March 2016

A 56-year-old man is listed for carotid endarterectomy 10 days after suffering a cerebrovascular accident.
  • a)  What are the advantages (4 marks) and disadvantages (4 marks) of performing the procedure under
    regional anaesthesia?
  • b)  What local or regional anaesthetic techniques may be used? (3 marks)
  • c)  How can his risk of perioperative cerebrovascular accident be minimised? (6 marks)
  • d)  Following this procedure what other specific postoperative complications may occur? (3 marks)
Pass rate 53.9% This question had one of the highest correlations with overall performance i.e. candidates who did well in this question performed well in the SAQ overall. As mentioned above some candidates did not read the question properly but fortunately did not lose too many marks as a result.
March 2012

A 79-year-old patient presents with a leaking abdominal aortic aneurysm. The vascular surgery/radiology team decide to undertake an endovascular aneurysm repair (EVAR) procedure.

a) What are the main preoperative anaesthetic considerations for this procedure? (55%)

b) Describe options for providing anaesthesia for this case and give the advantages/disadvantages of each. (45%)
Question 5 Vascular/anaesthetic considerations for EVAR

54.1% pass rate

Many candidates missed the point of the question and launched into the detailed anaesthetic management, not mentioning many of the organizational issues. It appeared from the answers that many candidates had not seen elective or emergency EVAR.
March 2011

a) Describe the anatomy of the cervical plexus. (40%)

b) How would you perform a superficial cervical plexus block? (25%)

c) A carotid endarterectomy is being performed using a superficial cervical plexus block. A few minutes
after clamping the carotid artery the patient becomes unresponsive to verbal command. Describe your management of this situation. (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

A 65 year-old man has suffered two recent episodes of transient blindness in the left eye. Doppler studies confirm a left internal carotid artery stenosis of 81%. He is now scheduled for a carotid endarterectomy (CEA).

a) What are the benefits of early CEA compared with conservative management in this patient? (15%)

b) List methods for predicting and detecting cerebral ischaemia during CEA. (25%)

c) What techniques may diminish the risk of cerebral ischaemia during cross clamping of the internal carotid artery? (25%)

d) Why might this patient have difficulty with breathing in the recovery room following CEA? (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) What features in the clinical history and examination would suggest a diagnosis of acute aortic dissection? (30%)

b) Which investigations may be used in making the diagnosis? (20%)

c) Describe your initial management of a patient with confirmed aortic dissection in the district general hospital environment. (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) A patient presents to the Emergency Department with a suspected ruptured abdominal aortic aneurysm. What are the priorities in your preoperative management? (40%)

b) The consultant vascular surgeon would like to repair the ruptured aortic aneurysm. Describe your anaesthetic management in the operating theatre. (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) Briefly describe your technique for performing a deep cervical plexus block for carotid endarterectomy under local anaesthesia. (35%)

b) List the complications of a deep cervical plexus block. (35%)

c) List the advantages and disadvantages of performing a carotid endarterectomy under regional anaesthesia. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

Discuss the principles underlying the anaesthetic management of carotid endarterectomy.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question