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STRUCTURED VIVAS
Treatment of pulmonary embolism. 3 year-old with stridor: management GA for epiglottitis. Temperature regulation in theatre. HFJV and ICNBs.
ARDS: describe, aetiology & management. Core temperature measurement: sites, anaesthetic relevance. OLA: DL tubes, position, management low SpO2.
Management of difficult intubation, awareness. Factors controlling alveolar concentration of volatile anaesthetics. Management of patient for organ donation in ITU, brain death tests. What is haemophilia? Factor VIII manufacture, why heated. Other bleeding disorders. Management of wisdom teeth extraction.
Explain role of regional & national BTS centres. Pulse oximetry: how it works, interference, P50. Anaesthesia for hip replacement, precautions, why LA. DVT incidence, pressor agents. Asthma, management, IPPV criteria, weaning, status, auscultation, end of the bed signs. IHD: importance in anaesthesia, drugs, associated with >Bp, exercise tests. Ketamine.
Features of phencyclidine compounds. Suitable drugs for TIVA. Oxygen dissociation curve, differences between tension and saturation, P50. Acute severe asthma, features. Blood products, complications of transfusion. Hypotensive anaesthesia.
Arterial cannulation, Allan's test, complications of a-lines. Anaesthesia for foetal distress: GA v regional technique. Role of spinals in LUSC pre-op assessment, allowed one test pre-op which one? Indications for difficult intubation, failed intubation drill. Maintenance of GA following intubation, FiO2. Spinal & epidurals in presence of anticoagulants. Aspirin and regional blocks, treatment of hypotension. Haemophilia: classification, clotting profiles, PTTK, PTR, bleeding times.
Advantages & disadvantages of: side arm flow & wave form display. How does a CO2 analyser work? Uses? O2 analysers: readings in PA. Causes of post-op jaundice: drugs giving: haemolysis & obstructive. Theories halothane hepatitis: time course, enflurane hepatitis. Approaches to neonate anaesthesia: anatomy of airway. Laryngoscope blades, GA hernia repair, premedication. Sympathetic response to intubation in neonates.
& vomiting, known asthmatic, Ht and Wt given: preoperative assessment. Monitoring and positioning of patient, anaesthetic agents. Local anaesthesia for shoulder surgery. Suprascapular/ interscalene nerve block. Halothane hepatitis.
N-M agents in neonates. Who was Hofmann? Tell me about atracurium. Problems with MAOIs in anaesthesia. Management for ECT in patient on MAOIs. Non-opioids and pain relief. Gut in the critically ill. Discuss gastric pH & omeprazole. Do you read the journals -recent reading?
NIBP. Sleep apnoea. ET-tube suction in the critically ill.
Discuss pre-operative investigations and preparation. Discuss anaesthetic techniques, problems with cross clamping. Prevention of the hypertensive response to laryngoscopy. MH: define, risk groups, presentation, management, dantrolene. Tec 2 vaporizer: how does it differ from modern vaporizers. Desflurane: physical properties. Advantages & disadvantages compared with other volatiles.
What more information do you need? Explain Drugs and bolus for induction ? thiopentone. Dose of salbutamol. Would you use steroids, which? Posterior fossa syndrome, explain problems of surgery, coning & results. Laser surgery: problems, how would you put out and treat an airway fire? Doses used in propofol infusions
Technique & needles: reasons. Use of thromboprophylaxis in # NOFs. Advantages in obstetric patients. Other drugs used in subarachnoid space. Arrhythmias: Presentations, detection, causes & GA association. Bronchoscopy: Indications & techniques. Arrangement of bronchopleural segments. LA & GA techniques. Sander's injector and airway pressures. HIV & AIDS: Definitions and causes (at risk groups). Transmission of infection. Management of HIV positive patient for bronchoscopy. Screening of blood. AAGBI booklet recommendations for HIV+ve anaesthetist.
What determines your choice of LA or GA? Problems of spinals. What anaesthetic circuits do you use? Explain the Bain and Lack, who was Lack ( Why use a circle? Problems with circle. Monitoring in and outside circle. What is in soda lime? Explain mechanisms of sympathetic dystrophy. How is a stellate ganglion block performed? LA used, complications. What is Horner's syndrome? (who was Horner?). Failure to relax after suxamethonium, continue GA or stop? why? Myotonia congenita and signs. Explain calcium homeostasis. Explain actin and myosin contraction.
