EDAIC PREVIOUS EXAMS from colleagues

collected by (AHMED BADR)

Control of respiration.

Ankle block.

Blood transfusion (preservatives, massive, indications and complications).

Local anesthetics (types, mode of action and toxicity).

Anti-coagulants (oral, heparin and LMWH).

Vaporizers

Physiological changes associated with pregnancy . . . anesthesia for C.S. with

bronchial asthma . . . suppose this patient under GA desaturates, what’s your
management?

Management of Head trauma.

Patient with Mitral stenosis is scheduled for DHS, management.

Management of patient with myasthenia gravis for laparoscopic surgery.

Complex regional pain syndrome

Statistics (forgot the question)

Porphyrias

Femoral nerve anatomy.

Appendectomy in cardiac transplant patient.

Hypoxia

Hypothyroidism

Laparoscopic surgery in cardiac patient

Airway fire

Fluid management in burns

Oxygen cascade

Obstetric physiology

Post-operative nausea and vomiting

Physiologic shunt

Brachial plexus blocks

Ideal anesthetic gas

DC shock

Trigeminal block
 Modes of ventilation
 Myasthenia gravis in preeclampsia
 Morbid obese ( awake intubation)
 Blunt chest trauma
 Colloid
 x ray >>> cvp to inf vena cava
 Diabetes, preoperative assessment,

 Heart failure
 Pulse oximetry or Capnogragh
 Receptors (agonists / antagonists)
 Septic shock
 Prolonged QT syndrome
 Pain assessment
 ARDS
 Spirometry
 Lung compliance
Ventricular pressure-volume loops
Tamponade, Tension pneumothorax
Anaesthesia of recent MI for TURP

Station I

Alveolar-Arterial O2 difference : (causes that increase, what happens during

induction of anesthesia and alveolar gas equation)

Drugs: =Amiodarone = Adenosine = Clonidine

= Atrial natruretic peptide

Anaphylactoid reactions

Nerves of the femoral triangle

Station II
 2 Induction agents: pharmacology, pharmacodynamics and
pharmacokinetics

Body response to hypovolemia and estimation of blood loss in Pediatrics.

Compare sevoflurane with TIVA

Non-respiratory functions of the lungs.

Station III

A 4-year old child was involved in RTA presented to ER awake then his
consciousness deteriorated (GCS 4/15). What is your management.

Cerebral blood flow and brain protection.

Tension pneumothorax

Treatment of pulmonary edema

Treatment of hyperkalemia

Anesthetic Management of vaginal delivery for placenta previa patient.

Station IV:

A 58 y old male patient with known DM and CABG done 2 years ago
presented with lower limb weakness, perineal numbness due to acute L4-5 disc
prolapse . . .anesthetic management.

WPW syndrome (diagnosis and treatment)

Pancreatic cancer pain relief

Non-invasive ventilation
 Post-spinal surgery complications.

Stockholm exam

Important to know by heart

( CVS and Respiratory physiology – general pharmacology – ARDS and

Septic shock in ICU- all anesthesia drugs (IV, inhalational, MR, LA)

Drawings and graphs

All blocks.

ECG : be systematic (confirm patient ID, calibration, axis)

X-ray: be systematic, “pulmonary artery cath with pneumothorax on the same

side”

Parkinsonism.

Brachial plexus blocks.

Prolonged QT syndrome

How to calculate loading and maintenance doses.

Drug receptors.

Ideal muscle relaxant.

O2 dissociation curve . . . compare to CO2 dissociation curve.

Bier’s block.

Capnography

Clark’s electrode.

Anesthetic gas monitoring.

Osmolality.

Starling forces and edema formation.

Glucose homeostasis.

Blood flow to the liver.

Volume of distribution.

T1/2 and elimination.

History taking.

Arterial wave form.

Pulse oximeter.

Anesthesia for renal transplantation.

TURP syndrome.

Hyperkalemia.

PIH.
 Morbid obesity.

OSA.

Case: patient with bronchial asthma who presents with acute neurological
deficit requiring surgery. He is on 3 drugs for asthma (he doesn’t remember the
names) . . . “they went into PFT and Pressure volume loops”

Case: 30 y old female admitted to ICU following 2 days of fever, cough and
no response to penicillin. Ex: lower left lung fields show bronchial breathing.

