Finals SAQ-page 2
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- Finals May-2010 Q10 a. 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%)
- Finals May-2013 Q1 How is the need for manual in-line stabilisation of the neck determined? (50%) What are the implications of inline stabilisation for endotracheal intubation of the airway (50%).
- Finals Oct-2011 Q3 What are the benefits and limitations of red blood cell salvage? (50%) How would you justify its introduction into your institution? (50%)
- (Oct-2012 Q10) 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 to see in this patient at this stage (60%). 2. Discuss the current evidence for treatment of these abnormalities (40%).
- (Apr-2009 Q7) Outline the coagulation changes you would expect in a patient with a ruptured liver from blunt abdominal trauma requiring massive transfusion (50%) and describe how you would minimise then (50%).
- (May-2008 Q4) Describe the clinical features and treatment of Fat Embolism Syndrome.
- (Sep-2007 Q3) 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.
- (Sep-2006 Q14)Critically evaluate the role of recombinant factor VIIa in blood loss requiring massive transfusion in the trauma patient.
- (Sep-2001 Q10) A 72 yo male has been bought to your emergency room after being removed from a motor vehicle, which has been involved in a high speed collision. He is moaning, his eyes are closed and he withdraws to pain. What are the priorities in managing this patient on arrival in the emergency department?
- (Sep-2001 Q11) What is the place for early intubation and controlled ventilation for this patient?
- (Sep-2001 Q12) On transfer to the CT scanner his left pupil dilates. Describe your management.
- (May-2001 Q10) A 17 yo trail bike rider was struck on the neck by a low branch and thrown from his bike. He presents to your casualty with a hoarse voice, stridor and subcutaneous emphysema of the neck. Discuss your plan to secure this patient's airway.
- (Jul97) A 65 yo active man with a 40 yr pack history of smoking presents with 6 broken ribs and a small flail segment, soon after a fall from a ladder. He has no other significant injury. How would you manage his respiratory care in the first four days?
- (Jul97) Six hours after the injury, he develops ventricular ectopic beats. How would you diagnose the cause of these ectopic beats?
- Finals May-2012 Q6 A 25-year-old man with recurrent pneumothorax and persistent air leak is scheduled for video-assisted thoracoscopic pleurodesis. Outline the considerations involved in induction of anaesthesia in a patient with a persistent air leak (50%) Outline the management of an intraoperative deterioration of oxygen saturation in this patient (50%)
- Finals May-2013 Q13 a. 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%)
- Finals Oct-2013 Q8 You are asked to evaluate a 35-year-old patient who has been scheduled for mediastinoscopy to biopsy a symptomatic anterior mediastinal mass. Discuss the features specific to this condition that need to be considered when planning an anaesthetic for this patient. (50%). Describe how you may need to adapt your anaesthetic plan in response to each of these features. (50%)
- Finals Oct-2013 Q6 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. (see full gas on examiners report)
- Finals Oct-2009 Q4 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.
- (Sep-2007 Q2) 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.
- (May-2007 Q7) 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.
- (Sep-2003 Q15) Evaluate the methods available to confirm correct placement of a double lumen endobronchial tube.
- (Aug-2000 Q1) A 57 yo man with a primary lung tumour is scheduled to have a thoracotomy for a left pneumonectomy. Justify your choice of airway deice for this surgery and describe how it is placed.
- (Aug-2000 Q2) Discuss the advantages and disadvantages of using a bronchoscope to check the position of the device.
- (Aug-2000 Q3) Outline your management of an oxygen saturation of 82% during one lung ventilation.
- Finals Oct-2013 Q9 A 25-year-old boilermaker is scheduled for repair of a penetrating eye injury on the emergency list. List the determinants of intraocular pressure in general. (30%) Discuss the perioperative measures available to minimise increases in intraocular pressure in this patient. (70%)
- Finals May-2010 Q8 a. 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%)
- (Oct-2008 Q9) Describe a technique of peribulbar block for cataract surgery. Describe how you would minimise complications of this block.
- (May-2004 Q7) Discuss the advantages and disadvantages of sub-tenon's eye block compared with other eye block techniques.
- Finals May-2011 Q5 (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%)
- Finals Oct-2011 Q12 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%)
- Finals May-2013 Q14 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%)
- (Apr-2009 Q4) 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 a suparclavicular block (50%).
- (Oct-2008 Q2) Describe the innvervation of the lower abdominal wall from the umbilicus to the pubis symphesis. Describe a technique of peripheral nerve block (not wound infiltration) to provide post-operative analgesia for a low transverse abdominal incision.
- (Sep-2007 Q3) 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.
- (Sep-2007 Q13) Describe a technique of neural blockade in the popliteal fossa for surgery on the foot and ankle including a description of the relevant anatomy.
- (May-2007 Q2) Describe the relevant anatomy and technique for field block for inguinal hernia repair.
- (Sep-2006 Q2) 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.
- (Sep-2006 Q5) 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.
- (May-2006 Q10)Describe the anatomy of the orbit relevant to a peribulbar eye block.
- (Sep-2004 Q4) Outline the diagnostic criteria for an epidural abscess
- (Sep-2004 Q8) Describe the anatomy relevant to providing an ankle block for surgery on the big toe.
- (Sep-2004 Q9) Give reasons for your choice of local anaesthetic agent to provide intravenous regional anaesthesia for a reduction of a Colle's fracture in an 80 year old woman weighing 95kg.