Extradural: anatomy, techniques for identifying & drug choice. Asthma: management, criteria for ventilation & ITU management. NIBP: mercury sphigs & oscillotonometers.
History of bleeding in the family: haemophilia, FVIII types. Haemophilia: FVIII levels needed, other investigations (HIV & HepB). Management of HIV +ve patient. Management of haemophilia boy for dental extraction, pre-operative investigations. Pre-eclampsia: features, assessment for epidural, investigations, Management of epidural if patient on aspirin, GA management of an eclamptic patient for an emergency LUSC, How would you modify pressor response to intubation?
Upper airway obstruction: how to anaesthetise, Haemophilia, Pre-eclampsia.
Intra-operative arrhythmias: causes & treatment. Spinals: indications, contraindications, complications and treatment.
Associated diseases & potential anaesthetic problems. Cleaning of equipment regulations. NSAIDs: ketorolac vs diclofenac, mechanism of action, problems, contraindications, latest opinions on them, gastric protection. Flowmeters: design, physics, pressures, potential dangers. Critical incidents. Sudden increase in Paw to 50 cm H20: causes from ventilator to patient. Protocol for identifying problems.
Oxygen delivery systems. Paediatric breathing systems. Brain stem death tests.
Nerve supply to the larynx: partial or complete paralysis: management. Temperature monitoring: mechanisms, when, how, where, complications.
Rotameters. Patient for cholecystectomy: sudden increase in Paw: causes (tube, pneumothorax,bronchospasm, cardiac failure). Patient with AIDs for Hickman line insertion 5. Ayre’s T-piece: advantages, disadvantages, fresh gas flow. T-piece compared to circle system. Metered oxygen therapy: need for accurate FiO2. Pacemakers: classification, pre-op assessment, problems (diathermy, synchronisation). Pre-op assessment for gastrectomy. Xylocaine spray, uses, contents, advantages over bupivacaine, other uses.
First rib. Phantom limb pain. Aortic stenosis: history, examination, type of anaesthesia, monitoring, cardiological referral, what looking for, etc.
Oxygen delivery systems, oxygen saturation curve (saturation vs tension). Anatomical relations to the internal jugular vein, surface anatomy, procedure for insertion of IJV catheters. ITU scoring systems APACHE 2 & 3, TISS, GCS, TRISS. Making decisions to stop treatment for patient with #NOF. Talking to relatives. Fire hazards, safety in theatre, combustion (stoichiometric measures), theatre design,combustible anaesthetic agents.
Emergency caesarean section in patient with +ve sickledex test. TURP syndrome. Suctioning critically ill patients in the ITU: precautions & complications. Indications for minitracheostomy & complications.
Acute pain service: function and administration. Bernoulli principle, venturi: uses in anaesthesia. Coanda effect. Classification of ventilators: discuss examples.
Stellate ganglion & coeliac plexus block. Cardiopulmonary bypass (CPBP) - types of oxygenator. Continuous vs pulsatile flow. Resuscitation of PPH.
Differential diagnosis probable metastatic carcinoma prostate. Assessment, examination to identify nerve roots involved, investigations. Pain treatment options. Patient collapses with abdominal pain: differential diagnosis. Resuscitation and perioperative management of AAA, ITU care of AAA. Complications of suxamethonium.
Classification of inotropes: how do they work? Management of 32 yr-old female with UC with toxic megacolon. How do you treat traumatic pneumothorax?
Initial management, massive transfusion problems, post-op care. Anatomy sympathetic NS, stellate ganglion block. Basic principles of CPBP. Humidification and HMEs, measurement of humidity and types of HMEs.
Paracetamol: graph plasma levels with time, n-acetyl cysteine. Gastric lavage, activated charcoal mechanism of action. Salicilate: forced diuresis. GCS scores: meaning and when used. Electrical safety: electrical services, static, floor shoe impedance. Stoichiometric mixtures. Dental anaesthesia: day case problems, assessment, chair vs supine, airway control. Intubation vs mask, dental packs & props, IV vs gas induction, maintenance, Poswillow report. Clonidine: uses, mechanism of action.
CPAP & PEEP: airway pressure changes. Electrical safety. Post-dural tap: headache, symptoms, differential diagnosis, blood patch. Pre-eclamptic patient in labour: diagnosis, management, treatment. Gas laws: ECG: acute MI, management, thrombolytic therapy, other medication post MI.
