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& Dr Podcast Dr Podcast Scripts for the Final FRCA EDITED BY: Rebecca A. Leslie Emily K. Johnson Gary Thomas Alexander P. L. Goodwin CAMBRIDGE Medicine CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sdo Paulo, Delhi, Tokyo, Mexico City Cambridge University Press ‘The Edinburgh Building, Cambridge CB2 8RU,UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9781 107401006 ©R.A. Leslie, E. K. Johnson, G. Thomas and A.P.L. Goodwin 2011 ‘This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2011 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library ISBN 978-1-107-40100-6 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Dedicated to Alan and my parents, For their help and understanding through my exams and again through the busy times with Dr Podcast, and the editing of this book. Ey Dedicated to my sister Claire and all of my family, For their wise words, love and support. RL Dedicated to Pat, Dan and Laura. DGT Dedicated to my lovely wife Juliette. AG Dr Podcast Scripts for the Final FRCA Dr Podcast Scripts for the Final FRCA Edited by Rebecca A Leslie Specialty Regia inAraesthesa Sever Deanery, Bris UX Emily K Johnson Specialty Risa in Anaesthesia ‘West Midlands Deanery, Birmingham, UK Gary Thomas Cnsuiiant in Anaesthesia and Psoprate Medicine Princess of Wales Hospital, ridgend, Wales, Alexander PL Goodwin Constantin Aneshesla and Intense are Royal United Hospital, Bath, UK CAMBRIDGE UNIVERSITY PRESS Contents List of contributors page xii Consultant Reviewing Panel xiv Preface xv Acknowledgements xvi 1— Medicine . Bone, joint and connective tissue 1 1.1.1, Rheumatoid arthritis 1 Sarah F Bell Cardiovascular 7 1.2.1. Pre-operative assessment and management of patients with cardiac disease 7 Timothy JB Wood 1.2.2, Arrhythmias 13 Rebecca A Leslie 1.23. Hypertension 19 Matthew JC Thomas 1.2.4. Anaesthesia for patients with ischaemic heart disease and congestive cardiac failure 22 James D Griffin 1.2.5. Post-operative management of myocardial infarction 29 Andrea C Binks 1.26. Cardiomyopathy 31 Richard LI Skone 1.2.7. Valvular defects 34 Mari H Roberts 1.28. Pacemakers and implantable cardioverter devices. 41 William A English Endocrine and metabolic 47 1.3.1. Hormonal and metabolic responses to trauma 47 Andrea C Binks tome 133, tenet 1.3.6. 13,7. 138. ae 1.3.10. 13.11, Endocrine disease 50 Helen L Jewitt Obesity 54 Caroline SG Janes Diabetes 58 Andrea C Binks Calcium and magnesium homeostasis 62 Sarah F Bell Hypokalaemia and hyperkalaemia 65 Sarah F Bell Hyponatraemia and hypernatraemia 67 Sarah F Bell Hypothermia 70 Andrea C Binks Hyperthermia 73 Ami Jones Thyroid disease and thyroid surgery 78 Helen L Jewitt Phaeochromocytoma 80 Caroline SG Janes 14, Gastrointestinal 84 1 142. 143. Enteral and parenteral nutrition 84 Caroline SG Janes Nutritional requirements and malnutrition 88 Caroline SG Janes Nausea and vomiting 90 Alison J Brewer vil vill Contents 144. O0esophageal reflux 94 1.9, Renal 168 Michael B Clarke 19.1. Chronic renal failure 168 14,5. Pancreatitis 98 Jessie R Welbourne Matt Thomas 1.5. Haematological 104 2—Surgery 1 Blood groups 104 2.1. Cardiac/thoracic 173 16. ) Rebecca A Leslie Anaemia and abnormal haemoglobins 109 Sarah F Bell Abnormalities in coagulation and haemostasis 114 Justin C Mandeville and Emily K Johnson Anti-coagulant, anti-platelet and antisbrinolytic agents 121 Susanna T Walker Prevention, diagnosis and management of fat embolism, DVTandPE 129 Ami Jones 15.2. 15.4. 155. 136 136 Hepatic medicine 1.6.1. Hepatic failure Matt Thomas Jaundice 141 Dana L Kelly 1.6.2. Neurological and muscular 1.7.1, Myasthenia and muscle diseases 147 Helen L Jewitt 147 Respiratory 152 1.8.1. Pneumothorax 152 Matthew P Morgan Chronic obstructive pulmonary disease and asthma 156 Matthew P Morgan Pneumonia 162 Matthew P Morgan Lung cancer and pulmonary fibrosis 164 Matthew P Morgan 1.8.2. 18.3. 184. 2.2. 23. 241d, 212, 2.1.3. 214. 2.15. 