December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

LONG CASES

1. Long case 42yo with Raynaud's disease for oesophagectomy. She has reflux. Mp2 mouth opening 2 fingers.
• Summarise this case
• Talk about investigations
• What further investigations you want
• How would you anaesthetise her: pre, intra
• How will you intubate wanted AFOI or RSI
• What tube
• How confirm position
• Difficult to ventilate how do you manage ( it was tube dislodgement)
• Post op pain epi, pvb, morphine
• Why might she be difficult to do epidural ( pointed to cxr but I didn't see anything)
• Where will she go post op.
• Hypertensive crisis post op on ITU- causes.
• How would you manage renal crisis

2. 34 year old for ORIF of ankle. Ex IVDU. Very limited info, no X rays, normal blood profile.
• They wanted to know my concerns
• How I would anaesthetise the patient?- options
o What antibiotics would I give
• Which would I do
o -Explanation of block technique
o -Intra-op analgesia, simple stuff plus magnessium- ?evidence
• Post op analgesia
o Paracetamol
o NSAIDS
o Opiods- PCA
o Ketamine
o Clonidine
o Additional block incl mechanism of action for all agent

3. 38yr male presented with abdomen pain & distension. 4yr history of dilated cardiomyopathy. Has a pacemaker and ICD
in situ. He is an ex-smoker and is known to have a bilateral inguinal hernias. He was able to swim for ½hr 6 months ago
but has been only able to walk 100yds recently. The surgeon would like to take him to theatre for repair of umbilical
hernia.
• Summarise the case
• Discuss bloods, ECG, CXR
o -What could be the cause of the anaemia, renal impairment, CRP
o -Why do you say it is an effusion?
o -Indications of a pacemaker and ICD
• What drugs should this guy be on for his DCM?
• What other investigations would you want?
o -Shown ECHO, discuss. Global LV dysfunction, EF 30%, mild MR
• What are the anaesthetic principles in anaesthetising this patient?
• How would you anaesthetise him?
• Causes of macrocytic anaemia
• Indications for insertion of ICD andf indications for pacing a patient
• Indications for biventricular pacing
• Why would he have a raised lactate and the mechanism behind this
• What would I expect to see on an ABG
• What else would I want to know pre-operatively (I think the focus was on the ICD which was what I spoke about)
• How would I optimise him pre-operatively
• What type of invasive monitoring would I like (this then focused on cardiac output monitoring)
• What would be involved in his post-operative care
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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• What would I use for analgesia

• What medications would I expect a patient with heart failure to be on
• What anticoagulants could he be on and what is their mechanism of action

4. 70’s male with severe IHD with diet controlled diabetes with some renal impairment. For a free flap for maxillary defect
following radiotherapy for cancer. ACEI, Bisoprolol, Furosemide. Angio gram picture – showing LAD 85%, LCX 85% and
diffuse RCA 80% stenosis.
• Summarise
• Important issues and medication to be added or optimised.
• Management of his IHD – specifically Balloon angioplasty vs stenting – advantages and disadvantages. Bare metal vs
drug eluting stents.
• Control of diabetes – perioperative management any preop investigations
• Goals of managing flap – things to do, things to avoid.
• Post op care of the patient
• Post op Acute coronary.

5. 78 female plan for EVAR, 7.1cm AAA Non smoker, able to walk more than a mile, PMH - hypertension, diabetes

•
• Did not ask to give a summary, no interpretation of results either
• Does this patient need surgery?
• What is the risk of rupturing?
• Any other investigation I would like to do? They were trying to ask me to talk about HBA1C
• What is normal HBA1C? What is the unit? How does it compare to the old unit (percentage)
• Anaesthetics options for EVAR
• Advantages comparing regional and GA
• Was asked patient was keen to be done under regional, how are you going to do it, talk about monitoring etc
• Would you give any sedation?
• Comparing advantages and disadvantages between benzodiazepine and propofol sedation
• What drugs would you give intraoperatively?
• Dose of Heparin
• What antibiotics would you give?
• Critical incident post op pale and painful leg, differential diagnosis
• Symptoms and signs of ischemic leg
• How soon does this patient need surgery?
• How are you going to Anaesthetise this patient?

