March 2019 (SAQs converted to CRQ format)

Question 1

 

a) List 3 of the commonest causes of end stage renal failure (ESRF) in the UK? (3 marks)

b) Name 6 complications of ESRF that are of importance to the anaesthetist? (6 marks)

c) Outline 3 acute physiological disturbances that may be seen in a patient who has just had haemodialysis? (3 marks)

d) What are the key practical consideration when providing general anaesthesia for a patient with ESRF on haemodialysis? (8 marks)

Question 2

 

You are asked to assess a 15kg 4-year-old child who is scheduled for a strabismus (squint) correction as a day case procedure

List the anaesthetic considerations of this case, with regards to:

a)  Age of the patient (4 marks)

 

b) Day case surgery (3 marks)

c) Type of surgery (4 marks)

 

d) During the operation, the patient suddenly develops a profound bradycardia. What is your immediate management of this situation? (2 marks)

e) What strategies would you employ to reduce postoperative nausea and vomiting (4 marks)

f) What strategies would you employ to reduce postoperative pain (3 marks)

Question 3

 

a) Name four airway risk factors that may indicate a difficult extubation? (4 marks)

b) Name 5 factors you can optimise prior to extubation (5 marks)

c) What strategies could you employ to manage a high risk extubation? (5 marks)

d) Outline the steps you would take to exchange an endotracheal tube to a supraglottic airway device (SAD) to aid extubation. (6 marks)

Question 4

A 28-year-old woman presents for an acute appendicectomy under GA – she is 22 weeks pregnant

a) List 5 risks to the foetus during anaesthesia (5 marks)

b) Outline 2 ways the risk to the foetus can be minimised pre-operatively (2 marks)

c) Outline 5 ways the risk to the foetus can be minimised intra-operatively (5 marks)

 

d) Outline 3 specific management decisions to do post-operatively (3 marks)

e) What additional preoperative and intraoperative steps would you take to ensure foetal safety if she is 27 weeks pregnant instead (5 marks)

Question 5

 

Refeeding syndrome

a) What is the daily energy requirement of a normal healthy 70kg man (1 mark)

b) What are the recommended daily proportions of carbohydrate, fat and protein (3 marks)

c) What is refeeding syndrome (2 marks)

d) What are the three major electrolyte abnormalities seen in refeeding syndrome (3 marks)

e) What is the commonest nutritional deficiency (1 mark)

f) Which patients are at particular risk of refeeding syndrome (6 marks)

g) How should these patients’ nutritional requirements be managed? (4 marks)

Question 6

A 77-year-old man is scheduled for laser surgery to a laryngeal tumour

a) What does the term LASER stand for (1 mark)

b) What different types of laser can be used for surgery (3 marks)

c) Name 5 ways the risk of an airway fire can be minimised (5 marks)

d) Name 6 measures you would take to protect staff when a laser is in use (6 marks)

 

e) What anaesthetic techniques can be used to allow a tubeless filed for laryngeal surgery (5 marks)

Question 7

 

a) List 6 effects of cigarette smoking on the cardiovascular system and oxygen delivery (6 marks) and outline the pathophysiological mechanism for each (6 marks)

b) Give 5 respiratory system effects of cigarette smoking, other than those you have outlined above, that are relevant to general anaesthesia (5 marks)

c) What advice would you give a smoker the day before a scheduled procedure under general anaesthesia (1 mark) and why (2 marks)

Question 8

 

a) Describe three ways a patient with dilated cardiomyopathy (DCM) could present (3 marks)
 

b) Name 3 pharmacological management options for a patient with DCM (3 marks)

c) Name 2 non-pharmacological management options for a patient with DCM (2 marks)

d) List 2 predictors of poor outcome in patients with DCM undergoing surgery (2 marks)

e) What are the haemodynamic goals when anaesthetising patients with DCM (4 marks)

f) What measures would you take to achieve these haemodynamic goals during anaesthesia (6 marks)

Question 9

 

You are called to see a patient who has had a below knee amputation 24 hours ago. Despite using a PCA pump with IV morphine he is still in pain.

 

 a) State 6 reasons why his pain control may have become inadequate (6 marks)

b) Outline 6 ways you could re-establish optimal pain control (6 marks)

c) Name 3 features that would indicate this patient is suffering from post-amputation pain syndrome (phantom limb pain) (3 marks)

d) Name 5 other pharmacological options that are available for managing post-amputation pain syndrome (5 marks)

Question 10

 

NAP6

a) List the four commonest triggers for perioperative anaphylaxis according to the RCoAs’ 6th National Audit Project (NAP 6). (4 marks)

b) What is the estimated incidence of perioperative anaphylaxis? (1 mark)

c) Outline the pathophysiological process of anaphylaxis (5 marks)

d) Describe your management of intraoperative anaphylaxis in an adult patient (8 marks)

e) What should be done after successful treatment of anaphylaxis (2 marks)

Question 11

 

Prehabiltation

a) What is prehabilitation in perioperative medicine (1 mark)

b) Name 3 outcome benefits of a prehabilitation programme? (3 marks)

 

c) Outline 6 specific issues addressed as part of medical optimisation in a prehabilitation programme (6 marks)

d) Describe how a prehabilitation exercise programme can improve a patient’s cardiorespiratory physiology (4 marks)

e) Outline 4 benefits of carbohydrate preloading and nutritional optimisation (4 marks)

f) What psychosociological supportive interventions may be used in prehabilitation (2 marks)

Question 12

 

a) What imaging modalities are recommended by NICE in acute stroke (1 mark)

b) What specific treatments can be considered for acute thrombotic ischaemic strokes (4 marks)

c) In these patients what is the potential consequence of severe hypertension (1 mark)

d) What level of hypertension (systolic and diastolic) is regarded as severe after ischaemic stroke (2 marks)?

e) A patient has had a large hemispheric infarction following a stroke. Outline your management of this patient following admission to critical care (12 marks)