3

Exam 3 Questions


Exam 3 contains 12 selected Constructed Response Questions (CRQs) balanced across the intermediate curriculum, reflecting the Final Fellowship of the Royal College of Anaesthetists (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 56-year-old man attends for trans-sphenoid resection of hypophyseal tumour. He has a long history of headaches and blurred vision. The diagnosis is of benign pituitary adenoma and he has clinical features of acromegaly.



A. What pathophysiology causes acromegaly? (1 mark)


————————


————————


————————



B. Which other hormones are secreted from the pituitary gland? (2 marks)














Location in pituitary Hormones secreted
Anterior lobe (1 mark) 1.———————

2.———————

3.———————

4.———————

Posterior lobe (1 mark) 1.———————

2.———————


C. What are the patient-specific features of acromegaly which are relevant to anaesthesia? (4 marks)



D. What are the special considerations within the anaesthetic management of this patient for trans-sphenoidal hypophysectomy that you would consider in your preoperative assessment? (5 marks)


————————


————————


————————



E. The surgeon asks you to facilitate a bloodless field. What can you do to help? (2 marks)


————————


————————


————————



F. You plan to awaken and extubate the patient immediately at the end of the procedure. What homeostatic variables must be achieved to facilitate this? (3 marks)


————————


————————


————————



G. You plan to place the patient in high dependency unit (HDU) postoperatively. What specific management should be instituted for this patient as an adjunct to standard HDU care? (3 marks)


————————


————————


————————



Total 20 marks


Question 2


A 39-year-old female is listed for deep inferior epigastric perforator (DIEP) breast reconstruction. Her only medical history is breast cancer.



Total 20 marks


Question 3


A 67-year-old man is scheduled for laryngoscopy and biopsy for suspected carcinoma. The surgeon has requested a tubeless field so you have therefore decided to use total intravenous anaesthesia (TIVA).



Total 20 marks


Question 4


You and your consultant are about to perform brainstem death testing on a 64-year-old woman in the intensive care unit (ICU).



Outline your cardiovascular targets for this patient to maximize donor potential (3 marks)














Heart rate range (bpm) (1 mark)  
Mean arterial pressure range (mmHg) (1 mark)  
CVP range (mmHg) (1 mark)  



Total 20 marks


Question 5


A 32-year-old woman attends for pelvic laparoscopy. She weighs 70kg and her body mass index (BMI) is 35. Her medical history is severe reflux. She had generalized muscular ache following administration of suxamethonium during a previous anaesthetic. Her medication is omeprazole 20mg bd and the oral contraceptive pill. You decide to use rocuronium to facilitate intubation.



Process 1



Process 2



Total 20 marks


Question 6


A company representative attends your department one lunchtime to showcase their new ultrasound machine.



Total 20 marks


Question 7


A 59-year-old woman has presented with gradual onset leg weakness and now has difficulty walking. She is normally fit and well but had a self-limiting episode of gastroenteritis 3 weeks ago. She takes no regular medication.



Total 20 marks


Question 8


You receive a trauma call to the ED. A 22-year old man was the driver of a car involved in a high-speed road traffic collision. He has multiple injuries.





Total 20 marks


Question 9


You are to anaesthetise a 78-year-old woman for an elective right total hip replacement. She weighs 51kg and has a past medical history including stable angina, hypertension, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease. You plan a spinal anaesthetic with a target-controlled infusion of propofol (TCI) for deep sedation.



Total 20 marks


Question 10


A 32-year-old woman, Para 2 + 0 is having a caesarean section under spinal anaesthesia.


The baby and placenta have been delivered successfully but there is ongoing bleeding of approximately 800mls so far.



Total 20 marks


Question 11


A 6-year-old girl requires elective tonsillectomy. She has no significant medical history.


















Gas induction (4 marks) Rapid sequence IV induction (4 marks)
Advantages 1. 1.———————

2.———————

Disadvantages 1.———————

2.———————

3.———————

1.———————

2.———————


Total 20 marks


Question 12


A 74-year-old female requires laparoscopic cholecystectomy. She has no past medical history. Preoperative assessment reveals she is a current long-term smoker. You suspect she should be diagnosed with COPD.



A. Name 3 of the clinical features of COPD? (3 marks)



B. You request pulmonary function tests (PFTs) to assess severity. What features on PFTs are characteristic of COPD? (2 marks)



C. The PFTs indicate severe COPD. What other investigations should be considered in a patient with severe COPD and why? (4 marks)



















Investigation Reason for Investigation

———————
  ———————
  ———————
  ———————

Note: Need to have correct test and reasoning to get each full mark.


D. You decide to refer the patient for a respiratory opinion before surgery. List 6 possible treatment modalities that are considered for optimization of this patient? (6 marks)



E. The patient is optimized and listed for theatre. The airway pressure is high during laparoscopy and the patient is difficult to ventilate.



F. Briefly describe 2 ways in which PEEPi can be recognized on a ventilator (2 marks)



G. What strategies can be used to reduce airway pressures in this patient, assuming a patent airway and normal equipment function? (3 marks)




Exam 3 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 56-year-old man attends for trans-sphenoid resection of hypophyseal tumour. He has a long history of headaches and blurred vision. The diagnosis is of benign pituitary adenoma and he has clinical features of acromegaly.



A. What pathophysiology causes acromegaly? (1 mark)



(1)


Note: if the disorder occurs before the growth plates have fused, as in childhood, it is called gigantism.


B. Which other hormones are secreted from the pituitary gland? (2 marks)





(2)


C. What are the patient specific features of acromegaly which are relevant to anaesthesia? (4 marks)



(4)


D. What are the special considerations within the anaesthetic management of this patient for trans-sphenoidal hypophysectomy that you would consider in your preoperative assessment? (5 marks)



(5)


E. The surgeon asks you to facilitate a bloodless field. What can you do to help? (2 marks)


Aug 27, 2021 | Posted by in ANESTHESIA | Comments Off on 3
Premium Wordpress Themes by UFO Themes