Structured Oral Examination in Clinical Anaesthesia : Practice Examination Papers

578 Pages·2013·7.56 MB·English

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This book comprises ten complete sets of examination papers, each of which ru
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This book is essential study material for candidates sitting senior anaesthetic e
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problem solving, organisation and planning. With thorough revision of this io
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with training. Practice examination papers
ISBN 978-1-903378-68-7
f Cyprian Mendonca, Carl Hillermann
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9 781903 378687 Josephine James, GS Anil Kumar
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The Structured Oral
Examination in Clinical
A N A E S T H E S I A
Practice examination papers
Cyprian Mendonca, Carl Hillermann
Josephine James, GS Anil Kumar
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The Structured Oral Examination in Clinical Anaesthesia Practice examination papers
tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5
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Paperback ISBN: 978-1-903378-68-7
E-book editions: 2013
ePub ISBN: 978-1-908986-45-0
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The entire contents of ‘The Structured Oral Examination in Clinical
Anaesthesia Practice examination papers’ is copyright tfm Publishing Ltd.
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Contents
Page
ix
Preface
x
Acknowledgements
xii
Abbreviations
SOE 1 1
Clinical Anaesthesia
Long case 1
Postoperative hypoxia and renal failure following 1
abdominal aortic aneurysm repair
Short cases
1.1: Pyloric stenosis 14
1.2: Difficult airway 20
1.3: Tension pneumothorax 29
Clinical Science
Applied anatomy 1.1: Anatomy for ophthalmic anaesthesia 36
Applied physiology 1.2: Pulmonary vascular resistance 44
Applied pharmacology 1.3: Calcium channel blockers 51
Equipment, clinical measurement and monitoring 1.4: Ayre’s T piece 56
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The Structured Oral Examination in Clinical Anaesthesia Practice examination papers
SOE 2 61
Clinical Anaesthesia
Long case 2
Peri-operative myocardial infarction in a patient 61
scheduled for a hip hemi-arthroplasty
Short cases
2.1: Jehovah’s Witness 75
2.2: Aspiration under general anaesthesia 81
2.3: Emergency Caesarean section 86
Clinical Science
Applied anatomy 2.1: Anatomy of the epidural space 91
Applied physiology 2.2: Arterial tourniquet 98
Applied pharmacology 2.3: Patient-controlled analgesia 103
Equipment, clinical measurement and monitoring 2.4: Defibrillator 107
SOE 3 111
Clinical Anaesthesia
Long case 3
An elderly lady with cervical spondylosis, rheumatoid arthritis and 111
obstructive sleep apnoea scheduled for a posterior cervical fusion
Short cases
3.1: Down’s syndrome 127
3.2: Transurethral resection of the prostate (TURP) 132
3.3: Head injury 141
Clinical Science
Applied anatomy 3.1: Pain pathways 147
Applied physiology 3.2: Oxygen delivery 151
Applied pharmacology 3.3: Neuromuscular blocking drugs 160
Equipment, clinical measurement and monitoring 3.4: Capnometry 166
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Contents
SOE 4 173
Clinical Anaesthesia
Long case 4
A young female patient with hyperthyroidism and sickle 173
cell disease scheduled for a subtotal thyroidectomy
Short cases
4.1: Latex allergy 189
4.2: Wolff-Parkinson-White (WPW) syndrome 194
4.3: Post-tonsillectomy bleeding 199
Clinical Science
Applied anatomy 4.1: Blood supply to the spinal cord 203
Applied physiology 4.2: Physiology of pregnancy 208
Applied pharmacology 4.3: Non-steroidal anti-inflammatory 213
drugs (NSAIDs)
Equipment, clinical measurement and monitoring 4.4: 219
Invasive blood pressure measurement
SOE 5 227
Clinical Anaesthesia
Long case 5
Elective craniotomy for clipping of a cerebral 227
aneurysm in an obese patient
Short cases
5.1: Malignant hyperthermia 242
5.2: Guillain-Barre syndrome 247
5.3: Dental anaesthesia 252
Clinical Science
Applied anatomy 5.1: Phrenic nerve 258
Applied physiology 5.2: Pre-eclampsia 264
Applied pharmacology 5.3: Remifentanil 271
Equipment, clinical measurement and monitoring 5.4: 276
Monitoring the depth of anaesthesia
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The Structured Oral Examination in Clinical Anaesthesia Practice examination papers
SOE 6 283
Clinical Anaesthesia
