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Final clinical long case 46

Created: 20/3/2013
A 67-year-old man presents for elective abdominal aortic aneurysm repair. He has hypertension and ischaemic heart disease.


Blood pressure: 160/90 mmHg
Grade 1 hypertensive changes in the eye
Full blood count: marginally high mean cell volume (MCV), otherwise normal.
K+: 3.2 mEq/L
Creatinine: 190 µmol/L
ECG: left ventricular hypertrophy; strain pattern.
Chest X-ray: cardiomegaly; scoliosis.

1. Summarise the case.
2. What are the consequences of hypertension?
3. Why might he have high creatinine and low K+?
4. Discuss the hypertensive changes in the eye.
5. Discuss the mechanism of action of enalapril.
6. What are the causes of high and low MCV?
7. Explain the ECG and chest X-ray changes.
8. What are the causes of aortic aneurysm?
9. How would you optimise the patient preoperatively?
10. How would you induce anaesthesia?
11. What problems might you encounter intraoperatively?
12. What are the consequences of cross-clamping?
13. What are the problems of cross-clamp release?

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