*Remember : goal directed therapy . . .

1) you can admit critically ill patient to ICU for a few hours preoperatively to
improve condition and optimize tissue O2 delivery 2) in treatment of patients with
septic shock

Zurich 2014

Effects of gas exchange on pressure-volume loop of the chest? ? and discuss

oxygenation.

Ankle block

Magnesium

Amiodarone

Classification of anti-arrhythmic drugs

Choose a drug of induction and show changes in concentration after

induction.

Context-sensitive half life

 Plasma expanders

Near drowning

Physiological changes after bleeding

Anesthesia for eye surgery

Anesthesia for non-cardiac surgery in a cardiac patient

Rheumatoid

PLUS: X-ray and ECG

ISTANBUL 2014

Day I

Session I:

Head Q: What do you understand by “respiratory insufficiency”. Which pulmonary

function tests would help in assessment ? How does anesthesia affect respiratory
functions?

During discussion the following questions were asked:

Pulmonary function tests and how to tell obstructive vs restrictive

(clinical…blood… then spirometry and so on ….).

O2 cascade, alveolar gas equation and shunt equation, O2 content, DO2, ….

The other 12.5 minutes:

Blood supply to the brain: the circle of Willis, Draw, explain why it’s a circle then
went into CEA and how to avoid brain ischemia (monitoring, the use of shunt, . . .
) which type of anesthesia . . . stellate ganglion block . . . its complications . . .
complications of Local Anesthetics.

Physiological changes in pregnancy and how you manage a young lady with
advanced pregnancy who collapses inside hospital.

Anticoagulants and precautions with blocks

A patient underwent 60% hepatectomy: what is the investigation you would do

immediately postop and what are the likely electrolyte disturbance? What about his
renal function?

Session II:

Draw a diagram representing drug concentration of a short acting induction agent.

Show half time marks. What’s clearance, volume of distribution and how can you
use this knowledge in drug infusion of anesthetics.

Context sensitive half life.

Factors affecting MAC and how to speed induction.

Metabolism of muscle relaxants.

The other 12.5 min

Visceral pain(define, criteria, . . )

ECG : wide complex tachycardia (can you calculate axis?)

Session III:
A 66 y old male patient, smoker for 20 year (30 pack/ year) and stopped 3 years
ago, underwent radical cystectomy for cancer bladder. The procedure was lengthy
because of adhesions. The patient was shifted to ICU postoperativel where he was
extubated successfully but then developed dyspnea.

Discussion of the case involved assessment, investigations and causes of his

dyspnea.

Which anesthetics you can/can’t use in surgery for cancer. (recent studies showed
that patients with cancer anesthetized with GA+ regional technique had less
recurrence than when opiods were used)

X-ray: left-sided diaphragmatic hernia.

A patient undergoing laparoscopic fundoplication develops intraoperative hypoxia

(diagnosis and management)

Management of status asthmaticus.

Session IV:

A 35 Y old, 34 week pregnant female with repeated attacks of severe headache

undergoes a brain CT which shows a big frontal meningioma leading to increased
ICP and midline shift. Her blood pressure is 170/110.

During case discussion I was asked the following (what’s your plan, what is
causing her hypertension, how would you manage her hypertension and how to
prevent acute increases in ICP with intubation)

TEF (tracheoesophageal fistula): management and suppose fistula is at carina what

will you do?
Polythiacemia rubra vera: define, is there any bleeding tendency and what are the
measures to prevent peri-operative venous thrombosis and PE.

Anesthetic management of patient with untreated hypertension.

ICP (intracranial pressure): monitoring, normal value and how to decrease,

neuraxial with increased ICP?

DAY II:

Station I:

Pulmonary function tests.

Stellate ganglion block(anatomy, indications and complications)

Hypo- and hypercalcemia (causes, treatment and ECG changes)

Station II:

Measurements that can be obtained from pulmonary artery catheter

Anti-coagulants (peri-operative management)

Perioperative use of B-blockers.

Perioperative oral hypoglycemic.

Diuretics (perioperatively).