6. 14-week old infant (NVD, born at 38/40) presents with multiple vomiting episodes and failure to thrive. Ultrasound
examination of his abdomen revealed pyloric stenosis, and he’s now been booked for a repair procedure. He’s also been
recently found to have a heart murmur, and an echocardiogram revealed a moderately-sized ASD, and currently under
surveillance by the paediatric cardiologists. On examination, sunken fontanelle, reduced skin turgor. BP 70/40, HR 130,
apyrexial.Na 129, K 2.4, U 10, Cr 79, Cl low. Hb 141, PCH, MCV, MCH all low. WCC & platelets normal. CXR appeared
largely normal, but ?upper right zone shadowing. ECG sinus tachycardia at 150, with borderline RBBB, T-wave inversions
v4-v6.
• What are the pertinent issues in this case?
• Why do you say he’s dehydrated? (goes to show you can direct your own viva)
• How do you assess dehydration in a paediatric patient? What percentage dehydration?
• Comment on the blood results. Why is he hyponatraemic/hypokalaemic/hypochloraemic? What happens to his urine?
(acidic/alkalotic?) Why is his Hb high?
• How would you correct his dehydration & electrolyte abnormalities? (wanted a precise fluid type, and regime)
• Comment on his CXR. What can be other causes of the upper zone shadowing in a paediatric patient? (thymus)

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• Comment on his ECG. What do you think of these changes? (said some normal for paeds, but also changes can be due
to his ASD)
• How would you assess him, and what would you do pre-operatively?
• How would you anaesthetise this child? (classic RSI vs real-life inhalational)
• What monitoring would you use?
• If you were doing an RSI, what drugs & doses would you use at induction?
• What would be the difficulties of performing an RSI in a 14-week old?
• What are the airway differences between a paediatric patient, and an adult patient?
• What agents would you use for inhalational induction? Would you use nitrous oxide?
• What size ETT would you use? What formula?
• What else can you use his NGT for? Would you put anything down his NGT prior to aspirating?
• What would you use for analgesia? Would you use opioids? (it is an open procedure)
• Where will this patient go to post-op?
• Critical incident part
o Post-extubation hypoxia – what do you think is happening?
o How would you manage him?
o How would you manage laryngospasm? What breathing circuit, what manoeuvres, what drugs, would you
intubate?
o When do you decide to intubate?
o Why would a 14-week old desaturate quickly?

7. Lady 8hrs post C-section for failure to progress (long labour and various other signs of impending atonic uterus) Had been
on a syntocinon infusion since surgery. Drowsy, unrecordable BP, tachycardic, (carotid pulse present, peripheral absent)
Hb 2.3, DIC, Renal Failure.
• Management of Post Partum haemorrhage (A,B,Cs; Medical (with pharmacology), Surgical)
o usual discussion about how to resuscitate
o what are the potential causes for bleeding (obstetric and non-obstetric)
• discussion about TEG
• Definition of Post Partum Haemorrage
• What does calling a major haemorrhage actually get you
• How would you guide what blood products to use.
• what would you prepare in theatre
• How would you anaesthetise this patient? Would you insert an a-line? How would you modify your anaesthetic agents?
• Post Op Pain Relief (discussion about TAP blocks)
• how does your pain relief affect breast feeding.
• Brief discussion on physiological changes in pregnancy.
• Question concluded with her management in ICU, specifically a discussion about potential pulmonary problems
(pulmonary oedema/TRALI/ARDS).
• Mechanism of TRALI

8. 42F scleroderma and Raynaud's Oesophagectomy for ca

• Summarise case
• What is scleroderma, manifestations
• What to do with meds
• How to anaesthetise
• Position of a line as raynauds
• Double lumen tube insertion and check position if not difficult airway
• Difficult to ventilate what to do. Didn't really talk about hypoxia management, just importance of checking position of
tube. Also other options to double lumen tube
• Hypertensive post op-what to give
• Analgesic options-talk about paravertebral block
• Where to put patient post-op. Post-op problems

