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Primary Viva 11 (Clinical)

Created: 7/9/2004


1. An 80-year-old man presents with intestinal obstruction for an emergency laparotomy. He has not passed urine for eight hours, he is slightly breathless while sitting up in bed, his blood pressure is 100/60 mmHg and his radial pulse is irregular.
– What might be of particular concern regarding his condition, and what further information would you need to know?
– How would you assess him on the ward?
– Demonstrate how you would perform a capillary refill test. Explain what constitutes a positive test.
– Why might the patient not have been passing urine?
– How would you rate his blood pressure? What is the likeliest cause for this?
– How would you manage the patient’s fluid status?
– If the patient’s radial pulse rate is 90 bpm and apical pulse rate is 120 bpm, what would you do? If the apical rate now drops to 110 bpm, how would you respond?
– What dose of digoxin would you administer?
– Once the patient is in the operating theatre, how would you anaesthetise him?  

2. A man is undergoing a laparoscopy. During the procedure, you notice that his airway pressures have been gradually rising and are now very high.

– What would you do?
– What are the likely causes for this increase in pressure?

3. How is temperature measured?

– Name the different sites in the body where it is measured, and discuss the advantages and disadvantages of these different sites.
– In the operating theatre, when would a patient’s temperature be measured?

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