Live viva exam demo for the ANZCA part 1 exam - Pat v2

Mar 31, 2021

In this lively discussion, Pat dives into the intricate workings of heparin and its low-molecular-weight counterpart, explaining the reasons for their differing monitoring needs. The conversation shifts to the role of potassium in cellular function and the significance of Nernst potentials, against a backdrop of hyperkalaemia's ECG changes. As the discussion broadens, Pat compares the placenta to the lung, uncovering their unique gas exchange mechanisms. Listeners gain insights on managing CO2 differences during anaesthesia and tips for acing clinical vivas.

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INSIGHT

ECG Evolution In Hyperkalaemia

Hyperkalaemia produces peaked T waves, shortened QT, prolonged PR, progressive QRS widening and can progress to sine-wave and ventricular arrest.
These ECG changes reflect impaired depolarisation and conduction as extracellular K+ rises.

ADVICE

Act Fast For Severe Hyperkalaemia

Treat hyperkalaemia by recognizing it hypopolarizes cells and slows action potentials, affecting conduction.
Act promptly to stabilise membrane potential and reduce serum potassium to prevent fatal arrhythmia.

INSIGHT

Placenta Is A Multifunctional Organ

The placenta exchanges gases, nutrients and wastes, secretes pregnancy hormones, and modulates maternal–fetal immunology.
It therefore functions as an organ of transport, metabolism, endocrine activity and immune interaction.

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Time for round 2 with Pat are very generous trainee who's offered to be quizzed on our podcast.

Here are the questions from this round:

Stem 5

1. How does heparin work?

2. How about low molecular weight heparin?

3. Why do we monitor unfractionated heparin but not low molecular weight heparin?
Due to lower binding to plasma proteins and to cell surfaces, the plasma anti Xa activity generated by a given dose of LMWH is more predictable than for UH.

4. How do we monitor unfractionated heparin’s effect?

5. How is the clearance of unfractionated heparin different to that of low molecular weight heparin?

Stem 6

1. What are the main differences between intracellular and extracellular ion concentrations?

2. What is the function of potassium?

3. What is the NERST potential?

4. What are the ECG changes in hyperkalaemia?

5. What is the treatment for hyperkalaemia?

Stem 7

1. What are the functions of the placenta?

2. How is the placenta different to the lung?

3. How are substances transferred across the placenta?

4. What are the factors that affect transfer of O2 across the placenta?

5. What are the factors that affect placental blood flow?

Stem 8

1. During anaesthesia, you notice a difference between the End Tidal CO2 and Arterial CO2. What can you do to minimise this difference?

2. How do you measure physiological dead space?

3. How do you measure anatomical dead space?

4. What increases anatomical dead space?

5. What is closing capacity?

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Disclaimer:

The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.

This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.

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