ANAKAYUB's Notes

2024 1st Feb FCAI SOE (Malaysia) 

SOE 1

1. Parkinsonism
- what is Parkinson disease and main pathophysiology, main clinical features
- different type of parkinsonism
- type of medication used in Parkinson
- concern in anesthesia
- if patient cannot tolerate orally, how you manage
- drugs to avoid

2. IDA
- how you investigate for IDA and expected result (FBC, serum iron study, eryhrtopoitin)
- how you optimise
- if this pt need emergency op, how you optimize and reduce HB loss
- what is prerehabilitation
- what benefit it offers
- how it improve cardiovascular reserve, (i mention exercise, physio) what specific exercise
- how it improve respiratory reserve, what is the effect on vo2 max
- how it works (like increase functional status so can recovery faster after stress event, the graph)

3. Facial fracture, trauma, bleeding in oral, missing tooth
- what's your anaesthesia concern
- how you secure airway
- why cricoid contraindicated
- how you perform afoi (after explain sTOP, he wants more ?oropharangeal gag then put tube?)
- failed afoi, but pt need GA, other option? (FONA)
- different type of FONA, and explain

4. Triple A hpt dm ckd come for preop at anaes clinic
- interpret ECG ( tall tented t wave) hyper k
- Classify hyperk (serum conc, ecg)
- what blood you want to take for this pt
- indication of pre op dialysis
- what's your anaes concern for ESRF pt undergo surgery
- if you mention roc for intubation they will ask minimum crcl to use sugammadex
- effect of esrf on opioid, LA etc
- risk factor for worsening of renal function

5. Mitral stenosis
- Classify severity
- positive physical examination
- hemodynamic goal
- how you maintain SVR during anaes process
- what's your concern if using PDE2 inhibitor
- how about PVR
- Interpret ECG (fast AF)
- Patient on Warfarin, what’s your preoperative management ? How do you bridge the warfarin?

6. Pacemaker
- how pacemaker works
- component of pacemaker
- alphabet for pacemaker
- anaes concern (what other thing than diathermy that affect pacemaker? I suppose electrolyte, but didn't say)
- patient poor historian, don't know anything, no card, no letter, no technician, how you proceed for op

SOE 2

1. T1DM, on continuous subcutaneous insulin
- what’s insulin role in peripheral glucose utilization
- if glucose high but insulin low, what will happen
- effect of hypoglycemia on brain
- are you familiar with continuous subq insulin? Tell me about it. Can you give bolus with the pump?
- how you manage this pt pre op
- how frequent to monitor blood glucose and how (have to include ketone!!)
- what is VRIII, what's your glucose aim
- intraop concern

2. Failed back surgery syndrome
- red flag
- inv to rule of all diagnosis
- how you manage the pain
- role of antidepressant on chronic pain, (SSRI, TCA, MAOI). MAOI MOA, SSRI MOA
- are you aware of role of cannabis on chronic pain? (NO!) What is the proposed mechanism of action? (I say no already, why ask haha)
- Any interventional treatment
- Any more advanced treatment

3. 4yo, 4H post tonsillectomy bleeding. HR 150, BP 97/60
- What is primary post tonsillectomy haemorrhage
- concern for this pt
- management (call ent, call PREVIOUS anaesthetist and review old note for intubation etc)
- what you want to see in previous anaes chart
- why difficult airway (bleeding, edema)
- how you resus
- how you manage again, intubation etc

4. 32 weeks pregnant lady, plan for emergency laparoscopic appendicectomy
- cardio and resp physio changes in this gestation
- mother is worried about anaes drug effect on fetus, what you tell
- what drugs to avoid perioperative
- how you ensure fetal well being
- what's your modification in your anaesthesia technique
- what you tell surgeon about laparoscopic? (Use minimum pressure, prevent extreme head down?)

5. Abdominal hysterectomy for endometrial CA
- what's the layer of abdomen
- what's the innervation anterior abdomen
- shows ultrasound image of tap block, show where you will deposit the LA
- where does TAP block cover
- how you perform the block
- 10min after you perform block, this is the monitor (VT, HR 120, IABP 41/20, SPO2 47%)
- what's your diagnosis?
- what's your immediate management (Declare crisis, call for help, airway then DEFIB!, after airway I jump to definite mx by saying too much on lipid emulsion, lucky she pull me back and say what about the vitals, ecg?)

6. Cyclist with trauma. Massive hemorrhage.
- How to resuscitate
- What’s massive hemorrhage - definition
- what do you give, how much is the ratio?
- PCC- component of PCC, what’s the other indication for PCC other than trauma?
- What products consist of fibrinogen ?
- Fibrinogen- dose, indication, source
- What’s the target of fibrinogen level in massive hemorrhage?

SOE 3

1. Ards
- tell me about Berlin's criteria
- pathophysiology of ARDS
- respi and non respi causes (Non respi I said burn, pancreatitis, severe sepsis, blood tx, he still wants moreeee)
- describe your ventilator and non ventilator mx
- you say appropriate peep, what's that
- what's recruitment strategy
- is ards reversible?
- Prone and how it improves oxygenation

2. Intraosseous
- where can you do
- how you do
- what's the layer you pass through for IO route
- blood supply for medulla (wtf)
- contraindication
- special contraindication in children
- what's the different between iv and intraosseous route (need pressure bag for saline infusion)
- what type of Marrow you know
- How does fluids transferred to systemic circulation
- Complication of IO (in adult and children)
- Differences of IO and IV fluid administration
- Anything that cannot be given by IO
- Any difference of blood taken from IO compared to IV

3. 30yo admit to icu, diarrhea 5 days, complain of weakness in icu
- differential diagnosis (need to give more neuromuscular differential other than GBS and MG)
- what history you want to take / clinical features suggestive of GBS
- pathophysiology of GBS
- other than GI infection, other cause that cause GBS (I say vaccination, he wants more, maybe respi infection?)
- how you investigate, what you expect in LP, MRI, NCS
- what's the treatment
- ICU management- specific and non-specific
- What’s the mechanisms of action of IVIG?
- Does plasma exchange helps?

4. Post cardiac transplant
- describe the autonomic innervation of cardiac, what's the Para and sympathetic affect - HR, CO, SVR
- definition of CO, what's the formula
- define preload, afterlaod, stroke volume
- anaes concern specific for post cardiac transplant, concern on the heart, other concern (immunosuppression, steroid, chemo etc I guess)
- effect of indirect and direct sympathomimeitc on heart
- what heart disease is this patient high risk for

5. TCA toxicity
- what history you want to take in patient with suspected overdose
- how TCA cause CVS instability
- ECG changes
- central and peripheral manifestation of TCA toxicity
- management of TCA toxicity, how you treat seizure, why cannot use Phenytoin
- what's your aim for urine Ph
- how sodium bicarbonate helps in reduce cardiac toxicity
- can pt have low serum tca level and cardiac toxicity?

6. Hypothermia
- define temperature and what's the SI unit
- how heat loss intraop
- what is radiation, convection, evaporation
- how you minimise Hypothermia
- different methods to measure temperature (I classify to non electric vs electric method as that is asked in my MCAI osce, but i guess other ways maybe according to site? Like nasopharynx, bladder, skin etc?)
- adverse effects of Hypothermia

Special thanks to Cindy, Lim WY, Hoo JT & WYF