9. Asked to see 14 year old boy on paediatric ward re admission to PICU. Usually fit and well, taking Isotretinoin for acne.
Slightly obese. 10 day history of weakness and pain in limbs. Now more weak and drooling. Patient and parents are
Jehovah's witnesses. Also a CSF result with a raised CSF protein and said that there had been no growth on a M,C & S

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

sample. There was an ABG which showed a compensated respiratory acidosis. PCO2 was 6.5KPa. P02 was
a bit on the low side for being on air. The HCO3- was high as was the anion gap.
• They started by asking for a summary and asked what the most likely diagnosis was and what concerns
• They asked me what Guillain Barre was.
• They wanted differential diagnoses
• They asked for the causes of Guillain Barre, again they seemed to want loads of causes
They asked me about drugs e.g. Isotretinion
• They asked what test could I do immediately to help assess the patient
• They wanted normal values for the FEV1 and FVC in his age group.
• We talked a bit about where I would intubate him and what drugs I would use.
• They asked about what else I would normally see on a CSF result
They showed an x-ray which looked like it had a probable aspiration pneumonia on the right. It also had a
pneumomediastinum
• the management of GBS so I said it was mostly supportive and had just mentioned IV Immunoglobulins when the
examiner said - but he's a Jehovah's witness then the bell went.

Short cases
1. 30/40 pregnant woman presenting after RTC.
• Discussed: ATLS management with consideration of pregnancy: aortocaval compression, etc
• Need to multidisciplinary team involve obstetricians early
• Physiology of pregnancy: she was tachycardic with a normal BP. Asked if I’d be worried or not. Explained difficult to
assess as would compensate.
• Where to look for blood loss: chest, pelvis, abdomen
• Would I Xray her? Would I CT her?

2. Shown CXR of a child with a round radiodense object in neck

• Where the object might be: airway or oesophagus
• What the object might be: coin or battery
• What are the problems if it’s a coin: more urgent due to alkali eroding oesophagus
• How to differentiate where it might be: clinical signs eg airway compromise, inability to swallow, drooling, etc
• Preop assessments
• If a coin in oesophagus would you do it now or wait til child fasted
• Anaesthetic plan: would I intubate and give IPPV?
Would I give relaxant?
• Problems of surgery: short, very stimulating, shared airway

3. Patient presenting for elective surgery (?lap chole from memory) with sickle cell disease
• Specific aspects of pre-op assessment
• Physiology of sickle cell: they focused a lot on cardiovascular changes
• What is sickle cell disease
• How to optimize pre-op

4. PONV
• Risks
• Management : peri-operatively
• NNT for anti-emetics, reduction with multiple agents, evidence

5. Dental extraction in a paeds case with learning difficulties

• Peri-operative concerns
• How would you do it
• Suitable for day case

6. Pre-op assessment - man in CHB (shown ECG) for elective case

• What's the diagnosis

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• What would you do

• Admit and ref to cardiology, not fir for elective surgery
• Treatment- PPM, and temporary treatment, pacing- external and IV, what drugs- not happy with isoprenaline (where is
it in you hospital?/Whats the dose?), ?happier with adrenaline
• What type of PPM does he need- dual chamber, they wanted more than this whats the ?manufacture name

7. Sepsis outreach nurse calls you to say lady with cholecystitis is hypotensive. What will you say to her?
• How assess
• What is most likely cause?
• Showed me severe metabolic acidosis abg
• Pathophysiology for sepsis
• Evidence for early abx
• Why noradrenaline

8. Pre op man for THR has mid systolic murmur

• I started talking about mitral regurg
• He said it was AS-
• How will you assess?
• Notes, History, exam
• Do symptoms grade severity?
• What is prognosis when symptomatic
• Ecg what looking for? Talked about AF and coronary perfusion pressure
• investigations echo
• How do you grade with echo. How do you work out valve area?
• Principles of anaesthetising AS

9. 32 yo post partum retained placenta

• Concerns in this lady
• Causes of retained placenta. I talked about accreta, percreta
• How will you assess her for surgery
• Went through this then he said - you need to find out if she has epidural.
• What block height for spinal.
• Why is this different post partum. Why would you need to alter drug dose
• When do risks of reflux post partum return.
• How would you do epi top up. Check block working
• She has spinal and cries out. - what would you do? Bell went.

