Short Answer Questions in Anaesthesia: How to Manage the Answers

134 Pages·1997·0.8 MB·English

by  Geoffrey B. Rushman

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Short Answer Questions in Anaesthesia
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© 1997
Greenwich Medical Media
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162-168 Regent Street
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ISBN 1 900151 235
First Published 1997
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright
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should be sent to the publishers at the London address printed above.
The right of Geoffrey B Rushman to be identified as author of this work has been asserted by him in accordance with the Copyright,
Designs and Patents Act 1988.
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cannot accept any legal responsibility or liability for any errors or omissions that may be made.
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Short Answer Questions in Anaesthesia
How to Manage the Answers
Geoffrey Rushman
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Contents
Preface v
1. Advice on answering short answer questions 2

What the words in examination questions mean

2. General anaesthesia
What factors show that intubation of the larynx will be difficult enough to indicate 6
fibroptic intubation?
How do you manage the physiological consequences of surgical manoeuvres during 7
abdominal laparoscopy?
What are the factors that prolong the action of nondepolarising relaxants? 7
What are the "anaesthetic" problems caused by morbid obesity? 8
How would you prevent unplanned awareness during general anaesthesia? 8
How do you detect unplanned awareness during general anaesthesia? 9
What are the advantages and limitations of the laryngeal mask airway? 9
How do you manage total intravenous anaesthesia? 10
Write short notes on ondansetron 10
How do you manage sedoanalgesia? 11
Under what circumstances should general anaesthesia for elective cases be postponed 11
and why?
How would you determine the causes of arterial hypotension (80/60 mmHg.) during a 12
prostatectomy, and how would you manage it?
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What are the causes and management of hypoventilation immediately following 12
anaesthesia?
What causes bradycardia during general anaesthesia and what is the management of 13
this condition?
List the causes and briefly note the management of tachycardia (>100 bpm) during 14
general anaesthesia in an adult
Why do some patients suffer circulatory collapse at the induction of general 15
anaesthesia and how would you manage it?
What signs would lead you to suspect that a patient under general anaesthesia was 16
developing malignant hyperpyrexia? Describe your immediate management
What is the pathophysiology of malignant hyperpyrexia? How would you investigate 17
it?
You are asked to construct a question sheet for day-case patients to answer on 18
admission to hospital. What questions would you ask?
What protocol would you construct to guide surgeons on selecting adult patients for 19
day-case anaesthesia?
Describe the anaesthetic arrangements involved in a gynaecological day-case list of 15 20
patients for dilatation and curettage of the uterus
Write short notes on rocuronium 21
Give an account of the pharmacology of propofol 22
Compare and contrast halothane and desflurane 22
What are the pharmacological problems presented by a patient taking monoamine- 23
oxidase inhibitors (MAOI) who requires emergency anaesthesia for a bleeding
duodenal ulcer? Discuss the pharmacological problems presented
List the causes of "suxamethonium apnoea". How would you diagnose and manage it 23
once it had occurred?
Describe the Bain system and its functions 23
What are the safety devices involved in delivery of oxygen from a cylinder on an 24
anaesthetic machine to an anaesthetised patient through a Bain system?
Compare two types of anaesthetic breathing system used for a healthy spontaneously 24
breathing child weighing 20kg
Write short notes on desflurane 25
Describe the circle system for anaesthesia. What are its advantages and limitations? 26
What are the features of an anaesthetic machine which are designed to minimise the 27
risk of delivering hypoxic gas mixtures?
Write short notes on dantrolene 27
Write short notes on ketamine 28
List the physical properties of desflurane, and describe the characteristics of a suitable 29
vaporiser
How do you estimate bloodloss during various types of surgery? 29
Write short notes on minimum alveolar concentration 30
Write short notes on propofol 30
Write short notes on mivacurium 31
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Write short notes on hyoscine 31
Write short notes on glycopyrronium (glycopyrollate) 32

3. Paediatric anaesthesia
How does the physiology of children aged 1 year differ from that of adults? 34
Write short notes on EMLA cream 34
What psychological factors influence your anaesthesia for children aged 2-3 years? 35
What facilities are required for transfer of a 2-month old baby to a paediatric unit? 35
A 6-week old child has projectile vomiting and is presented for laparotomy. Describe 36
the general anaesthetic problems of this case
Describe the management of acute epiglottitis in a child of three years 36
Describe the management of acute laryngotracheitis in a child of three years of age, 37
presenting with cyanosis
What are the aims of premedication in children? Describe the pharmacology of two 37
such premedicant drugs

4. Neuroanaesthesia
How does concomitant head injury influence your anaesthetic management of an 40
operation for a fracture of the hand?
What monitoring do you consider necessary for a posterior fossa craniotomy? What 40
are the possible sources of error associated with two of the monitors you mention?
Describe the physiological effects of high arterial carbon dioxide tension (10 kpa, 70 41
mmHg.)
What factors affect cerebral blood flow? State briefly their importance in relation to 41
anaesthesia within 12 hours of head injury
How may cerebral bloodflow be affected by general anaesthesia? 42

5. Obstetric anaesthesia
How do obstetric factors affect the management of anaesthesia for the removal of a 44
retained placenta?
Write short notes on ranitidine 44
Describe the anaesthetic management of massive intrapartum haemorrhage requiring 45
emergency operation
Describe the pathophysiological processes of pre-eclamptic toxaemia of pregnancy 45
You are asked to help with a case of severe pre-eclamptic toxaemia of pregnancy. 46
What is your management?
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6. Cardiothoracic anaesthesia
Describe the anatomy of the trachea, including its relations 48
Describe the anatomy of the diaphragm, including its relations 48
Describe the arterial blood supply of the myocardium 49
Describe the venous drainage of the myocardium 49
Describe the conducting system of the heart 50
How may abnormalities of cardiac conduction be revealed by the electrocardiogram? 50
Describe the anatomy of the bronchial tree 51
Describe the nerve supply of the larynx 51
Describe the anatomy of the first rib, including its relations 52

7. Trauma and emergency anaesthesia
What are the effects of an overdose of a tricyclic antidepressant drug? 54
A child of 12 years has been admitted following a road accident. At emergency 54
laparotomy the surgeon announces that the liver is ruptured. Describe your
management of the case up to the end of the operation
Write short notes on Hartmann's solution 55
Describe the adverse effects of blood transfusion. How may they be reduced? 55
Describe the alternatives to donor blood transfusion 56
What are the contents of a unit of transfusion blood? Describe briefly the alternatives 56
which can be used in an emergency haemorrhage situation until transfusion blood
becomes available
Write short notes on Gelatin-based plasma substitutes 57
Describe the features of the Boyle's anaesthetic machine and Bain system which 57
protect the patient from pulmonary barotrauma
What physiological changes follow acute hypovolaemia? 58
What is the physiological response to the rapid loss of 1 litre of blood in the adult? 58
Outline the factors responsible for the maintenance of cardiac output 59
What are the causes and effects of hypothermia? 59
Detail the immediate rescusitation (in the first hour) of an unconscious patient 60
admitted to the A & E department after falling off a ladder
8. Acute and nonacute pain management
What are the medical effects of opioid drugs? 62
Write short notes on pethidine 62