| September
98 Anaes Final Vivas - (from Mark Lai)
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| Scenario
1: 57
year old with supratentorial meningioma. She has past
history of NIDDM on Glibenclamide and she is also
Dexamethasone 4 mg Qid.
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Pre Operative assessment
Effects of operations on BSL and ? effect due to steroids
Bulging dura after opening - management
Excessive bleeding - management
Vasodilator - clinical effects and which ones does not
affect CBF
20 mins post op - still no respiration and still tubed -
management
All the usual tricks have been tried and all drugs reversed
- no better - management
When do you extubate ?
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| Scenario
2: An 11/12 old child for cleft palate repair
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Airway anatomy
Child has Pierre Robin - clinical features, Medical Mx and
other organ involvement
Anaesthetic Mx of airway - options : awake, spont vent, tube
?
How would you do awake in this child
Child has stridor in recovery - DDx and management
Despite best effort, still blue and has resp obstructions
and struggles - Mx?
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| Scenario
3: A
67 year old male for pneumonectomy on the right side. On
examination, he has sharp stabbing pain on the right nipple
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Etiology of this pain
Has HVZ - clinical features, symptomatic Mx - options,
sequelae of HZV
Will you go ahead with operation
Ill effects of clinical infection
Describe PHN (post herpetic neuralgia)
Who is disposed
Treatment options
Mechanism of drugs used
How to titrate opioids and effects of opioids
NMDA antagonist and clonidine - how to give
Regional blocks and HZV
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| Scenario
4: A
46 year old for face lift, on prozac and has hx of severe
PONV
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What is a face lift - explanation given by the examiner
How would you anaesthetise patient
How much local infiltrate would you allow and how much
adrenaline
Problem with this operation
Monitoring
Maintenance
Rx of PONV and prophylaxis
Aims of perioperative Anaes Mx technique - airway,
hypotension, analgesia
Describe hypotensive anaesthesia
Classify antiemetics
Mx of hypertension in recovery
How would you manage her nausea
Equipment :air viva / resuscitator and Feature
of non re-breathing valve
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| Scenario
5: A
53 year old for liver resection with secondaries from Ca
colon removed two years ago.
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Pre operative assessment - intraoperative risk, approaches
Minimization of blood loss
Criteria for autologous blood donation
Post op analgesia
Thoracic vertebra anatomy - how to do thoracic epidural
Warming techniques available
Blood warmers - varies type and their principles
Complication of epidural abscess and haematoma
How are they formed and how do they show up
DVT prophylaxis
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| Scenario
6:
36 year old with chronic pelvic pain for diagnostic
laparoscopy. She complained of sore throat and hoarseness of
voice one month after the last operation.
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Describe your approach
Criteria for LMA
BP 70/- and SaO2 88% with HR 40 bpm - DDx, Mx
Mx of VAE
Mx of PTX
Etiology of PTX in LMA patient
Asystole - Mx
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| Scenario
7: 73 year old male for elective AAA repair
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Risk factors in relations to cardiac morbidity
Assessment and Ix
How would you optimise
How would you anaesthetise this man
Options for detection of perioperative ischaemia
Shown ECG on diagnostic mode - inferior MI - Mx
No effect despite your best Rx - what next ?
If this is before the X clamp - what do you do?
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| Scenario
8: A
60 year old for discectomy , Hx of hypertension, diabetes
and morbid obesity (120kg and 160 cm)
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Risk factors and assessment
Optimise pre op
How to assess pulmonary hypertension
Assess respiratory function
Physiological causes of desaturation in morbidly obese
Describe mechanism of VQ mismatch
Problem with prone position
BP low once prone - why?
Which position can precipitate hypotension
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Scenario
9: 21
year old male in MVA, lap sash seat belt, pinned
between seat and dash, A&E at 1900
with Clear Cx spine, neck bruising, compound # ankle;
ATSP at 2130 for C/S and debride ankle
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Assessment
CT neck cleared BP 125/90, PR 112 and SaO2 94% - 6 litre /
min O2
Anxious in pain with RR increase and 3 litre of colloid has
been given
Assessment of EBL
What else are you worried about this chap
CXR - PTX, sub-cut emphysema and mediastinal emphysema - DDx
Rx and Mx
Where's the leak - bronchial or where ?
Bronchoscopy - can't do flexi
- for rigid - anaesthetic Mx with full stomach
Tracheal tear 3 cm above carina - anaesthetic approach
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