10. Jehovah Witness for elective surgery for major blood loss, seeing in clinic
• What their beliefs
• What do you want to do (document, cons present, what they'll except/decline)
• Capacity/ Gillick competence/ Autonomy
• Pre optimise
• What do intra op (all normal stuff for anaemia) and post op
• Drugs you want to give (antifibrinolytics)

11. AF
• Shown ECG - AF
• Causes (wanted MV disease)
• Treatment options
• Talk through DC cardioversion in compromised patient- how many shocks (3) then what (Amiodarone) Doses
• CHADS2 scoring and embolic disease
• Dabigatran V Warfarin

12. Obs 37 F primip with epidural in situ, just had NVD Now complaining severe dyspnea
• Causes- AFE, PE, Pulm oedema, Cardiomyopathy, LRTI, Epi block high, MI
• Pathophysiology of AFE- signs
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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• Pathophysiology of Pulm oedema ( low colloid pressure)

• Rx- they wanted ECHO? What would you see?

13. PET 36weeks, 1st baby, in labour for 6 hours, no epidural, Suspicious CTG and Obstetricians want to do a C/S. BP 150/90
• Definition of pre-eclampsia and how I knew this was pre-eclampsia. Wanted protein in urine and symptoms
• Implication for anaesthesia
• Cut-off values for platelets and RA
• Control of BP. What I would use and if I wanted to control it before going to theatre. Had already started on hydralazine
and wanted labetolol and Mg
• Wanted to know the dose of Mg and infusion rate
• How many % of pre-eclampsia develop eclampsia
• If CTG was a reliable monitor of the wellbeing of the baby

14. Emergency AAA 80 years old, hypotensive, low GCS, cold peripheries
• Management in A and E. Who I needed to contact: haematologist, blood bank, surgeons, senior help etc
• Large bore access, x-match,
• Induction, where? How to induce, monitoring
• Art line pre induction? CVP line pre induction?
• Patient went to ITU
• Developed severe lactic acidosis the day after. Wanted to know possible reason for this. Where happy with gut
ischemia but wanted DDx
• What was I going to tell the family and wanted to know if we should have done nothing to begin with for this patient.
They wanted to talk about Hardman study and how that gave an idea of mortality

15. ARDS 50 y.o. man. Dry cough and diarrhoea. Recent travel abroad
• Developed hypoxia and respiratory distress on ward
• ABG showed severe hypoxia. pO2 6 on 40% O2
• Management, ABC,
• Chest x-ray : bilateral infiltrates
• Most likely cause?
• Definition of ARDS
• Management in ITU
• Role of NIV and ARDS and when to go from NIV to invasive

16. Child with a runny nose/ URTI for an ENT procedure

• What are the potential problems
• how would you assess the patient
• would you provide anaesthesia
• then told that the consultant is happy that it is just a URTI and to proceed with the case.
• how would you anaesthetise the child (discussed EMLA, parental presence, gaseous induction vs Iv induction)
• Post op analgesia - specifically interested in why not to give NSAIDS
• Child the develops laryngospasm, how do you manage it.

17. Obstructive Sleep Apnoea

• What is OSA
• STOPBAND criteria
• any other diagnostic tests/screening tools other than STOPBANG
• Discussed CPAP
• what investigations would you require.
• Shown a polysomnograph - only featured heart rate and SpO2 (no AHI). Multiple desaturations and episodes of
tachycardia.
• Long discussion on physiology of OSA
o why does the patient become tachycardic when he desaturates (discussed valsalva)
o mechanism of right heart failure with the level of detail extending to inhibition of nitric oxide
o discussion about pulmonary hypoxic vasoconstriction.

