CASE STUDY

At the end of your week, you should present a case study to an anaesthetist and have this signed off on your log book. The aim of this case study is to follow a patient through the pre-, intra- and early post-operative phase. It does not need to be a complicated case but the key is to present and discuss the salient features of the case.

In addition, there are sample Vivas that have been published by UNSW. Some of the relevant vivas to your Anaesthetic Term are listed here. You should be able to comfortably answer all of these by the end of your Anaesthetic Rotation.

Anaesthetic Viva Practice

Time limit: 5 minutes

A 65 year old man is booked for a radical prostatectomy for prostate cancer. He had a right leg deep venous thrombosis 5 months ago and is currently on Warfarin. What are the measures you would take to prevent a recurrence?

A 65 year old man has been transferred from the ward to the operating theatres for an elective right knee replacement. Outline his pre-operative management and post-operative recovery room care.

A 36 year old woman is to have a repair of a shoulder rotator cuff injury. She has a history of ITP and is on oral prednisone. How would you manage her?

A 70 year old man is booked for an elective colonoscopy because of a positive faecal occult blood test. He is diabetic and takes metformin but no insulin. He has mild renal impairment (serum creatinine 0.14mmol/L, NR 0.06-0.12). How would you assess and manage this man peri-operatively?

A 70 year old man is booked for an elective cystoscopy. He is taking clopidogrel and aspirin because of emergency insertion of a coronary stent two months earlier. Outline your pre-operative management.

A 65 year old man is on the operating theatre table for a liver resection for metastases from colorectal cancer. Outline the non-surgical intra-operative components of this patient’s care.

A 60 year old man is admitted for an anterior resection of the rectum for carcinoma. How would you manage the risk of deep venous thrombosis?

A 35 year old woman presents to the pre-operative clinic for assessment prior to a
laparoscopic cholecystectomy. She has history of excessive menstrual loss and of bleeding problems after tooth extraction. How would you assess her?

A 63 year old man presents to the pre-operative clinic prior to a laparoscopic cholecystectomy. He has a history of angina. How would you assess and improve his fitness for surgery?

A 64 year old man has severe osteoarthritis of the right knee and a knee replacement has been recommended. He also has intermittent claudication at 100 metres. How would you assess him prior to surgery?

An 87-year-old male is admitted to hospital for elective inguinal hernia surgery. He had a metallic aortic valve replacement 20 years ago. His last warfarin dose was 4 pm yesterday and his INR today is 3.4. How would you manage him?

A 57 year old man has a central line inserted into his right subclavian vein. Immediately after the insertion, he develops acute shortness of breath. How would you assess and manage him?

What intravenous fluid bags (crystalloids and colloids) are available for patients and what are their constituents?