General/Urology/Gynae
Question 1 (Sept 2019)
A 74- year old man is going to have a total hip replacement. On preoperative assessment is found to have a pan-systolic murmur and is being investigated for aortic stenosis.
a) List 3 worrying symptoms of aortic stenosis that you should screen for in your preoperative assessment. (3 marks)
b) What measurements 3 measurements are used in echo and what values would be deemed as severe aortic stenosis (6 marks)
c) Describe the pathophysiology of aortic stenosis on the left ventricle (5 marks)
It is found to be mild aortic stenosis on echocardiography so is scheduled for his total hip replacment.
d) Name four key haemodynamic goals you would aim for perioperatively (4 marks)
e) Name 2 treatment options that are available for severe aortic stenosis (2 marks)
Question 6 (Sept 2019)
a) In a patient with diabetes mellitus, name 4 clinical features that may indicate autonomic involvement? (4 marks)
b) Name 3 other microvascular and 3 macrovascular complications of diabetes mellitus (6 marks)
c) What is the recommended upper limit of HbA1C for elective surgery (1 mark)
d) What is the association of Anaesthetists of Great Britain and Ireland (AAGBI) guidance for perioperative blood glucose monitoring in diabetic patients (3 marks)
e) List 3 classes of oral hypoglycaemic agents that are available (3 marks) and describe the mechanism of action of each (3 marks)
Question 9 (Sept 2019)
A 33 year old woman who has myasthenia gravis is due to have a thymectomy. You have been asked to see her in preoperative assessment.
a) What are the clinical features of myasthenia gravis? (2 marks)
b) What is the pathophysiology of myasthenia gravis? (2 marks)
c) Name 3 treatment options available for myasthenia gravis? (3 marks)
d) What scorings system is used to grade for myasthenia gravis (1 mark)
e) Name 2 factors correlate with need for prolonged ventilation following a thymectomy (2 marks)
f) What would preoperative assessment focus on and what advice might you give to the patient about their medications? (5 marks)
g) How do patients with myasthenia gravis respond to depolarising and non-depolarising muscle relaxants ?(2 marks)
h) What would your postoperative plan for this patient be? (3 marks)
Question 11(Sept 2019)
A 74-year-old man with osteoarthritis, known CVD and AF who is on rivaroxaban is booked in for a revision hip replacement. He is found to be anaemic in preoperative assessment.
a) What are the 3 pillars of patient blood management? (3 marks)
b) What strategies can be used to treat this patient’s anaemia preoperatively? (4 marks)
c) How long before the operation should the patient be assessed? (1 mark)
d) Name 4 intraoperative changes would you make (4 marks)?
e) The patient starts to bleed, how would 1L blood loss differ physiologically to a whole blood volume loss (3 marks)?
f) What point of care testing do you know of? (1 mark)
g) What other laboratory targets would you use to manage his bleeding? (4 marks)
Question 1 (March 2019)
a) List 3 of the commonest causes of end stage renal failure (ESRF) in the UK? (3 marks)
b) Name 6 complications of ESRF that are of importance to the anaesthetist? (6 marks)
c) Outline 3 acute physiological disturbances that may be seen in a patient who has just had haemodialysis? (3 marks)
d) What are the key practical consideration when providing general anaesthesia for a patient with ESRF on haemodialysis? (8 marks)
Question 7 (March 2019)
a) List 6 effects of cigarette smoking on the cardiovascular system and oxygen delivery (6 marks) and outline the pathophysiological mechanism for each (6 marks)
b) Give 5 respiratory system effects of cigarette smoking, other than those you have outlined above, that are relevant to general anaesthesia (5 marks)
c) What advice would you give a smoker the day before a scheduled procedure under general anaesthesia (1 mark) and why (2 marks)
Question 11(March 2019)
Prehabiltation
a) What is prehabilitation in perioperative medicine (1 mark)
b) Name 3 outcome benefits of a prehabilitation programme? (3 marks)
c) Outline 6 specific issues addressed as part of medical optimisation in a prehabilitation programme (6 marks)
d) Describe how a prehabilitation exercise programme can improve a patient’s cardiorespiratory physiology (4 marks)
e) Outline 4 benefits of carbohydrate preloading and nutritional optimisation (4 marks)
f) What psychosociological supportive interventions may be used in prehabilitation (2 marks)
Question 2 (September 2018)
a) List 3 postoperative pulmonary complications that may occur following non-cardiothoracic surgery (3 marks)
b) Name 4 patient related risk factors for postoperative pulmonary ompications following non-cardiothoracic surgery (4 marks)
c) Name 2 surgery related risk factors for postoperativ polmonay complications following non-cardiothoracic surgery (2 marks)
d) Name 4 ways anaesthesia may contribute to postoperative pulmonary complications. (4 marks)
e) Name 7 perioperative strategies you may adopt to reduce postop pulmonary complications (7 marks)
Question 10 (September 2018)
A 52 year-old woman is to undergo a laparotomy (open procedure) for ovarian malignancy, having completed 3 cycles of primary chemotherapy. She has a BMI of 23 and has massive ascites.
What specific features of this cas will affect your approach to the patient with regards to:
a) Preoperative history and examinaton? (6 marks)
b) Investigations? (4 marks)
c) Intraoperative management (8 marks)
d) Why are these patients at high risk of VTE (2 marks)
Question 6 (March 2018)
A 54 year old male with acrogmegaly presents for a trans-sphenoidal hypophysectomy
a) Define acromegaly (2 marks)
b) Name 8 clinical features of acromegaly which are of relevance to the anaesthetist (8 marks)
c) What 2 other clinical presentations of a pituitary adenoma may be encountered (2 marks)
d) What 8 specific considerations, including surgical facors, may influence the condct of anaesthesia in this patient? (8 marks)
Question 9 (March 2018)
A 45 year old patient is reviewed in the preoperative assessment clinic prior to surgery to excise a phaeochromocytoma
a) List 7 characteristic clinical features of a phaeochromocytoma (7 marks)
b) Name 2 specific biochemical investigations and 2 radiological investigations that might confirm a diagnosis of a phaeochromocytoma (4 marks)
c) Describe how you would pharmacologically optimise the cardiovascular system prior to surgery (7 marks)
d) Outline 2 ways you would assess the adequacy of cardiovascular optimisation preoperatively (2 marks)