Station III

A 27 y old male patient was found unconscious in a closed space during a burn
accident. There were burns to his face with soot around mouth. (Discussion went
through management of inhalational burn, complications and anesthesia for such
patients.)

Pulmonary embolism (management)

X-ray: intubated patient with fracture rib and pneumothorax and lung contusion on
the right side.

Station IV

65 y old male patient, 179 cm height and 105 kg weight, was operated for right
hemicolectomy was admitted to ICU 5 weeks post-op for heart failure and sepsis.
During his stay he developed bed sores and he’s scheduled for grafting of the bed
sores. (discussion went into causes for this, how to evaluate preoperatively and
investigations needed then anesthetic management of such patient)

Phantom limb pain.

Multiple sclerosis

Airway assessment for a patient with goiter and hypothyroidism

ECG: 1st degree heart block with septal infarction.

Compare ropivacaine to bupivacaine.

EDAIC Vienna 2014(1ST DAY):

Physiology:
-Difference in systemic PaCO2 and PaO2 in normal and supine one lung
ventilation, explanation with curves..

- pulmonary functions

- differences between pediatrics and adults with stress on the airway anatomy
and physiology.

Pharmacolgy:
- a stat dose of 200 mg of propofol given to a 70 kg patient.
How to estimate plasma concentration and What you will need to know to do
that.
-Single and multi compartment models.
Difference between propofol and thiopental.

-toxic effects of inhalational anesthetics

-drugs acting on the uterus

Case:
--63 years old with cancer colon and received chemotherapy but stopped 6
months ago due to cardiac and renal toxicity, coming for liver resection due to
single metastasis , splenic injury intra operative but manged to save the spleen.
Nurse calling you in the recovery for low urine output..

--options for anesthesia in old age coming for cataract, advantages and
disadvantages of each option.

--intra operative bradycardia and hypotension in a patient with a pacemaker..

-chest X ray of rt lower lobe collapse

Case:
-asthmatic patient on 3 (unknown)medications for emergency lumbar vertebral
decompression with acute lower limb paralysis.
How would you proceed.

-How to assess pain. Pain scales, effects of pain on the postoperative period.

-ECG of Heart block.

-prolonged QT syndrome. Causes, complications and management.

EDIAC Vienna (second day) 2014

How to calculate the loading dose of propofol

What is the factors affecting drug distribution
Ionization and solubility
pKa, pH, Hassel pack equation
Local anaesthetics: mechanism of action, chemical formula, factors affects
potency and solubility
Compare between ropivacaine and bubivacaine
Pulmonary function test: normal, obstructive, restrictive, changes under
anaesthesia
Pulmonary shunt, V/Q mismatch, lung zones
Ca homeostasis and role of it in the body and haemodialysis in CRF patients
with coagulopathy
Case 1: case of CABG complicated with bleeding and shifted to the ICU,
management, complications (they like to hear MI in the differential diagnosis
of any oliguria)
CXR: ICU patient with lung opacity (note the tubes like ICT, ECG, ETT,
CVP)
Case 2: case with history of stable angina, HTN and for aortic aneurysm repair
(pre-intra –post)
Acute pancreatitis, VF (torsade de point)
NB: cardiac physiology and assessment manly asked in the clinical

London 2014

Pharmacokinetics of opoids.
Contex sensitive half life.
Pharmacokinetics of propofol and comparison to thiopentone
Anatomy of brachial plexus
Comparison of aortic and femoral pulse wave. In which pressure is higher?
Comparison of O2 and CO2 dissociation curve and causes of shifting.
Transport of CO2.
Bohr effect.
Haldane effect.
Post tonsillectomy bleeding.
65 yrs old pt transferred to ICU after successful distal esophagectomy he was
stable and extubated. In the 1st po day he became tachypnic tachycardiac and
feverish: your management.
CXR: patient with cardiomegamly, pleural effusion, intubated and
pacemaker in place.
60 yr pt with obstructed inguinal hernia he had inferior MI 2 months ago and
pacemaker one week ago: your management.
Scaral nerve block.

Types of pacemaker and intraoperative management.

Cerebral autoregulation curve.

Factors affecting speed of inhalation induction.

