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Final clinical short case 25

Created: 31/7/2009
1. A woman who has just returned from India presents for emergency laparotomy for a ruptured ectopic pregnancy. Her chest X-ray shows left apical fibrosis, mediastinal shift to the left and multiple small miliary spots on the right side.

- What are the possible causes?
- In which regions of the world is tuberculosis (TB) prevalent?
- What is the causative organism for TB?
- Discuss the concerns about TB in the UK.
- How will you proceed?
- Whom will you inform?
- How will you protect staff and other patients?
- What precautions will you take?
- Do filters in the anaesthetic machine provide protection from bacterial contamination?
- What drugs are used to in treat TB?

2. A patient presents with latex allergy:

- What symptoms/signs would lead you to suspect latex allergy?
- How would you diagnose it?
- What sort of medical history would give rise to latex allergy?
- Which food allergies might cross-react with latex?
- What percentage of patients cross-react?
- What percentage of healthcare workers are allergic to latex?
- What percentage of people have hay fever?
- What are the advantages of the radioallergosorbent (RAST) test over the pinprick test?
- How will you plan your anaesthetic management?
- What is the Latex-Free Database?
- The patient develops anaphylaxis: what are the clinical signs and symptoms?
- How will you manage it?

3. Conscious sedation:

- What is the definition?
- What are the indications?
- How is it performed?
- How should patients be monitored?
- What drugs are used?
- What target-controlled infusion levels should be used?
- What are the advantages and disadvantages of benzodiazepines?

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