March 2014

a) What are the indications for (20%) and possible contraindications to (25%) elective percutaneous tracheostomy (PCT)?

b) List the potential early (40%) and late (15%) patient complications of PCT.
Pass Rate 79.4%

This question is highly relevant to modern critical care practice, and the involvement of trainees in PCT procedures is reflected by the very high pass rate. Most marks were lost in the section on complications but in general this question was well answered. It was obvious which candidates had observed or performed a significant numbers of PCTs and which had not.
March 2014

A 71-year-old patient requires a rigid bronchoscopy for biopsy and possible laser resection of an endobronchial tumour.

a) Outline the options available to maintain anaesthesia (20%) and manage gas exchange. (30%)

b) How will use of the laser change the management of anaesthesia? (15%)

c) What are the possible complications of rigid bronchoscopy? (35%)
Pass Rate 60.8%

This question proved discriminatory between candidates who gave a mature and thoughtful answer and those that did not understand the implications of “tubeless” ENT / thoracic surgery. Weaker candidates proposed the use of laser-proof endotracheal tubes, and even double lumen endobronchial tubes and cardiac bypass to facilitate gas exchange. Part (a) tended to score scored badly whilst parts (b) and (c) were better known. Focus in part (c) was dominated by traumatic complications with candidates forgetting “anaesthetic” issues such as; laryngospasm and bronchospasm, pneumothorax / barotrauma / volutrauma from jet ventilation, cardiovascular disturbances, pulmonary infection, hypoxaemia, hypercarbia and awareness.
September 2012

A 23-year-old man is brought to the Emergency Department following an assault in a nightclub. He appears to have suffered significant mid-face fractures and is uncooperative with staff. You are asked to accompany him to the CT scanner.

a) Outline the immediate management plan for this patient. (25%)

b) List the options for securing the airway in this case and any advantage or disadvantage of the methods. (25%)

c) What problems should be anticipated before securing the airway? (50%)
Question 8: Facial trauma management of the airway.

51.3% pass rate.

Answers to this question were generally appropriate. It should be noted that “securing the airway” using a laryngeal mask airway as a primary technique was not part of the model answer. Perhaps a rapid sequence induction would be “plan A” rather than an inhalational induction to achieve the definitive airway.
September 2012

a) Which factors are most likely to lead to an adverse airway event when using a supraglottic airway device (SAD)? (30%)

b) How would you recognise that a patient has regurgitated and aspirated gastric contents during an anaesthetic administered via a SAD? (30%)

c) How would you manage this patient? (40%)
Question12: NAP4 audit/supraglottic aiways/diagnosis and management of aspiration. 78.4% pass rate.

Generally well answered. There was significant variation in the knowledge detailed in the NAP4 relating to the safe use of supraglottic airways.
The diagnosis and management of aspiration was of appropriate standard.
March 2012

You have been called urgently to attend a ventilated patient on the ICU who has become acutely agitated, hypertensive and profoundly hypoxic. A percutaneous tracheostomy was performed 18 hours ago and is being weaned from ventilatory support.

a) List possible causes for this patient’s acute hypoxia. (25%)

b) What clinical features support an airway problem? (40%)

c) How would you manage an airway problem in this patient? (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2011

a) Which nerves supply sensation to: i) the nasal air passages (10%) ii) the oropharynx (10%) iii) the
larynx? (10%)

b) Outline the techniques for achieving local anaesthesia of these areas? (15%)

c) What are the indications (15%) and contraindications (15%) for awake fibreoptic intubation?

d) List the complications of awake fibreoptic intubation. (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2011

a) What airway, respiratory and cardiovascular problems may follow the removal of a tracheal tube? (50%)

b) List the patient and surgical factors that may contribute to a high-risk extubation. (30%)

c) Outline the strategies used to prevent airway complications if a difficult extubation is anticipated in the operating theatre (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2011

A 30-year-old man attempted suicide by jumping from a building. He sustained severe trauma including major facial injuries.

a) What are the potential airway management problems? (25%)

b) List five possible options for securing the airway in this patient. (25%)

c) Outline the potential disadvantages for each of these options? (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2011

a) What are the diagnostic (25%) and therapeutic (25%) indications for bronchoscopy?

b) List the major contraindications for bronchoscopy. (20%)

c) How should a fibreoptic bronchoscope be reprocessed after use? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

You have been called to attend a patient in ICU urgently because he has become agitated, hypertensive and acutely hypoxic. The patient is suffering from Guillian BarreĢ syndrome and has a tracheostomy. He is being maintained on 30% oxygen, 8cm H20 CPAP. The percutaneous tracheostomy was performed 18 hours ago without complication.

a) List possible causes for his acute hypoxia. (20%)

b) Describe your immediate assessment. (45%)

c) How would you manage an airway problem in this patient? (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

List the bedside tests available to predict a difficult intubation. Comment on their usefulness.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2003

Discuss the risks and benefits associated with intermittent positive pressure ventilation through a laryngeal mask airway.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

How would you recognise that a patient has regurgitated during an anaesthetic administered using a laryngeal mask airway? How would you manage the problem?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question