Patient had splenectomy surgery with intra operative bleeding and transfused
and got stable with large fluid support . He was admitted to intensive care post
operative ..In 1st 12 Hrs ..exposed to Anurea / Oliguria .then sudden onset
tachycardia......explain what to expect ....what is best 1st choice management
...you need to do urgently.

CO2& O2 dissociation curve.

ETCo2 curve.

Propofol & thiopental.

Glucose metabolism.

Osmolality & osmorality.

Upper limb blocks.

Opioids: routes, pharmacokinetics.

Brain circulation

Autoregulation.

Plum function tests.

Central & peripheral arterial pressure curve.
Patient post lower oesophageal op, hypotension, tachypnea, tachycardia,
oliguria.

Management of septic shock.

Managment of atrial fibrillation,

Anesthesia for emergency CS & difficult airway managment,

Types of LMA,

Anesthesia for post tonsillectomy bleeding 10yo.

CXR W pacemaker, ETT, cardiomegaly.

Patient with abd pain, nausia & vomiting, history of inferior MI 2month ago &
pacemaker insertion, with incarcerated inguainal hernia... Anesth managment,
(pacemaker letters, anticoagulant, post op complications, post op tachypnea,)

Lower limb blocks.

LA toxicity.

Inherited disease associated with problems in anesthesia.

ECG: bradycardia, junctional rhythm, LVH.

Second part EDAIC Porto 2015 exam

1. oxygen delivery and consumption and factors affecting it .

2.stellate ganglion block and local anesthetic toxicity
3.physiological implications of acute and chronic renal failure
4.factors affecting partial pressure of inhalational anesthetic at induction
choose 2 induction agents including nitrous
5.biers block
6.chemical burn to the face and chest
7.end stage chronic renal failure coming for av fistula ... your anesthetic
management
8.aortic stenosis aetiology symptoms signs and anesthetic managment
9. 4 year old with strabismus concerns
10.physiological implication of an adult losing 1liter of blood and your
management .....
Good luck to you all.

The second day at Porto, 2015:

Station 4:
Lscs with multiple sclerosis
Pulmonary hypertension
ECG : torsades de pointes
Inguinal hernia blocks
Oxygen toxicity

Station3:
TURP case with hypotension and Brady(DD & management). (They want to
hear heart block and pacing)
Cxr :ARDS
Paed anesthesia considerations
Transplant heart: anaesthetic implications
Lap.chole: drop of ETCO2, DD and Managment.

Station2:
Dose response curve and EC50
Hypoxemia
Measurement vol anes agents with explanation.
Etomidate: pharmacodynamics and kinetics.
Pain pathway, gate theory, treatment aid pain.

Station1:
Resp control: shunt equation, alveolar equation.
Diuretics mechanism of action, sites and indications.
Anatomy :cvp
Parathyroid
Hepatectomy: physiological methods to reduce blood loss

EDAIC 2 Warsaw June 2015 first day

Station 1:
-chemical regulation of respiration in details .
-Pco2 ventilation curve.
-Anemia and ventilation .
-diuretics esp thiazides and drug reactions.
-Cvp line insertion anatomy and complication for each.
-liver metabolism ,pathophysiology of hepatoectomy
Station 2:
-If you are recommending A new I v induction agent produced to the market
what are its criteria.
- Volume of distribution.
-Therapeutic index.
-Pulse wave ,peripheral pulsation effect of aortic stenosis and anesthesia of
such patient.
-Pulse oximeter in details.
-Hormonal Function of kidney in details.
-Pain pathway,and opioid receptors in details.

station 3:
-67 years COPD
Smoking for 30 years
quit before 3 hears posted for nephrectomy in lateral position, causes of post
op. dysnea( Mr ' high level epidu)
-NM monitoring .
-Estimation of anaesthetic level.
-X ray: ETT CVP line , Pace maker.
- Complications of different anaesthetic positions in details.
-Invasive BP monitoring.
-Stress response.

#station 4:
-Cirrhotic pt for bowel resection.
-Spinal for CA .
-Blue patient in the recovery room in stridor.
-Delayed recovery in hepatic patient.
 -Again NM monitoring.
-ECG: RBBB , MI ,Rt side strain pattern.
-Epidural anesthesia in details.
-Post op pain management in hepatic patient.

