Breast, Soft Tissue, Advanced Wound and Superficial Surgical Pathology — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style breast, soft tissue, advanced wound and superficial surgical pathology viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 52-year-old female with locally advanced breast cancer (Stage IIIb) following neoadjuvant anthracycline- and taxane-based chemotherapy is scheduled for modified radical mastectomy and level III axillary lymph node dissection. She reports exertional dyspnoea and fatigue. On examination, blood pressure is 130/80 mmHg, heart rate is 98 beats per minute regular, SpO₂ is 96% on room air, and haemoglobin is 9.0 g/dL. Outline your perioperative anaesthetic management plan including cardiotoxicity assessment, regional block techniques, and pain management.
• SCENARIO 2: A 58-year-old male with poorly controlled type 2 diabetes mellitus presents with a 4-day history of severe perineal pain, scrotal swelling, bullae, skin crepitus, and foul-smelling discharge, diagnosed as Fournier's gangrene with necrotizing fasciitis extending to the anterior abdominal wall. On admission, blood pressure is 80/45 mmHg, heart rate is 132 beats per minute, temperature is 39.4°C, respiratory rate is 32 breaths per minute, SpO₂ is 92% on room air, random blood glucose is 23.4 mmol/L, serum sodium is 127 mmol/L, potassium is 5.8 mmol/L, and arterial blood lactate is 5.2 mmol/L. Out
• SCENARIO 3: A 46-year-old male presents with a massive, rapidly enlarging soft tissue sarcoma of the proximal right anterior thigh measuring 22 x 18 cm, closely abutting the femoral neurovascular bundle, scheduled for radical compartmental resection. Preoperative haemoglobin is 10.2 g/dL, blood pressure is 120/75 mmHg, and pulse rate is 78 beats per minute. Discuss your anaesthetic evaluation, vascular access and massive transfusion preparedness, intraoperative neurovascular monitoring, and multimodal pain management strategies.
• SCENARIO 4: A 65-year-old female with long-standing type 2 diabetes mellitus, peripheral arterial disease, and chronic kidney disease (baseline creatinine 185 micromol/L, estimated GFR 28 mL/min/1.73m²) presents with wet gangrene of the right foot, spreading ascending cellulitis to the mid-calf, and septic encephalopathy. On examination, blood pressure is 95/50 mmHg, heart rate is 114 beats per minute, SpO₂ is 94% on room air, capillary blood glucose is 24.5 mmol/L, and urine output is 15 mL/hr with moderate ketonuria. Discuss your perioperative resuscitation, choice of anaesthesia (neuraxial vs. peripher