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9 active stations, two rest stations, 55 min

1.) Question 1
a. A 40 pack year smoker is having difficulty breathing and his respiratory rate is
decreasing on facemask. Which of these instruments would you give him and why?
i. Venturi Mask – because you can control the percentage of oxygen he receives
and will not depress his remaining respiratory center that measures his level of
b. A patient is on oxygen supplement but takes it off for toileting and to eat, then her
oxygen saturations decrease rapidly. Which device would you switch her to?
i. Nasal canula because it allows the patient to eat and for easy toileting
c. A patient has an oxygen saturation of 85% on 5L/min face mask. Which device would
you switch her to?
i. The face mask with reservoir bag because it increases the inspired oxygen to
almost 100%.
2.) Question 2
a. What do you see on this ECG? (Similar to picture )
i. Ventricular Tachycardia?
b. Name 2 symptoms the patient will have?
i. Chest pain, dizziness, fainting, fatigue,
shortness of breath
c. What investigations and management will you do for
the patient prior to anaesthesia?
i. Echo, Holter monitor for 24-72 hours, coronary angiography, Implantable
cardioverter-defibrillator (ICD), MRI of heart, CT, X-ray, stress test, U&E
imbalances corrected, preparation of an anti-arrhythmic eg lidocaine, beta-
blockers eg propranolol, preparation of a defibrillator.

3.) Question 3
a. What do you see on this x-ray? (Similar to picture )
i. Pneumothorax?
b. What symptoms would they have
i. Shortness of breath, shallow breathing, tachypnea,
chest pain, difficulty breathing, chest tightness, rapid
heart rate, cough, fatigue
c. How would you treat this patient?
i. Decompress the chest cavity using an occlusive
bandage or chest tube
d. What are the complications of anesthesia in this patient? (Not
sure if this was a question?)
i. Risk of worsening condition – tension pneumothorax
ii. Increase risk of respiratory failure?
4.) Question 4
a. Patient with congestive heart failure is having shortness of breath, RR is 35bpm.
PaO2 40 mmHg
PaCo2 114mmHg
HCO3 26.1 mEq/L
pH 7.012
Base excess 3.3
SaO2 68%
Name all of the values that are abnormal?
i. PaO2 (L), PaCO2 (H), pH (L), SaO2 (L), base excess (H)
b. What is the acid/base status of the patient?
i. Respiratory Acidosis – normal HCO3, markedly elevated PaCO2 and decreased
c. What would be the emergency management for this patient?
i. Oxygen therapy
ii. Combination of afterload-reduction with angiotensin-converting-enzyme (ACE)
inhibitors, reduction of catecholamine surges with blockers, and preload-
reduction with diuretics

5.) Question 5
a. Name 2 crystalloids
i. Lactated Ringer, Normal Saline, Dextrose
b. What is one advantage and one disadvantage of crystalloids
i. Adv – Cheap, last longer, can use larger volume,
ii. Dis – Excess fluid can cause hypoxia, it is not a very good volume expander, does
not stay in the intravascular space long comparative to colloids
c. How would you manage fluid resuscitation in a patient with intestinal obstruction
before surgery?
i. Investigate U&Es and dehydration status
ii. Calculate maintenance fluid based on patient weight (4, 2, 1 for hourly or 15, 10,
5 for daily)
iii. Calculate losses eg vomiting, decrease fluid intake (replaced at 1:1 for gastric
iv. Resuscitate patient using appropriate fluids for electrolytes correction
v. Reassess to adjust regimen
vi. Anticipate more loses from an enema as pre-op management

6.) Question 6
a. Give 4 indications for device #1 (CVP)
i. Measure the central venous pressure
ii. Deliver Total Parenteral Nutrition
iii. Deliver thrombophlebitis causing drugs eg chemo, potassium
iv. For severe burn patient fluid management (no burns at site of
v. Continuous blood gas, CBC, and U&E monitoring
vi. For patients with difficulty finding peripheral veins eg obese, very thin
vii. Rapid IV fluid infusion
viii. Aspiration of air emboli
ix. Insertion of transcutaneous pacing leads
x. Haemodialysis and plasmapharesis
b. How do you insert device #1?
i. Use aseptic technique and find anatomical land marks ( triangle with clavicle
and medial heads of the sternocleidomastoid)
ii. Lay patient in Trendelenburg position – decrease risk of air embolism and
distend internal jugular vein
iii. Palpate the carotid and remain lateral to the carotid
iv. Insert needle and wait for flashback of venous blood (colour, psO2
measurement, lack of pulsation in syringe)
v. Insert wire into needle
vi. Remove needle while holding the wire in place
vii. Cut small shallow slice next to wire to facilitate passage of catheter
viii. Palpate sternal notch and measure catheter from there to the wire
ix. Advance dilator over the wire to dilate the soft tissue while keeping the wire in
place, then remove the dilator
x. Then run catheter over the wire until you can see the end of the wire at the
catheter hub
xi. Uncap the hub and pull the wire out until it exits the port while advancing the
catheter through the soft tissue
xii. Once wire is out, cover the hub with your finger and cap it
xiii. Check patency and accurate placement using syringe to pull and push fluid
xiv. Sew it in place and apply sterile dressing
c. Which device 2 or 3 would you use for a 6 month old child and why?
i. Buratrol better than regular IV line because You can limit the
amount of fluid delivered to the child that is less than the bag.
It is often designed to prevent free flow of fluid or air once the
infusion is done.
7.) Question 7
a. What is the mode of action of lignocaine
i. It is a local anesthetic that alters the signal conduction in neurons by blocking
the fast voltage-gated Na+ channels in the neuronal cell membrane to prevent
action potential
b. What are two contraindications of propofol
i. Allergy to soy, eggs – because it contains soybean oil, egg yolk or egg lecithin
ii. Patients with sensitivity to benzyl alcohol
iii. Hypotensive patients – because it causes bradycardia
c. Give 4 indications for adrenaline?
i. Anaphylactic shock
ii. Allergic reaction
iii. Hypotensive correction – infusion for maintaining blood pressure
iv. Cardiac arrest
v. Acute asthmatic attack
vi. Can be added to LA to increase duration of action

8.) Question 8
a. Name 4 things in the history that would clue you in to a patient with a difficult airway?
i. H/O difficult airway in previous surgery
ii. H/O tracheal stenosis
iii. H/O treacheostomy
iv. H/O sleep apnea
v. Chief complain of foreign body to throat causing difficulty breathing
b. Name 4 physical signs that would indicate difficult airway
i. Tracheostomy scar
ii. Mallamtpati score of 4
iii. Short neck
iv. Obesity
v. Goiter or other throat obstruction
c. Name two devices that can aid in intubation of a difficult airway?
i. Boujie, stylet
9.) Question 9
a. What is device # 1?
i. Stylet
b. Give an advantage and disadvantage of the above device
i. Adv - It adds rigidity to the ETT
ii. Dis - May cause trauma if it passes the murphy’s eye
c. What is a complication of device #2
i. Laryngoscope may break/ knock out teeth that can go down the airway
d. What are two advantages of device #3 over #4?
i. The north-facing tube vs regular ETT is better because it
allows for clearing of the surgical zone in ENT surgeries
(especially dentistry)
ii. The performed bend lies comfortably at the nares and
can be cut shorter pot-operatively for easier suctioning