EDAIC part 2 Paris July 2015 2nd day

Station1:
-Co2 transport- capnography- rebreathing-dead space(anatomical and
physiological).
-Blood investigations for bleeding patient.
-Draw thromboelastogram (every thing about the apparatus).
-INR - Anticoagulants -Vitamin K.
-Anatomy of the Inguinal canal .
-Abdominal wall blocks .

Station2:
-SEVO:
-Draw its structure, what is its boiling point,mention all physical properties .
-SVP-Blood gas coefficient .
-Propofol - Bupivacaine -opioids .
-Cardiac potential- draw diagram showing deferences between cardiac and skeletal
action potential
Station3:
(5 days after trauma, post laparotomy, on mechanical ventilation:
Fever, reduced UOP ):
-What are the features of ARDS .
-Full discussion about sepsis.
-Antibiotics commonly used in such cases and different cases .
-Most common organisms , gram -ve , Vancomycin complications.
-During appendicetomy : disappearance of ETCO2 trace.
-CXR: (B/L pulmonary infiltrates ??)

Station4:
-ERSD Pt for A-V fistula:
-Problems of this Pt preparation .
-Which anaesthesia can be given.
-Pt refused LA what can you do?.
-Discuss GA for Renal Pt ( induction agents , RSI for renal Pt, induction dose
immediately after dialysis and 2 days after dialysis )
-Aortic stenosis for Knee surgery .
-Needle brick injury .
-Anesthesia for awake intubation .
-ECG unclear ( Lt axis deviation ?,ischemic changes?).

EDAIC part 2 Istanbul-Turkey Nov-2015:

Physiology:
How partial pressure influence oxygenation,Oxygen cascade,ODC , Ficks
principle, Arterial Oxyen content , Mixed venous oxygen content and it's
importance, ADH secretion and control , K- regulations ,Osmolality and
calculation.
Pharmacology:

Ideal IV drug, pharmacokinetics, Halothane vs propofol,compartment model,

CSHT ,Bolus vs Infusion,PONV mangement each drug adverse reactions
Anatomy:Tracheo-bronchial tree, DLT, Optholmic blocks
ICU: Post laparotomy multiorgan failure -DD, SEPSIS/PE
Clinical: DM patient for Femoro-popliteal bypass , ICD , HIV patient ,ECG-
Atrial Flutter. Xray - AICD with sternal wire ?transplanted heart .

EDAIC part 2 Athens 1st day

Hypoxemia causes general question and later discuss respiratory physiology in

details.
What factors affect drug response in different payients? It is an open question
for general pharmacology in-depth?
Prostaglandins
ADH ,motor end plate. ACh receptors, rhabdomyolsis - malignant hayper
thermia?
Clinical scenario of a case lap choly. Differential diagnosis of elvated peak
airway pressure,the need pneumothorax in details diagnosis and management.
2nd case truama child 6 year gcs 4 your management,discussion elevated ICP
management ,diagnosis of brain stem death.
 Physics laser ,oxygen analyzer paramagnetic analyzer?
Pharma alpha blockers
Anatomy of brachial plexus.
Chest x rays lung collapse mediastainal shift.N.B. the 2 days are the same x
Ray. ECG 1st day atrial flutter 2nd day ,AF
Post operative hypertension at recovery d.d, and management
The last case pneumonectomy 72 years old for squamous cell carcinoma,
smoker AF ? Investigations management ,double lumen discussion.