18. Carotid Endartrectomy

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• Why do we do this procedure?

• How does the best?
• What are the NICE guidelines and on what evidence were they based?
o GALA trial and discussion about the pros and cons of GA vs Regional
o How to perform superficial and deep cervical plexus blocks
o discussion regarding baroreceptor reflex and changes in blood pressure during this type of surgery.
o Long discussion on cerebral monitoring
o Discussion about post operative care.

19. 4yr having squint surgery

• What are the specific problems associated with squint surgery
• What conditions could be associated with a child presenting for squint surgery
• Is there an association between squint surgery and MH
• What pre-operative adjuncts could be used in this case
• How would I anaesthetise for this case
• What emergency drugs would I have available and why
• What would I do if the child became bradycardic
• How can I minimise the risk of PONV
• Is she suitable to be a day case
• Main problems
• Occulo-cardiac reflex ( what you would do, any role for premed with atropine)
• Nausea and vomiting (drugs and doses)
• Pain control (probs with morphine, have to stay in)

20. Hypotensive anaesthesia

• Indications for
• Pharmaocological methods (wanted CO =HR x SV SV=preload and after load, drugs to decrease each component)

21. Awareness Woman following hysterectomy comes back a couple of weeks later saying she was aware during the surgery
• Management plan e.g. anaesthetic records (what do you look at specifically), speaking to pt, documentation, psych
referral
• Define awareness
• incidence of awareness, incidence in different surgeries
• Consequences of awareness e.g. PTSD, anxiety, depression, socioeconomical consequences
• Risk factors for awareness e.g. surgical, anaesthetic, equipment, patient
• Ways to monitor awareness
• What guidelines are there
• Specific details about BIS monitor
• What do these monitors actually measure - i.e. doesn't prevent awareness
• Actual use of these monitors - i.e. prevent giving too much anaesthetic

22. Phrenic Nerve Palsy. Elderly woman having had right humerus operation, post-operative difficulty in breathing
• shown CXR of patient with raised right hemidiaphragm and associated right lower lobe collapse
• Differentials of postop difficulty in breathing
• How do you approach this patient - management plan and investigations and why
• Differentials of raised right hemidiaphragm
• Causes of phrenic nerve palsy
• Other ways to distinguish this as phrenic nerve palsy
• CXR signs of phrenic nerve palsy
• Incidence of phrenic nerve palsy following interscalene block
• How long does it last
• What else would you see following interscalane block e.g. Horner's syndrome

23. HOCM Phoned by pre-assessment nurse as has found an ejection systolic murmur on 36 year old male.
• What would you do now?
• What else do you want to know from the history e.g. family history of sudden death, symptoms
• What other investigations do you need (including bedside - found to have equal pulse and BP on each side)
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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• Shown ECG - asked to interpret - LAD and LVH

• Causes of LVH
• Differential diagnosis for this patient
• Pathophysiology behind LVH in general
• Pathophysiology of HOCM i.e. LVOT leading to function aortic stenosis
• What are the main issues anticipated
• How would you manage the patient under GA i.e. keep sinus rhythm etc

24. Fess Procedure (in an otherwise fit and healthy 28 year old)
• Definition of hypotensive anaesthesia
• Indications for hypotensive anaesthesia
• What BP/MAP would I be happy with in this case
• What do the surgeons do to improve their surgical field
• How can anaesthetis induce hypotensive anaesthesia
• How would I anaesthetise for this case
• Would I consider using a throat pack
• What are the safety aspects involved in ensuring safe use of a throat pack

25. Autonomic Dysreflexia (in a patient with T2 injury requiring bladder stone removal
• What are the anaesthetic complications associated with this cas
• What is autonomic dysrelexia and how does it occu
• Discuss the use of suxamehtonium and spinal cord injur
• How would I anaesthetise for this cas
• Why do they need an anaesthetic if they are unable to feel below the level of the injur
• Why could they suddenly become bradycardi
• How would I treat a sudden bradycardi
• What treatment could be used for hypertension