- (Sep-2003 Q7) At the end of an open cholecystectomy, intercostal nerve blocks with a total of 20ml bupivacaine 0.5% are placed at two levels while the patient is still under general endotracheal anaesthesia. The patient develops ventricular fibrillation within 3 minutes. Describe your management of this situation.
- (Sep-2003 Q8) A 75 you man having a TURP under spinal anaesthesia which has been uneventful, becomes restless 70 minutes into the procedure. Explain your management.
- (Sep-2002 Q7) A 60 yo woman presents for elective right bunion surgery. She is hypertensive, controlled on medication, and would like the procedure to be performed under spinal anaesthesia. The surgeon requests this procedure be done under tourniquet control. How would you apply the tourniquet, what pressures would you choose, and what precautions would you take?
- (Sep-2002 Q8) Three weeks following the surgery, the patient contacts you as she has persistent numbness in her big toe. Describe your management of this situation.
- (Sep-2002 Q9) Describe in detail how you would perform and ankle block for this patient if spinal anaesthesia was contra-indicated and a tourniquet was not required.
- (May-2002 Q7) A 75 yo heavy smoker presents for a total knee replacement. He has a mechanical mitral valve prosthesis and is warfarinised. Discuss your strategy for perioperative anticoagulation.
- (May-2002 Q8) What is the place of a spinal anaesthetic in this patient?
- (May-2002 Q9) Discuss your plan for postoperative analgesia given that the surgeon plans for the patient to use a continuous passive motion device.
- (Sep-2001 Q9) Describe the symptoms, natural history and causes of "transient neurological symptoms" following spinal anaesthesia.
- (Aug-2000 Q4) A 46 yo male presents to a day procedure unit for a right knee arthoscopy. He wished to avoid general anaesthesia as he has experienced significant nausea in the past. In performing a spinal anaesthetic for this procedure, what factors would you consider in choosing the local anaesthetic agent?
- (Aug-2000 Q5) The following day the surgeon calls you because the patient is complaining of pain in his right thigh. What possible causes would you consider and how would you respond?
- (Aug-2000 Q6) When you contact the patient that day, he tells you that he has also been suffering from moderately severe headache since arriving home. What information would you seek and what advice would you give him?
- (Aug99) An 83 year old woman slips and sustains a left Colles' fracture after a birthday lunch, and is booked for manipulation and plaster of her fracture. Discuss the benefits and drawbacks of intravenous regional anaesthesia in this patient.
- (Aug99) Give reasons for your choice and dose of local anaesthetic agent for intravenous regional anaesthesia.
- (Aug99) What hazards does the use of a tourniquet present in this situation, and how might they be minimised.
- (Apr98) An otherwise well 20 yo requires circumcision. Describe the anatomy of the penis relevant to providing regional anaesthesia for circumcision in an adult.
- (Apr98) The patient becomes unconscious after injection of a total of 10 mls of bupivacaine 5mg/ml for penile block. Describe your initial assessment.
- (Apr98) The patient is found to be in ventricular fibrillation. Describe your management of this situation.
- (Jul97) A 50 year old apparently well man presents for inguinal hernia repair under spinal anaesthesia. Discuss the factors which would influence your choice of subarachnoid drug(s) for this surgery.
- (Jul97) Another anaesthetist administers 4 ml plain bupivacaine 0.5% into the subarachnoid space for his anaesthesia, and you are called to assist with resuscitation of the patient when he becomes asystolic 10 minutes after surgery commences. Discuss the possible causes of the asystole.
- (Jul97) Describe your management of this critical event.
- (Apr97) A 75 yo man requiring TURP takes a diuretic and beta blocker for hypertension. Spinal anaesthesia with 0.5% bupivacaine (plain) results in a sensory level of T10 and a fall in blood pressure from 170/95 to 130/80. Outline the considerations in the selection of spinal as compared with general anaesthesia for this man.
- (Apr97) How would you respond to a fall in blood pressure to 80/50, occurring after 30 minutes of surgery?
- (Apr97) After 70 minutes of surgery the patient becomes restless. Explain your management.
Professional Issues and Ethics
- Finals Oct-2010 Q14 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?
- Finals May-2011 Q3 Explain the professional attributes of an anaesthetist in specialist practice.
- Finals Oct-2011 Q11 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%)
- Finals May-2010 Q12 a. 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%)
- Finals May-2012 Q4 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.
- Finals May-2010 Q13 a. What do you understand by the term “Universal Precautions”? (40%) b. Describe how you apply these precautions in your daily anaesthesia practice. (60%)
- Finals Oct-2010 Q10 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%)
- (Oct-2012 Q8) OUtline the key steps in gaining informed consent for anaesthesia in a competent ASA 1 adult undergoing minor elective surgery.
- (Oct-2012 Q6) You are the consultant who has been tasked with introduction of the WHO 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%).
- (Oct-2008 Q14) What are the signs that may make you suspect opioid abuse in a colleage? If you had suspicions of opioid abuse in a colleague outline the principles that should guide intervention?
- (Oct-2008 Q4) In what circumstances is it permissible to permanently handover responsibility for a colleague and how would you ensure that this handover occurs safely?
- (May-2007 Q11) Why is consent for a medical procedure necessary? What makes consent for a medical procedure valid?
