September 2018
Question 1
An otherwise healthy, ASA 1, 32 year oldman who was involvd in a road traffic accident has suffered a penetrating eye injury
a) Name 3 factors that determine the intraocular pressure in a healthy eye? (3 marks)
b) Name 5 key points that you would need to know when assessing thi patient preoperativley (5 marks)
c) The patient requires urgent surgery. Discuss 4 key goals of your specific intraoperative management (4 marks)
d) Name 5 contraindications to performinga regional bok in elective opthalminc surgery (5 marks)
e) Name 3 different types of regional block that are suitable for opthalmic surgery (3 marks)
Question 2
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 3
A 68-year old man is referred to the neuro-intensive care unit with Guillian Barre syndrome (GBS)
a) What is Guillian-Barre syndrome (GBS)? (1 mark)
b) Name 2 causes of GBS (2 marks)
c) List six clinical features of GBS (6 marks)
d) Name 2 investigations and their findings that can be used to aid diagnosis (2 marks)
e) What are the problems associated with anaesthetising a patient with GBS (7 marks)
f) Name 2 specific treatments that are available? (2 marks)
Question 4
A patient presents for a total thyroidectomy:
a) Name 5 investigations that are specifically idicated in the properative assessment and why are they done? (5 marks)
In a euthryoid patient name:
b) 3 factors that the anaesthetist must consider during the induction phase of a total thyroidectomy (3 marks)
c) 5 factors that the anaesthetist must consider during the maintenance phase of a total thyroidectomy (5 marks)
d) 3 factors that the anaesthetist must consider during the extubation phase of a total thyroidectomy (3 marks)
e) Name 4 specific postoperative complications following this surgery (4 marks)
Question 5
a) Name and explain 3 ways to quantify preoperatively risks associated with lung resection (6 marks)
b) Name 6 factors that can lead to the development of high airway pressures during one lung ventilation (OLV) (6 marks)
c) Outline how you would manage the development of hypoxaemia during OLV (8 marks)
Question 6
A recent meta-analysis of Mallampati scoring of the airway found that it had a sensitivity of 60% and specificty of 70%
a) Briefly define the terms of systematic review (1 mark) and meta-analysis (1 mark)
b) Explain what is meant by sensitivity (2 marks) andspecificity (2 marks) of Mallampati scoring of the airway in this meta-analysis.
c) What other information do you require and how would you calculate the positive predictive value for Mallampati scoring (2 marks)
d) Rank the levels of scientific proof used to grade medical evidence (4 marks)
e) List 8 factors that help to ensure a high-quality conclusion from a meta-analysis (8 marks)
Question 7
You are asked to transfer an intubated intesive care patient for a magnetic resonance imaging (MRI scan)
a) What is meant by the term "magnetic resonance conditional" in relation to equipment used in the MRI scanner room? (1 mark)
b) Name 6 precautions that should be taken to prevent burns caused by monitoring equipment sed in an MRI scanner? (6 marks)
c) Describe 8 ther general recautions you should take to reduce harm to this patient whilst they ave an MRI scan (8 marks)
d) Name 5 relative/absolute contraindications to an MRI scan for any patient (5 marks)
Question 8
A 45 year-old patient is due to have an elective open hemicolectomy for diverticular disease. He has chronic abdominal pain for which he has been using fentanyl patches (100mcg/hour) for the last 10 months.
a) How would you manage his postoperative pain? (10 marks)
b) What are the additional peioperative implications if the patient is on high dose sublingual buprenorphine instead of fentanyl patches (3 marks)
c) What doses of oral tramadol, oral codeine and oral oxycodone are equivalent to 10mg of oral morphine? (3 marks)
d) What other precautions should be taken if the patient as a spinal cord stimulator fitted? (4 marks)
Question 9
a) What is meant by the term ventilator associated pneumonia? (3 marks)
b) List 7 patient factors that increase the risk of development of ventilator associated pneumonia? (7 marks)
c) List 3 other factors that increase the risk of developing ventilator associated pneumonia (3 marks)
d) Why is endotracheal cuff pressure ideally kept between 20-30cm H20 (1 mark)
e) Name 6 other measures (other than cuff pressure) that may reduce th risk of the development of ventilaor associated pneumonia? (6 marks)
Question 10
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 11
A primiparous patient with a BMI of 55 presents in the high risk anaesthetic antenatal assessment clinic at 34 weeks gestation. She is hoping to have a normal delivery.
a) Name 5 specific points you need to elicit from anaesthetic history and examination (5 marks)
b) Name 5 specific obstetric risks associated with a raised BMI in pregnancy (5 marks)
c) Explain 8 things you would communicate to the patient about the delivery i no C-section occurs (8 marks)
d) Outline 2 SPECIFIC things you would mention regards a C-section with respect to her BMI (2 marks)
Question 12
You are caled to the Emergency department to se a 2 year-old child who presents with a 4 hour history of high temperature and drowsiness. On examination there is prolonged capillary refill time and a non-blanching rash. A presumptive diagnosis of meningococcal septicaemia is made.
a) What is the normal weight for this child, please show your working? (1 mark)
b) What is a normal CRT and how would you perform this? (2 marks)
c) List 2 approriate resuscitation goals for this child (2 marks)
d) In each of the categories below name 2 managment strategies/goals to do in the first 15 minutes: (8 marks)
- Airway/Breathing
- Circulation
- Blood test
- Drugs
e) After 15 minutes, the child remains shocked and is unresponsive to fluid. What are the most likely pathophysiological derangements in this child's circulation? (2 marks)
f) Name 5 important treatment options (5 marks)