March 2016

  • a)  List and briefly state the reasons for the cardiovascular (7 marks) and respiratory (4 marks) effects of laparoscopy in the head up position for a Nissen fundoplication (anti-reflux procedure).
  • b)  How may these effects be minimised? (9 marks)
Pass rate 54.5% This question was judged to be of moderate difficulty. It would appear from their answers that many candidates had not seen a Nissen fundoplication and were unable to go back to first principles and talk about the effects of laparoscopy in the head up position. Also candidates failed to read part (a) of the question and so did not give the cardiovascular and respiratory effects and their causes.
September 2015

  • A 26 year-old patient with stage 4B Hodgkin’s disease (spread to lymph nodes and other organs) requires an open splenectomy.
  • a)  List the specific factors that are of importance when planning your anaesthetic management. (10
    marks)
  • b)  Outline the options for providing postoperative analgesia for this patient and give a possible
    disadvantage of each. (6 marks)
  • c)  Which vaccinations should this patient receive and what is the optimal timing of these? (4 marks)
Splenectomy in a patient with Hodgkin’s lymphoma Pass rate 38.8% Many examiners marking this question felt that either the candidates had not read the question as carefully as they should have done, or they lacked knowledge of the implications of Hodgkin’s lymphoma and its treatment for anaesthesia. Rather than focusing on specific factors of importance many candidates wrote about general problems when anaesthetising for a splenectomy. This was reflected in the pass rate.
September 2013

A 45-year-old man is scheduled for a laparoscopic Nissen fundoplication under general anaesthesia. He is graded ASA 1.

a) Describe how laparoscopy can cause adverse effects in this patient. (70%)

b) How may these effects be minimised? (30%)
72.5% pass rate.

This was a modification of a question on the adverse effects of abdominal laparoscopy previously used in the May 2006 paper. The effect of steep head-up position and not Trendelenberg tilt was not appreciated by a number of candidates. A significant number of answers incorrectly referred to the effects of a Trendelenberg position raising intracranial and intraocular pressure. The question was otherwise answered with a good systematic approach to the physiological effects of a pneumoperitoneum and the adverse effects of performing a laparoscopy.
March 2012

A 57-year-old patient is scheduled for resection of a colonic carcinoma in 3 weeks time. The haemoglobin is 10.1 g/dl at time of referral to the pre-assessment clinic.

a) What intraoperative methods can be used to minimise allogeneic blood transfusion? (35%)

b) What steps constitute the final check required by the National Patient Safety Agency’s “Right Patient, Right Blood” guideline? (25%)

c) What are the additional preoperative preparations that must be made if this patient is a Jehovah’s Witness. (40%)
Question12 JW blood conservation and checking a unit of blood

45.2% pass rate

A routine question on core knowledge not answered well. The knowledge of blood checking procedure was particularly disappointing. Very few candidates failed to mention the need to check with the patient, the ID band and the blood form. Very few stated that the personal responsible for the transfusion should check.
March 2011

A 67-year-old man requires a thoraco-abdominal oesophagectomy for adenocarcinoma.

a) Describe the clinical features associated with the condition that are relevant to anaesthesia. (35%)

b) List the preoperative investigations you might need to consider. (30%)

c) What aspects of perioperative anaesthetic care can help reduce postoperative morbidity following this
procedure? (35%)
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 potential benefits of an enhanced recovery (“fast-track”)
programme for a patient undergoing major abdominal surgery? (25%)

b) List the preoperative (25%), intra-operative (25%) and postoperative goals (25%) that aim to achieve “fast track” status.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2010

A 24 year-old male is scheduled for exploration and laying open of a pilonidal sinus under general anaesthesia.

a) Outline the anaesthetic implications of managing this patient in the prone position. (40%)

b) How may the complications of this position be minimised? (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

a) List the indications for intra-operative cell salvage (ICS). (20%)

b) Which therapeutic substances should not be aspirated into the ICS system (10%)

c) What are the current controversies regarding the use of ICS in obstetrics and in patients with malignancy? (20%)

d) What additional measures can be applied to reduce the need for allogeneic blood transfusion during an operation? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) What are the adverse effects of abdominal laparoscopy? (75%)
b) How may these effects be minimised? (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

An otherwise fit patient requires nephrectomy for a large solitary renal tumour.
What surgical factors might influence your conduct of the anaesthetic?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

What perioperative measures can be taken to minimize non-autologous red cell transfusion in a patient undergoing elective surgery?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question