Abdominoplasty in morbidly obese female (5’ 4”, 160 Kg). Definition & management. Vaporisers.
Dural puncture: immediate and subsequent management. Sepsis: causes of hypotension, mediators. Phantom limb pain, causes, prevention & treatments.
TIVA: how do you use it, what drugs, indications, risks of awareness? CPB: oxygenators, pumps, cooling (to what temperature and why), anticoagulation: dose of heparin, monitoring dose, reversal of heparin? Premedication: What premeds do you give routinely? What different types of premed are there (classes?).
SS from AS clinically. Management of a sickle cell +ve patient, pros and cons of epidural v GA, causes & prevention of hypothermia during anaesthesia, aorto-caval syndrome, rationale for pre- & postoperative transfusion of above patient? Scavenging systems: descriptions of active, semi-active, passive, necessity for scavenging, studies done and their findings, other methods for reducing anaesthetic agents in the environment, do anaesthetic agents constitute an environmental danger, flammable anaesthetic agents, other causes of fires in the operating theatre? A 59 year-old male has a laryngeal tumour on ENT indirect laryngoscopic examination, assessment and anaesthetic management for EUA and biopsy, preop history and examination, difficult intubation assessment, intubation technique (inhalational or awake), when would you use intravenous technique, microlaryngoscopy ET-tube descriptions. Ankle block: nerves, technique & indications.
Elective patient with aortic stenosis for a THR: diagnosis and anaesthetic management? PCA: problems associated with it.
Local anaesthetic toxicity: worst sites, doses, clinical presentation, treatment especially bupivacaine toxicity. Dose and use of bretylium. ITU case: male 32 years, HIV +ve, ? pneumonia, discuss likely organisms, how to treat PCP,appropriate treatment and management, long discussion over when/ how long/ when not to treat, what if AFBs are found in the sputum? ECG: atrial tachycardia, justify your treatment, ECG in great depth, calibration, speed, etc, treatment options on the ITU, CSM, adenosine, verapamil, esmolol, amiodarone.
What are the methods available to measure ICP? list the problems and advantages of each, ways to prevent rise in ICP during anaesthesia. Inotropes: types, advantages, disadvantages, doses & modes of action. Anaphylaxis: definitions, causative agents, management of severe reaction, post-reaction management.
Anatomy of trachea and bronchopulmonary segments. Tracheal bifurcation and importance to anaesthetists. Aspiration in the sitting and supine positions - which bronchopulmonary segments involved? Anatomy of the intercostal nerves. Methods, indications and complications of ICNB Indications for intubating critically ill patients in the ITU. Advantages and disadvantages of nasotracheal intubation.
Morbid obese female for abdominoplasty. Define BMI & morbid obesity, problems pre/ intraop/postop. Phantom limb pain: aetiology and treatment. Emergency LSCS, assessment, difficult intubation, failed intubation drill.
Local anaesthesia for awake intubation or rigid bronchoscopy (!) Discussion of maximum safe dose of lignocaine, nerve supply to structures, how to block superior laryngeal nerve. How do GAs work? Why do we need to know? What are the desirable characteristics of a volatile agent. IV drug abuser has injected his femoral artery which has caused necrosis needing debridement.Problems presented by this patient. Precautions to be taken for IV access. How to sterilise equipment afterwards, what methods are available? What would you do if you sustained a needle stick injury while treating this patient?
Pyloric stenosis: what is the defect, how old, presentation, must we delay operation? How long to resuscitate? What fluid, volume, ABG & U & E abnormalities? How is induction achieved, awake intubation? Who will you intubate awake? Relaxants & dosage? Post-op pain relief, opioids?
Guillain barre. Epidurals. Clonidine.
Mechanisms of action of anaesthetics (volatiles, ketamine). GABA & NMDA receptors. LSCS: various scenarios, foetal distress, cord prolapse, antacid prophylaxis. 220 Kg woman for abdominoplasty.
Cylinder manufacture, filling pressures, filling ratios. Emergency AVR for stenosis: perioperative management. The by-pass machine.
Invent your own breathing system! Clinical scenario: breathing difficulties following thyroidectomy, differentiate causes, management, anaesthetic technique for evacuation of haematoma. Ideal muscle relaxant.
Coagulopathy & treatment. Oxygen cascade. Oxygen: flux, delivery, consumption.
