FCAI SAQ Feb 2021
1) A 68 years old, presented to the ED found unconscious in his house basement by his friend on a cold night. He has previous multiple admission with alcohol related issues. SpO2 98% under oxygen supplementation. (shows ABG pH 7.21, PaO2 60mmHg, PCO2 normal, Lactate 6.1, SaO2 54)
(a) What is your diagnosis? And evidence to support your diagnosis.
(b) Pathophysiology of your diagnosis
(a) Can you prognosticate the patient with the above given data? And explain how?
(c) How Would you manage the patient above when you sees him in the ED
(d) The ICU team wants to transfer him to a specialized centre for the specific treatment? What is the treatment that is going to be offered?
2) A young patient presented for surgery with underlying Duchenne Muscular dystrophy and is on the wheelchair. He is also on BiPAP NIV and ICD implanted.
(a) What is the genetic linkage of DMD? Pathophysiology of DMD
(b) What clinical feature do you expect to see?
(c) What SPECIFIC pre-op history and SPECIFIC investigation you will request prior to surgery.
(d) What is the anaesthetic concern regarding this patient?
(e) Outline your anaesthetic technique and explain them.
3) Patient presented with acute hydrocephalus
(a) What are the types of hydrocephalus?
(b) What is the clinical feature of acute hydrocephalus
(c) CSF production and absorption
(d) Patient is planned for EVD - how does it affect your anaesthesia? Briefly explained how an EVD is done?
(e) Indication of EVD insertion
(f) Monroe- Kellie hypothesis and what is the significance of it?
4) DM Peripheral neuropathy
(a) What is neuropathic pain? Types of neuropathic pain? What is DM peripheral neuropathy classified under?
(b) List other examples of neuropathic pain? (5 mark)
(c) What is Mechanism of action of gabapentin? And topical capsaicin
(d) General management and specific management of DM neuropathic pain
5) Robotic minimally invasive prostatectomy
(a) Advantages and Disadvantages of robotic surgery
(b) How would you anaesthetize this patient and what are the concerns?
(c) What gas is being used? Why is such gas being chosen?
(d) Surgeon accidentally advances the laparoscopic scope and Etco2 suddenly drops. What is your likely diagnosis and your management?
6) Patient with known supraglottic tumour, refused surgery previously, currently planned for lower limb surgery. Complaint of dyspnea and occasional stridor when he is stressed or exertional.
(a) Pre-operative assessment and investigation in regards to the airway
(b) Patient was eventually proceed with surgery under spinal anaesthesia and 40 mins into surgery, he develop respiratory distress - getting agitated and altered mental status - What is your immediate management?
(c) Patient able to maintain airway by basic maneuvers of the airway, but getting more
drowsy and lethargy.
- What intubation technique you know of and which is your preferred route, why?
(d) Outline how do you do an awake fiberoptic nasal intubation if this patient was planned for elective intubation for an elective surgery?
7) Young patient come in with drop in GCS upon arrival at ED, her blood sugar is only 1.2
(a) What is gluconeogenesis and what is glycolysis?
(b) Early and late symptoms of hypoglycemia
(c) Differential diagnosis of the above case?
(d) What is your management when you see the patient in the ED?
(e) What blood investigation would you request and why?
8) 37 week pregnant lady, presented with severe preeclampsia and you were called to the labour room.
(a) What is severe pre-eclampsia (5 marks)
(b) What is your management for this patient?
(c) What specific consideration will you have for this patient compared with other pregnant lady?
(d) What is HELLP syndrome? And its significance?
9) Young girl, scoliosis, cobbs angle 60, planned for corrective surgery
(a) What is cobbs angle? And what is the significant? What does the cobbs angle of this patient means?
(b) Pre-op assessment for this patient
(c) Anaesthetic monitoring that you will consider for this patient? What are the neuromonitoring that is used in scoliosis surgery
(d) What is your anaesthetic technique in relation to the intra-op monitoring that you mentioned above?
10) Thoracoabdominal Aortic Aneurysm (TAAA) planned for surgery
(a) Classification of TAAA, and what are the component
(b) What is left heart bypass? And what are the advantages?
(c) How to reduce the risk of paraplegia (spinal cord ischemia)
(d) Determinant factor for post-op analgesia for this patient
(e) Patient on One lung ventilation (OLV) and desaturated to 85% after 40 mins into surgery? What do you do? (8 marks)
(f) Indication of OLV (besides above surgery)
Special thanks to Yeoh JC