- (Sep-2005 Q9) Discuss the purpose of a postoperative visit.
- (Sep-2005 Q14) You see a patient in the preanaesthetic clinic who asks you to administer an "alternative medicine" as part of their anaesthetic for total hip replacement. How would you respond to this?
- (May-2005 Q14) A recovery charge nurse approaches you as Supervisor of Training because she is concerned at the amount of opiates one of your trainees has been signed out for patients. What will be your priorities in addressing the nurses concern?
- (Sep-2004 Q12) What are your obligations if you suspect a colleague to be chronically impaired?
- (May-2003 Q6) Discuss the importance of a routine post-anaesthetic visit by the anaesthetist
- (Sep-2002 Q1) A colleague seeks your advice. A patient to whom they gave an anaesthetic 2 days ago for removal of wisdom teeth as a day case, claims that she was awake during the operation. The patient remembers hearing someone refering to her as a "fat old cow". Your colleague has been notified that a formal complaint about this matter is to be investigated by the relevant legal authority. Discuss the factors which may have contributed to awareness in this patient.
- (Sep-2002 Q2) Give your recommendations for management of this patient's complaint.
- (Sep-2002 Q3) What strategies may be used to assist your colleague with the stress they may feel about the forthcoming investigation?
- (Sep-2001 Q4) A recovery charge nurse approaches you expressing concern at the amount of opiates one of your consultant colleagues is booking out for minor procedures. Today this colleague is working as the sole anaesthetist in the cardiac theatre. What will your be priorities in addressing the nurse's concerns?
- (Sep-2001 Q5) If opiate abuse were found to be the problem, what would the important elements of rehabilitation for this anaesthetist?
- (Apr-2000 Q7) You are asked to provide anaesthesia for an appendicectomy late at night. When you arrive, you smell alcohol on the surgeons breath. How would you respond to this situation?
- (Apr-2000 Q8) What are your obligations if you suspect a colleague may be chronically impaired?
- (Apr-2000 Q9) What are the signs of alcohol abuse in a colleague?
Complications of Anaesthesia
- Finals Oct-2009 Q8 Question 8 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%)
- Finals May-2011 Q10 (a) What factors contribute to acute kidney injury in the perioperative period? (70%) (b) Outline the efficacy of perioperative strategies to reduce acute kidney injury. (30%)
- Finals May-2011 Q6 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.
- Finals May-2011 Q1 (a) 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%)
- Finals Oct-2011 Q14 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%)
- Finals Oct-2011 Q5 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%)
- Finals May-2012 Q13 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%)
- Finals Oct 2013 Q12 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. What features would distinguish between delirium and dysfunction in this setting? (50%) What you would advise the family to be the expected outcome? (50%)
- Finals May-2011 Q12 (a) What are the complications associated with residual neuromuscular blockade? (30%) (b) Evaluate the methods available to assess residual neuromuscular blockade. (70%)
- Finals May-2013 Q3 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%)
- Finals Oct 2013 Q4 Outline methods available to minimise intraoperative drug errors
- (May-2010 Q2) a. List the hazards to the patient associated with the prone position under general anaesthesia. (60%) b. How can these hazards be minimised? (40%)
- (Oct-2009 Q3) 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%)
- (Apr-2009 Q3) A previously well 80kg 19-year-old male is anaesthetised for ORIF of # tib and fib. He has a RSI including Suxamethonium and is intubated and ventilated via a circle system at 12 breaths per minute and a TV of 700mL with a FiO2 of 0.5. He has had 500mcg of fentanyl and anaesthesia is maintained with 1.5 MAC Sevoflurane. He develops an increasing sinus tachycardia to 160/min with frequent ventricular ectopic beats and his ET CO2 rises to 60mmHg despite increasing his ventilation. There is no rebreathing evident of capnography. ABGs now
Outline the steps you would follow to manage this situation.
- (Oct-2008 Q3) What would make you suspect venous gas emnbolism during a surgical procedure? Briefly outline the principles of management of venous gas embolism causing haemodynamic compromise.
- (May-2008 Q2) 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?
- (May-2007 Q10) A 56 year old diabetic is scheduled for laparoscopic nephrectomy. This is his pre-operative 12 lead ECG. (See Examiners Reports.)
Ten minutes into the procedure his BP is 70/30 and his ECG lead 2 monitor looks like this. (Shows CHB). What does ECG 1 show? What Does ECG2 show? Outline your management of the situation associated with ECG 2.
- (Sep-2006 Q13) List the risks associated with the placement of a central venous catheter? Discuss the ways in which these risks may be modified.
- (May-2006 Q1) 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.
- (May-2006 Q2) Describe the factors that contribute to intravenous drug errors in anaesthesia practice. Discuss the methods available to reduce the incidents of such errors.
- (May-2006 Q7) 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.
- (Sep-2005 Q8) A 35 year old female is found to have a small pneumothorax following removal of a breast lump under local anaesthesia in a day surgery facility. How would you manage this?
- (Sep-2005 Q12) Describe the symptoms and signs of commonly seen perioperative nerve injuries in the upper limb. List the causes and possible strategies for prevention. Do not include injuries due to neural blockade or direct surgical trauma.
