Question 1 Outline the anatomy relevant to performing a brachial plexus block using the axillary approach. (70%) Describe the limitations of this block when used for upper limb surgery. (30%) Pass rate 58.2%
Question 2 Explain your strategies to minimise the risk of hypoxia during induction, maintenance and emergence from anaesthesia in a morbidly obese patient undergoing a laparoscopic total hysterectomy. Pass rate 72.4%
Question 3 In a large clinical trial, patients were randomised into two groups to study the impact of bispectral index (BISTM) monitoring on the incidence of awareness. The table below shows the results. Groups Sample size, n Cases of awareness, n BIS-guided 1250 2 Routine care 1250 11 Data analysis found that the statistical difference in the incidence of awareness had a p value of 0.022. The study reported that BIS-guided anaesthesia reduced the risk of awareness by 82% (95% confidence interval 17-98%) with an odds ratio of 0.2 and a number needed to treat of 140. Define the following terms and explain their meaning in relation to this study: p value risk reduction confidence interval odds ratio number needed to treat Pass rate 85.2%
Question 4 A 24-year-old woman requires urgent manual removal of placenta due to ongoing bleeding following a vaginal delivery (estimated blood loss 1500ml). Outline your initial management prior to her arrival in theatre. (50%) Discuss the options available for managing persistent uterine atony in theatre. (50%) Pass rate 69.4%
Question 5 This is the standard 12-lead electrocardiogram (ECG) of a 56-year-old man in the post-anaesthesia care unit (PACU) two hours after an emergency laparotomy for bowel obstruction. He is complaining of shortness of breath, abdominal pain and has a blood pressure of 160/110mmHg. He has a history of hypertension controlled with atenolol and hydrochlorothiazide. The preoperative ECG is missing. The anaesthetic assessment only notes that it showed sinus rhythm. Considering all the clinical information, interpret this ECG and outline the appropriate management of this patient in PACU. Pass rate 66.8%
Question 6 You will be anaesthetising a 63-year-old man with severe Parkinson’s disease who is booked for an inguinal hernia repair. Discuss the issues that are relevant to providing perioperative care for this patient. Pass rate 54.6%
Question 7 Your department has exceeded its drug budget for the last financial year. You have been asked to develop a departmental policy document for the rational use of sugammadex. Discuss the issues to be considered. Pass rate 27.6%
Question 8 A patient takes a 60mg slow-release morphine tablet twice daily for chronic low back pain. They have been appropriately investigated and there is no surgically treatable pathology. In relation to this patient List the risks of long-term opioid therapy. (30%) Justify the appropriate treatment of chronic low back pain. (70%) Pass rate 85.7%
Question 9 Evaluate the equipment available for the delivery of oxygen to postoperative patients on a general surgical ward. Pass rate 86.2%
Question 10 List the signs of malignant hyperthermia. (30%) Outline the immediate management of a patient where malignant hyperthermia is suspected. (70%) Pass rate 67.3%
Question 11 Discuss the issues relevant to the perioperative care of a seven-year-old child with Down Syndrome who has sustained a supracondylar fracture of the humerus. Pass rate 64.3%
Question 12 A patient presents on the day of surgery with a blood pressure of 180/110mmHg. Justify your decision to proceed with or postpone surgery for this patient. Pass rate 25.5%
Question 13 A 77-year-old patient is admitted to hospital with a fractured neck of femur requiring total hip arthroplasty. Physical examination on admission reveals signs of congestive cardiac failure. Outline how congestive cardiac failure influences the perioperative risk for this patient. (30%) Discuss how the finding of congestive cardiac failure influences your perioperative management of this patient. (70%) Pass rate 84.2%
Question 14 Discuss the options for anticoagulation management in the perioperative period for a patient taking warfarin for atrial fibrillation who requires a laparotomy for ischaemic bowel. Pass rate 53.6%
Question 15 Evaluate the use of five (5) of the following additives that may be combined with local anaesthetics for neural blockade. adrenaline clonidine dexamethasone glucose hyaluronidase midazolam morphine neostigmine sodium bicarbonate Pass rate 67.3%