5

Exam 5 Questions


Exam 5 contains 12 selected Constructed Response Questions (CRQs) balanced across the intermediate curriculum, reflecting the Final Examination of the Diploma of 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 69-year-old man presents following an episode of amaurosis fugax. His investigations have identified an 80% stenosis of his left carotid artery. You see him in the preoperative period.



Total 20 marks


Question 2


A 74-year-old woman presents to the emergency department with a 24-hour history of severe abdominal pain and signs of septic shock. She has a history of transient ischaemic attack. Her drug history is clopidogrel. Erect chest X-ray shows a pneumoperitoneum. The surgeons request anaesthetic review pending urgent laparotomy.
















System Goals

Cardiovascular


(2 marks)

1.———————

2.———————


Respiratory


(3 marks)

1.———————

2.———————

3.———————


Total 20 marks


Question 3


A 79-year-old life-long smoker attends for preoperative assessment, prior to right pneumonectomy.



Total marks 20


Question 4



Total 20 marks


Question 5


A 39-year-old man is scheduled for the excision of a medulloblastoma from his posterior cranial fossa.


He is to be in the sitting position for his surgery.



Total 20 marks


Question 6


A 49-year-old woman requires elective total thyroidectomy. She has a history of hyperthyroidism and Graves’ disease. Her drug history includes carbimazole and propranolol.
















Clinical sign (2 marks) Examination findings (2 marks)
———————— ————————
———————— ————————

Total 20 marks


Question 7


A 6-year-old child presents with a dental abscess requiring surgery. She suffers from Down’s syndrome. She has mild developmental delay and cannot cooperate with preoperative assessment.



Total 20 marks


Question 8


A 29-year-old woman is ventilated in intensive care unit (ICU). She was admitted 48 hours ago with community acquired pneumonia. She has a history of anorexia nervosa and depression. She weighs 46kg.



Total 20 marks


Question 9


A 61-year-old unknown male is admitted to the intensive care unit with deteriorating conscious level. He is intubated and ventilated. The neurology team have recommended further investigation with an MRI scan of the head.



Total 20 marks


Question 10


A 9-year-old child requires anaesthesia for appendicectomy. He has been vomiting and you plan a rapid sequence induction.



Total 20 marks


Question 11


You are asked to urgently assess a 2-year-old boy in the emergency department who has stridor of acute onset over 2–3 hours. He is sitting upright with suprasternal and subcostal recession. He has no medical history.



Total 20 marks


Question 12


A 76-year-old lady presents with an infected hip replacement. She is scheduled for a revision hip replacement. You intend to use cell salvage as part of your perioperative management.



Reproduced from SAQs for the Final FRCA, Shorthouse J et al., Figure 3. Copyright Oxford University Press, 2011. Reproduced with permission of the Licensor through PLSclear.





















  Name Description
R (2 marks)  
α angle (2 marks)  
MA (2 marks)  

Total 20 marks


Exam 5 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 69-year-old man presents following an episode of amaurosis fugax. His investigations have identified an 80% stenosis of his left carotid artery. You see him in the preoperative period.



A. What is the optimal medical management of this clinical picture? (4 marks)



(4)


B. Following a multidisciplinary team discussion, he is to have a left carotid endarterectomy.


List the advantages and disadvantages of regional anaesthesia for this operation (6 marks)




(6)


C. You are going to perform deep and superficial cervical plexus blocks as part of your anaesthetic management.


Outline the relevant anatomy and relations of the cervical plexus for the blocks (2 marks)



Note: The first cervical root is primarily motor and not of major concern for regional anaesthesia. It is the anterior rami of C2–C4 that are important.


————————


————————


————————



Reproduced from SAQs for the Final FRCA, Shorthouse J et al., Figure 10. Copyright Oxford University Press, 2011. Reproduced with permission of the Licensor through PLSclear.


D. You intend to perform a deep cervical plexus block. The patient has given full informed consent for the procedure. You have established intravenous access, full AAGBI monitoring, and have a trained assistant. The patient is awake and you use an aseptic technique.


Describe how you would position the patient and identify points for injection (4 marks)


Aug 27, 2021 | Posted by in ANESTHESIA | Comments Off on 5
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