both the surface anatomy and anatomical relations of the internal jugular vein
relevant to central venous cannulation.
24.1
Describe the mechanism of action of tranexamic acid and evaluate its use in obstetric
anaesthesia practice.
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%)
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.
24.1
Evaluate the use of a processed electroencephalogram (EEG) as a routine monitor
during general anaesthesia.
24.1
Discuss the anaesthetic considerations for a patient requiring cerebral aneurysm
coiling.
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%)
24.1
Discuss your perioperative analgesic management plan for a 20 kg, four-year-old child
undergoing elective adenotonsillectomy.
24.1
Evaluate the practice of deliberately-induced intraoperative hypotension.
24.1
Discuss the anaesthetic considerations for a patient with myotonic dystrophy
presenting for an emergency laparotomy.
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%)
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
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%)
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.