EDAIC 2015 Athens

-physiological changes when ventilating healthy anaesthized lung with 12 liters

-airway nerve supply and AFOI
-glucose homeostasis
-hormones secreted by the kidney
-ideal Anaesthetic drug to be used in TIVA
-pulse oximetry
-ECG AF
CXR. Pneumothorax
-2 clinical cases one for morbid obese pt for hiatus hernia and the other for heavy
smoker for nephrectomy
With related questions related to what you say ...questions are direct straight
escalating .the faster you finish answer the more questions you get

Athens 2017 2nd day (by ahmed badr)

1st viva:
-opening question: compare between 30 years old man and 80 years old man as
regarding their anaesthesia and ventilation(they want to hear all changes of
respiration and circulation with age and effect on drugs)
-the curve of blood gas solubility co-offient without data and the want the name of
the axes and the inhalational anaesthetics and discussion about all what concern
-radial nerve anatomy(root value,course,injury,and all blocks related)
-glucose( everything: glycogenolyis gluconeogenesis glycolysis tca cycle and
HMP shunt) all in details
-central senstization of pain and then asked in periphral senstization,modulation in
details( central projections and gate theory)hyperalgesia,wind up,allodynia and
chronic pain types and managment in details.

2nd viva:
-opening question:how to calculate the dose of prpofol for infusion and what will
happen after taking a single dose of morphine( they discuss all the
pharmacokinetics in details)
-VD in adults and children
-compartmental models and CSHT
-TCA drugs have high volume of distribution...explain
-lung volumes in details and how to measure with drawing the flow volume loops
-how to measure gas flow in anaesthesia( equipment names and bobbin flowmeter
and ultrasound flowmeter in details)
-N2O talk about everything( mechanism of analgesia and neuro toxicity
-NO: what is it,uses,how it works,benfits,dose in pHTN
-erythropoietin:what do you know,uses,route,adverse effects and illegal use!! also
the discussion went to blood salvage techniques
3rd viva:
-opening case: chemical factory worker,50 years,come with burn and black face
and GCS 15/15(discuss every thing in burn,cyanide toxicity,CO poisoning and
managment of them in details)
-case of lap chole with sudden decrease in end tidal co2( DD,venous embolism in
details) with development of postoperative neurological insult( she wants to hear
paradoxical embolism from patent foramen ovale!)
-carotid endartrectomy( preoperative assesment,types of anaestheia,postoperative
complications and how to monitor cerebral function)
-patient taking oral steroids for 2 months, your concerns( she want to hear the
adverse effects and steroids cover according to the operation minor moderate or
major)
-antidepressants: types and conerns in anaesthesia
-X-ray: Rt lower lobe pneumonia mostly aspiration in ventillated patient

4th viva:
-opening case: post tonsillectomy bleeding not yet shocked( managment,shock
assessment and grades,rapid sequence induction,doses of rocuronium and
suggamadex)
-postoperative HTN: DD,treatments( asked about beta blockers with doses!!
nitroglycerin,nitroprusside all in doses and details) and she wants to hear clonidine
and asked about dose also
-ECG: (not obvious) vetricular tachycardia ( polymorphic) and she wants to hear
about torsade de points
-primigravida,inserted epidural and after 2 days complain from numbness in lower
limbs.. managment( asked about epidural hematoma incidence! and they want to
hear about nerve injures with lithotomy as the MRI seems to be normal)
-Von-willebrand disease every thing( types,preoperative assessment and
preparation,desmopressin and dose,what is the most common cardiac problem with
those patients!?)

Porto 2nd day 2017(by Khaled abozeid)

viva 1:
-main question : draw the cardiac cycle illustrating the changes in pressure in
pressure in LV ,LA and the Aorta and volume changes with relation to ECG ,CVP
waves and determine the performance of the LV from your graph. Iwas asked
about every detail in these topics up to how evaluate the cardiac performance in
echo study and frank starling law with drawing
-Ideal muscle relaxant characters,everything about neostigmine ,
glycopyyrolate(why better than atropine , sugamadex regarding chemical structure
and doses and side effects
-autonomic neuropathy went to mechanism of pain how to test for it then went to
valsalva maneuver with drawing the graph and details with every stage
- every single detail about calcium up to describing the mechanism of coupling
excitation mechanism of the muscle and its rule in coagulation
-draw the brachial plexus with different blocks at different stages with indication
-when I done before time I was asked about baroreceptors