Anatomy
1. Cerebral Perfusion
• When would you use monitors for cerebral perfusion and oxygenation? (curveball question I thought)
• Tell me about the arterial supply to the brain from the aorta.
• When can arterial supply to the brain be compromised?
• What monitors can you use to check cerebral perfusion and oxygenation?
• Tell me about subarachnoid haemorrhage.
• What is the pathophysiology of vasospasm following subarachnoid haemorrhage? When does it occur?
• How do you prevent vasospasm?
• 8) Management strategies and how they work
- What is HHH therapy and its significance What is the perceived advantage of haemodilution? What haematocrit
would you aim for?

2. Ulnar Nerve
• where was it derived from?
• describe its course from the roots of the brachial plexus all the way to the terminal branches in the fingers
• where could you block it? (I offered interscalance and explained this may miss the ulnar, supra clavicular, infrclavicular,
axillary, mid humeral, elbow and wrist)
• detailed discussion about elbow and wrist blocks
• how may the ulnar nerve become damaged?
• how would you investigate the damage? what would you tell the patient?

3. Considerations of heart transplant

• Physiological dennervated
• Action of drugs
• Anti rejection drugs
• Accelerated atherosclerosis

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• Anatomy of sympathetic and parasympathetic

• Neurotransmitters in autonomic nervous syste
• Horners-what is it, how does present, how can anaesthetists cause i
• CN 3 role in autonomic nervous syste
• Patients that get autonomic neuropathy

4. Stellate Ganglion Block

• Tell me the practical and ethical considerations when undertaking a stellate ganglion block? Bit of a weird
question.
• We talked about indications, complications then actually how I would perform the block.

5. Internal jugular vein anatomy

• Indications of central line, they would like a lot
• Course of jugular vein from brain, where does it start and end?
• borders of ijv, in details, relation of ijv and carotid within the carotid shealth, then ask about medial, lateral, anterior
and posterior borders
• why choose right side rather than the left side
• How do you do a rij line?
• how can you confirm the line is in the right place?

6. Femoral Nerve- in detail

• course in the pelvis, the names of the motor branches in the thigh
• how to perform a block

7. Carotid Endartarectomy
• Indications for carotid endarterectomy
• Which part of the carotid artery is being operated on
• The course of the cervical plexus (in detail)
• What is the sensory supply to the face
• Analgesic techniques for carotid endarterectomy
• How would I perform a superficial cervical plexus block
• How would I perform a deep cervical plexus block
• What are the complications associated with each technique

8. Paravertebral block.
• Indications
• Contraindications
• Anatomy of the space
• What nerves?
• Procedure of insertion of blocks
• Compare with thoracic epidural - benefits and disadvantages

Physiology
1. Aortic Stenosis This was a man in his 60s I think with moderate aortic stenosis coming for elective inguinal hernia repair and
I was seeing him in pre op assessment.
• Causes of aortic stenosis
• Pathophysiology.
• How you would diagnose the grades of as
• The most useful bedside test i could request
• She asked what the echo would show.
• We then talked about anaesthetising this patient.
• Neuroaxial
• Incidence of sudden death in people with asymptomatic as.

2. Management of patient with previous spinal cord injury

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• which areas are vulnerable to damage

• various types of cord syndromes
• airway implications
• discussed lots of management problems
• concluded with a very molecular discussion about hyperkalaemia with sux and autonomic dysreflexia
• how would you anaesthetise this patient for a dressing change

3. Smoking and Carbon Monoxide

• Is there any benefit of someone stopping smoking 24hrs before surgery?
• When would you advise someone to stop smoking prior to elective surgery? Timelines.
• What are the problems with smoking?
• What are the problems with nicotine?
• What is the half-life of COHb?
• Why is COHb bad? How does it affect humans?
• What is the expected COHb in non-smokers, and in smokers?
• What are the symptoms of CO poisoning? What percentages?
• How do measure COHb? Why co-oximeter? Why not normal pulse oximeter?
• How do you treat COHb poisoning?
• What are the problems with hyperbaric oxygen therapy?

