Endocrine Surgery (Thyroid, Parathyroid and Adrenal Glands) — WACS Viva & Clinical Scenarios (General Surgery)

Exam-style endocrine surgery (thyroid, parathyroid and adrenal glands) viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 46-year-old female presents with a 15-year history of a massive anterior neck swelling. She reports orthopnoea and stridor when lying supine. Computed tomography of the neck and chest reveals a retrosternal goitre extending to the aortic arch with 60% tracheal lumen narrowing. Discuss your preoperative airway assessment, intubation strategy, and perioperative management for total thyroidectomy.
• SCENARIO 2: A 35-year-old female with Graves' disease is scheduled for subtotal thyroidectomy. Despite taking carbimazole and propranolol, her resting heart rate is 112 beats per minute, fine hand tremors are present, and she is anxious. How will you evaluate her degree of control, prepare her acutely if surgery is non-deferrable, and manage the risk of intraoperative thyroid storm?
• SCENARIO 3: A 40-year-old male with paroxysmal hypertension, headaches, and palpitations is diagnosed with a 6 cm right adrenal phaeochromocytoma. Describe your criteria for adequate preoperative medical optimization (Roizen criteria) and your intraoperative anaesthetic plan during tumour handling and immediately following ligation of the adrenal vein.
• SCENARIO 4: A 50-year-old female with end-stage renal disease on maintenance haemodialysis presents with severe tertiary hyperparathyroidism and bone pain. Serum calcium is 2.9 mmol/L, phosphate is 2.1 mmol/L, and PTH is markedly elevated. Outline your anaesthetic plan for total parathyroidectomy and auto-transplantation, with special attention to perioperative electrolyte shifts and vocal cord monitoring.