EDAIC Questions: Paper B, Clinical Aspects of Anaesthesia, Intensive Care, Internal and Emergency Medicine.

  • Issue 60

Sue Hill | Chairperson Part I EDAIC Subcommittee
sue.hill@uhs.nhs.uk

1. Inadvertent surgical pneumothorax is associated with

  1. nephrectomy
  2. cervical sympathectomy
  3. adrenalectomy
  4. thyroidectomy

2. A 3-month-old infant is listed for primary closure of a cleft lip. Abnormalities associated with cleft lip and palate include

  1. prolonged INR (International Normalised Ratio)
  2. cardiac anomalies
  3. thrombocytopaenia
  4. renal anomalies
  5. micrognathia

3. Nerves which must be blocked to provide anaesthesia for amputation of the leg above the knee include sciatic

  1. sural
  2. femoral
  3. common peroneal
  4. tibial

4. Complications in a patient who survives near-drowning in fresh water include intrapulmonary shunting

  1. metabolic acidosis
  2. pulmonary oedema
  3. hypernatraemia
  4. hypotension

5. Bilateral hilar lymphadenopathy is a feature of pulmonary tuberculosis

  1. Hodgkin’s disease
  2. erythema multiforme
  3. sarcoidosis
  4. systemic lupus erythematosus

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Answers and Explanations

1. TTTTT

This is a general anaesthesia category question. Pneumothorax can be associated with surgery in the neck, such as thyroidectomy, where the pleura may be damaged or in the abdomen particularly where the retroperitoneal space (as in the remaining four procedures) is entered and air can track up into the thorax. This can occur with both open and laparoscopic surgery.

2. FTTFT

This is a special anaesthesia category question: paediatric anaesthesia. Cleft lip and palate are particularly associated with cardiac, renal and skeletal abnormalities. Blood clotting is generally normal; there are no particular reasons to expect platelet or vitamin K coagulation factors to be abnormal. Other facial problems may be encountered – ears, eyes and facial bones – such as micrognathia (small lower jaw).

3.TFTFF

This is a regional and local anaesthesia category question. Above knee amputation is commonly performed under spinal anaesthesia. A 3-in-1 block or fascia iliaca block may be appropriate, but these are used more commonly for post-operative analgesia. The femoral, sciatic and obturator nerves must be blocked. The tibial and peroneal nerves are branches of the sciatic nerve at the level of the knee and the sural nerve arises below the knee; these are not blocked in addition to the sciatic, obturator and femoral nerves.

 4. FTTFT

This is an intensive care category question. The consequences of freshwater and seawater drowning differ, with a higher mortality after freshwater drowning. In freshwater drowning ingestion and absorption of large volumes of water can cause hyponatraemia. Hypotension and metabolic acidosis are secondary effects due to loss of fluid from the vascular space. In the lungs, pulmonary oedema occurs with freshwater drowning due to reduced osmolarity of the intravascular fluid, ARDS follows. Intrapulmonary shunting is not a specific complication of near-drowning.

 5. FTFTF

This is an internal medicine category question. Interpretation of chest X-rays and knowing differential medical diagnoses associated with specific features is important. Bilateral hilar lymphadenopathy is common in lymphomas such as Hodgkin’s Disease and in inflammatory diseases such as sarcoidosis as well as in lung carcinoma. Pulmonary tuberculosis commonly causes apical lesions and although bilateral hilar lymphadenopathy can be found, it is not a specific feature of the disease. Erythema multiforme is an immune condition of the skin and SLE a multi-system autoimmune disease; bilateral hilar lymphadenopathy is not a specific feature of either condition.