Fellowship - obs

Question 1

Discuss how pregnancy influences your perioperative management of a patient at 25 weeks gestation scheduled for laparoscopic appendicectomy

Question 2

Describe the indications for referral for an antenatal anaesthetic assessment.

Question 3

Describe the innervation relevant to the stages of labour (30%). Evaluate the regional analgesia options for each stage (70%).

Question 4

Evaluate the options for managing a confirmed postdural puncture headache in an obstetric patient (78.6%)

Question 5

While performing an epidural for labour analgesia in an otherwise healthyprimigravida during the first stage of labour you inadvertently cause a dural punctur ewith the Tuohy needle. Discuss your management of this complication.

Question 6

A healthy 28-year-old primigravida is scheduled for elective lower segment caesarean section for breech presentation at 39 weeks gestation. You have performed a spinal anaesthetic using 0.5% bupivacaine 2.2 ml and fentanyl 15 μg (total volume 2.5 ml). a. Describe the issues in assessing adequacy of the block for the planned surgery (50%) b. Describe the options for managing an inadequate block recognised prior to commencement of surgery (50%)

Question 7

Discuss the implications of anticoagulation as well as an appropriate anticoagulant management strategy for a 25-year-old with a mechanical aortic valve for the duration of pregnancy, delivery and the postpartum period

Question 8

“A 30-year-old woman who is 28 weeks pregnant has been referred to your tertiary high-risk obstetric clinic. She has complex cyanotic heart disease and now functions with a Fontan circulation. How would you stratify her cardiovascular risk? (30%)
What are the relevant anaesthetic issues for this patient? (70%) “

Question 9

“A 25 year old woman who is 30 weeks pregnant has been referred to your tertiary high risk obstetric clinic.She has complex cyanotic congenital heart disease and now functions with a Fontan circulation.a) How would you stratify the cardiovascular risk? (30%)
b) What are the issues relevant to anaesthetic care that will need to be managed for this patient? (70%)”

Question 10

A 25 year old woman at 28 weeks gestation, with a body mass index (BMI) of 45 attends the high risk obstetric clinic. Outline the pathophysiology of morbid obesity affecting pregnancy and describe the implications for obstetric anaesthetic care.

Question 11

“You have been asked to provide anaesthesia for a lower uterine segment caesarean section (LUSCS) in a woman at 38 weeks gestation. She has a pacemaker-defibrillator implanted for a known cardiomyopathy. Her current echocardiogram demonstrates an ejection
fraction of 35% with mild to moderate left ventricular global hypokinesis. Clinically, the patient feels very well. 1. What additional preparations with respect to her cardiovascular system would you make to ensure the safe management of this patient during her Caesarean Section? 2. Outline the relative benefits and risks of a regional technique compared with general anaesthesia in this patient.”

Question 12

A 26 year old woman with subclinical myotonic dystrophy presents to the high risk obstetric clinic. She is 25 weeks pregnant in her first pregnancy and otherwise well. She hopes for a normal vaginal delivery. Describe and justify your recommendations for the management of her analgesia for labour and the perioperative management of any potential operative delivery.

Question 13

You are asked to review a 32-year-old G1P1 woman complaining of right leg weakness the day after an instrumental vaginal birth of a 4.2 kg baby under epidural analgesia. Describe your assessment of the patient and managmenet of the likely differential diagnoses

Question 14

“A 22-year-old primigravida at 31 weeks gestation is admitted to hospital with a diagnosis of severe pre-eclampsia. Her blood pressure is 180/115 mmHg.
Describe the symptoms and signs she may have due to her pre-eclampsia. (50%) Outline the appropriate immediate management of this patient. (50%)”

Question 15

A 24-year-old woman requires urgent manual removal of placenta due to ongoing bleeding following a vaginal delivery (estimated blood loss 1500ml). Outline your initial management prior to her arrival in theatre. (50%) Discuss the options available for managing persistent uterine atony in theatre. (50%)

Question 16

“A 30-year-old woman at full term collapses in early labour and is unresponsive. List the most likely causes of her collapse. (30%) A presumptive diagnosis of amniotic fluid embolism is made.
Describe the immediate and ongoing management of this patient. (70%)”

Question 17

A 24-year-old with a breech presentation at 35 weeks gestation has severe preeclampsia and requires delivery by lower segment caesarean section. You witness her having a short self- limiting generalised seizure in the delivery suite. Outline the key points of her management prior to theatre. (50%) Describe the changes you would make to your usual general anaesthetic technique for her lower segment caesarean section. (50%)

Question 18

A 30-year-old female at term requires a general anaesthetic for lower uterine segment caesarean section for significant antepartum haemorrhage. Discuss how significant antepartum haemorrhage affects your perioperative management.

Question 19

You are called to see a 30-year-old woman who has collapsed 2 hours post normal vaginal delivery. What is the differential diagnosis? (30%) Outline the clinical features and investigations that would support a diagnosis of postpartum haemorrhage. (70%)

Question 20

“You are asked to assess a 35-year-old woman on labour ward. She has uncontrolled hypertension at 34 weeks’ gestation. Her blood pressure is 180/110 mmHg and urinalysis shows 3+ of protein.Her obstetrician wants to deliver her by caesarean section as soon
as feasible.Outline your management to optimise her status prior to transfer to theatre.”