- (May-2005 Q7) List the possible causes of failure to emerge from general anaesthesia and describe how you would differentiate them
- (Sep-2004 Q2) Outline the possible causes of postoperative loss of vision
- (Sep-2003 Q11) A 68 y.o. man with pancreatic carcinoma is undergoing sedation for ERCP. His is in a semi-prone position. Soon after commencing ERCP you notice the oximeter reading is 73%. Describe your management.
- (Sep-2003 Q12) Discuss the options for management of a cold white hand with poor capillary refill ten minutes after placement of a radial artery cannula.
- (May-2003 Q10) A 25 yo woman has undergone a dianostic laparoscopy. In the PACU she complains of nausea and vomits repeatedly. Discuss the factors that make this patient more prone to post op nausea and vomiting.
- (May-2003 Q11) Discuss your management options in the PACU
- (May-2003 Q12) You are to anaesthetise this patient for repeat laparoscopy. Justify the strategies you would use to minimise PONV
- (May-2003 Q13) On removal of the drapes after a two hour mastectomy on a 20 yo patient, the endotracheal tube is found to be disconnected from the breathing circuit. How would you estimate the probably time interval from disconnection to detection?
- (May-2003 Q14) Two hours later, the patient has still failed to regain consciousness. Describe how you would explain this to the relatives.
- (May-2001 Q13) How would you try to decrease the likelihood of post-operative nausea and vomiting in a 40 yo woman who gives a history of severe distress from this, and now requires a laparoscopic cholecystectomy.
- (Aug96) Permanent loss of vision may occur following surgery unrelated to the eye. How may the likelihood of loss of vision following general anaesthesia for laminectomy be minimized?
- (Aug96) An otherwise healthy 25 year old woman undergoes hysteroscopic endometrial ablation. After an uneventful general anaesthetic she is slow to wake in the recovery ward and becomes restless and confused. How would you diagnose the cause of this delayed recovery?
- (Aug96) While you are assessing her, she begins to convulse. Describe your management.
- (Aug96) Compare the pharmacology of diazepam and thiopentone, with respect to the management of the patient's convulsions.
- Finals Oct-2010 Q4 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%)
- Finals May-2011 Q8 (a) Describe the anatomy, including surface landmarks, relevant to performing cricothyroidotomy. (50%) FIX INDENT (b) What are the complications of this procedure? (50%) FIX INDENT
- (May-2010 Q15) a. What is the physiological basis of preoxygenation? (50%) b. Describe your method of preoxygenation including how you assess its adequacy. (50%)
- (May-2007 Q12) How do you assess an otherwise well patient with regard to difficulty of intubation at the bedside? How accurate is such an assessment?
- (Sep-2006 Q1) Discuss the risks and benefits associated with intermittent positive pressure ventilation through proseal ® laryngeal mask airway for a patient undergoing laparoscopic cholecystectomy.
- (May-2006 Q6) Describe your immediate assessment and management of the airway in a patient with smoke inhalation injury.
- (May-2006 Q13) What is the physiological basis of preoxygenation? Describe your method of preoxygenation including how you assess its adequacy.
- (Sep-2005 Q5) What is the role of a laryngeal mask airway in a failed intubation for laparotomy?
- (Sep-2004 Q13) Describe the technique of applying cricoid pressure to prevent regurgitation of gastric contents.
- (May-2004 Q2) Discuss the presence of morbid obesity as a predictor of difficult intubation.
- (Sep-2002 Q15) Discuss the role of the LMA in the management of a difficult intubation
- (May-2001 Q14) What are the arguments for and against leaving a laryngeal mask airway in place for unsupervised removal by recovery room nurses?
- (Apr98) A 50 yo man with gastro-oesophageal reflux and occasional nocturnal pharyngeal reflux is to have knee arthroscopy under general anaesthesia. What are the methods which could be used to minimise the risk of aspiration of gastric contents?
- (Apr98) What are the adverse effects of the pharmacological agents which could be used for this purpose (to minimise the risks of aspiration of gastric contents)? Exclude any considerations of anaesthetic agents or muscle relaxants.
- (Apr98) Despite your best management the patient does regurgitate and aspirate at induction. How would you manage this?
- (Jul97) What are the arguments for and against the use of a laryngeal mask airway for general anaesthesia for laparoscopic tubal ligation?
- (Apr96 Q1) Explain your bedside assessment of the airway in an adult who has a history of a difficult tracheal intubation.
- Finals May-2014 Q2 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?
- Finals May-2014 Q4 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%)
- Finals May-2014 Q6 A 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%)
- Finals Oct-2013 Q1 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.
- Finals May-2013 Q11 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%)
- Finals Oct-2012 Q2 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?
- (Oct-2012 Q4) 1. what is the natural history of aortic stenosis? (30%). 2. What are the key echocardiographic features in haemodynamically significant aortic stenosis? (70%)
- Finals Oct-2011 Q14 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%)
- Finals May-2011 Q14 (a) Describe the abnormality on this electrocardiogram. (30%) (b) What are the implications of this abnormality for anaesthesia? (70%)
- Finals May-2010 Q14 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 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%)
- Finals May-2010 Q6 A 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%)
- Finals Oct-2010 Q11 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%)
- Finals Oct-2010 Q7 (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%)
- Finals Oct-2009 Q1 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. Describe the mechanism and duration of action of clopidogrel. (30%) What are the major considerations for the perioperative period in view of the patient’s stent? (70%)
- Finals Oct-2009 Q2 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%)
- (Apr-2009 Q9) A 65yo male presents in PAC. He is scheduled for fem-pop bypass surgery for PVD in 4 days time. He has ischaemic 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.
