POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO. MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2011 Time : 1.00 p.m p.m.

Transcription

1 POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2011 Date : 5 th August 2011 Time : 1.00 p.m p.m. Answer any three questions. Answer each question in a separate book. Long Essay Questions 1. A 19 year old patient with acute asthma is admitted with severe respiratory distress to the intensive care unit. Describe your immediate management. What are the indecations for mechanical ventilation? How would you intubate and ventilate this patient? 2. A 60 year old male patient is scheduled for a left hepatic resection for primary hepatocellular carcinoma. What are your special considerations when optimizing this patient? What specific strategies would you undertake to reduce intraoperative bleeding? Discuss the post-operative care of this patient.

2 3. A 65 year old man is scheduled for a posterior fossa craniotomy. What are the preoperative problems you would expect in this patient? Give reasons. How would you prepare this patient for surgery, indicating why such measures are necessary? What are the intra operative problems you might encounter in this patient and how you would avoid them? 4. Discuss the anaesthetic management of a patient who has major degree placenta praevia with percreta undergoing elective caesarean section. If there is massive haemorrhage during surgery explain how the laboratory investigations could guide you in using blood and blood products.

3 POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2011 Date : 8 th August 2011 Time : 1.00 p.m p.m. Short Answer Questions Candidates are required to answer all twelve questions. Candidates who fail to attempt any one question will not pass the examination. All questions carry equal marks. Answer each part in a separate book marked A and B. PART A 1. What is fat embolism syndrome and what is its clinical presentation and mortality rate? List the conditions that may be associated with fat embolism? What basic measures may be used to prevent and treat fat embolism? 2. Define the term massive blood transfusion. List the potential problems associated with blood transfusions. 3. Draw a typical trace obtained from an indwelling arterial line and label to demonstrate the information one can obtain from it. What information can be gained from this trace? List the indications and complications of invasive arterial monitoring.

4 4. A 30 year old, 70kg, man presents with 50% burns after his clothes caught fire in a house fire. There is no other injury. How would you calculate his fluid requirements in the first 24 hours and what fluid would you use? What features suggest airway involvement and if so, how would you manage it? What else apart from hot air may classically be inhaled from a fire? (d) What colloids are typically used for plasma volume expansion? 5. What is oxygen saturation? Describe the physical principles of pulse oximetry. Explain the sources of error during clinical use. 6. What is Myasthenia Gravis and how is it diagnosed? What factors would suggest advanced disease? Outline the main problems in the intraoperative management specific to a myasthenic patient for an elective abdominal surgery.

5 PART B 7. An anaesthetist performing an epidural for labour analgesia in a healthy mother accidentally punctures the dura with the epidural needle and sees CSF rapidly coming out the epidural needle : What are the options for analgesia at this point? What are the advantages and disadvantages of each option? If the patient presents 2 hours later for an emergency caesarean section, what are the management options? (d) If the patient exhibits a headache 24 hours later in the postpartum period, what are the differential diagnoses? 8. List the basic principles and physiological effects of intra aortic balloon pump counter pulsation. (IABP) What are the contraindications for its use? List the complications associated with the use of IABP? 9. A 60 year old male was admitted to the surgical ward with a diagnosis of bowel obstruction. Six hours later an emergency laparotomy was done. This revealed multiple adhesions and two ileal perforations which were repaired. Post operatively the patient was sent top the ICU for further care. What post operative problems would you anticipate in this patient? Briefly describe how you would manage this patient during the first 24 hours.

6 10. What are the indications for thoracic paravertebral block? Describe the anatomy of the paravertebral space. List the complications of the block. 11. What are the advantages of day case surgery in children? What criteria would you consider when selecting a child for day case surgery? How would you modify your anaesthetic technique for paediatric day case anaesthesia? 12. A 65 year old man who has undergone a drug eluting stent insertion for a stenotic lesion in the left anterior descending coronary artery 2 months ago, is to have plating for a mid shaft fracture of the femur. He is on aspirin and clopidogrel. He has been well but has a feeble pulse distal to the fracture. Explain the mode of action of aspirin and clopidogrel. Outline your anaesthetic management giving reasons.