4. Blood Groups
• What is blood incompatibility signs and symptoms
• Incidence of haemolytic transfusion reaction
• How do we avoid incompatibility
• Blood groups
• Other blood groups

5. Brain stem death

• What would make a patient who is brain stem dead appropriate for transplantation (ended up mentioning contra-
indications instead!)
• Patient is eligible. How do you proceed?
• What are the effects of brain stem death on body systems?
• What hormones need replacing?

6. Thyroid hormone
• production and homeostasis
• function
• symptons and signs of hypo and hyperthyroidism
• peri-operative consideration
• how would I anaesthetise patients with hypothyroidism
• asked about thyroid storm

Pharmacology
1. Parkinsons Disease
• What pathophysiology behind Parkinson’s disease?
• What are the main features of Parkinson’s disease?
• What is dopamine?
• How is dopamine synthesised? What is the enzyme the converts DOPA to dopamine? How is dopamine metabolised,
and where? What are the enzymes involved in its metabolism?
• What are the other diseases that can mimic Parkinsons?
• What are the drugs used to treat Parkinson’s disease? Why is L-dopa used and not dopamine? What is L-dopa’s
bioavailability?
• What is normally given alongside L-dopa? Can you give examples?
• How does apomorphine work? What are its side effects?
• What is selegiline? How does it work?

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• What are the principles of anaesthetising a patient with Parkinson’s disease?

• What anti-emetics that can be used? Or not used?

2. Suxamethonium
• What are complications of using suxamethonium
• What is the structure of suxamethoniium (they wanted me to draw the molecule, I said I couldn't)
• Why do you get a raise potassium with using suxamethonium (exact mechanism behind this)
• Why do you get a bradycardia with using suxamethonium (exact mechanism behind this)
• When do you get a phase II block
• What are the features of a phase II block
• What problems does suxamethonium apnoea cause and the mechanisms behind this
• How would you anaesthetise a patient differently who has known suxamethonium apnoea
• What duration of block would you expect with Es:Es genotype
• How would you manage a patient who is discovered to have suxamethonium apnoea

3. Glucose Control
• How does body regulate blood glucose
• Hypoglycaemia in perioperatively setting: risks, causes
• Hyperglycaemia stress response, DKA and HONK
• Are there any guidelines for perioperative glucose control
• Effects of surgery on blood glucose-why hyper/hypoglycaemia
• What is structure of insulin and Insulin-types
• Oral hypoglaycaemics
• Management of glucose on ITU-wanted to know when I would treat hypo

4. Myasthenia Gravis
• What is it?
• How does it present?
• How do you diagnose it?
• Tell me about edrophonium.
• Tell me how other anticholinesterases work. Can you classify them (they accepted me saying how they modified AChE
enzyme)

5. Drugs used post MI

• ACEi
• How do they work
• Want to know that Ramipril is a pro-drug
• which is more active ramipril or ramiprilat
• PHARMACOKINETICS of Ramiprilat
o protein binding
o peak plasma conc occurs when
o half life
o metabolism and excretion

6. Pre-op assessment of a patient with asthma.

• Talked about specific questions you would ask in the history
• Mechanisms of action of various drugs used in asthma.
• Monteleukast and how it works best in children.
• Talked about drugs used in anaesthetics that may trigger asthma symptoms
• Pulmonary function tests.

7. VTE
• Are you aware of any guideline for VTE?
• What is it in details?
• Risk factors of VTE
• Ask about risk assessment of the risk factor and what would you do
• Compare LMWH to UFH
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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• How do you classify anticoagulant

• Examiner was nice, said choose your favorite one to talk about, I chose Antiplatlet
• Then ask about how does Warfarin work

7. Tolerance
• What are the problems with anaesthetising a heroin addict
• Brief discussion regarding infection and ppe, malnutrition, dentition
• Discussion about opiate tolerance
• What is the mechanism of tolerance
• Discussion about synaptic plasticity
• Pain management in those who have developed opiate tolerance
• Discussion regarding regional alternatives, clonidine, ketamine, nsaids etc.