- (Oct-2008 Q12) List the indications and contra-indications for the use of an intra-aortic balloon pump. Describe how its performance is optimised.
- (May-2008 Q10) A patient with an AICD with biventricular pacing presents for elective surgery. Describe how the presence of this device influences your perioperative management of this patient.
- (May-2007 Q8) Describe how the ECG should be used to monitor for intraoperative myocardial ischemia in a patient with ischemic heart disease.
- (Sep-2005 Q16) Critically evaluate the use of Beta blockers in the perioperative period to prevent myocardial infarction.
- (May-2006 Q8) 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.
- (May-2006 Q12) 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.
- (Sep-2005 Q10) Critically evaluate the role of cardioversion in the management of intraoperative arrythmias.
- (Sep-2005 Q11) How would you assess the severity of cardiac failure in a 75 year old man presenting for joint replacement surgery? Include any relevant investigations.
- (Sep-2004 Q11) What is the role for radionucleotide imaging in the assessment of ischaemic heart disease prior to general anaesthesia for non-cardiac surgery?
- (May-2004 Q1) A 50yo patient with a past history of well controlled ischaemic heart disease is anaesthetised for an emergency laparotomy. Thirty minutes into the surgery, you notice new ST segment depression on the ECG. Describe your management.
- (Sep-2002 Q14) Discuss the methods available for investigating a clinical suspicion of acute postoperative MI.
- (May-2001 Q1) A 63 yo man who lives independently, presents with a perforated ulcer requiring laparotomy. He has been treated for cardiac failure for 5 years. How would you assess the severity of his cardaic failure at the bedside?
- (May-2001 Q2) Justify your choice of deep venous thrombosis prophylaxis.
- (May-2001 Q3) How would you manage him if he developed pulmonary oedema during his surgery?
- (Aug99) What is the role for radionuclide imaging in the assessment of ischaemic heart disease prior to general anaesthesia for non-cardiac surgery?
- (Apr98) A 59 yo patient presents for the first time with a subacute bowel obstruction requiring laparotomy in the next two or three days. You are asked by the surgeon to review the patient because on admission his blood pressure is 210/120. Hypertension has not been previously diagnosed in this man and he is on no medications. Describe your assessment of his hypertension by history and examination.
- (Apr98) How would you proceed with investigation of his hypertension if no cause was apparent from the assessment described above?
- (Apr98) How would you manage his blood pressure in the peri-operative period if no cause had been found for this hypertension?
- (Apr96) A man is to have a left shoulder arthroplasty under general anaesthesia. He has a permanent pacemaker located subcutaneously under the left clavicle. How would you assess this aspect of his condition pre-operatively?
- (Apr96) What precautions would you take to prevent malfunction of the pacemaker?
Infection and Antibiotics
- Finals Oct-2009 Q9 What are the indications for prophylaxis against perioperative bacterial endocarditis? Justify your choice of antibiotics. (50%)
- (May-2005 Q11) Discuss the management options for an epidural abscess.
- (Sep-2004 Q4) Outline the diagnostic criteria for an epidural abscess.
- (May-2004 Q8) Discuss the indications for peri-operative antibiotic prophylaxis. Include consideration of the appropriate class of antibiotic for each indication.
- (Sep-2003 Q9) A 35 yo man had a heart transplant 4 years ago. He now requires elective hip surgery. He is on cyclosporine, azathioprine and prednisolone. What are the implications of his immunosuppressive treatment for perioperative anaesthesia care?
- (Sep-2003 Q10) How may the spread of blood borne viral infectious agents from patient to health care worker be minimised in anaesthesia?
- (Jul98) A 35 yo man had a heart transplant 4 years ago. He is now troubled by pain from avascular necrosis of the head of the femur, and requires surgery. He is on cyclosporin, azathioprine and prednisolone. What are the implications of his immunosuppressive treatment for perioperative anaesthesia care?
- (Jul98) How does the history of him having a heart transplant influence your anaesthetic management?
- (Jul98) Describe the strategies which should be employed to minimise the risk of sepsis associated with his periperhal venous cannula.
Allergy and Anaphylaxis
- Finals May-2013 Q6 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%)
- (Sep-2005 Q7) How would you diagnose a clinically significant latex allergy occurring intra-operatively?
- (Sep-2003 Q1) Describe the precautions that should be taken to prevent a patient with known latex allergy from having a reaction to latex in the peri-operative period.
- (Sep-2005 Q15) List the physiological effects of ECT and how they may be modified?
- (Sep-2002 Q10) As a result of a suicide attempt, a 22 yo male sustained a compound fracture of his lower tibia with extensive skin loss. Other injuries include a t12 and l1 crush fracture with no neurological sequelae. The patient suffers from schizophrenia. He is to undergo a free flap from the lower abdomen to the leg wound. What problems relating to his schizophrenia may impact on anaesthesia?
- (Sep-2002 Q11) Evalutae the options for postoperative analgesia.
- (Sep-2002 Q12) He becomes acutely agitated in the post anaesthesia care unit. Discuss the possible causes of this problem.
- (May-2002 Q14) Outline the anaesthetic risks specific to patients undergoing electro-convulsive therapy.