Oxygen cascade: describe all the levels, values and effect of increasing FiO2. DIC: causes, what clotting factors are affected, coagulation tests, renal effects of microemboli. Transducers: types, damping, factors which affect pressure wave form.
Measurement of oxygen: fuel cell, Clarke electrode & paramagnetic analyser. Anatomical relations to the first rib. Gut physiology: how a decrease in blood flow occurs, what it causes, TPN & enteral feeding.
PONV: physiology, those at risk, methods to prevent. ECG: acute MI, treatment, why in a CCU? IPPV in those with ‘neurological signs’: indications for ITU in Guillain barre, head injury & myasthenia gravis.
Awareness: “what would you do if a patient complained of being awake?” causes, management of patient & machine checks. Vaporisers: Plenum vs draw-over, reasons for vaporiser chamber, sources of inaccuracies & explain flow splitting & temperature compensation. Hypertension: clinical scenario in asthmatic with high BP, side effects of high BP, would you anaesthetise patient, investigations of cause, treatment, management in an emergency? Myasthenia gravis, pathophysiology, SOB in A/E & tests. What is an isotope/ radioactive isotope? Uses in anaesthesia. Brain stem death tests. Ways to monitor respiration and ventilation/ End-tidal CO2
HME: how it works and disadvantages. Classify ventilators: draw flow/ time & pressure/ time curves. Malignant hyperthermia, describe, diagnosis, management, follow-up. Inotropes, dopamine: when used, in MI, Starling curve effects. Post-op fluid regimes, post cholecystectomy normal fluid requirements. Rotameter construction and physical principles.
Anaesthesia for surgery on the knee: anatomy femoral nerve. Contraindications to spinals. Anaesthesia for D & C and bronchoscopy.
How is entonox administered? Epidural infusions. NM blockers in ITU. Neuro intensive care. Asthma: recent literature. Suxamethonium: when and when not to use. Post-op analgesia in children: assessments, neonatal analgesia. 65 year-old post colectomy: fluid regimes, why Hartmann's. Daily Na+ requirements, Na+ shifts in ICV & ECV. Malignant hyperpyrexia. Pharmacology: handling drugs in renal failure: initial dose of morphine in renal failure. Benzodiazepines and volume of distribution.
Humidifiers. Prophylaxis for DVT, acid aspiration syndrome. Temperature monitoring devices. Minimal monitoring standard.
Ways to decrease infection incidence. Paediatric laryngoscope: use of hook on handle. Problems anaesthetising neonates. Anaesthesia for 93 year-old for fractured NOF. Causes for confusion, GA v LA. Causes for K+ = 5.8 mmol l-1 in 23 year-old with torsion of testicle. Ventimask: operation, how used. COAD type II respiratory failure and shunt graphs.
Oxygen: content in blood equation, oxygen cascade. Forces aiding oxygen transfer into cells, O2 dissociation curve. Clinical trials: random, double blind, prospective. Statistical data given: which test (Chi squared). Explain statistical significance and probability. Enteral and parentral feeding, indications, composition. Methods of introducing enteral feeding complications. What is the necessary nitrogen/ calorie ratio in feeding? What isotopes do you know: uses, action, advantages/ disadvantages? Doses of inotropes: enoximone/ dopexamine: mechanism of action. Hepato-renal syndrome, causes, mechanism.
Anaesthesia for 4 month-old for inguinal hernia, GA v LA. Post-operative analgesia, sites for post-op nursing. Causes of stridor in 4 year-old. Management of epiglottitis. Malignant hyperpyrexia. Needle cricothyroidotomy. Called to A/E: 30 year-old multiple trauma, fractured ribs, respiratory difficulty. Tension pneumothorax, pericardial tamponade: Management & pain relief techniques.
Who was Magill? Differences between adult and paediatric airways. Who was MacIntosh? Tell me about the problems in long anaesthetic cases. What would you do for cases longer than 3 hours? Content of TPN. Problems with high concentrations dextrose or lipid or excessive volume.
Management of cardiac arrest. Temperature monitoring. Temperature conservation. Malignant hyperpyrexia. ARDS. Suxamethonium apnoea.
Management of sudden post-op hypotension following CABG. Management of unconscious overdose in A/E, likely causes.
Explain cation and anions in anionic gap. Explain APGAR, when would you intubate the neonate. What type of ITU ventilator for neonate? 16g CVP: has it the same flow rate of a 16g venflon. Explain the Hagen-Poiseuille equation. Flow meters. Bourdon gauge and N2O. Classify ventilators & power sources. Bain circuit: problems with disconnections. Head injury: effect on ICP: mannitol, frusemide & dexamethasone.
