| May
1999 Anaes
Final
Vivas - (from
Anthony Coorey)
|
| Scenario
1: A 22
year old in a high speed MVA, HR 110, BP 160/100, moaning, eyes
not opened, withdrawing to pain.
|
What are your management priorities?
How do you assess airway, breathing ?
What are the potential problems?
How do you protect C spine?
Are hemodynamics consistent with Cervical spine injury?
What X ray would you order to assess Cx Spine?
What do you look for?
What is his GCS?
What are the signs of - CNS injury
and High cord transection?
How do you intubate this patient?
Who do you want to assist you ?
How do you do cricoid pressure / axial inline stabilisation
?
Do you take the collar on / off?
What do you do if you can't see?
What about Cricoid pressure ?
What drugs and how much ?
En route to CT scan, he blows a pupil - your Mx.
BP 180/110 - how do you treat?
SDH drained and now in ICU - undisplaced # femur noted
Large swing in ICP with suctioning - would you do the case ?
ECG - deep TWI with LBBB = Increase ICP ??
Anterior ST elevation - what Dx ??
|
| Scenario
2: Elderly female with dementia for fem pop bypass |
What are the issues?
Who gives consent?
How do you assess the ability to give consent?
What are the DDx of Alzheimer's disease?
What drugs are these patients commonly on?
How do these drugs interfere with your anaesthetic?
Are there any new drugs specially used for Alzheimer's to
treat Sx?
How would you do the procedure?
In recovery, the patient is agitated, Mx and causes.
Overnight, you are called to see her for confusion.
What is your approach? And what Mx options are available?
What are the issues with RA and anticoagulation?
|
| Scenario
3: You are called by your registrar who cannot intubate an
obese male for decompressive laminectomy. |
What advise would you give?
How do you insert a nasopharyngeal airway?
What constitutes a difficult airway?
What pre-operative predictors are there?
What are their sensitivities and specificities and what do
they mean?
What are PPV and NPV?
Do you attend ??
On arrival - SaO2 80% with problem with ventilation.
What do you do ?
Fast track failed - and now unable to ventilate - how likely
is this ?
How do you do Trans Tracheal ventilation?
Despite your best effort - patient dies.
How do you contact the family?
What do you say?
Who else do you contact?
What are the provisions for
removing the apparatus?
Who is responsible for organising the autopsy?
How do you de-brief the registrar?
When should he return to work?
What do you do with the surgical team and nursing staff?
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| Scenario
4: 82 year old male with frontal glioma, headaches and ESM. |
What are the issues here?
How do you determine ICP increase?
How do you grade a valve lesion?
What Ix are required?
ECG showed LVH and Echo showed gradient of 45 but no ASA
available
Is there anything else you want?
Premeds and access.
What monitors and why?
How do you induce?
What are your goals?
Benefits of Propofol maintenance vs Isoflurane
Any difference with other volatiles?
What is the role of N2O?
Tight Brain - what do you do?
What are the effects of mannitol?
Any other drugs?
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|
Scenario 5: K = 30/40 with twins presented with acute appendicitis
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What are the issues here?
Quantify the risk for the unborn children
What else could cause the symptoms?
Surgeon is very good at lap surgery - would you be agreeable
for Lap appendix?
He is actually the world's expert at this - would you be
happy?
What monitors would you use?
How do you conduct anaesthesia?
What if you could not intubate?
What if you could not ventilate?
Post op premature labour - what are the issues?
How do you manage it ?
How do you make up the salbutamol infusion ?
What disadvantages of Mg are there ?
Post op analgesia ?
Innervation of uterus and appendix ?
|
| Scenario
6: A 6/12 old male child with pyloric stenosis |
How do you assess?
What level of hydration?
How do you give fluid?
What are the indications for preoperative hydration?
What level of HCO3 should you aim for?
Shown set of U&E's consistent with PS
What changes with improvement?
How do you conduct anaesthesia?
What monitors would you use?
What analgesia would you use ? Fentanyl? Atropine?
What disadvantages exist
with atropine?
What post op concerns are there?
Laryngospasm post op - Mx.
IV out - Mx
Cyanosed - HR 40 - still in spasm - Mx
Emergency Airway Mx
Compare Sevo vs other volatiles for gaseous induction.
SE's of Sevoflurane vs Halothane
|
Scenario
7: A 44 year old male, post MVA with central chest pain and #
right femur.
Given 1500 ml Crystalloid and Sx/Sy are : tachycardia,
hypotensive and irregular HR |
What is his degree
of EBL?
How do you assess his cardiac status?
ECG = AF
What other test ? Echo = right sided RWMA.
Acute Mx - place of cardioversion?
What are the overall issues here?
Alternative to crystalloid for Resuscitation.
What do you use and when?
SE's of haemacel.
Mx of haemacel hypotension.
Use of Albumnix IV - advantages and disadvantges.
Intra-operative hypornesion and fast AF - Mx
Post op Mx.
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| Scenario
8: A 56 year old male presented with abdo pain for laparotomy -
he is confused with increased urinary ketones, proteinuria
and tachypnoea and fast AF |
What are the issues here.
How do you assess?
What Ix would you want?
What is the anion gap? Osmolarity?
How do you assess ABG's
What is the role of NaHCO3 in this ?
How do you use it? And how do you manage its complications?
What ketones makes up ketone bodies?
What could be the cause of his abdo pain?
DKA Mx:
Why use dextrose and how much?
How much insulin would you use?
What will you do to AF?
What drugs would you use?
Should you cardiovert?
How much energy is needed?
How do you set up the cardioverter?
Why use 100J at the start?
Post op Mx - pH 7.27 and pCO2 31
Where are you going to send him?
Would you ventilate him?
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