September 2014

A 54 year-old patient with base of tongue cancer presents for a hemiglossectomy and radial forearm free flap reconstruction
  • a)  Which specific factors must the anaesthetist consider when assessing this patient prior to surgery? (10 marks)
  • b)  List the benefits of a free flap reconstruction. (2 marks)
  • c)  What are the causes of flap failure and how may they be prevented in the peri-operative period? (8 marks)
Pass Rate 31.5%
Inexperience probably accounts for the poor pass rate for this question. Weak candidates suggested assessment of a potentially difficult airway as the important pre-operative feature, but ignored the co- morbidities associated with causative factors such as smoking and alcohol consumption. The impacts of major physiological changes that are caused by such prolonged and invasive surgery were ignored. The role of the anaesthetist in influencing free-flap survival was particularly poorly answered.
Stacks Image 134521
Stacks Image 134523
Stacks Image 134525
Stacks Image 134527
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 2011

A 52-year-old man has been admitted for a tympanoplasty on the morning of surgery. He is a longstanding insulin dependent diabetic who has failed to attend the pre-operative assessment clinic.

a) What specific issues does this patient’s diabetes present? (30%)

b) How should his diabetes be managed whilst in hospital? (35%)

c) What are the anaesthetic considerations for tympanoplasty? (35%)
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
May 2006

A 20 year old male was assaulted and sustained a bilateral fractured mandible which requires surgical fixation. Following the assault he was unconscious for 5 minutes. You are asked to see him the next day. He has no other injuries.

a) Outline your preoperative assessment of this patient. (55%)

b) What are anaesthetic options for surgery? (45%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

A 60 year old smoker requires non-laser surgery to the vocal cords. Outline the various anaesthetic techniques available, listing advantages and disadvantages of each.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

Summarise the peri-operative anaesthetic management of a patient who requires plating of his jaw fractured in a fight?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question