Viva 4 *New*

	Final FCARCSI vivas Autumn 2009 Long Case Elderly gentleman coming in for strangulated femoral hernia repair. SOB on 100 yards, murmur systolic, wears a cervical collar, ankylosing spondylitis with back and neck pain. Claimed to have blood disorder and easily bruised and large spleen. Warfarin, frusemide, naproxen Blood test - Normal blood, Plat 81 INR 3.4 ECG - SR (?cardiac changes - LVH) Peak flow test - restrictive picture CXR - reticular changes bronchiectasis Questions 1. valvular disease - Aortic regurgitation/stenosis - both signs and symptoms - the difference and measurement of severity (valvular, gradient etc) 2. Blood test - why platelets low - causes 3. How to optimise - action of plan including correction of INR 4. Anaesthetic plan 5. ICU management - including post operative complication 6. Treatment futile - how are you going to tell the family about withdrawal treatment Clinical Sciences 1. Critical Illness Polyneuropathy - causes, why, what happens 2. Meningitis vs Meingitis Septicaemia - differences, bacterial causes, treatment etc 3. Weaning from ventilation - why can't wean, how to wean 4. Oxygen sats probe 5. Hyponatraemia - causes,classification, signs and symptoms and action 7. CRPS - what is it, criteria, how to examine 8. What do you know about Fast track surgery and all factors to carry out fast track surgery 9. Nerve supply of the knee 10. What supply the femoral triangle - how to do femoral nerve block and criteria associated with it. 11. Signs and symptoms of PE including treatment following surgical procedure. Problems with that. 1) Transdermal opioids ---------------------------- Principles Why not diamorphine even though highly lipid soluble Types of transdelivery systems Advantage over oral opioids How will you go about patients coming to elective surgery with transdelivery patches-? remove it or continue and what are options for peri operative analgesia complications ------------------------------------------------------------------------------------- 2) Intra ocular pressure ----------------------------- Value-normal Factors affect IOP-Production, drainage anaesthesia and IOP drugs affect IOP-inhalational/intravenous agents, muscle relaxants LA blocks and IOP-peribulbar, retro bulbar, sub tenon Auto regulation and IOP Factors like-PEEP, position and IOP Raised Intra cranial pressure ------------------------- clinica features-symptoms and signs cranial nerves affected and why Methods to detect factors affect ICP/auto regulation drugs and ICP ------------------------------------------------------------------------------------- 3) CO2-measurement ------------------------- what is capnography draw the diagram and label the graph draw the diagram of different clinical situations Principle of measurement difference between side stream and main stream transit time and rise time methods to measure CO2 ------------------------------------------------------------------------------------- 4) ARDS ---------- Define Diagnostic criteria Causes pathophysiology Ventilatory streategies ARDSNET-protocols Methods to prevent hypoxia in ARDS All the trails-sterods, prone, HFO Vs conventional 5) Central line related infection --------------------------------- Reasons for central line related infections How to prevent line related infections Different CVC lines Short case ------------- 55 year old male for DHS-desaturation Causes Define fat embolism syndrome Clinical features of FES How to prevent FES Complications of FES prognosis

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