March 2016

A 45-year-old man has a major haemorrhage following significant trauma and is admitted to your emergency department. He does not have a head injury. a) Give one definition of major haemorrhage. (1 mark) b) What are the principles of management of major haemorrhage in this patient? (11 marks)
c) What complications might follow a massive blood transfusion? (8 marks)
Pass rate 85.3%
This is an important topic and was generally well answered. It is reassuring that candidates have sound knowledge of the management of major haemorrhage, and of the complications of massive transfusion.
September 2015

A 19 year-old patient has suffered a complete transection of the spinal cord at the first thoracic vertebral level due to a fall, but has no other injuries.
  • a)  Outline the sequence of neurological effects that may develop in the first three months following injury.
    (6 marks)
  • b)  Which disturbances of the cardiovascular, respiratory and gastrointestinal systems may subsequently
    occur? (8 marks)
  • c)  When and why may suxamethonium be contraindicated in this patient? (2 marks)
  • d)  Give the advantages of a regional anaesthetic technique for a patient having elective lower limb
    surgery 2 years after a high thoracic spine transection. (4 marks)
Spinal injury Pass rate 49.4% This question had the highest correlation with overall performance i.e. candidates who did well in this question performed well overall in the SAQ. The examiners commented that part (d) about the advantages of regional anaesthesia for elective lower limb surgery, was not well answered. Candidates tended to give general answers such as “avoids the need for general anaesthesia” or “maintains cardiovascular stability” rather than specific advantages such as “reduces the risk of autonomic dysreflexia” or “avoids postoperative respiratory inadequacy due to general anaesthesia”.
March 2014

An elderly patient has sustained a fractured neck of femur following a fall and is scheduled for surgery.

a) Which aspects of this patient’s care have a significant impact on outcome? (45%)

b) Outline the recommendations of best practice for the management of pain in this patient. (30%)

c) What causes of a fall in this patient might impact on the anaesthetic management? (25%)
Pass Rate 53.1%

Management of a patient with a hip fracture is fundamental to anaesthetic practice and very topical. This question was straightforward for candidates who had read one of the recent guidelines published by NICE or the AAGBI, and a number of individuals gained maximum marks. The question proved highly discriminatory between generally strong and generally weak candidates.
March 2012

A 90-year-old woman sustains a fractured neck of femur following a fall. She is scheduled for surgery.

a) What aspects of this patient’s care will have the highest impact on outcome? (45%)

b) Outline the recommendations made by The National Institute for Heath and Clinical Excellence (2011) on the management of pain in this patient. (30%)

c) What causes of a fall in this patient might impact on the anaesthetic management? (25%)
Question 1 Trauma/Fractured neck of femur/NICE guideline.

52.9% pass rate.

Significant number of candidates gave a generic answer without relating to the current NICE guidelines. A significant number of candidates in section b) failed to concentrate on the management of pain and digressed to general aspects of care.
September 2011

a) What characteristic neurological changes occur immediately and in the first three months following transection of the spinal cord at the fourth thoracic vertebra? (25%)

b) What other clinical problems may develop following this type of injury? (40%)

c) List the advantages of a regional anaesthetic technique for a cystoscopy in this patient. (20%)

d) Why and when may suxamethonium be contraindicated in a patient with spinal injury? (15%)
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 2004

List the radiological investigations that are available to help exclude an unstable cervical spine injury in an unconscious, ventilated adult with multiple severe injuries. (25%)
What are the limitations of each technique? (75%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question