VIVA questions

Here are some of the questions which turned up at the VIVA section of European Diploma of Anaesthesiology. Further details about the Diploma can be found at ESA website.

Viva I. – Physiology

  1. Describe the physiological changes occurring during single lung ventilation.
  2. Discuss the peripherial pain pathways.
  3. What is the effect on muscle of hyperventilation?
  4. What nerve fibers do you recognise?
  5. How do you measure blood volume?
  6. How can you measure the blood pressure?
  7. Can you draw the pressures seen when a pulmonary artery flotation catheter is inserted?
  8. What is arterio-venous O2 difference?
  9. What are the carotid bodies and sinuses and their differences?
  10. What cardio respiratory changes occur in pregnancy?
  11. How does coronary blood flow alter during the cardiac cycle?
  12. Can you draw the cardiac action potential?
  13. What is the alveolar-arterial O2 gradient?
  14. What is the oxygen cascade?
  15. How is alveolar ventilation controlled?
  16. Can you describe respiration in the neonate?
  17. How is CO2 transported in the blood?
  18. Can you draw the oxyhaemoglobin dissociation curve?
  19. How do you measure respiratory dead space?
  20. What factors affect pulmonary vascular resistance?
  21. How does the kidney excrete H+ ion?
  22. Oxygen delivery, oxygen consumption. How could you measure them? What factors influence these?
  23. What blood products do you know? Side effects of massive blood transfusion.
  24. Describe the anatomy of fetal circulation. What is the oxygen saturation in different parts of fetal circulation?
  25. Could you draw the coagulation cascade? How could you check the extrinsic and intrinsic pathway?
  26. Describe the role of magnesium in human body.
  27. How could you measure cardiac output? Describe the sources of error in different kind of techniques.
  28. Why is a capnogram useful? Explain the phases of a capnogram and the changes during different clinical situations!

Viva II. – Pahrmacology

  1. What are the toxic effects of local anaesthetic?
  2. What factors modify minimum alveolar concentration (MAC)?
  3. What is the significance of the oil-gas partition coefficient?
  4. What are the degradation products of Sevoflurane?
  5. What is the second gas effect?
  6. Draw the inspired concentration against the alveolar concentration for a volatile anaesthetic agent.
  7. What does saturated vapour pressure say about in inhalational agent?
  8. Why alfentanil start to work so much faster than fentanyl, and why is its duration of action so much shorter?
  9. Why has fentanyl a shorter duration than morphine?
  10. What is an allergic reaction?
  11. How do you manage an allergic reaction?
  12. Discuss the anaesthetic dosage in hypothyroidism.
  13. Can you define bioavailability?
  14. Can you define volume of distribution?
  15. What indicates the presence of a true receptor?
  16. What are non-linear pharmacokinetics?
  17. What are active metabolites and which exist for morphine and pethidine?
  18. What is an agonist and antagonist?
  19. How does the liver dispose of drugs?
  20. Where else may drugs be metabolised?
  21. What second messengers do you recognise?
  22. Describe the structure of the acetylcholine receptor.
  23. How do benzodiazepines work?
  24. What are encephalins and endorphins?
  25. What are the factors that influence the uptake and distribution of volatile agents?
  26. What are the advantages and disadvantages of every one of non depolarizing muscle relaxant? What are the structure of nicotinic receptors?
  27. Describe the classification and mechanism of action of antiepileptics.
  28. What does happen after the injectin of an i.v. Induction agent? Can you draw a curve of concentration against time?

