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Exam 2 Questions



Exam 2 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


A 23-year-old man is admitted to a surgical high dependency unit (HDU). He has a history of Crohn’s disease. He presents with gastrointestinal obstruction. His drug history is regular sulphasalazine and a recent course of prednisolone 40mg daily. He weighs 50kg. He is to have 24 hours of conservative management prior to laparotomy. You attend the ward to assess him preoperatively.



Total 20 marks


Question 2


You are called to the emergency department for a stand-by call for a collapsed 13-month-old child.



Total 20 marks


Question 3



Total 20 marks


Question 4


A 21-year-old man is listed for dental extractions (UR8, LR8, UL8, LL8) as a day case. His only medical history is von Willebrand’s disease (vWD) type 1, associated with easy bruising.



Total 20 marks


Question 5



Total 20 marks


Question 6


A 73-year-old man presents with a gangrenous left foot and requires an urgent below-knee amputation. He is known to have peripheral vascular disease, previous CVA, COPD, and stable angina. His current medication includes clopidogrel, ramipril, simvastatin, isosorbide mononitrate. He also takes zomorph 30mg b.d. with sevredol 5mg for breakthrough pain and regular paracetamol for ischaemic limb pain.
















Nerve (2 marks) Motor response (2 marks)
   
   

Total 20 marks


Question 7


A 68-year-old man is known to have aortic stenosis.



Total 20 marks


Question 8


A 59-year-old man is scheduled for an elective lumbar discectomy. At the preassessment clinic the nurse is concerned he may have obstructive sleep apnoea (OSA)



Total 20 marks


Question 9


A 90-year-old woman with a fractured neck of femur is scheduled for operative fixation with a dynamic hip screw. She weighs 45kg. She has atrial fibrillation (AF) and takes digoxin 125µg, warfarin 5mg, and furosemide 20mg daily. Her blood pressure is 150/90mmHg and heart rate is 80 beats per minute.



Total 20 marks


Question 10


In the preassessment clinic, a 62-year-old patient requires hysterectomy for endometrial cancer. She has hypertension, depression, back pain, and fibromyalgia. Her body mass index (BMI) is 45.


She takes lisinopril, sertraline, co-codamol (30/500) 8 tablets per day, oxycodone 40mg b.d., and shortec 10mg for breakthrough pain, which she usually requires twice per day. The gynaecologists do not wish to postpone her operation.



Total 20 marks


Question 11


You have been called to the emergency department to review a 24-year-old man with a significant traumatic brain injury, following an assault. He has no other injuries.



Total 20 marks


Question 12


You are asked to see a 24-year-old woman on the postnatal ward who is 36 hours following a spontaneous vaginal delivery. She had an epidural in labour. She is now complaining of severe headache. You suspect a postdural puncture headache (PDPH).



Total 20 marks


Exam 2 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


A 23-year-old man is admitted to surgical HDU. He has a history of Crohn’s disease. He presents with gastrointestinal obstruction. His drug history is regular sulphasalazine and a recent course of prednisolone 40mg daily. He weighs 50kg. He is to have 24 hours of conservative management prior to laparotomy. You attend the ward to assess him preoperatively.



A. Briefly outline how you will assess his fluid balance (4 marks)



Note: Need at least 2 per category for 1 mark


(4)


B. What factors may contribute to this patient’s fluid deficit? (4 marks)



(4)


C. You determine he needs fluid prior to theatre due to his recent losses. List the 4 categories of fluid replacement to be considered (2 marks)



(2)


D. What are the guiding principles of fluids required for resuscitation and maintenance? (4 marks)



(2)



(2)


E. Calculate the volume of maintenance fluid this patient needs in 24 hours? (1 mark)



(1)


F. Prescribe maintenance fluid for him for the first 24 hours (1 mark)



(1)


G. Define the anion gap (2 marks)


Aug 27, 2021 | Posted by in ANESTHESIA | Comments Off on 2
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