- (Apr99) A severely depressed 60yo man presents for electroconvulsive therapy. His history includes controlled hypertension and stable ischaemic heart disease. He is taking MAO inhibitor phenelzine for depression. What are the implications of his phenelzine therapy of relevance to GA for ECT?
- (Apr99) Describe the physiological effects of electroconvulsive therapy relevant to his anaesthetic management. Omit any considerations concerning phenelzine.
- (Apr99) Discuss your choice of induction agent for this procedure.
- (Jul97) Describe the clinical features of an overdose of tricyclic antidepressant.
- Finals Oct-2011 Q10 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%)
- Finals May-2012 Q11 You are asked to initiate an opioid patient-controlled analgesia service in your hospital. How would you ensure patient safety? (70%) What are the key components to include in designing an order form? (30%)
- Finals May-2013 Q8 a. 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%)
- Finals Oct-2010 Q9 (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%)
- Finals Oct-2012 Q1 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%)
- (May-2010 Q11) 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%)
- (Oct-2009 Q5) 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%)
- (Apr-2009 Q14) A previously healthy 28-year-old male has persistent pain 12 weeks after compound fracture to his lower leg and is on slow-release oxycodone 80mg twice daily and immediate release oxycodone 20mg 4 hourly. Discuss the advantages and disadvantages of switching his opioid to methadone in this situation and how this may be achieved safely.
- (Oct-2008 Q11) 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.
- (May-2008 Q5) A 65 yo female who weighs 85kg and is 165cm tall (BMI 31) is scheduled for TKR surgery. Discuss the pros and cons of intrathecal morphine for post operative analgesia in this patient.
- (May-2008 Q13) Evaluate the role of gapapentin in acute and chronic post surgical pain management.
- (Sep-2007 Q14) A clinical trail is planned to evaluate a new analgesic. Discuss the ethical considerations in having a placebo group in the trial.
- (May-2006 Q4) Discuss the role of non steroidal anti-inflammatory drugs for post operative analgesia in adult day surgery patients.
- (May-2005 Q4) Discuss the requirements for and limitation of the use of patient-controlled analgesia (PCA) as a technique.
- (May-2004 Q6) A 71 year old man presents with acute herpes zoster involving the ophthalmic division of his left trigeminal nerve. He complains of severe unrelenting facial and eye pain which started 3 days ago. Discuss the pharmacological treatment options. Include information about the relevant efficacy of the treatments you prescribe.
- (Apr99) What is the role of non-steroidal anti-inflammatory drugs for post-operative analgesia in adult day surgery patients?
- SAQ-Jul05-Q4 Describe the features and management of phantom limb pain.
- Finals Oct-2009 Q7 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. Discuss the characteristics of remifentanil with respect to its use as an infusion. (50%) What are the advantages and disadvantages of using effect site calculations to guide remifentanil infusions? (50%)
- Finals May-2011 Q11 (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%)
- (Sep-2006 Q9) Nitrous oxide should not be used routinely as a component of general anaesthesia. Discuss.
- (Sep-2006 Q12)Discuss the role of ketamine in current anaesthesia practice.
- (Sep-2005 Q13) The hospital pharmacist notifies you as Director of Anaesthesia that Thiopentone is to be withdrawn from the hospital formulary due to minimal usage. Outline and justify your response.
- (May-2006 Q9) Describe the clinical features and management of bupivacaine toxicity.
- (May-2006 Q14) Discuss the role of desflurane in current anaesthesia practice.
- (May-2005 Q5) Compare the relative merits of gelatin-based intravenous solutions and dextran intravenous solutions.
- (May-2005 Q9) What significant side-effects are associated with the use of anti-emetic agents?
- (Sep-2004 Q14) What are the relative merits of sodium nitroprusside and glyceryl trinitrate in the control of blood pressure in anaesthetised patients?
- (May-2004 Q9) Compare and contrast thiopentone and propofol for use in rapid sequence induction of anaesthesia.
- (May-2002 Q13) Outline the issues to be considered when a patient wishes to continue self-prescribed herbal preparations in the peri-operative period.
- (Sep-2001 Q6) Outline the pharmacology of naltrexone relevant to providing anaesthesia and postoperative care for a patient on naltrexone undergoing major abdominal surgery?
- (Aug-2000 Q8) Compare the relative merits of gelatin-based intravenous solutions and dextran intravenous solutions.
- (Apr-2000 Q12) Describe the pharmacokinetics and dosing schedule of paracetamol for post op analagesia.
- (Apr98) Use of at least 30% O2 in the inspired gas has been traditional practice in anaesthesia for healthy adults. Is this practice valid?
- (Apr97) Outline the undesirable effects of intravenous protamine sulphate.
- (Aug96) What are the advantages and disadvantages of the use of propofol for sedation of intensive care patients?
- Finals Oct-2009 Q11 What are the key objectives of ethical review of a research project?
- Finals Oct-2010 Q6 How would you critically appraise a paper published in a journal?
- Finals Oct-2011 Q2 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?
- Finals May-2013 Q9 a. What is evidence based medicine. (30%) b. Describe the features of a systematic review, indicating how it may influence your practice of anaesthesia. (70%)
- Finals Oct-2013 Q2 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.
- (Oct-2012 Q14) The mallampati test is a commonly used bedside screening tool to assess the probability of a difficult intubation. Explain the terms sensitivity, specificity, PPV and NPV when applied to this test.