LAs: lignocaine: maximum safe dose, pKa, factors affecting toxicity. factors affecting speed of onset. EMLA: define and uses, other eutectic mixtures. Femoral nerve block: indications and technique. Sciatic nerve block: indications. Why do LAs 'sting' on injection? Explain reason for pattern of regression of a LA block. Why carbonated solutions/ bicarbonate? Laryngeal mask: What is black the line for, indications for use? Extra-dural haematoma: Assessment and management in A/E. Urgency of surgery & anaesthetic management. Effect of N2O on cerebral circulation. Prone position: problems for anaesthetist, type of ET tube recommended. Resuscitation in prone position. Capnography: Shape and significance of trace. Relationship to PaO2. Emergency situations where capnography useful.
Most common gynaecological operation. Laparoscopic sterilisation & instillation of LA into peritoneum. Children and fasting. Burns assessment, airway burn when to intubate. What is PEEP? When would you use it & complications. What is 'best PEEP', how do you assess it? Oxygen delivery equation. Anaesthesia for hysterectomy. What vasopressor do you use & why autologous blood transfusion (salvage)? Incidence of AIDS from blood transfusion.
Hypotensive anaesthesia. Day-case anaesthesia. Spinal anaesthesia for obstetrics. EMLA cream. Nacl vs Ringers lactate. Intra-arterial thiopentone: treatment. Laryngeal mask. Forrester laryngeal spray. Poswillo Report. ET-tubes:
Cyanotic heart disease: causes, problems & GA management. Humidifiers: Which ones & why? Efficiency & problems. EMLA: Max recommended dose for a 3 Kg neonate. First pass metabolism: metabolism and metabolites of morphine. How to measure pain: adults and children. Why premedicate adults? Metoclopramide: effects and mechanism of action. Splanchnic nerve block: How and why? Coeliac plexus block: How, why & what complications.
Unable to reverse NMB agent. Spontaneous respiration post-operatively.
Red rubber COTT: indications. Sterilisation of equipment: eg. ETTs. Anaesthesia for a 35 year-old with hallux valgus who is taking: a) MAOIs b) warfarin c) BP 180/120 Anaesthesia for 9 year-old with a fractured wrist and a family history of a sibling admitted to an ITU after surgery
RA medication. Problems with unusual patient positions. Opioids: pharmacology, constituents of omnopon, recent noscopine controversy. Your required ‘list’ for setting up a GA service in an isolated dental practice. Resuscitation drugs and their uses.
Basic and advanced resuscitation. Immune systems: lymphocytes, causes of immune depression.
Armoured tubes: uses, placement, complications in thyroid surgery. New muscle relaxants: why? Smoke inhalation: clinical scenario of patient admitted from house fire. Entonox: what makes it useful. What is ‘steal’: where is it important? Agents associated with it. Electrical safety in theatre: diathermy.
Local anaesthetic toxicity, Bier’s block, safe doses. Critical incidents: define, monitors to avoid. Fixed rate oxygen masks. Rae ET tubes: disadvantages, uses. Sickle cell anaemia.
Management of fractured mandible and fractured base of skull. Post op management of fractured mandible. Bleeding tonsil: 7 year-old, wt, blood volume, allowable losses, anaesthetic problems. Fluids: colloids, crystalloids and blood.
Helium: density, role, type & colour of cylinder, turbulent flow, etc. Obstetrics: GA caesarean section, failed intubation when to continue, massive transfusion. Oxygen analysers: paramagnetic, Clark electrode, etc. Statistics: 2 x 2 contingency tables, X2, degrees of freedom and p-values. APACHE & GCS scoring.
ABC, chest drain insertion, principles of chest drains, 1, 2, 3 bottle systems. bronchopleural fistula and induction of anaesthesia. thoracic anatomy and sources of bleeding from stabbing. Humidification: efficiency, measurement. Statistics: examples of student t-test (parametric & non-parametric), Chi square, Yate’s correction, confidence intervals, SEM, Wilcoxon test, distributions. Distribution of body fluid: ICF, ECF, TBW etc. Resuscitation: Crystalloid vs colloid in case of # pelvis, definition of ‘volume expander’, colloid half- life, draw graphs of O2 delivery v Hct and viscosity v Hct. Eisenmenger’s syndrome: VSDs, shunt, reverse shunt, HPV. Starling’s Law of the heart in normal and failure. Valsalva manoeuvre and BP changes. Desflurane: MAC, metabolism, uses and preservative? Magill circuit: valves and blow off pressure, barotrauma.
