March 2017

  • a)  List the implications for the patient of an inadvertent wrong-sided peripheral nerve block. (5 marks)
  • b)  Summarise the recommendations of the “Stop Before You Block’’ campaign, (4 marks) and list factors
    that have been identified as contributing to the performance of a wrong side block. (5 marks)
  • c)  Define the term “never event” (2 marks) and list four drug related never events. (4 marks)
Question 2: Wrong side block and never events
Pass rate 39.0%
This question related to an important safety initiative. Candidates did not have adequate knowledge of the factors contributing to the performance of a wrong side block such as distraction, the patient being lateral or prone or site mark being covered by blankets.
March 2016

  • a)  What are the factors associated with an increased risk of accidental awareness under general anaesthesia (AAGA)? (14 marks)
  • b)  What monitoring devices can be used to help reduce the incidence of AAGA? (2 marks)
  • c)  What are the possible consequences to the patient of an episode of AAGA? (4 marks)
Accidental awareness under general anaesthesia Pass rate 57.1% This question had the highest correlation with overall performance. Most candidates obviously had good knowledge of the recent NAP5 publication and this resulted in a relatively high pass rate.
Candidates who presented their answers in an organized way tended to score more highly than those who did not, probably reflecting their greater knowledge. Again, some candidates disadvantaged themselves by not reading the question carefully.
March 2015

a) List the factors that may have contributed to an increase in the prevalence of asthma in developed countries in the last 20 years. (5 marks) b) What are the possible causes of acute bronchospasm during general anaesthesia in a patient with mild asthma? (5 marks) c) Outline the immediate management of acute severe bronchospasm in an intubated patient during general anaesthesia. (10 marks)
Asthma Pass Rate 47.0%, 8.5% of candidates received a poor fail
The poor pass rate for this question is of concern as patients with asthma are regularly encountered in daily practice. The treatment of common co-existing medical disorders is specified in the syllabus for the CCT. In general the management of acute bronchospasm was more thoroughly answered than the aetiology and causation sections. This was reflected in a lower poor fail rate compared to other questions which is reassuring for patient safety under general anaesthesia.
March 2015

A 75 year-old man is having a transurethral resection of the prostate (TURP) under spinal anaesthesia.
  • a)  Which clinical features would make you suspect the patient has TURP syndrome? (6 marks)
  • b)  List the intraoperative factors that may increase the risk of developing TURP syndrome. (7 marks)
  • c)  How would you manage suspected TURP syndrome? (7 marks)

TURP Syndrome Pass Rate 84.5%, 4.3% of candidates received a poor fail
Overall this question was answered very well and was only a moderate discriminator between candidates. However weaker candidates did not mention CNS features and many had not read the question thoroughly and ignored the information that the patient had received neuraxial anaesthesia. Very few candidates mentioned repeated measurements of sodium and osmolality. This clinical problem is an old chestnut which all trainees should be able to manage safely and effectively.

September 2014

  • a)  What is Propofol-Related Infusion Syndrome (PRIS) and what are its clinical effects? (7 marks)
  • b)  List the risk factors for PRIS. (5 marks)
  • c)  What specific laboratory findings might be expected in a case of PRIS? (3 marks)
  • d)  How may PRIS be prevented (3 marks) and managed? (2 marks)
Pass Rate 35.8%
This question was felt to be hard to answer and was assigned a low pass mark after the Angoff process. It proved to be another very strong discriminator between candidates and was answered poorly in the main. Weak candidates had no real knowledge of the subject and did not appreciate that the cardiovascular consequences of the syndrome predominate. Many referred incorrectly to the precipitation of liver failure. Trainees undertaking a block of intensive care medicine will use propofol sedation for some patients so it is important that they understand any potential complications.
September 2013

a) What factors predispose to inadvertent intra-arterial (IA) drug injection that could lead to severe extremity injury? (35%)

b) Outline the possible intravascular mechanisms of injury. (15%)

c) What are the acute clinical features of inadvertent IA injection? (20%)

d) What is the early management of an acute IA injection injury? (30%)
71.9% pass rate.