viva 2:
-What is the different between in TIVA between manual and computerized , what
parameters do you want to know . discussion wend to Vd, clearance , context half
life (with numbers of propofol,fentanyl and thiopentone . compartmemt module
then the discussion went to draw graphs of bolus ,then bolus followed by infusion,
infusion from the start and lastly TCI . the discussion then went to the fourth
compartment (Ce)
and the difference between marshel and schnider modules of TCI
-Parathormone site of secretion, actions, and difference in action between it and
vitamin D and negative loop inhibtion
-Clotting cascade, coagulation inv. and its factors testing,draw the elastogram with
labels and normal parameters and different parameter affection ,then draw
elastogram with heparin and DIC
-effect of hypercarpia
-draw the oxygen dissociation curve
-discuss soda lime composition ,write down the reaction ,what is the function of
NAOH , diffrent compositions of baralyme and amsorb and different reactions
with different inhalational , save lels of compound A and its chemical structure

viva 3:
-60 male patient admitted to the ICU with BP 63\34 , HR 110, tachypenic with
paO2 57, paCO2 27 on oxygen mask 40% with intense vasoconstriction ,Temp.
39.2 , urinary catheter was inserted with difficulty with frank blood even after
saline wash for your management ?
discussion went to ABC protocol, Sepsis with the difference in the latest 2016 SSC
guidelines and the latest approaches in ARDS (transpulmonary pressure
measurement) N.B. (other collegues where blamed about the blood coming as DIC
, but I already escaped this point by saying early seeking advice from a urologist)
-patient 50 years old with right hemicloctomy presented with sudden onset of PVC
every fourth beat progressing to VT then VF N.B. (same start but with diferent
scenarios with other colleagues ) so no diffenate answer .Just looking for your
approach
-chest X ray with right pleural effusion chest drain CVP, Iwas asked about the
view AP or PA from radiological point of view how to asses penetration right
radiological site of CVP and how to count the intercostal spaces
-laser endoscopic surgery problems and how to avoid and type of ventilations
-discuss low flow ventilation

viva 4:
-75 years old F patient with fracture hand 170 cm/48kg for closed reduction.patient
has compensated HF on digoxin and recently on fureasamide .Bier block was done
and 10 min after the start the tourniquet was accidentally released for your
managment
many collegues started with pre .intra and post operative managent for a cardiac
patient which was accepted answer .
for me I started as a critical indecent , the examiner frowned then he was
convinced as it is a critical incident and continued
(as I said no right answer just right management) , how to do the block , drawbacks
, limitation , doses and conc.. LA toxicity with management and signs what to do
after its time . dose of digoxin conc. in blood toxic conc., signs of toxicity ECG
signs draw the signs (ST sagging he was waiting to hear) how to treat arrhythmia
(dont forget phenytoin)
digibind side effect ,dose and when to administer
-ECG with PVC inverted T in in lead V1 ,V5,V6 and LVH (dont forget to ask
about pulse before assesment to exclude PEA)
how to calculate rate ,axis determine LVH ,QT interval how to calculate normal
value and significance
-post herpatic neuralgia causes management in acute attack and the PHN , how to
decrease the incidence , how is more succiptable and managment in
immunocompromised.
 warsaw 2017 2days (by Manoj kumar)

DAY 1

Any thing from basic sciences can be asked at the first two tables so be prepared
for both station 1 and station 2 at the same time.

Station 1 :
-how is oxygen delivered to different parts of the body ? explanation in detail( O2
dissociation curve etc)
- mixed venous o2 saturation and importance
- pregnancy related changes including graphs of how physiologic variables change
( from plunkett)
- innervation of airway and awake fibre optic intubation
- compartment models diagram and variation
station2 :
- All about neuromuscular junction
- neuromuscular blockr and vecuronium in detail
- Target controlled infusions- graph from plunklett
- How would you introduce a new drug being used on a trial basis to the patient
and take consent for it.(what all things you would like to know about the drug
before talking to the patient)
Station 3 :
- Acute pancreatitis management in ICU including pain management. coeliac
plexus block.
- x ray bilateral lower and middle pulmonary infiltrates with CVP line.( possible
pneumonia)
- discussion on sepsis
Station 4 :
- Obese lady coming for hiatus hernia surgery - your management
- ECG - paced rhythm - all captured beats (is the pacemaker functioning properly
or not?)