Markings on an ET-tube. Failed obstetric intubation: Equipment in a ‘difficult intubation box’. Laryngeal mask: Preparation, insertion, uses, complications.
GA for IDDM for eye operation: management of diabetes. Paediatric oral RAE tube: advantages disadvantages, why not cuffed? ITU sedation regimes: drugs used, pros and cons. Shown premedication chart: morphine 10 mg, diazepam 10 mg, atropine 0.2 mg for a 13 Kg child. Give comments. Management of cyanotic heart disease, physiology.
PEEP valve and how it works. Alpha agonists and analgesia. PCA.
Anaesthesia in the dental chair: problems, monitoring, Poswillo report. Equipment: single lumen CVP, insertion, complications, PA catheter problems. Principles of pulse oximetry.
Problems with laparoscopic surgery. CSF: Where made, how, contents & physiological functions? “What do you think people are afraid of most when they come for an anaesthetic”? Hazards of hip surgery, specific measures to decrease the incidence of air embolism.
Anaesthesia for elderly man with respiratory disease for TURP: spinal & complications. Tec 3 vaporizer, filling port, spillage, scavenging, literature evidence for complications with exposure to volatile agents. Nitric oxide - ARDS. NMDA receptors - role of glutamate in the CNS.
Nutrition: Enteral & TPN problems, glutathione + enterocytes. Temperature: How, when, where & how? Methods, thermisters & thermocouples. Methods for administering oxygen: headbox, nasal cannulae, masks, CPAP, IPPV, PEEP, reverse I : E ratio.
Ketamine. PAFC: causes of over & under damping. HMEs: paediatric vs adult differences, resistance measurement of gas flow.
Hypotensive anaesthesia: techniques. Electrical safety in theatre: spark proof plugs, why? Causes of a flat line on the capnograph.
Profile cuff: how does it get its name? Pressure in cuff, mechanism for cuff induced ischaemic necrosis. Problems with nitrous oxide. Atelectasis: problems and role of sighs. Favourite inhalational agent. Have you ever used ketamine? Management of patient with ruptured aortic aneurysm in A/E. What would you like the Hb to be?
Management of post thyoidectomy stridor. Induction agents: reasons for and against propofol and etomidate. Nitrous oxide: pollution guidelines, limits & side effects. Ventimask: physical principles, problems of decreased flow through masks clinical applications.
Management of diabetes perioperatively (GKI & sliding scale). Clinical scenario of a 90 year-old for cataract extraction. Tracheostomy tube: different types, fenestrated type with removable inner tube, why advantageous? What do you do if blocked? MLT: what is it? Indications for thoracic epidural: when do you put it in? Differences between thoracic & lumbar levels, test does, causes of hypotension during oesophagectomy with epidural in situ. End tidal carbon dioxide monitoring during laparotomy. What level do you aim for? Causes of rebreathing. How do you achieve normocarbia without reducing minute ventilation (DS extension), advantages & disadvantages of hypo- & hypercarbia, FGF on a Bain circuit, carbon dioxide isopleths with minute volume & FGF.
assessment of blockade & reversal, physiology of neuromuscular junction, arrangement of nerve supply to eye muscles v respiratory muscles? Cardiac index: Goldman’s criteria, population studies for myocardial infarction and risk index (%) Prostatic resection: problems, TURP syndrome, assessment, investigations & management? Uses of glycine v normal saline, indicators of excessive absorption of glycine (ammonia, alcohol).
Rheumatoid arthritis: blind nasal intubation & awake fibreoptic. Management of hypothermia: skiing victim & drowning. Audit definition & difference from research?
Nuffield 200 ventilator: how does it work. setting, calculate tidal volume, alarms required, how to set them & other circuit alarms. Oxygen saturation & ET CO2 traces: explain traces, how monitors function, ET CO2 trace. abnormalities MvO2: Is this useful? examples cardiogenic and septic shock. Pulmonary artery pressure: Why bad when elevated, how to treat, explain how NO works and where. Pitfalls of NO therapy and what to monitor? Mini-tracheostomy: what is it & when to use it? Newer methods: which is best percutaneous or cutting/ dilatational forceps tracheostomy. Laryngectomy: pre-operative assessment, anaesthetic technique, intraoperative problems, postoperative analgesia. PCA: explain to the patient how it is used & outline safety features.
