| Index
to
some remembered Vivas
May 98 (this page)
| September 98
| May
1999
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2000
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2000
| September
2001
| May 2005 |
| May
1998 Part
II Anaes Finals
Viva |
Viva
One
A 24
year old opera singer for bilateral nasal polypectomy.
She is otherwise in excellent health.
She is worried about her voice being damage by the
anaesthetic. |
How
do you response to her worry.
What are the damage that can be caused by airway
instrumentation.
What nerve that can be damaged?
What other technique is available for this procedure -
LMA and LA.
What are the problem with LMA?
What nerves do you have to block for the nose?
Describe your GA technique - position, induction and
drugs used.
How would you manage her hypertension?
How low would you be happy to go?
What would you use?
VEB's ++++ and BP normal - Mx?
How would you wake her up?
Post extubation - spasm - your Mx?
She bit on your metal sucker and broke her teeth -
your Mx? |
Viva
2
An 84
year old female sustained a Colles # of her left wrist
during her birthday lunch one hour prior.
You are the anaesthetic consultant and you plan to
perform a Bier's block for her. |
What
are the pros and cons for the performance of this
block for this case
What drugs would you use? And why?
Side effects of prilocaine - Met Hb - dose, etiology
and Rx.
Describe your technique.
Where would you be happy to do the block?
If the block fails and she needs a GA - when would you
do it?
What about the timing of the operation?
What other LA can you use? And how do they compare
with other LA?
List the LA in order of their toxicity.
What are the signs of systemic toxicity?
The arterial tourniquet - what size and maintenance
would you like it in?
What are the side effects and contra-indications in
its use?
After the initial reduction and you let the tourniquet
down , the ortho reg saw the post reduction film and
wanted another yank - how long would you wait and what
dose would you use?
Despite your best effort, the tourniquet deflated soon
after injection of the second dose of prilocaine and
she fitted - your management.
What other classes of drugs can you use?
You are asked to see her the next day with sore arm
despite the POP being split - what are the DDx here ? |
Viva
3
You are
the new anaesthetic consultant at a new major regional
hospital. You are asked to perform anaesthesia for ECT
for a 72 year old female for very severe depression.
She has a known history of hypertension. |
Describe
your approach
What is the major requirements of the college
regarding ECT?
What drugs would you like available at the ECT site?
No history available - how else do you get the history
More
details: Medications - Phenelzine,
Metoprolol, Hydralazine, Ranitidine
PMHx - AP ;
BP and 180/95 ; HR 90
Would you perform the procedure?
What are the physiological changes associated with ECT?
How would this potentially affect this lady?
What are the major anaesthetic issues here?
How would you optimize this women?
You have a assistance who is usually is a psych EN and
she asked you what is a laryngoscope?
What is the college requirement for anaesthetic
assistance ? |
Viva
4
18 year old female for elective
CS with kyphoscoliosis. She has heard of CSE technique
from a friend and requested this technique for her
anaesthesia. |
Describe
your approach to this lady
What are the benefits of CSE compared to either
epidural and spinal alone?
Are there any benefits with CSE compared with a two
needle technique?
What do you tell her for her consent of RA
What are the risk and complications of CSE?
What is the risk of PDPH in general?
What about with a touhy needle in this age group and
what percentage of these women will need a patch?
How do you perform your CSE?
What if there is no CSF return?
Do you do a test dose for this lady?
What are the problems of CS and kyphoscoliosis?
Post CSE hypotension - your Mx?
Aortocaval compression - describe the pathophysiology? |
Viva
5
You are the anaesthetic
consultant at your local cardiac hospital. A female
patient is about to come off CPB after 4 vessel CAG
and MVR.
What are your preparation for this lady to ensure she
will come off CPB?
* Further history for later on :
70 year old lady with PMHx of
IHD and recent AMI with UAP; Long history of IDDM. Smoker
Meds: digoxin, lasix, KCl, ACE Inhibitor
Angiography: Left
main 70% stenosis, LCx
60%, RCA 70%
LV gram 25%
Swan data = PHT and LV failure; 85/50 ; SR 60; PAOP 30; CVP 13 |
How
would you optimise this lady pre-op
Would you consider a IABP?
How would you insert one and draw the modified trace
of IABP
Describe the timing of the inflation and deflation.
How do you explain the diastolic drop in pressure on
the curve?
Shown CVP and Swan data:
CI normal, SVR low-ish, PVR normal, PAOP 8
[Hb] 80 g/l
Further fluid loading: CI still low and lower,
Right heart failure ensures
Management of this - back on CPB
Bell went! |
Viva
6
84 year old female , NH patient, admitted to your ICU
with confusion, hypotension, hypothermia 35C and HR 90
bpm. Her medications include : Digoxin 0.125 mg, KCl,
Lasix, and ACEI. Her CXR shown subphrenic air and she
has mild MR. |
What
are the issues here?
How would you manage this lady pre-operatively?
U&E's - Na 148, K 5.2, Cr 0.21, Ur 18 - what is
the r/ship between Ur and Cr to assess pre or renal
failure?
What other Ix would you need to do?
What lines would you use? What about PAC?
Induction technique? Any special concerns for this
particular lady.
CV Collapse post induction - your Mx.
Renal protection - your views AND method? |
Viva
7
A 64 year old female for open
cholecystectomy. She is a heavy smoker with 60
cigarettes per day for the last 40 years and she
requested intra-pleural blockade as the mode of
analgesia of choice. |
Your
response to her request
Options for analgesia in this case
How would you have performed this block
Position
Site
and approach
Technique
Dosing
- dose, bolus vs infusion
Complications
Timing
of insertion
Hypertension and Tachycardia during OT 30 mins into
case
DDx
Mx
MH - Dx, Mx and post op follow up
Daughter in country next week having GA CS by GP
Phone advise to GP
Masseter spasm - tell me about it |
Viva
8
A 3 year old female child had a
tonsillectomy on the morning list. You are requested
to attend to her regarding her coughing and vomiting
up some fresh and some old blood. She is very
distressed. |
Your
approach
Estimated blood loss - how can you tell - clinically
??
they threw out the bowl of
blood
HR 140 bpm; UO uncertain; BP 95/-.
Mx of fluid - bolus, maintenance and losses.
2 hours later - ENT wants to take her to OT - pre op
preparation (they wanted IV and XM)
What size tube ? no weight given
Induction technique and expected problems
Circuit problems and TV and RR settings etc
Interpretation of capnogram with T piece and other
capnograms |
Viva
9
A 24 year old female, 2/52 post
partum, suffered a massive PTE. She is currently being
transferred to your ICU for potential pre-op
optimisation in preparation for pulmonary embolectomy. |
What
signs and symptoms
do you expect to see?
What Ix would you use to confirm the Dx?
What do you expect to see on ECG?
Shown ABG’s -
PaO2 70
PaCO2 26
pH 7.42
FiO2 50%
Rx options of PTE for this lady.
TPa was given approx 4 hours ago - what lines would
you like in ICU?
TPa and its complications etc.
How would you perform her anaesthesia?
Post operative low output indicating RHF - what is
your Mx? |