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Primary Viva 2 (Clinical)

Created: 14/9/2004


 A 26-year-old male attends an accident and emergency department with a compound fracture of the left tibia. The orthopaedic team want to take him to the operating theatre. His girlfriend says that he is hepatitis B positive.


1. Would you take him for surgery?
2. Why is there a need for an urgent operation?
3. What is the significance of saying he is hepatitis B positive?
4. List the types of hepatitis
5. What other non-hepatitis group viruses could cause jaundice?
6. How is hepatitis transmitted?
7. What risks are involved when anaesthetising a patient with hepatitis B?
8. What risks would he pose to staff?
9. How can you avoid risks – what precautions would you take?
10. What are the universal precautions that should be taken?
11. How would you resuscitate the patient? Would blood loss have occurred?
12. What investigations would you ask for?
13. What anaesthetic technique would you use?
14. What monitors would you use?

 Critical incident: postoperatively, the nurse says that he has breathing difficulty and he is cyanosed.


1. What would you do?
2. What are the various causes of cyanosis?
3. How is cyanosis diagnosed?
4. How would you diagnose and differentiate between opiate overdose and non-reversal of neuromuscular blockade?
5. What would you look for on the nerve stimulator in this patient?
6. How would you treat the various causes of cyanosis?


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