September 2017

Question 1

a) List 8 indications for renal replacement therapy (RRT) in the intensive care setting (8 marks)

b) List 6 types of RRT available in intensive care (6 marks)

c) Describe the principle mechanisms of solute and water removal by filtration during RRT (3 marks)

d) Describe the principle mechansim of solute and water removal by dialysis during RRT (3 marks)

Question 2

a) List 6 anaesthetic factors that predisposeto perioperative dental damage (6 marks)

b) Outline 4 dental factors that predispose to perioperative dental damage (4 marks)

c) You have anaesthetised a 22 year-old-man and you notice a missing front tooth after intubation, ouline 6 steps you need to take in your initial management of this situation (6 marks)

d) What is required for the follow up of this patient? - mention 4 key points (4 marks)

Question 3

a) Outline 6 key principles involved in the formation of an ultrasound image (6 marks)

b) List 3 patient factors that may influence the ultrasound image quality (3 marks)

c) List 4 acoustic factors that may influence the ultraousnd image quality (4 marks)

d) Name the 2 needling techniquesthat are commonly used in ultrasound guided nerve blocks (2 marks)

e) Outline 5 advantages and disadvantages of one of these techniques (5 marks)

Question 4

a) What is meant by counter pulsation in the context of an intra-aortic balloon pump (IABP)? (1 mark)

b) Briefly outline 4 effects of counter pulsation from an IABP on coronary blood flow and the left ventricle (4 marks)

c) List 6 indications for IABP in an adult (6 marks)

d) List 3 contraindications to the use of an IABP in an adult (3 marks)

e) Outline 6 possible complications of an IABP (6 marks)

Question 5

A 35 year old woman presents for splenectomy for idiopathic/immune thrombocytopenic purpura which is not controlled with medical management.

a) What are the 3 vaccinations this patient should receive? (3 marks)

b) When should these vaccinations be given (2 marks)

c) List 3 immunological functions of the spleen in the adult (3 marks)

d) Outline 8 pre-operative considerations related to this patient's condition (8 marks)

e) State the rationale for conservative management for traumatic splenic rupture (1 mark)

f) List 3 principles of conservative management for traumatic splenic rupture (3 marks)

Question 6

A 19-year-old patient has suffered a complete transection of the spinal cord at the 6th cervical vertebral level due to a fall, he has no other injuries.

a) Outline 6 neurological effects in sequence, that may develop in the first 3 months following injury (6 marks)

b) List 3 cardiovascular disturbances that can occur after 3 months (3 marks)

c) List 3 respiratory disturbances that can occur after 3 months (3 marks)

d) List 2 gastrointestinal disturbances that can occur after 3 months (2 marks)

e) Outline 4 advantages of chossing a regional anaesthetic technique if this patient is subsequently listed for lower limb surgery (4 marks)

f) When, and why, may suxamethonium be contraindicated in this patient? (2 marks)

Question 7

You are called to Emergency Department to assess a 63-year-old man with known chronic obstructive pulmonary disease (COPD). He has sustained fractures to his 9th, 10th and 11th ribs but has no other injuries. Paracetamol and codeine phosphate have not provided adequate pain relief.

a) List 6 possible effects on the respiratory system of inadequate pain relief in this patient (6 marks)

b) Outline 5 ways in which the effectiveness of his pain relief can be monitored (5 marks)

c) Detail 9 methods, other than the drugs that hae already been given that are available to improve the management of this patient's pain (9 marks)

Question 8

a) What are the 4 main measures of fitness that are obtained by a cardio-pulmonary exercise test (CPET)? (4 marks)

b) What 4 abnormalities seen at the time of testig in a CPET may suggest cardio-respiratory disease? (6 marks)

c) List 3 reasons why using a bike in CPET might be impractical (3 marks)

d) List 3 other ways that patients' functional capacity can be assessed (3 marks)

e) Outline 6 scoring systems that can help predict perioperative risk before major (non-cardiac) surgery (6 marks)

Question 9

A woman, who has had an intrauterine foetal death (IUFD) at 36 weeks gestation in her first pregnancy, is admitted to your delivery suite for induction of labour.

a) Describe the important non-clinical aspects of her management. (4 marks)

b) List the considerations when providing pain relief for this woman (13 marks)

c) List 3 advantages of using regional anaesthesia (other than the avoidance of the effects of general anaesthesia) if this patient requires a caesarean section

Question 10

a) List all 8 elements of the STOP-BANG assessment for a patient with suspected obstructive sleep apnoea (OSA) (4 marks)

b) How is the STOP-BANG assessment used to quantify a patient’s risk of OSA (3 marks)

c) List 3 cardiovascular consequences of OSA (3 marks)

d) Outline 10 ways in which the perioperative risks may be minimised in a patient with known severe OSA (but no other cardiovascular or respiratory comorbidities) who is having peripheral surgery involving at least one night in hospital (10 marks)

Question 11

a) Define pulmonary hypertension. (2 marks)

b) Outline 5 causes of pulmonary hypertension (5 marks)

c) Describe 7 specific anaesthetic goals when anaesthetising a patient with pulmonary hypertension (7 marks)

d) List 6 pharmacological treatments that are available for this condition (6 marks)

Question 12

A 5-year-old boy presents for a myringotomy and grommet insertion as a day case. During your pre-operative assessment, you notice that he has a nasal discharge.

a) List 5 features in the history that would potentially cause an increased risk of airway complications (5 marks)

b) List 6 features of an examination that would potentially cause an increased risk of airway complications (6 marks)

c) Outline 6 reasons why it would be inappropriate to cancel the operation (6 marks)

d) List 3 social factors that would prevent this child being treated as a day case

(3 marks)