Long case 6
A patient with anaemia and chronic alcohol 283
abuse scheduled for a hernia repair
Short cases
6.1: Septic shock 295
6.2: Myasthenia gravis 300
6.3: Epidural abscess 305
Clinical Science
Applied anatomy 6.1: Coeliac plexus block 309
Applied physiology 6.2: Cerebral circulation 312
Applied pharmacology 6.3: Respiratory pharmacology 319
Equipment, clinical measurement and monitoring 6.4: 324
Magnetic resonance imaging
SOE 7 329
Clinical Anaesthesia
Long case 7
A middle-aged man with mania/depression 329
scheduled for a full dental clearance
Short cases
7.1: Carotid endarterectomy 341
7.2: Trifascicular heart block 348
7.3: Burns 355
Clinical Science
Applied anatomy 7.1: Anatomy of the nose 362
Applied physiology 7.2: Haemorrhagic shock 372
Applied pharmacology 7.3: Alpha-adrenergic blockers 377
Equipment, clinical measurement and monitoring 7.4: 386
Temperature measurement
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Contents
SOE 8 393
Clinical Anaesthesia
Long case 8
Post partum haemorrhage and postoperative 393
acute respiratory distress syndrome
Short cases
8.1: Carcinoid syndrome 405
8.2: Heart transplant 409
8.3: Postoperative confusion 414
Clinical Science
Applied anatomy 8.1: Ankle block 418
Applied physiology 8.2: Weaning from ventilation 423
Applied pharmacology 8.3: Post-herpetic neuralgia 428
Equipment, clinical measurement and monitoring 8.4: 433
Measurement of blood gases
SOE 9 441
Clinical Anaesthesia
Long case 9
An elderly lady with ischaemic heart disease 441
scheduled for an extended colectomy
Short cases
9.1: Ulcerative colitis 453
9.2: Intravenous drug abuse 459
9.3: Ruptured abdominal aortic aneurysm (AAA) 464
Clinical Science
Applied anatomy 9.1: Brachial plexus block 468
Applied physiology 9.2: Coagulation cascade 475
Applied pharmacology 9.3: Insulin and hypoglycaemic drugs 481
Equipment, clinical measurement and monitoring 9.4: 489
Fibreoptic bronchoscope and sterilisation
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The Structured Oral Examination in Clinical Anaesthesia Practice examination papers
SOE 10 497
Clinical Anaesthesia
Long case 10
An elderly man with chronic obstructive airway disease 497
(COAD) scheduled for a total knee replacement
Short cases
10.1: Aortic stenosis 510
10.2: Laparoscopic Nissen fundoplication 516
10.3: Penetrating eye injury 522
Clinical Science
Applied anatomy 10.1: Arterial system of the hand 525
Applied physiology 10.2: Postoperative nausea and vomiting (PONV) 530
Applied pharmacology 10.3: Conscious sedation 536
Equipment, clinical measurement and monitoring 10.4: 541
Physics of ultrasound
549
Section index
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Preface
This book consists of ten complete sets of structured oral examination (SOE)
papers. Each set is subdivided into two sections: clinical anaesthesia and
clinical science. Each clinical anaesthesia section is composed of one long
case and three short cases. For each long case clear candidate information
and relevant clinical material have been presented. The clinical science
section is composed of four key topics, one each from applied anatomy,
applied physiology, applied pharmacology and the physics of equipment used
in anaesthetic practice. In order to provide additional breadth and depth of
knowledge, a further tutorial on the key topic is included.
The aim of this book is to help trainees who are sitting their anaesthetic
examinations. The book enables candidates to assess their knowledge
and skills within certain time limits. A thorough revision of the book should
enable the trainee to understand their strengths and weaknesses in areas
of clinical knowledge, clinical skills, technical skills, problem solving,
organisaton and planning.
We are grateful for the feedback and suggestions provided by trainees
who attended the examination preparation courses at Coventry. We
sincerely hope that the information in this book will be beneficial to
trainees in their preparation for postgraduate examinations and
competency assessments.
We wish you good luck with your revision and the exam.
Cyprian Mendonca MD, FRCA, Consultant Anaesthetist
University Hospitals Coventry and Warwickshire, Coventry, UK
Carl Hillermann FRCA, Consultant Anaesthetist
University Hospitals Coventry and Warwickshire, Coventry, UK
Josephine James FRCA, Consultant Anaesthetist
Heart of England Foundation Trust, Birmingham, UK
GS Anil Kumar FCARCSI, Specialist Registrar
Warwickshire School of Anaesthesia, UK