Day 2

station 1 :
- effect of o2 and co2 on pulmonary ventilation ( pp of o2 and co2 versus minute
ventilation graph from plunkett)
- control of ventilation various factors influencing it
- Describe nerve supply of the eye - neurology behind pupillary light reflex.
- methods of heat loss during surgery- how to control
- describe buffer systems in the body and next their relative importance

stations 2 :
- Discuss concentration versus time graph after a loaing dose of propofol in detail
- reference to compartment models and how the above graph is influenced by the
models- what variables of a drug and distribution do u need to know about for
building these models
- what is time constant and its influence?
-contest sensitive half life - variability of different drugs
- define VOl. of distribution and clearance ? what factors influence these
- how are inhalational agents measured clinically? sources of error in
measurement.
- Desflurane - all details about desflurane including svp and b/g and o/g
coefficients.
- MAC definitions and factors influencing it
- spirometry restrictive and obstructive patters - variations of FEV1 and FVC and
ratios
- flow volume loops - graphs
- Rhabdomyolysis - causes, diagnosis, management and treatment of hyperkalemia

Station 3
- Explosion occured in paint store. 34 year old man came out burning bystanders
put out the fires and brought him to A and E in 20 mins. hes conscious but
confused. your management ( all about carbon mono oxide poisoning )
-burns complete management including pain relief.
- Describe how you would do RSI in this patient.
- Hyperbaric o2 therapy
- problems with pulse oximetry and sources of error
- what is a bypass machine ? where is it used
- describe Coronary artery bypass machine and draw a diagram of the circuit if u
can. ( they expect just the basics nothing in detail)
- Xray -rotated film ,intubated, possible cardiomegaly, chest infiltrates, cvp line,
pacemaker insitu

station 4
- Patient 54 year old Heavy smoker ( 54 pack years) is brought for an excision of
an left sided adrenal mass. he has had hot flushes before and also is complaining of
breathlessness since one week. management of the case.
- hypotensive agents intraop management.
- management of an in advertant needle prick injury( discussion went on to HIV
positive patient and Prophylaxis )
- ECG : T inversions in v1 to v6 ? old ischemic changes
 Istanbul 2017 (by Nahidh Almamoori)

Viva1
all about capnograph, tow clinical implication and curve changes,Increase Co2(
causes, mx,dx,)
Graph of normal and abnormal capnograph
Viva 2,,,,
Serum level after thiopentoe singl, multiple doses.
Criteria for ideal drug for infusion, CSHT, why thiopentone not an ideal for
infusion, steady state concentration,accumlation
Drugs used in epilepsy
All about ADH, secretion, uses,effect
Viva3
Pt. In paint store explosion
all about burn mx, ABCD approch, in details
sg of inhalational injury
Fluid replacment, uses of scoline why , mx of this pt. after 15 days
indication for 100% O2 in this case and in general
sg of co poising in percent
Type of fluid mx.for burn
Viva4
Pyloric stenosis, 5 wks baby with persist vomiting
Surgen want to proceds with doing surgery!
Mx in details, acid base and electrolytes , intubation, venous access, role if fluid
replacement
ECG in systematic way, this is important than dx of abnormalities
CXR systematic reading ( pleural effusion)
 Barcelona 2017 (by sarah ahmed)

1st session
# differences between inspired, alveolar &arterial O2 tesion.... causes of hypoxia
(different types)
# Heparin... mechanism of action; side effects, reversal, uses
# different mechanisms of heat loss
# Endocrinal functions of the kidney
# anatomy of coronary artery and venous drainage of the heart

2nd session
# choose 2 induction agents and discuss physical properties, pharmacokinetics,
pharmacodynamic of both
# hazards of AC

3rd session
# A 45 year old male diabetic patient with forearm abscess. ... he is unwell for the
last 2 days.... he was admitted to the ICU.... causes, diagnosis & management (
sepsis in details, ARDS )
# anesthetic management of liver resection
# X ray .... coin shadow in lt lung.... the systematic approach of reading the X ray
is very important

4th session
# 5 week old patient with pyloric stenosis. .. he is unwell. ... the surgeon wants to
operate in the emergency list... what do you think
# rheumatoid arthritis
# CRPS
# ECG. ... PVC and RVH ?!... not sure ( the systematic approach of reading the
ECG is very important. )