medical vivas

met roy after work (i was postcall)

STEMI
unilateral white out: differentials- previous pneumonectomy, hemothorax, collapse
bilateral pneumothorax

pleural effusion -transudative or exudative, light's criteria

Practice ACLS algorhythms

Time Is Of Essence.

'This CXR shows lung metastases as evidenced by bilateral cannonball lesions'

anaesthesia for renal transplant

Anaesthesia for renal transplant
1) comorbidities,
2) medications: immunosuppressants, anti-hypertensives
3) ESRF and underlying cause of it
-should have dialysis in 24 hours before op

Anaesthesia technique
GA: IPPV. (RA:caution in uraemic patients, residual heparin, concurrent liver disease)
CVP: for fluid monitoring. Aim 12-14. MAP: high normal
IA: not mandatory

TEE

Absolute contraindications:
Esophageal spasm.
Esophageal stricture.
Esophageal laceration.
Esophageal perforation.
Esophageal diverticula (e.g. Zenker's diverticulum).

Relative contraindications:
Large diaphragmatic hernia may significantly hinder TEE imaging because of lack of transducer mucosal approximation.
Atlantoaxial disease and severe generalized cervical arthritis: TEE should never be performed if there is any question about stability of cervical spine.
Patients who received extensive radiation to the mediastinum: this can cause significant difficulty in probe manipulation within the esophagus and is a relative contraindication if the anatomy of the esophagus is not known.
Upper gastrointestinal bleeding, significant dysphagia and odynophagia are also relative contraindications

Indication:
cardiac output
valve
congenital heart disease
evaluation of LA and LA appendage before cardioversion

Fat embolism

fat embolism-gurd criteria

major : (at least 1)

hypoxaemia

axillary or subconjunctival petechiae

CNS depression disproportionate to hypoxaemia

pulmonary edema

minor factors: (4 )

tachycardia >110

hyperthermia

sputum fat globules

retinal fat emboli

urinary fat

decreased platelets/haematocrit (unexplained)

increased ESR

highest risk of adverse outcome from IE

highest risk of IE:
prosthetic valve or material
previous IE
congenital HD-

• unrepaired cyanotic CHD,


• completely repaired CHD within 6 mths of procedure,


• repaired CHD with residual defects at site or adjacent to it (which prevents endothelisation), cardiac transplant recipients who develop cardiac valvulopathy

nitric oxide

-bronchodilator

-no tachyphylaxis

-synthesised in body from aspartate

-high affinity for Hb

-used therapeutically at 10-100bpm

confidential enquiries 2006-2008

International definition : maternal mortality RATIO number of direct and indirect deaths per (denominator:100000 live births)

UK: maternal mortality rate: denominator-per 100000 maternities)

overall maternal mortality rate: 11.39 (previous triennium 13.95)

Direct- mortality rate: 4.67 (previously 6.24)

• overall reduction,
• decrease in PE, hemorrhage,
• increase in deaths from sepsis esp group A strep
• causes: haemorrhage, AFE, genital tract sepsis, preclampsia and ecclampsia
• anaesthesia: 7 died

Indirect - suicide, asthma, epilepsy, cardiac disease (conditions aggravated by pregnancy)

• unchanged