Viva III. – Clinical anaesthesia

  1. A 54 year old lady is scheduled for right mastectomy. She has a history of chest pain on exertion and shortness of breath. Cardiac catheterisation revealed multiple coronary disease, aortic stenosis with gradient of 50 mmHg not suitable for surgical treatment. Chest X-ray showed left sided pleural effusion. She is on atenolol, nifedipine, furosemide. BP: 100/65 mmHg, HR: 70/min., RR: 16/min. How would you manage the anaesthesia?
  2. 6 month old boy is presented for surgical repair of his cleft lip and palate. What are the key points of the anaesthesia?
  3. A 13 year old girl presents for correction of kyphoscoliosis. The curve is 50%. How would you manage the anaesthesia?
  4. A 34 year old lady (gravida:2, para:1) with hypertrophic cardiomyopathy presents at 36 weeks with placental abruption. She is pale and clammy and has chest discomfort. HR:130/min., BP: 120/95 mmHg. How would you manage the cesarean section?
  5. A 6 year old boy with appendicitis is difficult to intubate after suxamethonium because of jaw rigidity. What could have happened? What can be the causes?
  6. A 20 year old male patient for Day Case hernia repair has a blood pressure of 180/115 mmHg. He is very anxious and has no past medical history. What would you do?
  7. After giving 5 mg morphine, thiopenthone, atracurium and intubating the SpO2 falls despite bagging on 100% oxygen. Your assistant cannot feel a pulse. What is your first thing to do?
  8. A very anxious lady at term for elective cesarean section is a known difficult intubation. After difficulty you perform spinal anaesthetic and on assessment the level of block is below T11. What would you do?
  9. A 1.7 m tall and 160 kg woman needs surgery for excision of a bony lump on her forearm and possible tendon transfer. Would you perform general anaesthetic? What type of regional block is available in this case and how would you perform?
  10. A 32 week pregnant lady suffers subarachnoid bleed. Her Glasgow Coma Score is 12. The neurosurgeon advise emergency clipping of a middle cerebral artery aneurysm. What are the key points of your anaesthetic plan?
  11. A 12 year old boy with spina bifida presents for urethral reconstruction. He has latex allergy and is paraplegic below L1. What type of anaesthetic would you do, if any?
  12. How would you perform a local nerve block for cataract surgery? What are the possible complication of these blocks?
  13. Young pregnant lady is scheduled for emergency cesarean section for foetal distress. She needs general anaesthetic as she is not happy to have regional block. After the induction you can not intubate her. What would you do?
  14. How would you perform an intercostal block for a 40 years old patients who has suffered multiple rib fractures due to a road traffic accident?
  15. Describe a difficult intubation protocoll.
  16. What kind of pacemakers do you recognize? How are pacemakers coded?
  17. A 68 year old man with uncontrolled hypertension (180/100 mmHg, medication thiazid diuretic) and with ECG signs of left ventricular hypertrophy is waiting for scheduled abdominal aortic aneurysm surgery. Tell me the advantages of postponing the surgery!
  18. Describe what anatomical structures would you see during fibreoptic bronchoscopy!

Viva IV. – Intensive care

  1. A 25 year old man with a history of cocaine and heroin abuse is shot in the leg by his grandmother. He is “stable” in casualty and the surgeon has been unable to obtain venous access. How could you help him?
  2. You are asked to see a 23 year old man who was admitted to Intensive Care Unit 4 days ago after having had road traffic accident. He has had facial and chest abrasions, pelvic fractures, compound right tibia fracture. Laparotomy was done and splenectomy performed after his admission. Now he complains difficult breathing. Respiratory rate is 40/min., oxygen saturation 90% although is breathing 5 l/min. oxygen via face mask. His urinary output dropped down to 15 ml/h. What can be the causes? What are your differential diagnoses? How would you manage the treatment?
  3. You are asked to see a 60 year old woman in the Recovery six hours after femoral nailing for traumatic fracture. She became agitated and cyanosed. There is nothing specific on examination, CXR is unremarkable, pH:7.27, pCO2: 3.8 kPa, pO2: 6.7 kPa. What would be your diagnosis?
  4. You are called urgently to Recovery because post carotid endarterectomy patient has developed a rapidly expanding haematoma and has difficulty breathing. What are the initial steps of your treatment?
  5. A 75 year old man has had laparotomy where an inoperable tumor was found. In the Recovery he has difficult breathing. What would you do?
  6. You are asked for help with analgesia for a 23 year old black man who is having severe leg pains from a sickle cell crisis. What kind of pain relief would you offer?