March 2017

Question 1

 

You are asked to review a 27-year-old male who is a known epileptic in convulsive status epilepticus.

 

a) Define convulsive status epilepticus (1 mark)

b) Outline 4 initial management steps excluding use of emergency antiepileptic drug therapy (4 marks)

c) List 3 pharmacological interventions including doses (3 marks)

d) If after 60 minutes the patient continues in status epilepticus despite your initial management, outline 5 further management options available (5 marks)

e) List 7 complications associated with refractory convulsive status epilepticus (7 marks)

Question 2:

 

a) List 5 implications for the patient of an inadvertent wrong sided peripheral nerve block (5 marks)

b) Summarise 4 key recommendations of the “Stop Before You Block” campaign (4 marks)

c) List 5 factors that have been identified as contributing to the performance of a wrong sided block (5 marks)

d) Define the term “never event” (2 marks)

e) List 4 drug related never events (4 marks)

Question 3

A patient scheduled for primary elective total knee replacement is found to be anaemic, with a haemoglobin level of 90 g/ litre.

a) List 5 peri-operative consequences associated with pre-operative anaemia (5 marks)

 

b) Outline 6 physiological adaptations that occur to offset the effects of anaemia (6 marks)

c) Describe 4 perioperative events that may worsen the effects of the anaemia (4 marks)

d) List 5 further blood tests that may help in the classification of this anaemia (5 marks)

Question 4:

 

a) List 7 theoretical advantages of “off pump” coronary artery bypass grafting (OPCAB) compared to an “on bypass” technique (7 marks)

b) Outline 5 causes of haemodynamic instability during OPCAB (5 marks)

c) List 8 strategies to help minimise this haemodynmic instability (8 marks)

Question 5

You are asked to assess a 24-year-old male who has been admitted to the Emergency Department with 30% burns from a house fire.

a) List 10 clinical features that would lead you to suspect significant inhalational injury (10 marks)

b) List 4 indications for early tracheal intubation to secure the airway (4 marks)

 

c) What 3 investigations would you use to assess the severity of the inhalational injury? (3 marks)

d) What are the likely findings of those investigations? (3 marks)

Question 6

 

The obstetric team tell you about a patient who is 2 days post-partum with what they suspect is a post-dural puncture headache (PDPH).

a) List 8 differential diagnoses of post-dural puncture headache (PDPH) (8 marks)

 

b) Outline 7 features, in this patient, that would lead you to consider a serious underlying cause (7 marks)

 

c) You diagnose PDPH and arranged treatment by epidural blood patch, outline 5 risks associated with an epidural blood patch (5 marks)

Question 7

 

A patient is to receive a cadaveric renal transplant

a) Describe 11 elements of your pre-operative assessment specific to chronic kidney disease (CKD) (11 marks)

 

b) Describe 3 ways in which the function of the transplanted kidney can be optimised intraoperatively (3 marks)

 

c) List 3 post-operative pain management options for this patient (3 marks)

 

d) Outline 3 reasons why some common post-operative analgesic drugs should be avoided or used with caution in these patients (3 marks)

Question 8

a) List 7 patient related risk factors for postoperative nausea and vomiting (PONV) in adult patients (7 marks)

b) List 3 anaesthetic related risk factors for PONV in adult patients (3 marks)

c) Outline 6 unwanted effects of PONV in adults (6 mark)

d) List 2 non-pharmacological interventions which have been shown to be effective in reducing PONV in adults (2 marks)

e) Describe 2 proposed mechanisms of action of 5HT3antagonists such as ondansetron when used as anti-emetics (2 marks)

Question 9

a) Define persistent postoperative pain. (Also known as chronic or persistent post-surgical pain) (3 marks)

b) List 5 surgical procedures that are most commonly associated with persistent postoperative pain (5 marks)

c) Outline 8 risk factors for development of persistent post-operative pain (8 marks)

d) Describe 4 pathophysiological changes that occur at spinal cord level during the transition from acute to persistent postoperative pain (4 marks)

Question 10

 

a) List criteria for a diagnosis of acute respiratory distress syndrome (ARDS)?(3 marks)

 

b) What 3 clinical indices are used to quantify oxygenation in ARDS (3 marks)

 

c) What tidal volume would you select for a patient that meets the criteria for ARDS, using the ARDSNet protcol?(2 marks)

 

d) Describe 6 ventilatory measures that can be taken to improve oxygenation or prevent further deterioration in a patient with ARDS (6 marks)

 

e) And what 6 non ventilatory measures can be taken? (6 marks)

Question 11

 

A 12-week-old male baby presents for a unilateral inguinal hernia repair. He was born at 30 weeks gestation(30/40)

a) Outline 3 specific perioperative concerns relating to this baby’s airway (3 marks)

 

b) Outline 4 specific perioperative concerns relating to this baby’s respiratory system (4 marks)

 

c) Outline 2 specific perioperative concerns relating to this baby’s cardiovascular system (2 marks)

 

d) Outline 3 specific perioperative concerns relating to this baby’s renal or hepatic system (3 marks)

 

e) Describe 3 anaesthetic options for anaesthesia (3 marks)

 

f) List a total of 5 advantages and disadvantages of general anaesthesia for this baby (5 marks)

Question 12

 

An 80-year-old woman is admitted to your hospital having sustained a proximal femoral (neck of femur) fracture in a fall.

a) How would you optimise this patient’s pain preoperatively? (5 marks)

You decide to perform a fascia iliaca compartment block for analgesia

b) What are the 4 borders of the fascia iliac compartment? (4 marks)

c) Which nerves are you intending to block (1 mark)

d) Describe how you would perform this block using an ultrasound-guided technique.(10 marks)

NB consent has already been obtained; you also have adequate assistance, emergency equipment, monitoring and venous access