Viva 1

	VIVA questions Irish final FCARCSI These are viva q's asked in previous Irish exams, they get repeated very often. Clinical Anaesthesia Pregnant patient – drugs contraindicated Anaphylaxis Pt for THR with multiple problems ( AF, COPD, HT) – preoptimisation, choice of anesthetics Spinal trauma- Management Old female patient with AF , CXR ??? - Anaesthetic technique Pre eclampsia Epidural not working – management PDPH Pt with Ankylosing spondylitis for TURP Spinal in obstetrics – assessing the level of the block Carotid endarterectomy – GA/RA Aspiration Elderly with Copd for hip surgery – anaesthetic management Pt for oesophagectomy undernourished , BMI 20, Low Albumin, Ischamec changes on ECG – optimisation , DLT, Anaesthetic management 6 yr old Olecranon # - Anaesthetic management Pt with CRF for AV fistula – Anaesthetic options Pt with Acute appendicitis 24 weeks pregnant for emergency laparotomy – Concerns, Anaesthetic Management, Effects on pregnancy, effects of pregnancy on Anaesthesia, post op analgesia, then shows CXR with pulmonary oedema in recovery – laryngospasm, DD, specific possible diagnosis – neg pressure pulm oedema Young woman with PPH needs to go back to theatre- How do you estimate blood loss / Volume status How will you resuscitate initially Discuss investigations, FBC, U/E, clotting Fibrinogen levels What anaesthetic technique What is Hemabate and side effects This patient had intraoperative cardiac arrest – Mx, DD, Post arrest CXR showed- Pul odema , what else could it be ( Aspiration , ARDS) ECG – 1^st degree block, post op ITU 39 yr old with MS and A. flutter for lap chole – Rx of Atrial Flutter, Discussed digoxin and Frusemide, Mx of pt with MS, post op analgesia after lap chole. Post tonsillectomy bleeding Pt with ankylosing spondylitis with AR – Anaesthetic management Pt with IDDM for amputation – Anaesthetic management Anaesthesia – vaginal hysterectomy Thyroid post op complications Pyloric stenosis – Met Alkalosis - anaesthetic management Chronic pain Trigeminal neuralgia - Definition, Management Acute pain team members Guillian Barre syndrome CRPS type I and II Personnel for chronic pain clinic Members of the chronic pain team Analgesia for rib # Management of chronic back pain Phantom limb pain Analgesia for day case surgery Failed back syndrome Post herpetic neuralgia Psoas compartment block ITU Haemostatic mechanism, coags – Discussion Meningococcal meningitis Myotonic dystrophy Critical illness neuropathy General approach of the Poisoning Sepsis ( case scenario) – 72 yr old with peritonitis following hartmanns procedure in ITU extubated following day, 1 day later hypoxic, tachycardia , hypotensive.Diagnosis, what is causing resp failure, pathophysiology of sepsis , Mx of ARDS Brain stem death Indications for central line CXR with pulmonary oedema – DD , management Downs syndrome Acute severe asthma Weaning form ventilation Acute pancreatitis ARDS SIRS Head Injury Intracranial pressure Fat embolism SCIWORA ( spinal cord injury with out radiological abnormality) Metabolic acidosis – Definition & Causes Guillian Barre Syndrome Physics & Equipment CVP – draw trace/explain, Normal and abnormal traces ETCO2 trace CPAP – draw the circuit Capnography Ultrasound ( CO monitoring) Oxygen cylinder Pulse oximetry