- (Apr-2009 Q15) How is appropriate sample size for a clinical trial determined? (50%) What are the ethical implications of using an inappropriate sample size in a clinical trial? (50%)
- (Oct-2008 Q13) Explain the terms sensitivity, specificity, positive predictive value and negative predictive value when applied to a diagnostic test.
- (May-2008 Q14) Describe the advantages and disadvantages of multi-centre trials in anaesthesia research.
- (Sep-2005 Q2) Discuss ways in which you can decrease bias in a clinical trial for a new antihypertensive agent.
- (May-2005 Q12) Discuss the value of case reports to anaesthetists in the era of evidence based medicine.
- (Sep-2001 Q14) What are the features of systematic reviews which contribute to their value in the context of evidence based medicine?
- (Apr97) A clinical trial is planned to evaluate a new analgesic. Outline the methods which could be used to reduce bias in this trial.
- (Apr97) A clinical trial is planned to evaluate a new analgesic. What are the ethical considerations in having a placebo group in the trial?
- (Aug96) From a study of two groups of patients, each of 43, it is concluded that drug A is better than drug B because fewer patients vomit when given A, (p=0.04). What is your view of the sample size with respect to the conclusion?
- Finals May-2010 Q4 a. Describe the pathophysiological changes associated with a haemoglobin of 75 g/L. (50%) b. 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%)
- Finals May-2010 Q3 A 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.
- Finals Oct-2010 Q15 Long question on Lung Function Tests (LFTs/PFTs) – see full question in examiner’s report
- Finals Oct-2010 Q13 Outline the principles of an initial management plan for diabetic ketoacidosis, having regard to the physiological derangements involved.
- Finals Oct 2010 Q3 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%)
- Finals May-2011 Q15 (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%)
- Finals May-2011 Q4 Evaluate the use of human albumin in perioperative volume replacement.
- Finals May-2011 Q2 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%)
- Finals Oct-2011 Q15 Explain your approach to thromboprophylaxis in the patient undergoing total knee replacement.
- Finals Oct-2011 Q13 A 50-year-old man presents with confusion and the following electrolyte profile: Na+ 155 mmol/l K+ 4 mmol/l HCO3− 15 mmol/l Creatinine 120 μmol/l Hb 200 g/l a. What are the possible causes of this abnormality? (30%) b. Howcantheybedistinguished?(70%)
- Finals May-2012 Q3 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. Define oliguria (10%) What are the potential causes of oliguria in this patient? (40%) How would you differentiate between these causes? (50%)
- Finals May-2013 Q15 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%)
- Finals May-2013 Q5 What are the perioperative concerns for the anaesthetist managing a patient with epilepsy?
- Finals Oct-2013 Q15 A 25-year-old female with longstanding C5-6 quadriplegia requires ureteric stent insertion. Outline the implications for anaesthesia.
- (May-2012 Q1) 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 epidsode of serotonin syndrome? (40%)
- (Apr-2009 Q5) A 70 year old man with a 10 year history of Parkinson's disease presents for a total knee joint replacement. He is on levodopa / carbidopa five times a day. Outline the main issues to consider in relation to his Parkinson's disease in planning the perioperative management of this patient.
- (Oct-2008 Q15) What symptoms and signs suggest the presence of OSA in a patient presenting for pre-operative assessment? How does the presence of OSA alter your anaesthetic plan?
- (Sep-2007 Q15) Draw flow volume loops associated with a) Fixed upper airway obstruction; b) Variable extrathoracic airway obstruction and c) Variable intrathoracic airway obstruction. Explain briefly the physiological reasons for the shape of these loops.
- (Sep-2006 Q5) List and explain the typical electrolyte abnormalities of chronic renal failure.
- (May-2006 Q3) 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.
- (May-2006 Q5) 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.
- (Sep-2005 Q3) What are the symptoms, signs and anaesthetic implications of an autonomic neuropathy associated with diabetes mellitus?
- (May-2005 Q13) How would you assess a patient's thyroid function preoperatively at the bedside?
- (Sep-2003 Q3) A 50 yo man taking a corticosteroid and pyridostigmine for myasthenia gravis is to have an elective right hemicolectomy under general anaesthesia. How would you manage his myasthenia pre and post-operatively?
- (May-2002 Q10) A 75 yo woman with severe long standing rheumatoid arthritis presents for hip replacement. How will her rheumatoid arthritis influence your anaesthetic management?
- (May-2002 Q11) She has the operation under a spinal anaesthesia and light sedation. Just as the femoral prosthesis is being cemented in, she loses consciousness. How will your manage this?
- (May-2002 Q12) Discuss the advantages and disadvantages of using cox-2 selective non-steroidal anti-inflammatory drugs as part of your postoperative analgesic plan in this patient.
- (Sep-2001 Q13) How would you assess a patient's thyroid function preoperatively, at the bedside?
- (Jul97) Describe the management of a thyroid crisis occurring 12 hrs after thyroidectomy.
- (Apr97) A 50 yo man taking a corticosteroid and pyridostigmine for myasthenia gravis is to have an elective right hemicolectomy under general anaesthesia. How would you manage his myasthenia pre and post-operatively?
- (Apr97) Discuss your options for providing muscle relaxation during surgery.
- (Apr97) 48 hours post-operatively the patient becomes profoundly weak. How would you manage this?
