Morning Clinical Viva 30mins: 82 year man with fracture femur was admitted for emergency surgery. He is 100kgs with a height of 158cm. He has the following problems: Aortic valve replacement 2 yrs ago, he is on warfarin AF CCF Hypertension Pacemaker in situ, Gestational Diabetes Medication: Bisoprolol Frusemide Aldosterone antagonist Warfarin Enalapril Insulin.... Investigations: Urea: 22 Cr: 230 Na: 135 K: 4.5 INR 3.5 No mention about Blood sugar. WBC : Normal, Hb:9.5 Other investigations only if you ask.... ECG, Cxr, echocardiogram....etc. ***Obviously plenty of scope to ask questions. Too many topics to ask from one clinical scenario. Summarise, pharmacology of those above drugs, Warfarin indication how does it act, what would you do about it before surgery, vit-K dose, FFP dose, pre-op optimization, questions on pacemaker, morbid obesity, Airway management, Obstructive sleep apnoea, etio-pathogenesis, and post op management of Sleep apnoea, CCF& AS clinical features and management, valve gradients and severity, indications for aortic valve replacement, cardiovascular examination, Jvp, What other investigations?, then read ECG... CXr.......Timeup. (For other candidates anaesthetic management and other detailed questions were asked. End less....)
Afternoon Viva:1 1.Pheochromacytoma..clinical features, diagnosis, site of origin,incidence...etc. (many more questions sufficient enough for 20 min) 2. Transfusion hazards, what advice you give to patients, What infection risks you think of with transfusion, For what viral infections you screen routinely, Transfusion thresholds, methods for avoiding transfusion during surgery including hemodilution, cell saver,hypotensive anaesthesia etc... 3. Child with inhaled foreign body...examination, assessment,anaesthetic options and management. 4. Labour analgesia, various methods, uterus innervations..etc 5. Stellate ganglion block
Afternoon viva 2: 1. 8 year old fell off the tree. CT head shows.....Rt-Frontal EDH...MIDLINE SHIFT)..management, any raised ICP from CT SCAN? How do you say? 2. Comment on this Blood gas picture (met. Acidosis, Hyperkalemia, etc) Mangement of hyperkalemia... 3. LASER, Physical properties, clinical uses, Hazards, precautions, management of laser burn accident in theatre.....etc 4. CPAP..Indications, components in a CPAP circuit, problems, NG tube requirement....etc 5. Nutrion in ITU and relevant questions on it.
