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Adenosine 6mg/6mg/12mg
Amiodarone 300mg
Atenolol 50mg
DC cardioversion Correct
Verapamil 10mg
Strictly speaking as this patient is
showing signs of decompromise (i.e.
systolic blood pressure <90) she should
be immediately DC cardioverted under
sedation/anaesthesia. In practice, most
people would try adenosine first whilst
organising a cardioversion.
Adenosine 6mg
Atropine 0.6mg Incorrect answer selected
Percussion pacing This is the correct answer
Transcutaneous pacing
Transvenous pacing
Adenosine and atropine are not front line
agents in this scenario, particularly
adenosine which blocks AV conduction
-1 marks if you elected this. Transvenous
pacing is not a fast enough intervention
here. Transcutaneous pacing is the
immediate management but percussion
pacing may be effective as a holding
measure whilst this is instituted.
(Percussion pacing involves gentle
thumping of the lower left sternal edge
with the fist.)
A 62-year-old male with a history of
ischaemic heart disease is admitted with
chest pain of 13 hours duration and some
ST depression inferolaterally.:
Which of the following would be the
most appropriate treatment option for
this patient?
(Please select 1 option)
IV Diamorphine 10mg
Oral aspirin 600mg
Oral Isosobide mononitrate 30mg
Oxygen 100%
Subcutaneous low molecular weight heparin Correct
The treatment approach in this patient
with acute coronary syndrome would be
aspirin 300mg, try some GTN, if this
fails then ISDN IV, diamorphine (or
Morphine) 2.5 mg, 4L oxygen, and
subcutaneous low molecular weight
heparin
Analgesia
Bag and mask ventilation
Face mask oxygen
Intubation Correct
IV fluid bolus
The picture is one of severe burns and
smoke inhalation. Shock can occur in the
first few hours from loss of large
Carbamazepine
Lisinopril
Morphine sulphate Incorrect answer selected
Phenelzine This is the correct answer
Pyridostigmine
Phenelzine and Tranylcypromine are
monoamine oxidase inhibitors, which
should be stopped at least 2 weeks prior
to elective surgery. It can cause lifethreatening interactions with pethidine
and indirect sympathomimetics. It also
prolongs the action of suxamethonium
by decreasing the concentration of
plasma cholinesterase. Carbamazepine is
an anticonvulsant and should be
continued throughout the perioperative
period. Gliclazide, a short acting oral
hypoglycaemic can be taken if the
anticipated duration of surgery is short.
Lisinopril, an ACEi and digoxin, a
cardiac glycoside, should be continued
pre-operatively. Morphine sulphate
tablets should be continued
preoperatively and a morphine Infusion
(PCA) considered for postoperative
analgesia. Pyridostigmine is used in the
management of myasthenia gravis and
Anaemic
Cardiogenic Correct
Distributive
Hypovolaemic
Septic
The picture suggests duct-dependent
congenital heart disease, with
progressive worsening of symptoms as
the duct closed. Typical conditions
include: aortic coarctation, critical aortic
stenosis, truncus arteriosus and
hypoplastic left heart syndrome.
Finger sweep
Heimlich manoeuvre Correct
High flow oxygen
Cricothyroidotomy
Removal with forceps
A finger sweep is more likely to push the
obstruction further into the airway and is
no longer advocated. High flow oxygen
is the Breathing part of A,B,C. and the
Airway is not clear. Nasopharyngeal
airways will not help in this situation.
Removal with forceps is potentially
hazardous. A Heimlich manoeuvre
should be performed with the possibility
of cricothyroidotomy in mind
immediately thereafter if this procedure
fails.
Correct
Heparinisation. Clinically this man has a
which does occur after surgery in the
lithotomy position, but usually occurs
earlier and active movement is lost. At
3am you will be very unlikely to get
confirmation of your diagnosis and so
treatment should be initiated whilst
waiting for a duplex scan to avoid
potential for clot propagation and
pulmonary emboli.
Correct
Elevate the bed to 30 degrees. This limb
is swelling due to a reperfusion
phenomena; DVT rarely occurs post
vascular surgery and compartment
syndrome usually occurs acutely. The
limb requires elevation to allow
increased venous/lymphatic drainage. If
left dependant swelling will increase and
the risk is that suture lines will give way
resulting in graft exposure.
Post-operative complications for different, specific operations...
Theme:Monitoring
AAirway pressures
BCardiac Output
CCentral venous pressure
DDisconnect alarm
EEnd tidal Carbon Dioxide
FHourly urine output
GInspired Oxygen concentration
HInvasive arterial pressure
IPeripheral nerve stimulator
JPulmonary artery flotation catheter
KTemperature
In the following scenarios all of the
patients are monitored using continuous
ECG, non-invasive blood pressure and
pulse oximetry. From the list of above
choose one additional yet essential
anaesthetic monitor for each case.