- (Aug96) What are the anaesthetic implications of autonomic dysfunction in a diabetic patient?
- (Apr96) An apparently healthy 71 yo woman presents with a fractured neck of femur requiring internal fixation. She smokes 15 cigarettes each day and drinks approximately 30 gm of alcohol daily. She takes no medications. Justify the blood tests you would request when making your pre-anaesthetic visit.
- (Apr96) How would you interpet a pre-operative serum potassium of 3.2 mmol/L in this woman if the laboratory normal range is 3.5-5.0 mmol/L?
- (Apr96) If her pre-operative serum potassium had been 5.7 mmol/L, how would this influence your anaesthetic management?
- Finals May-2011 Q7 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%)
- Finals May-2013 Q12 What are the hazards of the prone position for patients under general anaesthesia and how can they be minimized?
- Finals Oct-2010 Q1 (a) What are the clinical consequences of hypothermia to 34⁰C in adults? (50%) (b) How can you manage body temperature in a multi-trauma patient? (50%)
- Finals May-2012 Q2 A 65-year-old man is on your list for an arthroscopic acromioplasty that is to be performed in the beachchair position. List the complications associated with this position (30%) Describe how the risk of these complications can be minimised (70%)
- (Oct-2012 Q9) A developmentally delayed, uncooperative adult requires a magnet resonsance imaging scan 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?
- (Sep-2007 Q5) 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.
- (May-2008 Q15) Outline the problems of providing anaesthesia for an adult in the MRI suite.
- (Sep-2005 Q6) How does anaesthesia alter temperature homeostasis?
- (May-2005 Q10) What are the problems with the prone position for surgery?
- (Sep-2004 Q1) Discuss the advantages and disadvantages of the methods used to avoid hypothermia in the operating theatre.
- (Sep-2004 Q3) What are the problems of using the beach chair position for shoulder surgery?
- (Apr98) How may physiological control of temperature regulation in adults by altered by general anaesthesia?
- (Jul97) A 70 yo woman is scheduled for colectomy under GA. Comapre the effectiveness of the methods you would use to prevent her becoming hypothermic by the completion of surgery.
- (Jul97) Describe the adverse effects of a core temperature of 34.0 degrees centigrade at emergence from general anaesthesia.
- (Sep-2007 Q11) 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.
- (May-2004 Q3) Describe and justify your usual anaesthetic technique for colonoscopy in an otherwise uncompromised patient
- (May-2003 Q5) Desflurane should be used only for day case procedures. Discuss this statement.
- (Sep-2002 Q4) (Jul98) A healthy 34 yo man requires colonoscopy under intravenous sedation because of a strong family history of bowel cancer. Describe the composition and effects of bowel preparation solutions commonly used before colonoscopy.
- (Sep-2002 Q5) (Jul98) Soon after colonoscopy begins his pulse rate falls to 40 beats/min and blood pressure to 60/40 mmHg. Describe your management.
- (Sep-2002 Q6) (Jul98) What criteria would need to be met before he can be discharged home from the day procedure unit?
- (Aug96) Outline the criteria you would use in determining a patient's suitability for discharge from a day surgery unit.
Intensive care and Resuscitation
- Finals Oct-2011 Q9 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
- Finals May-2012 Q10 An adult patient from the intensive care unit with severe adult respiratory distress syndrome (ARDS) requires a laparotomy for an acute abdomen. What are the features of ARDS? (30%) Explain your perioperative ventilation strategy (70%)
- Finals Oct-2013 Q14 Intensive care patients may be at risk of ventilator-associated pneumonia (VAP). Describe the likely aetiology of, and risk factors for, VAP. (50%) Outline prevention strategies that reduce the incidence of VAP. (50%)
- (Oct-2012 Q7) In regard to total parenteral nutrition: 1. What are the indications? (30%). 2. What are the complications? (70%).
- (Oct-2008 Q6) You are covering ICU in your local district hospital when a 14-year-old boy presents to your ED obtunded and hypotensive with a rash suggestive of meningococcal sepsis. Describe your resuscitation
- (May-2008 Q6) The electrolyte results below were taken from a 38 year old woman found obtunded 30 hours after abdominal hysterectomy. She had no intercurrent llnesses prior tosurgery. Explain how these electrolyte abnormalities are most likely to have arisen and describe how you would correct them.
Result mmol/L Normal range mmol/L Sodium 110 135-145 Potassium 3 3.0-5.0 Chloride 80 95-105 Bicarbonate 25 20-32 Glucose 5.0 3.0-5.5 Urea 3.0 3.0-8.0 Creatinine 0.06 0.06-0.12 Measured Osmolality 225 mosmol/kg 280-295mosmol/kg
- (Sep-2007 Q6) Define circulatory shock Categorise the causes of circulatory shock and give an example in each category.
- (Sep-2007 Q7) 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.
- (May-2007 Q1) What are the principles of ventilatory management of patients with acute respiratory distress syndrome (ARDS)?
- (May-2007 Q5) Discuss the usefulness of the continuous measurement of mixed venous oxygen saturation in the intensive care patient?
- (May-2007 Q13) 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.
- (May-2007 Q15) Outline the steps necessary to diagnose brain death in a 38 year old woman who is comatose
following a subarachnoid haemorrhage.
- (Sep-2006 Q15) Discuss the usefulness of the ASA grading as a measure of perioperative risk.