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Exam 1 Questions


Exam 1 contains 12 selected Constructed Response Questions (CRQs) balanced across the intermediate curriculum, reflecting the Final Fellowship of the Royal College of Anaesthesia (FRCA) exam. We recommend attempting these questions under exam conditions. Please limit/contain your answer to/within the dotted lines given for each question.


Question 1


You are asked to review a 23-year-old primigravida. A lower limb postpartum neurological deficit is suspected. She is 24 hours post-delivery of a 3.9kg baby. She had a forceps delivery in theatre under epidural top-up anaesthesia.



Total 20 marks


Question 2


A nurse on the intensive care unit (ICU) has asked you to review a 69-year-old man. He is currently intubated as part of the management of an episode of urosepsis. He had been improving over the last 24 hours. However, he has now become restless and agitated. He has no history of alcohol excess but smokes 20 cigarettes a day.



List the non-pharmacological (3 marks) and pharmacological (2 marks) options for treating this patient’s delirium.


Non-pharmacological


1.————————–

2.————————–

3.————————–


Pharmacological


1.————————–

2.————————–


Total 20 marks


Question 3


A 79-year-old man requires transurethral resection of prostate (TURP) for benign prostatic hyperplasia. He has a history of chronic obstructive pulmonary disease (COPD) and angina.



What features of established TURP syndrome may be apparent? (4 marks)












CNS


(2 marks)

1.————————–

2.————————–


CVS


(2 marks)

1.————————–

2.————————–



Total 20 marks


Question 4


A 75-year-old man with type 2 diabetes presents to day surgery for elective inguinal hernia repair. He takes metformin and gliclazide daily, and Lantus 80u at night. He also takes enalapril for hypertension and has a glyceryl trinitrate (GTN) spray that he uses a few times per week.



Please answer Yes or No next and give one reason to support your answer.



F. List 2 pros and 2 cons of a spinal anaesthetic for this type of patient? (2 marks)


Pros


1.————————–

2.————————–


Cons


1.————————–

2.————————–


G. How would you manage his diabetes in the preoperative period? Give specific advice regarding medication (4 marks)


1.————————–

2.————————–

3.————————–

4.————————–


Total 20 marks


Question 5


A 37-year-old female presents to the emergency department with sudden onset of headache. Computed tomography (CT) head indicates subarachnoid haemorrhage (SAH). You are asked to review the patient and on examination find their eyes closed, moaning and groaning, and withdrawing from pain. There is no obvious motor deficit. Pupils are equal and reactive.



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Total 20 marks


Question 6


You are allocated to deliver anaesthesia for electroconvulsive therapy (ECT). The list is located in the psychiatry unit.



Total 20 marks


Question 7


A 76-year-old lady presents to the preoperative assessment clinic prior to a right total hip replacement. The nursing staff are concerned regarding her frailty.



Total 20 marks


Question 8


A 64-year-old man has refractory left ventricular failure following a myocardial infarction. The next step in his management is to insert an intra-aortic balloon pump (IABP).



Total 20 marks


Question 9


A 26-year-old lady breaks her ankle dancing in a nightclub. She has open reduction and internal fixation of fibula the following day which proceeds uneventfully.


At review 16 weeks later, she reports persisting severe pain in the ankle. The orthopaedic surgeon queries complex regional pain syndrome (CRPS) and refers her to the pain clinic.



Total 20 marks


Question 10


A 2-month-old baby is listed for pyloromyotomy. He was born at term gestation by spontaneous vaginal delivery. He has no other significant medical history.



Total 20 marks


Question 11


A 74-year-old female patient requires open reduction and internal fixation (ORIF) for fractured shaft of humerus. She takes morphine for arthritis and you decide to perform a brachial plexus block.



Total 20 marks


Question 12


A 32-year-old woman requires temporomandibular joint (TMJ) arthrocentesis under general anaesthesia. She has no other significant medical history.



What factors would influence whether the nasal FOI was undertaken with the patient awake or under general anaesthesia? (6 marks)















Factors

Awake FOI


(3 marks)

1.————————–

2.————————–

3.————————–


Asleep FOI


(3 marks)

1.————————–

2.————————–

3.————————–




Total 20 marks


Exam 1 Answers


Many of the following questions contain more answers than there are marks allocated. This redundancy is intentional and is to ensure that a spread of possible answers by the candidate are recognized. 1 mark is awarded per correct point up to the maximum specified in each subsection.


Question 1


You are asked to review a 23-year-old primigravida. A lower limb postpartum neurological deficit is suspected. She is 24 hours post-delivery of a 3.9kg baby. She had a forceps delivery in theatre under epidural top-up anaesthesia.



Note: Do not accept anaesthesia-related features (e.g. regional anaesthesia) as the question asks for obstetrics. Also, anaesthesia-related nerve injuries are less common.



B. Define the following terms with respect to nerve injury (3 marks)


















Nerve injury Definition
Neuropraxia (1 mark) Temporary and physiological interruption of conduction without loss of axonal continuity
Axonotmesis (1 mark) Loss of the relative continuity of the axon and its covering of myelin, but preservation of the connective tissue framework of the nerve
Neurotmesis (1 mark) Total severance or disruption of the entire nerve fibre with no distal nerve conduction

(3)


C. Describe the clinical features of the following nerve palsies (12 marks)


























Nerve affected

Common mechanism of injury


(4 marks)


Sensory and motor deficits


(8 marks)

Lateral cutaneous nerve of thigh 1. Compression with thigh flexion as it passes under the inguinal ligament, worsened by the pregnant abdomen

1. Sensory—anterolateral thigh


2. Motor—nil

Obturator nerve 2. Compression by the foetal head during descent or during forceps delivery

3. Sensory—inner thigh


4. Motor—weakness of hip adduction (crossing legs)

Common peroneal nerve 3. Compression at neck of fibula such as by stirrups in lithotomy position

5. Sensory—lateral lower leg and dorsum of foot


6. Motor—foot drop

Femoral nerve 4. Compression against inguinal canal during forceps or caesarean

7. Sensory—anterior thigh, absent knee jerk


8. Motor—weakness of knee extension/difficulty climbing stairs

Aug 27, 2021 | Posted by in ANESTHESIA | Comments Off on 1
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