A 34-year-old male with 20% partial
thickness burns to the legs is having his
burns debrided under general
anaesthesia. Preoperative fluid
resuscitation was less than adequate.
Correct
Correct
Correct
Correct
Correct
Correct
Chest infection. Aortic surgery often
leads to diaphragmatic splintage, basal
atelectasis and subsequent infection.
Aggressive physio, sitting out and early
mobilisation are methods of avoiding
this but once established treatment
should be with antibiotics, physio,
humidified oxygen and urgent culture of
both blood and sputum to ensure that the
organism is treated before it can infect
the graft.
Correct
and infection; with the information
currently available you have to treat as a
PE because he is hypoxic despite his
tachypnoea with low pCO2 and is
apyrexial. Treatment with supplemental
oxygen and heparin should begin whilst
waiting for FBC, U&E and troponin to
become available. A chest X ray and
ECG should be performed and if PE
remains the most likely diagnosis a CT
pulmonary angiogram/VQ scan should
be performed.
Post-operative pneumonia is a common chest infection...
Correct
The first patient is in cardiac arrest and
in order to activate the chain of survival,
calling the cardiac arrest team is
essential. When limited assistance is
available, performing effective basic life
support takes second priority over
alerting the arrest team.
Correct
Theme:Antibiotic prophylaxis
AAngiography
BBronchoscopy
CDental procedure for patient with atrial
septal defect
DEmergency Appendicectomy
EGut surgery
FSigmoidectomy
GSplenectomy
HThyroidectomy
Choose the most appropriate procedure
that would require the following
antibiotic prophylaxis and preparation
Correct
Correct
Correct
Correct
Correct
Theme:Anaesthetic choice
AA spinal (subarachnoid block)
BAn epidural
CBiers block
DFibreoptic intubation
EInhalational induction and blind nasal
intubation
FIntravenous sedation
GRapid sequence induction with cricoid
pressure
HSpontaneous ventilation through a
facemask
ISpontaneous ventilation through a
laryngeal mask airway (LMA)
JStandard intravenous induction and
intubation
KSubclavian perivascular block
Please select the most appropriate choice
of anaesthetic from the above list for the
following scenarios:
A 24-year-old previously well male gives
a history of right iliac fossa pain
Correct
A fractured mandible with restricted
mouth opening presents a patient with a
difficult airway. The safest approach
would be to perform an awake fibreoptic
intubation via the nose. The oral aperture
may not significantly increase following
induction of anaesthesia, adequate
analgesia and neuromuscular paralysis.
The patient needs to be intubated for the
operation but the mouth may not
accommodate the blade of a
laryngoscope and the subsequent view of
the vocal cords may be less than optimal.
Inhalational induction of anaesthesia and
blind nasal intubation has been used in
the past but it cannot be justified when
fibreoptic equipment is available.
Correct
Correct
Correct
Correct
Patients with pyloric stenosis develop hypochloremic hypokalaemic alkalosis as the
lose chloride ions with hydrogen ions when the vomit. The 65-year-old man has renal
failure as suggested by the anuria, hiccups and pruritus and will have a metabolic
acidosis (low pH, low bicarbonate and with compensation should have a high p02 and
low pC02). Villous adenoma is associated with profuse watery diarrhoea which is
typically associated with hypokalaemia. The post op female clearly has cardiac failure
with fluid overload as indicated by the raised JVP and bibasal crepitations.
EPudendal block
FSpinal anaesthetic
For each complication below select the
SINGLE most likely anaesthetic or
analgesic from the list of options above.
Malignant hyperpyrexia syndrome
Correct
Correct
Severe headache
Correct
Aspiration syndrome
Correct
Pethidine, other opiates and some anti-hypertensives (alpha methyldopa and labetalol)
reduce CTG variability. Maternal hypotension is more likely to be secondary to
spinal, rather than epidural anaesthetic. In a spinal anaesthetic, a very fine needle is
used to puncture the dura and this is not often associated with a headache. Postdural
puncture headache appears to be highr in association with spinal (3%) than epidural
(1%). Malignant hyperpyrexia is most likely to be secondary to the use of volatile
anaesthetic agents
Theme:Pre-operative investigations
AArterial blood gases
BChest X-ray
CECG (12 lead)
DEchocardiograph
EFull blood count
FGlucose concentration
GHaemoglobin electrophoresis
HHaemoglobin A1c concentration
ILung function test
JProthrombin time and Activated Partial
Thromboblastin Time
KUrea and electrolytes
Select the most appropriate investigation
from the list above for the following
scenarios:
Correct
Need to investigation for as a sickling
crisis can be precipitated by surgery.
Correct
This patient's confusion in the context of
his obstruction suggests marked
dehydration with sepsis and probable
renal impairment.
Correct
Obviously she requires appropriate
assessment of her INR before any
operative procedure.
Correct
Glucose always needs to be checked in a
diabetic patient and this yound woman
will require a sliding scale insulin regime
for her operation.
Finish