2.1.6. eae Day-case 22.1 ENT 23.1 pea eae Anaesthesia for cardiac surgery, cardiopulmonary bypass and cardioplegia Jessie R Welbourne and Emily K Johnson Anaesthesia for patients with cardiac disease for non-cardiac surgery 179 Andrea C Binks Congenital heart disease Richard LI Skone Post-operative management of cardiac surgery patients 188 Catherina Hoyer Anaesthesia for bronchoscopy Neil J Rasburn One-lung ventilation Carl J Morris Anaesthetic management of patients with transplanted organs, including heart, lungs and kidneys 203 Asim Iqbal 211 Day-case selection criteria. 211 Alison J Brewer 215 Difficult intubation Jonathan J Gatward Performing a tracheostomy 219 Jonathan J Gatward Bleeding tonsil and foreign body 224 Caroline SG Janes 173 183 194 199 215 24. 2: 234. Obstructive sleep apnoea Sarah F Bell 2.3.5. Upper airway infections Sarah F Bell 229 232 Neurosurgery 238 2.4.1. Head injury and control of ICP 238 Justin C Mandeville Anaesthesia for craniotomy 242 Timothy JB Wood Management of subarachnoid haemorrhage 248 Justin C Mandeville Management of acute spinal cord injury 251 Carl J Morris Late management of patients with spinal cord injury 254 Carl J Morris Brainstem death testing Susanna T Walker Anaesthesia for MRI scanning 264 Sarah F Bell Depth of anaesthesia monitoring 268 Susanna T Walker Electroconvulsive therapy (ECT) and anti-psychotics 274 Mari H Roberts 2.4.10. Epilepsy 279 Imran Mohammad 24.2. 2.43. 244 245. 246. 258 247. 248. 249. . Obstetrics 282 2.5.1. Physiological and anatomical changes of pregnancy 282 Sarah F Bell Anaesthesia in early pregnancy 285 Sarah F Bell Complications of pregnancy 289 Sarah F Bell aoa aco 26. 27. 28. Kencents | ow 254. Pre-eclampsia Sarah F Bell 295 Ophthalmic 302 26.1. Orbital anatomy 302 Poonam M Bopanna Control of intra-ocular pressure 306 Corinna J Hughes Penetrating eye injury Sarah F Bell Cataracts and retinal detachments 313 Joy M Sanders Strabismus 317 Joy M Sanders 26.2. 2.6.3. 309 26.4. 26.5. Orthopaedic 320 27.1. Procedures under tourniquet, reperfusion injury and antioxidants 320 Katherine A Holmes Paediatric 325 28.1. Principles of neonatal physiology 325 Helen L Jewitt Neonatal resuscitation and the effects of prematurity 328 Helen L Jewitt Development in infancy and childhood 331 Sarah F Bell Pyloric stenosis Sarah F Bell and Caroline SG Janes Intussusception Sarah F Bell and Caroline SG Janes Oesophageal atresia, diaphragmatic hernia and exomphalos » 345 Helen L Jewitt 2.8.2. 28.3. 28.4. 337 341 28.6. Contents 2.9. Vascular 2. 3.2. 4d 349 Abdominal aortic aneurysm repair 349 Emily K Johnson and Jessie R Welbourne Anaesthesia for carotid endarterectomy 354 Emily K Johnson and Jessie R Welbourne 29. ee 3 — Emergency medicine and intensive care Emergency medicine 3.1.1. Acute poisoning Ami Jones Burns and drowning Helen L Jewitt 362 362 3.1.2, 367 Intensive care 3.2.1, 372 The high-risk surgical patient 372 Matt Thomas Management of multi-organ failure 377 Matt Thomas ARDS and ventilation difficulties 382 Matt Thomas The management of severe sepsis 388 Gareth J Gibbon Oxygen toxicity 393 Emily K Johnson and Jessie R Welbourne Renal replacement therapies 398 Emily K Johnson auras 3.23. 3.24. ae 3.26. 4— Anatomy and regional anaesthesia Anatomy 406 42. 43. 411. 4.1.2. 4.13. 4.14. 4.15. Regional anaesthesia 42.1. 4.23. 4.24. 4.25. 426 Pain 43.1. Anatomy of central venous access 406 Poonam M Bopanna Anatomy of the extradural space and spinal cord blood supply 409 Amy K Swinson Anatomy of the trachea and bronchi 412 Mari H Roberts The anatomy of the autonomic nervous system 418 Gareth J Gibbon Cranial nerve anatomy 422 Poonam M Bopanna 427 Brachial plexus, inter-scalene and axillary blocks 427 Pascal J Boddy Stellate ganglion and coeliac plexus blocks 432 Jonathan J Gatward Ulnar, median and radial nerve blocks 436 Poonam M Bopanna Caudal block 440 Corinna J Hughes Ankle and knee blocks Matthew P Morgan Lumbar plexus, femoral and sciatic blocks 446 Jonathan J Gatward Local anaesthetic toxicity 453 Andrew P Georgiou 460 Pain pathways Michael B Clarke Neuropathic pain: complex regional pain syndrome, trigeminal neuralgia, post-herpetic neuralgia Sarah J Love-Jones 443 460 465