Question 21

(a) How would you clinically assess a patient complaining of leg numbness the day after a spinal anaesthetic for an emergency caesarean section? (70%)(b) How would you manage the situation? (30%)

Question 22

How and why is cardiopulmonary resuscitation modified for the pregnant patient at term compared with the non-pregnant patient?

Question 23

You see a 28-year-old woman at the pre-admission clinic who is 32 weeks pregnant. She weighs 150kg and has gestational diabetes. She is hoping to have a normal vaginal delivery at term. What are the issues you would discuss with her during the appointment? (50%) What would you recommend for her management when she goes in to labour? (50%)

Question 24

Outline the features and clinical management of amniotic fluid embolism.

Question 25

A 25yo primigravida patient presents to the delivery suite at 38 weeks gestation complaining of a headache and difficulty with her vision. Her BP is 180/115 and she has clonus. CTG monitoring shows no indications of foetal distress. Outline your initial management of her pre-eclampsia

Question 26

34yo woman presents at 36 weeks gestation with an anterior placenta previa and a caesarean section is scheduled. She has no intercurrent health problems. She has a history of two caesarean sections under regional anaesthesia. Describe and justify the changes this history would make to your pre-operative and intra-operative plan for CS.

Question 27

"You are asked to provide epidural pain relief for a woman in labour. She is having primigravida, and is 3cm dilated. Describe and justify both you choice of drugs for and the mode of administration of epidural analgesia in this situation."

Question 28

While performing an epidural for labour analgesia in an otherwise healthy primigravida in first stage you inadvertently cause a dural puncture with the Touhy needle. Describe and justify your management of this complication.

Question 29

Discuss the elements you consider important when obtaining consent for epidural analgesia in labor.

Question 30

Discuss the contra-indications to spinal anaesthesia for caesarean section.

Question 31

A 28 yo woman with a past history of two caesarian sections is at 34 weeks gestation with placenta praevia demonstrated by ultrasound. She is Jehovah's witness and will not accept blood products under any circumstances. She requires casesarian section. Do you consider regional anaesthesia a reasonable first option in this case? Give reasons.

Question 32

"A primiparous patient in active labour at 3 cm dilatation requests epidural analgesia. Examination reveals she has a temperature of 39.5 degrees. 7. What impact does this fever have on your decision to provide epidural analgesia? 8. Which complications would you discuss with this patient when obtaining consent for an epidural? Include your estimates of the incidence of these complications. 9. An epidural is placed. Two days later she complains of back pain, urinary incontinence and a weak sensation in her right leg. How would you manage this problem?"

Question 33

"After 10 hours labour, a healthy 28 yo primiparous woman at term requests epidural analgesia. Her cervix is 8cm dilated. 7. Discuss the assertion that ""a combined spinal epidural technique is a better choice of analgesia for this woman"". 8. She reaches full dilatation and delivers before any block is performed. Following delivery she has a retained placenta. Justify your choice of anaesthetic technique for manual removal of placenta. 9. Describe the symptoms, natural history and causes of ""transient neurological symptoms (TNS)"" following spinal anaesthesia."

Question 34

"You are asked to provide pain relief for a woman in labour. She is a primigravida, has twins and is 5cm dilated. 4. You provide epidural analgesia. Describe and give reasons for your choice and method of delivery of drug(s). 5. The patient is now ready for vaginal delivery, but perineal analgesia is inadequate. Discuss the method you would recommend to remedy this. 6. Indicate elements you consider important when obtaining consent for epidural analgesia in labour."

Question 35

"A 31 yo primigravida at 36 weeks gestation presents with a blood pressure of 170/110 mmHg, proteinuria, persistent headache and hyperreflexia. She requires delivery by caesarian section within 3 hours. 1. How would you manage her blood pressure in the time before surgery? 2. Justify your choice of anaesthesia for caesarian section. 3. If she had an uneventful general anaesthetic, but started convulsing in the recovery ward two hours post-operatively, how would you manage this?"

Question 36

"A 34 yo woman requires repeat lower section caesarean section. Last time she had a Caesarean section her post operative course was complicated by dural puncture headache (following dural puncture with a 16G needle), as well as a deep venous thrombosis. She won't have general anaesthesia. 13. How would you minimise the problem of post dural puncture headache on this occasion. 14. Describe and justify the regional anaesthesia technique you would choose for this woman. 15. Describe and justify your prophylaxis against deep venous thrombosis for her. (begin your answer by stating in just a word or two the regional anaesthesia technique you have chosen)."

Question 37

Describe the mechanism of action of tranexamic acid and evaluate its use in obstetric anaesthesia practice.

Question 38

A parturient on labour ward requests an epidural. On arrival the midwife informs you that the patient has a temperature of 38.1°C. Discuss the implications of a temperature in this patient and the impact on your decision regarding regional anaesthesia in this patient

Question 39

Discuss the anaesthesia and analgesia planning considerations for a G1P0 pregnant patient with a body mass index of 60 kg/m2 who is referred for antenatal anaesthesia assessment

Question 40

A 24 year old woman presents at term with limited antenatal care. She requires an emergency caesarean section due to an antepartum haemorrhage from a previously undiagnosed placenta praevia. A) Outline your initial management prior to her arrival in theatre (50%) B) Perioperative transfusion strategy (50%)