This question was answered well and proved to be a good discriminator. The factors that predispose to intra-arterial injection were broken down to patient factors, anatomical anomalies and the appreciation that some drugs are particularly harmful when injected intra-arterially. One candidate sadly misread the question and wrote about local anaesthetic toxicity confusing the abbreviation (IA) with (LA). All abbreviations are explained before using them later in the question. This resulted in a “poor fail” for that particular question but an overall pass for the paper. It should be pointed out that a poor fail in four or more questions is likely to result in an overall fail for the paper.
March 2013

a) Define the types of unintentional awareness that may occur during general anaesthesia? (20%)

b) What factors may increase the likelihood of intraoperative awareness? (55%)

c) What monitoring techniques can be employed to reduce the risk of awareness during general anaesthesia? (25%)
79.8% pass rate.
A straightforward and topical question (National Audit Project 5) that had been widely predicted by candidates and trainers! A question on awareness has featured in 1996, 1998, 2000 and 2006 papers.
September 2012

a) List the implications for the patient of an inadvertent wrong-sided peripheral nerve block. (25%)

b) Summarise the recommendations of the “Stop Before You Block’’ campaign and list factors that
have been identified as contributing to the performance of a wrong-sided block. (45%)

c) Define the term “never event” as described by the National Patient Safety Agency and list three
never events of relevance to anaesthetic or intensive care practice. (30%)
Question 6: Wrong side block/”Never events”.

40.5% pass rate.

It is disappointing that many candidates displayed a relative unfamiliarity with the Stop Before you Block Campaign. This is an important national patient safety initiative that was introduced recently to reduce the incidence of inadvertent wrong-sided nerve blocks. Many examinees left some sections unanswered. Some candidates could not adequately define the term “never event” despite its topicality.
September 2010

a) List the anaesthetic factors that predispose to perioperative dental damage. (25%)

b) List the patient-related factors that predispose to perioperative dental damage. (25%)

c) A 22 year-old man anaesthetised by a colleague awakens following tonsillectomy and complains that an upper incisor tooth has broken off during the operation. What is your management of this situation? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2010

a) Define the term “inadvertent perioperative hypothermia”. (10%)

b) What are the physical mechanisms by which heat is lost from a patient in an operating theatre? (20%)

c) List the clinical complications of hypothermia in the perioperative period. (30%)

d) Outline the current recommendations in the UK for the prevention of perioperative hypothermia. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

a) What is anaphylaxis and how may it present? (25%)

b) List three common types of precipitant in an anaesthetic setting. (15%)

c) Describe your initial management (including relevant drug doses) in an adult patient. (25%)

d) Outline your secondary management (including relevant drug doses) after immediate resuscitation. (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

A 75 year-old man is undergoing transurethral resection of the prostate gland (TURP) under spinal anaesthesia.

a) What clinical features would make you suspect the patient has TURP syndrome? (25%)

b) What intraoperative factors may increase the risk of developing TURP syndrome? (20%)

c) How would you manage the patient if you suspect he has developed TURP syndrome? (45%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) List the indications for using a throat pack during general anaesthesia. (25%)

b) What are the complications of using a throat pack? (30%)

c) Describe the strategies that may be adopted to minimise the potential for postoperative complications
associated with the use of throat packs. (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) Outline the clinical presentation of malignant hyperpyrexia associated with anaesthesia. (30%)

b) Describe your management in theatre. (50%)

c) What is the mechanism of action of dantrolene in this condition? (10%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

A 45 year-old woman is having a paravertebral block inserted prior to general anaesthesia for breast surgery.

a) List the possible causes of sudden collapse in this patient. (20%)

b) What symptoms and signs suggest local anaesthetic toxicity? (20%)

c) Briefly explain the pharmacological basis of severe local anaesthetic toxicity. (15%)

d) What is the immediate treatment of local anaesthetic toxicity? (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

a) List the anaesthetic factors that predispose to perioperative dental damage (25%).

