osce anaesthesia posting batch 5 yr 4 : cg 28, 29 & 30 friday, 2 september 2005
Post on 04-Jan-2016
215 Views
Preview:
TRANSCRIPT
OSCE
Anaesthesia Posting
Batch 5
Yr 4 : CG 28, 29 & 30
Friday, 2 September 2005
Question 1
1. How would you make a
clinical assessment of the
severity of this attack?
You are called to the accident and emergency department to see a 31-year-old lady, known to have asthma, who has been admitted with acute shortness of breath.
Question 1
2. What investigations might be
helpful?
(Name THREE, state how it might be
helpful)
You are called to the accident and emergency department to see a 31-year-old lady, known to have asthma, who has been admitted with acute shortness of breath.
Question 2
1. Nitrous oxide is
contraindicated in patients
with pneumothorax,
pneumopericardium or intestinal
obstruction because it
_______________________.
2. Thiopentone is short acting
because _______________.
Question 2
3. Suxamethonium should be
used with caution in patients
with renal failure because
_______________________.
4. Name TWO likely
complications of the use of
epidural morphine for postop
analgesia.
Question 2
5. Propofol causes
cardiovascular depression by
______________.
Question 3
1. State two uses of the part labeled A
2. What is the use of the Murphy’s eye (B) ?
3. Where should the tip of the tube (C) lie in the tracheal?
A
B
C
Question 3
4. Name two methods of confirming
a trachea intubation
5. State 4 complications of trachea
intubation
Question 4
1. Name TWO methods of pain relief
appropriate for this patient apart from
intra-muscular analgesics.
2. Give THREE medical reasons for
providing good post-operative pain
relief?
60 year old man had upper abdominal incision for total gastrectomy.
Question 4
3. Different patient require different amount of
intramuscular morphine for similar operation.
Give TWO reasons why this happens?
4. Write a postoperative order for analgesia for
this patient?
5. State TWO complications of this choice of
analgesia.
Question 5
1. List THREE basic requirements
of oxygen therapy systems.
2. What is device A
A
Question 5
2. What is device B 3. What is device C
BC
Question 5
3. Name THREE complications of
oxygen therapy.
Question 6
1. List 3 reasons for conducting a
preoperative visit.
A 60 year old patient is scheduled for a cystocopy under anaesthesia. He gives ahistory of hypertension. He also had a previous general anaesthesia for haemorrhoidectomy. On examination, his BP was 130/80 mmHg.
Question 6
2. What is his ASA status?
3. List 2 useful anaesthesia related
information can you drive from his
previous anaesthesia record.
Question 6
4. If the patient appear very anxious, what
can be done to help him? State 2
measures.
5. If the patient in on atenolol and
nifedipine for hypertension would you
stop the medication on the day of
surgery?
Question 7
1. Comment on his blood pressure on
admission. How would you check on this
reading.
A 51-year-old sales executive presents for extracton of his wisdom teeth. He has not seen a doctor for many years, and is not taking any medication. On admission to the ward, his blood pressure was found to be 170/110 mmHg. He weighs 80 kg.
2. His preoperative CXR
and ECG are as
shown. Comment on
the CXR and ECG.
Question 7
3. What should have been done before
this patient was anaesthetized?
4. Comment on the operative ECG.
This patient was subsequently given a standard anaesthetic. During extraction of his teeth, his BP rises to 200/115 mmHg, and his ECG is as shown:
Question 7
1. In an adult, name a suitable space in which a
spinal block can safely be performed?
2. Why is it safe to perform the spinal block at
that space?
3. The anaesthetist chose to perform the spinal
block with a rounded 27G spinal needle.
What complications was he trying to avoid
by using this needle?
Question 8
4. What are the patient risk factors for the
above complication?
Name TWO factors.
5. How does the anaesthetist know that he
has reached the subarachnoid space with
the spinal needle. Give ONE answer.
Question 8
6. After establishing that the spinal needle was in
the subarachnoid space, the anaesthetist
proceeded to inject 2.5 ml of 0.5% heavy
bupivacaine. The spinal block was established
to a level of T6.
What is the likely cardiovascular complications
that you will see? Name the most likely.
Question 8
7. How will you deal with this
complication? Name 2 answers.
8. If the block had extended to a level of
T1, what additional cardiovascular
complication are you likely to see.
Name
ONE answer.
Question 8
Question 9
1. Following intravenous thiopentone,
the following may occur
a. severe hypotension
b. respiratory depression
c. liver toxicity
d. increased intracranial
pressure
e. epileptic convulsions
Question 9
2. Which of the following results should
lead to postponement of a routine
operation and further investigation
a. haemoglobin 10.8 g/dl
b. glycosuria
c. serum potassium 5.0 mmol/l
d. serum sodium 135 mmol/l
e. platelets of 60,000/mm3
Question 93. The following are true in regard of arterial blood gases:
a. the normal pH is 7.0
b. the normal standard bicarbonate
is 32 mmol/l
c. a PO2 of 75 mmHg is normal for an
80-year-old man
d. the PCO2 is raised in hypothermia
e. the base deficit is the number of
mmol of bicarbonate per litre of blood
required to correct the pH to normal, at a PCO2
of 40 mmHg and temperature of 37°C
Question 9
4. On the ECG, P-waves are always
seen in
a. atrial flutter
b. ventricular tachycardia
c. nodal rhythm
d. complete heart block
e. supraventricular
tachycardia
5. Intubation of the right main bronchus
with unchanged ventilation may lead to:
a. hypotension
b. hypercapnia
c. increased requirement for
anaesthetic agent
d. collapse of the right upper
lobe
e. hypoxaemia
Question 9
Question 9
6. Depolarizing block may be produced
by:
a. suxamethionium
b. rocuronium
c. atracurium
d. atropine
e. isoflurane
Question 9
7. A patient 4 hours postoperatively shows the
following:- BP 170/100 mmHg, pulse 100/min, warm
periphery, arterial blood gases on air PCO2 70
mmHg, PO2 70 mmHg, bicarbonate 28 mmol/l.
This may be due to:
a. segmental pulmonary collapse
b. septicaemia
c. overtransfusion
d. underventilation
e. metabolic acidosis
Question 98. Morphine
a. may cause histamine release
b. is a partial agonist at the μ-
receptor
c. causes miosis
d. causes vomiting by direct
stimulation of the
chemoreceptor trigger zone
e. arterial PCO2 is markedly
raised with normal therapeutic
doses
Question 99. Inaccuracies in the measurement of
central venous pressure (CVP) may arise
from:
a. a change in the position of
the patient
b. misplacement of the
catheter
c. straining during respiration
d. arterial hypotension
e. hypoxaemia
Question 9
10. Cardiac output is increased by:
a. a rise in venous filling
pressure
b. a rise in body temperature
c. an increased metabolic rate
d. standing up from the lying
position
e. pregnancy in the last
trimester
T H E E N D
********
top related