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Final clinical short case 13

Created: 29/6/2005
1. A 50-year-old male presents for an open cholecystectomy. He is a known epileptic.
- What are the anaesthetic problems?
- Describe the classifications of epilepsy.
- What drugs are used in the management of the various forms of epilepsy?
- What are the side-effects associated with these drugs?
- What are the implications of anaesthetic drugs for this patient?
- How would you anaesthetise an epileptic patient?

2. You are shown an ECG; read this systematically.
The diagnosis in this case is of inferior lateral myocardial infarction
(MI) (how would you calculate the axis?). The patient in question is a 55-year-old male who had an MI 4 years ago. He did not have any chest pain at that time.
- What drugs is the patient likely to be on?
- How would you assess this patient?
- What are the symptoms of congestive cardiac failure?
- Differentiate between right heart / left heart symptoms
- Discuss beta blockade.

3. A 50-year-old woman presents 4 weeks after receiving an epidural steroid injection for chronic back pain. She is now experiencing severe back pain and perineal numbness.
- How would you proceed?
- What are the likely causes of her discomfort?
- What are the markers of infection?
- What further investigations would you carry out?

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