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

 

a) List 3 causes of flap failure (3 marks)

b) Outline 5 main physiological goals that are important for a healthy free flap outcome (5 marks)

c) List 7 important anaesthetic considerations for this type of surgery (7 marks)

d) What 5 specific parameters must be monitored of the free flap post operatively (5 marks)

Question 2

 

a) List 8 cases of pain in a patient with advanced cancer (8 marks)

b) Name 3 ways in which the side effects from opioid medications can be minimised in a patient with advanced cancer (3 marks)

c) Outline 6 pharmacological treatments used to relieve cancer pain (6 marks)

d) Outline 3 non-pharmacological treatments which are available to help relieve cancer pain (3 marks)

Question 3

 

a) List 5 possible indications for the insertion of cardiac implantalbe electronic devices (5 marks)

b) What 5 factors would you check preoperatively in a patient with these types of devices? (5 marks)

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)

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)

b) List 4 key clinical features that are used to diagnose delirium in critical care (4 marks)

c) List 9 common potentially treatable causes of delirium in a critical care patient (9 marks)

d) Name 2 indications for when pharmacological treatment is indicated in a patient with delirium (2 marks)

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.

a) Name 5 relevant features in the history that are important (5 marks)

b) List 8 investigations required for this patient (8 marks)

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

c) Outline your management of this patient  (7 marks)

Question 6

 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 7

 

a) Name 3 physiologica factors that determine the rate of fall in arterial oxygen saturation in an apnoeic patient (3 marks)

b) List 4 patient groups most likely to show a rapid fall in arterial oxygen saturations when apnoeic (4 marks)

c) List 8 ways in which alveolar oxygenation, prior to intubation,may be optimised during rapid sequence induction (8 marks)

d) How can the effectiveness of alveolar oxygenation be meausred? (1 mark)

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

a) Describe cerebral palsy (3 marks)

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:

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)

f) Outline 2 expected problems in providng adequate postoperative analgesia in this patient (2 marks)

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

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)

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

a) What is the definition of pre-eclampsia (1 mark)

b) List 4 symptoms that this oman may complain of due to her pre-eclampsia (4 marks)

c) What are the important priorities in her management when she arrives on the labour ward? (10 marks)

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

 

a) List 7 indications for total intravenous anaesthesia (TIVA) (3 marks)

b) What are the 3 main components of a target-controlled infusion (TCI) system? (3 marks)

c) Outline 4 potential technical problems with TIVA (4 marks)

d) How might each of the aboe technical problems be prevented? (4 marks)

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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