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Anaesthesia Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for a Medical Residency in Anaesthesia can require a breadth of knowledge and attributes. Here, we present 10 specific questions and answer suitable for candidates to a Anaesthesia Medical Residency in the US. These focus in on specialty knowledge. Further questions can be found in our Medical Residency Interview Question Bank

Knowledge of the Career

Why are you interested in anaesthesiology?

I have found anaesthesiology to be one of the most intellectually demanding specialties during medical school, but that it can also be very fast paced. A resident in my third year told me that much of anaesthesiology consists of doing very little – perhaps reading a textbook or chatting to the surgeon – but when you need to act, you need to know exactly what to do, be able to lead, and be able to act under intense pressure. The fact that the field combines this in-depth knowledge and heavy intellectual workload with such a knowledge of critical care medicine stands out to me – the idea of following a branch of Medicine in which I don’t truly feel that I could help an acutely ill patient does not appeal to me; equally I wish to become a true specialist, and be able to continue to learn in detail as my career progresses. Being able to deal with different cases, rather than be hyper-focused on one area – as might be the case for an orthopaedic surgeon, for example – is also hugely appealing, and I believe will allow me to retain something of a general medical knowledge whilst becoming an expert in my field.

Are there particular subspecialties that you are interested in?

I’m particularly interested in Critical Care Medicine. Being able to diagnose and treat patients with critical injury or illness – notably trauma victims – would be as immensely rewarding as it is undoubtedly challenging. Additionally, being able to coordinate the care of these patients – working with primary care physicians, other healthcare professionals in critical care, and other relevant specialists within the hospital, would allow me to lead, understand the case in its full complexity, and develop relationships across different fields of Medicine.

What do you know about the length of fellowships and total training time for anaesthesiology?

A residency is four years at a minimum, of which three years must be spent in clinical anaesthesia. One year of training must be the clinical base year, which will consist of 12 months of broad clinical education (typically the first year as a graduate). After the four year period, one can take a fellowship (subspecialty training) to specialise within anaesthesia. This is a one year fellowship – for example, one might take a fellowship in Cardiothoracic Anaesthesiology, which would be 8 months of adult cardiothoracic anaesthesiology, then one month dedicated to transesophageal echocardiography, a month in cardiothoracic intensive care unit, and two months of elective rotations.

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Anaesthetic Agents and Procedures

What is the mechanism of propofol?

The mechanism of action of propofol is not well understood. It is thought to be related to GABA-mediated chloride channels in the brain – it may work through decreasing dissociation of GABA from GABA receptors, thus potentiating its  inhibitory effects. This would keep the channel activated for longer, resulting in an increase in chloride conductance, which causes hyperpolarization. This in turn will make it more difficult for an action potential to fire successfully. 

What are the doses of propofol for induction and maintenance?

The induction dose for a 0.5% or 1% injection is 1.5-2.5mg/kg, to be administered at a rate of 20-40 mg every 10 seconds until response. For those over 55, it is 1-1.5 mg/kg, administered at a rate of 20 mg every 10 seconds. For maintenance, the usual dose is 4–12 mg/kg/hour, or 25-50 mg by slow IV injection. For the elderly, the dose is 3–6 mg/kg/hour, or 25–50 mg by slow IV injection. 

What is the mechanism of action of IV ketamine? What about IV barbiturates?

Ketamine depresses excitatory synaptic transmission through acting on NMDA glutamate receptors. Barbiturates enhance GABA (gamma-aminobutyric acid) mediated inhibition, depress glutamate mediated excitation, and hyperpolarize the membrane by increasing potassium conductance. Both types of IV anaesthetic agents thus depress brain activity.

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Acute Care & Deterioration

What is the algorithm for a difficult airway?

Begin with intubation with a planned blade
– If this fails, consider calling for backup support and limit the number of attempts
– To optimize the success of the second attempt at intubation, ventilate the patient to replenish the oxygen reserve.
– Ventilation is with a face mask, +/- oral airway
– If this fails, a supraglottic airway device should be used to attempt ventilation.

If initial intubation fails, but a face mask or SGA ventilation is successful, then the non-emergency pathway is as follows:
– Wake the patient and postpone OR intubate while ventilation is adequate
– Optimise airway management approach if intubation is to be attempted again
– With plan optimised, re-attempt intubation
– Limit the number of attempts once again

If this pathway is inadequate, or initial management failed, follow the emergency pathway:

– Immediately call for help
– Prepare for invasive access
– Continue to attempt intubation with further optimisation
– Be cognizant of the time that has elapsed
– Move on to emergency invasive airway as quickly as possible.

How is acute anaphylaxis managed?

A simple approach to the treatment of acute anaphylaxis is as follows:
– Assess airway, breathing, and circulation
– Give IM epinephrine 0.01mg/kg up to a maximum of 0.5mg. Repeat every 5-15 minutes if / as needed.
– Call for immediate transfer to the hospital if in primary care
– If breathing is not impaired, lie the patient flat and raise their legs
– Provide oxygen and IV fluids
– Supportive therapy may include inhaled beta2-agonists, antihistamines, vasopressors, and corticosteroids.
– If there is no improvement, initiate IV epinephrine 
The approach to management includes supportive treatment (fluids, nutrition, analgesia, antipyretics), treatment of the causative agent, and treatment of complications. All cases are treated as bacterial until proven otherwise – investigations must be conducted before optimal management can be decided, including lumbar puncture. Initial empirical therapy for children is IV ceftriaxone, with IV dexamethasone indicated in some situations (e.g. frankly purulent CSF).

How would you manage hyperkalemia?

Treatment focuses on preventing the further accumulation of potassium – which will involve stopping IV fluids with potassium, medications which could increase potassium, and supplements with potassium; stabilising the cardiac membrane, which will involve administer 10mls of 10% solution of calcium gluconate (if ECG changes are present); shifting potassium into cells, which can be performed using insulin-glucose infusion or salbutamol; removing potassium from the body if needed using calcium resonium. Of course, one should seek to correct the underlying cause.

What medications would you use to treat intraoperative hypotension?

Ephedrine or phenylephrine are first-line for the treatment of intraoperative hypotension during general anaesthesia. Ephedrine is an indirect alpha and beta-adrenergic agonist; phenylephrine is a direct sympathetic system alpha-agonist. Both drugs are equally effective in the management of spinal anaesthesia-induced hypotension, although phenylephrine is the first choice in obstetrics. Ephedrine increases the heart rate, whilst phenylephrine decreases it, meaning that ephedrine is better to maintain cardiac output.

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