Foetal circulation: congenital heart defects. Pulmonary oedema: management. Epidural: dural tap management. ITU patient feeding. Breathing circuits.
Symptoms and signs of fluid overload. Assessment of renal function: what is GFR? GFR of glucose? Why is inulin used to measure GFR? How do you measure renal plasma flow? Complications of benign hypertrophic prostate (obstruction, infection, renal failure). Paracetamol poisoning and its management. Obstructive sleep apnoea and its importance to the anaesthetist. Why are patients sensitive to opioids? Classification of drugs used in psychiatric practice and their mechanisms of action (MAOIs, TCA, lithium, etc). Different types of MAOIs and TC antidepressants. Lithium toxicity: clinical presentation and treatment.
consumption. Methods to increase oxygen delivery. ABG machines: what is calculated, derived, explain SBE/ BE & What is this formula (propofol !). “Tell me the good bit and the bad bits”. List iv agents in order of risk of producing anaphylaxis or nausea. Suxamethonium. Pathophysiology of nausea and vomiting, receptors involved. Is metoclopramide a good drug? What skin conditions, in patients, may affect the conduct of anaesthesia? Awake intubation. Mitral stenosis: problems with anaesthesia.
ever tell a patient he may die during an operation? Would you tell his relatives? What is the stress response to surgery? Which organ do anaesthetists worry about in relation to this? How can it be attenuated, what methods especially to laryngoscopy? What is a time constant? Draw the graph. What properties of the lung does it depend on? If you had to choose an ITU ventilator what properties would you look for? How do ventilators cycle between inspiration and expiration? How do they cycle back to inspiration? What is PEEP/ CPAP?
IHD monitoring: advantages of CM5, where is the indifferent electrode? What ECG changes may be seen? Post-thoracotomy patient not breathing well: causes, pain control (methods).
N2O cylinder. Morphine and its problems in neonates. Drugs: thiopentone, mivacurium, dopexamine & prostacyclin. Circle systems. LMA.
When to give blood: pre-op, in ITU. Bleeding tonsil in 5 year-old: start to finish! Soda lime, low flow anaesthesia. Scoring systems APACHE II vs III, TISS, ASA (discussed). Goldman’s cardiac index.
Suxamethonium genetics. Adrenaline in LAs. Metabolic acidosis. Desflurane.
thiopentone & pancuronium. Down’s syndrome: airway problems, HepB risks (institutional). Cataract: causes, LA blocks, retrobulbar vs peribulbar. Emergency management of facial, head, neck trauma. Cricothyroidotomy with 14g cannula. Further management? What is rate/ pressure product & stroke work? Significance?
Management of patient with ventricular ectopics during anaesthesia. Management of A/E patient with severe bronchospasm. Oxygen flux, delivery and consumption.
Neonatal resuscitation: problems ventilating neonate (32/40) for appendicectomy. Other causes of abdominal pain. Given results: pH = 7.0, PaO2 = 7.0, PaCO2 = 7.0, HCO3- = 7.0 and BS = 7.0: discussion of causes. Obstructive sleep apnoea: problems for anaesthetists. Soda lime: carbon monoxide with sevoflurane. Is there a role for desflurane/ sevoflurane? Association guidelines on filters in circuits: problems caused. Types of filter, which is the best?
Free flap: anaesthetic techniques. A patient, 1 week post CABG, needs free skin flap to close sternal wound: investigations & anaesthesia. ICP: what affects it, how do you deal with increases? Foetal circulation, pressures, saturations, what happens at birth, transitional circulation. L to R shunts: prostaglandins, prostacyclin, where produced, mechanism of action, uses, pulmonary hypertension HPV: NO, cyanide toxicity. Entonox: talk about it! What else has been used historically for pain relief in labour?
Liver function: lipid metabolism. Awareness management.
ventilators. Equipment (photographs): rotameters, physical principles, effects of gas density on calibration, could oxygen and nitrous oxide go through same rotameter? Oxygen failure devices, Bain circuit, FGF, SV/ IPPV, Rees T-piece, FGF, SV/ IPPV, Nuffield 200, how classified, connection for scavenging and patient circuits.
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