March 2018 (SAQ paper modified)
Question 1
A 35 year old woman is listed for a mastectomy and free-flap breast reconstruction for breast cancer
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a) List 3 causes of flap failure (3 marks)
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b) Outline 5 main physiological goals that are important for a healthy free flap outcome (5 marks)
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c) List 7 important anaesthetic considerations for this type of surgery (7 marks)
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d) What 5 specific parameters must be monitored of the free flap post operatively (5 marks)
Question 2
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a) List 8 cases of pain in a patient with advanced cancer (8 marks)
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b) Name 3 ways in which the side effects from opioid medications can be minimised in a patient with advanced cancer (3 marks)
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c) Outline 6 pharmacological treatments used to relieve cancer pain (6 marks)
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d) Outline 3 non-pharmacological treatments which are available to help relieve cancer pain (3 marks)
Question 3
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a) List 5 possible indications for the insertion of cardiac implantalbe electronic devices (5 marks)
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b) What 5 factors would you check preoperatively in a patient with these types of devices? (5 marks)
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c) Outline 6 relevant pieroperative mangement considerations of a patient with an automatc implantable cardioversion defibrillator who is having elective surgery under general anaesthetic (6 marks)
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d) A patient with a pacemaker develops severe bradycardia with circulatory compromiseand no pacemaker response. What 4 specific therapies should you consider in this situation? (4 marks)
Question 4
a) Define delirium (2 marks)
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b) List 4 key clinical features that are used to diagnose delirium in critical care (4 marks)
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c) List 9 common potentially treatable causes of delirium in a critical care patient (9 marks)
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d) Name 2 indications for when pharmacological treatment is indicated in a patient with delirium (2 marks)
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e) List 3 classes of drugs that an be used to treat delirium (3 marks)
Question 5
A 20 year old man is brough to the emergency department having been pulled from a river following a near drowning.
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a) Name 5 relevant features in the history that are important (5 marks)
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b) List 8 investigations required for this patient (8 marks)
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He has a GCS of 13 but is found to hae arterial oxygen partial presure of 6kPa (45mmHg) breathing 4L/min of oxygen via a variable performance mask
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c) Outline your management of this patient (7 marks)
Question 6
A 54 year old male with acrogmegaly presents for a trans-sphenoidal hypophysectomy
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a) Define acromegaly (2 marks)
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b) Name 8 clinical features of acromegaly which are of relevance to the anaesthetist (8 marks)
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c) What 2 other clinical presentations of a pituitary adenoma may be encountered (2 marks)
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d) What 8 specific considerations, including surgical facors, may influence the condct of anaesthesia in this patient? (8 marks)
Question 7
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a) Name 3 physiologica factors that determine the rate of fall in arterial oxygen saturation in an apnoeic patient (3 marks)
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b) List 4 patient groups most likely to show a rapid fall in arterial oxygen saturations when apnoeic (4 marks)
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c) List 8 ways in which alveolar oxygenation, prior to intubation,may be optimised during rapid sequence induction (8 marks)
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d) How can the effectiveness of alveolar oxygenation be meausred? (1 mark)
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e) Name 4 possible respiratory complications of prologned delivery of 100% oxygen (4 marks)
Question 8
An 8 year old child is scheduled for an elecctive right femoral osteotomy due to impending dislocation of the hip. She has severe cerebral palsy
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a) Describe cerebral palsy (3 marks)
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There are many clinical features of severe cerebral palsy which have associated anaesthetic implications. List these clinical features and their anaesthetic implications for each system below:
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b) 3 features of the central nervous system (3 marks)
c) 2 features for the respiratory system (2 marks)
d) 3 features for the muscoskeletal system (3 marks)
e) 2 features for the gastrointestinal system (2 marks)
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f) Outline 2 expected problems in providng adequate postoperative analgesia in this patient (2 marks)
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g) Name 5 ways you could optimise an analgesia management plan for this patient (5 marks)
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Question 9
A 45 year old patient is reviewed in the preoperative assessment clinic prior to surgery to excise a phaeochromocytoma
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a) List 7 characteristic clinical features of a phaeochromocytoma (7 marks)
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b) Name 2 specific biochemical investigations and 2 radiological investigations that might confirm a diagnosis of a phaeochromocytoma (4 marks)
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c) Describe how you would pharmacologically optimise the cardiovascular system prior to surgery (7 marks)
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d) Outline 2 ways you would assess the adequacy of cardiovascular optimisation preoperatively (2 marks)
Question 10
A 25 year old pregnant woman at 35 weeks gestation is admitted to labour ward with a blood pressure of 180/110mmHg. She is known to have pre-eclampsia and there is a plan to deliver her baby within the next 24 hours
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a) What is the definition of pre-eclampsia (1 mark)
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b) List 4 symptoms that this oman may complain of due to her pre-eclampsia (4 marks)
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c) What are the important priorities in her management when she arrives on the labour ward? (10 marks)
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d) A decision has been made to proceed to Caesarean section (CS) andthe patient insists on having a general anaesthetic. Explain 5 potential changes to ryou normal GA technique for CS due to her pre-eclampsia (5 marks)
Question 11
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a) List 7 indications for total intravenous anaesthesia (TIVA) (3 marks)
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b) What are the 3 main components of a target-controlled infusion (TCI) system? (3 marks)
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c) Outline 4 potential technical problems with TIVA (4 marks)
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d) How might each of the aboe technical problems be prevented? (4 marks)
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e) Name 2 potental patient complications with this technique (2 marks)
Question 12
A 24-year-old lady is listed for a bimaxillary osteotomy.
a)What would be your peri-operative airway concerns with such a patient? (7 marks)
b)Name 4 ways blood loss be minimised in this case? (4 marks)
c)Name 3 clinical advantages in using remifentanil for this operation? (3 marks)
d)Name 6 precautions you could take to reduce the risk of a retained throat pack post-surgery? (6 marks)
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