b) List the patient-related factors that predispose to perioperative dental damage (25%)

c) A 22 year-old man anaesthetised by a colleague awakens following tonsillectomy and complains that an upper incisor tooth has broken off during the operation. What is your management of this situation? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2008

a) What is fat embolism syndrome and what is its clinical presentation? (50%)

b) List the clinical conditions that may predispose to fat embolism. (20%)

c) What measures may be used to minimise and treat fat embolism? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) Describe the factors that may lead to i) venous air embolism (20%) and ii) arterial air embolism. (20%)

b) What is paradoxical air embolism and how does it occur? (20%)

c) Explain the physiological basis for the use of capnography in the detection of venous air embolism. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) The prevalence of asthma in developed countries has doubled in the last 20 years. List the factors that may have contributed to this increase. (20%)

b) What are the causes of acute bronchospasm during general anaesthesia in a patient with mild asthma? (25%)

c) Outline your immediate management of severe acute bronchospasm during general anaesthesia in an intubated patient. (45%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2007

a) List patient-related risk factors that make a patient susceptible to venous thrombo-embolism. (Do not list surgery-related risk factors.) (30%)

b) What measures are recommended to minimise the risk of venous thrombo-embolism in adult surgical inpatients? (Do not list all the interventions that have been investigated.) (50%)

c) Before discharge from hospital, what advice would you give to a patient at risk? (10%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2007

a) List the principal causes of delayed recovery of consciousness after anaesthesia. (40%)

b) Describe your approach to the management of such a patient with prolonged unconsciousness. (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) Outline the clinical presentation of malignant hyperpyrexia associated with anaesthesia. (30%)

b) Describe your management in theatre. (50%)

c) What is the mechanism of action of Dantrolene in this condition? (10%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2006

(a) Define explicit and implicit awareness during general anaesthesia. (10%)
(b) What may increase the likelihood of awareness? (40%)
(c) List the techniques used to assess depth of anaesthesia and comment on their value.(40%)

Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2006

(a) Explain the possible adverse consequences of hypotension during anaesthesia. (35%)
(b) What factors may increase the morbidity of hypotension? (30%)
(c) What principles would help you decide on the lowest acceptable blood pressure in each of the following patients undergoing anaesthesia for major abdominal surgery?
The preoperative blood pressure was 140/80 mmHg and there is no requirement for hypotensive anaesthesia. (25%)
1) A fit healthy 35 year old
2) A fit healthy 75 year old
3) A treated hypertensive 75 year old
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2005

What measures can be taken to prevent venous thromboembolism in a healthy 70 year old female scheduled to have a total knee replacement ? (20%)
Describe the pros and cons of each of these measures. (80%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2004

What factors contribute to intravenous drug errors in anaesthetic practice? (40%)
What strategies are available to reduce the incidence of such errors? (60%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2004

What procedures are associated with venous gas embolism ?
How can it be detected?
What are the effects of a large venous gas embolus? Describe its management.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2004

Define transfusion related acute lung injury (TRALI)?
Discuss its pathogenesis, presentation, management and outcome.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

What are the potential causes of delayed resumption of spontaneous ventilation after major intra- abdominal surgery with general anaesthesia?
Discuss prevention, diagnosis and management.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

How may unintended peri-operative hypothermia harm patients?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

What do you understand by the term critical incident? Following a critical incident what information should be recorded? What sequence of events should ensue?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

Write a guideline for reducing and treating post-operative nausea and vomiting.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

List the key clinical features, and commonest causative agents of severe anaphylaxis occurring during general anaesthesia. Outline its management.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

Describe the diagnosis and management of venous thromboembolism.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

Outline the anaesthetic management of an adult patient who requires surgery for a strangulated inguinal hernia. He suffers from obstructive sleep apnoea.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

What are the possible causes of intra-operative myocardial ischaemia in a 65 year old male undergoing major intra-abdominal surgery? Outline how the incidence of these may be minimised.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question