top of page

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)

bottom of page