Safety features of the Anaesthetic machine Ultrasound, ECHO – measurement of CO Humidification BP measurement Doppler US Anatomy Anatomy for paravertebral space Pharmacology Magnesium COX inhibitors Warfarin Gabapentin Pregabalin Tricyclic Antidepressants Physiology What is CaO2 Thermal regulation IRISH FINAL FELLOWSHIP YEAR APR 2007 LONG CASE 5 MINUTES FOR READING THE SUMMARY 20 MINUTES FOR QUESTIONING 82 YEAR OLD LADY FOR ELECTIVE HIP REPLACEMENT. SHE IS ON WHEELCHAIR. Ht.148 CM Wt. 110kg Known HT/CVA/HYPOTHROID/DM/DEPRESSION PULSE 60/MINUTE BP 160/90 JVP 0 CVS SYSTOLIC MURMUR INSPIRATORY CRACKLES PRESENT ANKLE OEDEMA MEDICATION ASPIRIN/BISOPROLOL/ELTROXIN/CITOLOPRAM/METFORMIN/GLYCLACIDE QUESTIONS? CAN YOU SUMMARISE THE CASE? TELL ME ABOUT WHAT ARE THE CVS HISTORY YOU WILL ASK? HOW DO YOU DO CVS EXAMINATION? IS CLUBBING IMPORTANT IN THIS CASE? IS JVP IMPORTANT? HOW WILL ASSES JVP? WHAT ARE THE FEATURES OF HEART FAILURE? HOW DO YOU DISTINGUISH PEDAL OEDEMA? WHAT ARE THE FEATURES OF HYPOTHROIDISM? CHANGE OF EXAMINER WHAT INVESTIGATIONS YOU WILL DO? READ THIS ECG? 1^ST DEGREE HEART BLOCK WITH VOLTAGE CRITERIA FOR LVH READ THE CXR WHAT ORTHER INVESTIGATION YOU NEED? HOW DO YOU ANAESTHETISE THIS PATIENT? AFTERNOON CLINICAL SCIENCE VIVA 64/M WITH DIVERTICULOSIS COLON FOR ELECTIVE LAPAROTOMY EX SMOKER 10-15/DAY HT H/O ANGINA-2YEARS ON LISINOPRIL/DIRUTIC/ISMO INV WCC NORMAL HB ANAEMIA QNS GRADE ANGINA WHAT INVESTIGATIONS YOU WILL DO? READ THE ECG A FLUTTER CAUSES IN THIS CASE PATIENT OPERATED AND IN RECOVERY SPO2 94% ON 40% O2 DRY COUGH CAUSES OF DRY COUGH CXR TRACHEA SHIFTED TO LEFT ?COLLAPSE CHANGE OF EXAMINER 1.ANALGESIA FOR BURNS HOW MUCH OF MORPHINE AND HOW DO YOU SET UP INFUSION WHAT ELSE ANALGESIA GIVEN BY NURSE CAN U THINK OF ANY GAS HOW DO YOU ANAESTHETISE FOR BURNS DRESSING CHANGE 2. EFFECTS OF ANALGESIA ON PREGNANCY? 3. TRIGEMINAL NEURALGESIA? SINGLE DRUG AND DOSE 4. 7YR OLD DOWNS SYNDROME FOR DENTAL WORK ANAESTHEIA PROBLEM EXPECTED CHANGE OF SIDE ENTERAL NUTRITION HUMIDIFICATION MENINGOCOCCAL SEPTICAEMIA DLT MENDELSON SYNDROME *IRISH FINAL VIVA Q's SEPT 2006* Clinical case: Morbidly obese man, about 70yrs old, with co-morbid conditions like severe COPD and PVDI was asked togive the summary to the examiners, then they asked me what the main concerns would be and what I would do ( so all the airway problems, obesity and COPD related points were discussed) then they showed me his X-ray and ECG....it was all basically around the pre-optimization of this patient and a bit about the main conduct of Anaesthesia Afternoon Table Viva 1.CVP trace and explanation of the waves... 2.Abnormal and normal Capnograph trace ( made me draw all the different ones and asked in detail about them 3.Which drugs can be used in pregnancy ( 2nd trimester) and which cant for pain relief 4.Trigeminal Neuralgia: start with definitions ( in everything!)Spinal injury ( ATLS Scenario) 5.Pre-eclampsia: mainly Magnesium therapy 5.Clinical case discussing a 75 yr old man , with comorbidities like Fast AF, Emphysema, HTN, ( showed me PFTs, X-rays, ECG) : pre-optimization and conduct of Anaesthesia....Choice of Anaesthetic technique....GA vs. Regional and justification for it

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IRISH FINAL FELLOWSHIP YEAR APR 2007

LONG CASE