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Final clinical short case 1

Created: 7/4/2004

1. Discuss infantile pyloric stenosis:

– What is the age distribution/sex distribution/population group most commonly affected?
– What is the pathology?
– What are the signs and symptoms?
– How would you assess a 10 week old child with pyloric stenosis?
– How would you assess the degree of dehydration?
– What are the biochemical abnormalities?
– At what stage would you be prepared to proceed with the anaesthetic?
– How would you anaesthetise the child?
– How would you ventilate the child intraoperatively (mode, rate etc)?
– How would you provide analgesia?
– what postoperative problems might you encounter?

2. You are presented with an intravenous drug abuser:

– What are the problems you might encounter?
– What precautions would you take?
– What would you do in the case of a needle stick injury?
– What measures would you take if blood spills onto the floor and the anaesthetic machine?
– How would you anaesthetise a patient who has injected himself in the femoral artery and is scheduled to have a debridement of his leg?
– What would be your choice of anaesthetic, and what problems might you encounter?
– How would you manage postoperative analgesia if the patient is a heroin addict?

3. A patient who is a known epileptic, taking phenytoin, presents for abscess drainage in his abdomen. You are shown his ECG (2:1 block).

– Is the ECG normal? If not, what is the problem? How is the action potential affected?
– How does phenytoin cause this problem? What does it do to the action potential?
– What investigations would you perform? (measure phenytoin levels/electrolytes)
– Would you anaesthetise the patient?
– What would you do if it were an emergency?
– What problems might you encounter, and what precautions would you take?


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