PHYSICS/MEASUREMENT
1. Scoring Systems
• What scoring systems are used in ITU e.g. general prediction, disease specific
• What do they look at e.g. physiological, co-morbidities
• Specific detail about APACHE scoring
o APACHE I, II & III
o Which parameters do they look at
o Values for higher risk with APACHE
• What is SOFA scoring and what does it stand for
• What can you derive from these scores and what are the problems e.g. cant be individualised
• What is ICNARC and what does is measure i.e. audit and comparison of units
• What is NEWS scoring & NICE guideline for it
• Can you describe the scoring system i.e. -3 to 3 for each variable; red/yellow/green
• What are the scores for calling a physician/intensivist
• Which physiological parameters hold more weight in the NEWS score e.g. heart rate, blood pressure

2. Epidural abscess/haematoma
• How do we prevent vertebral canal haematoma with epidural
• Who is most at risk
• What is on end of epidural- filter
• What other filters do we use
• What size are the filters
• How do we recognise epidural haematoma
• How can you prevent epidural abscess. Talked about pt selection, aseptic technique, train staff to clean before use,
sterile dressing. Forgot about the filter.
• Question went on to different types of filters in anaesthesia. Talked about HME and blood giving sets. Asked sizes of
each filter but didn't know.

3. Awareness
• What may she complain?
• How can we reduce incidence of awareness if we use volatile agent?
• What group of patient may require higher mac?
• What types of surgery has a higher chance of awareness? In cardiac surgery, at what stage may they experience
awareness
• How do you monitor volatile agent concentration?
• Discuss about infra red absorption and draw diagram of how it works
• What is mass spectrometry?

4. Humidification
• Why do we want humidifcation of respiratory gases
• What is the definition of absolute humidity
What are the complications of inadequate humididication of respiratory gases
• Which patients are at risk if humidification is inadequate

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December 2013 Final SOE Questions – Thanks to our Course Candidates of 2013

• What is the absolute humidity at room temperature and at 37degrees

• What methods do we use to humidity gases and how efficient are these methods
• What are the complictions of these methods
• What are the benefits of a circle system (in relation to humidification - e.g. sodalime),

5. C-Pex testing
• What is it
• vO2 max and anaerobic threshold- how are they useful
• how does C-Pex testing work
• What equipment do you need
• tight fitting mask
• Bike
• pneumotacograph
• how do you measure the 02
• they prompted me !! It uses a fuel cell
• how does a fuel cell work

6. Theatre pollution
• Give me causes of theatre pollution.
• Scavenging discussion.
• COSSH regulations
• Effects of volatiles on staff/ harmful effects
• How to reduce pollution? e.g. regional/ tiva/ circle/ low flow

7. Circle System
• Tell me the benefits to the patient and to the hospital/staff of using a circle system
• Talked about the problems of using a circle system.
• Delivering a hypoxic mixture despite the antihypoxic features of an anaesthetic machine.
• Degradation products of volatile agents
• Compound A so
• Sodalime and the features of sodalime that allow CO2 absorption
• What size are the sodalime particles

8. Oxygen toxicity
• Absorption atalectasis (brief), Hypoxic drive (brief)
• Free radical damage (extensive discussion including formation of hydroxyl radicals and superoxide dismutase)
• Detailed discussion on changes on the neonate with given oxygen concentrations
• CNS involvement (signs symptoms) vs Pulmonary problems (discussed tracheobronchitis, ARDs and pulmonary fibrosis)
• British Thoracic Society Guidelines on oxygen prescribing
• Discussion on Bleomycin
• Clark electode
• Fuel Cell
• Paramagnetic analyser
• Calorific Testing
.

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