Final FRCA exam MCQ-SBAs February 2012

Q. Patient with well controlled NIDDM for major surgery

a.
b.
c.
d.
e.

Will require insulin to help with stress response

Need urinalysis for ketones
Will require glucose load
Might require use of short acting insulin
More likely to develop ARDS post op

Q. The following are appropriate treatments for a post TURP patient who is continuing to
haemorrhage two hours post op:
a.
b.
c.
d.
e.

tranexamic acid
platelets
whole blood
fibrinogen
SAG-M stored blood

Q. Metabolic response to surgery includes:

a. increase use of insulin and lower blood glucose
b. decrease in serum cortisol
c. decrease in free fatty acids
d. increase potassium in urine
e. increase in ADH
Q. To treat bronchoconstriction is appropriate to use:
a.
b.
c.
d.
e.

Isoprenaline
Ketamine
Adrenaline
Sodium cromoglycate
Atropine

Q. Complication of percutaneous tracheostomy are:

a.
b.
c.
d.
e.

Tracheal stenosis
Surgical emphysema
Endobronchial intubation
Hypothyroidism
Trachea-oesophageal fistula

Q. Transcutaneous Nerve Stimulators:

a. work by stimulating A fibre
b. useful for treatment of thalamic pain
c. use frequency 1-100Hz
d. treat pain from peripheral nerve injury
e. use stimulus strength 0-50 V

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Final FRCA exam MCQ-SBAs February 2012

Q. Limb tourniquet used to provide bloodless field during surgery
a. increase SVR
b. decrease PVR
c. contraindicated in sickle cell
d. increase VCO2 on deflation
e. decrease PaO2 after deflation
Q. After dry drowning:
a. Resuscitation should be abandoned after 20 mins in salt water drowning
b. Defibrillation may be unsuccessful if rewarming is not undertaken
c. Fresh water drowning may result in hyperkalaemia
d. Resuscitation should be abandoned when core temp is 30C
e. Body temperature should be maintained between 32-34 C
Q. Effects of hypermagnesaemia
a.
b.
c.
d.
e.

positive Trousseaus sign

prolongation of AV conduction
prolongation of the action of rocuronium
hyporeflexia
coma

Q. 48 hours after chest trauma...

a. there is a decreased water excretion
b. increased Na retention
c. increased K excretion
d. increased ADH secretion
e. Increased insulin secretion
Q. The trigeminal nerve
a. arises from pons.
b. is sensory to the face.
c. motor to the muscles of mastication.
d. is attached to the trigeminal ganglion by a sensory root and a motor root.
e. is divided into 4 divisions.

Q.ECG changes seen with Digoxin include:

a)
b)
c)
d)
e)

prolonged PR interval
prolonged QT interval
tachycardia
nodal rhythm
ST depression.

Q )In the normal kidney, the daily excretion of creatinine depends on :

a) protein intake
b) muscle mass of the individual
c) GFR
d) urinary volume
e) degree of muscle wastin

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Final FRCA exam MCQ-SBAs February 2012

Q) Serum Osmolality
a)
b)
c)
d)
e)

Measure of the number of particles in solution

Usually expressed in Milimoles/L
Commonly determined by the temperature at which a solution freezes
Proportional to the valency of a particular solution
Depends upon serum albumin

Q) Drugs to avoid in Parkinsons

a) Butypheronones
b) Phenothiazine pre med
c) Sevoflurane
d) Pethidine
e) Tramadol

Q) A full cylinder of nitrous oxide:

a)
b)
c)
d)
e)

Has a pressure of 5100 KPa at 20 degrees celsius

Should be inverted several times before attaching to the anaesthetic machine
Has a filling ratio of 0.75 in the UK
Displays constant pressure throughout discharge
Contents are assessed by weight

Q) Desflurane
a)
b)
c)
d)
e)

At equal MAC, causes as much greater drop in SVR compared to Isoflurane

0.02 % of absorbed fraction is metabolised
Causes dose dependent decrease in tidal volume
Boiling point is 23.5 degrees celsius at one bar
it has a blood:gas coefficient of 4.2

Q) The following are compatible with a post op diagnosis of acute kidney injury
a.
b.
c.
d.
e.

Urinary sodium of 10 mmol/L

Urine output of 30 mls/hour
Urinary osmolality of 500 mosms/L
Urine urea 80 mmols/L
Urine specific gravity 1026

Q) Considering the intra-aortic balloon counter pulsation:

a.
b.
c.
d.
e.

increases aortic systolic pressure

decreases abdominal diastolic pressure
decreases myocardial oxygen demand
increases left atrial pressure
increases left end diastolic pressure

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Final FRCA exam MCQ-SBAs February 2012

Q) The following are requirements for diagnosis of brainstem death
a.
b.
c.
d.
e.

Absent knee and ankle jerk reflexes

Temp >35.0 degrees
Absent responses in CN III (oculomotor)
PaO2 >12 kPa
Absent corneal reflex

Q) Regarding the Femoral nerve

a. it is formed from L2 - L4 nerve roots
b. it lies lateral to the femoral artery at the inguinal ligament
c. it supplies cutaneous sensation to the lateral thigh
d. when blocked it provides effective pain relief for femoral shaft fractures
e. when blocked can be used as sole anaesthetic for TKR
Q) In Cystic Fibrosis
a.
b.
c.
d.
e.

Increased chloride in sweat

Cholelithiasis
Arthritis
Bronchiectasis
diabetes

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Final FRCA exam MCQ-SBAs February 2012

SBAs
Q) In a previously fit man, who presents to pain clinic with a 3 month history of lower back pain,
what is the most likely cause?
a.
b.
c.
d.
e.

Facet joint degeneration

Intervertebral disc degeneration
Osteoarthritis
Multiple myeloma
Psoariasis

Q) A patient who has been receiving, for 24 hours, a low dose epidural local anaesthetic infusion
with 0.1% bupivacaine for post-operative pain relief complains of total inability to move their legs.
What is the most appropriate action?
a.
b.
c.
d.
e.

stop the infusion and reassess in two hours

change the local anaesthetic solution infused to a more dilute solution
ask the surgical team to request a neurology opinion
request an urgent MRI scan of the lumbar spine
reassure the patient and halve the current infusion rate

Q) A 35 year-old patient with Downs syndrome and an untreated AVSD undergoes a dental
clearance. The patient is intubated and ventilated and anaesthesia is maintained with sevoflurane.
20 minutes into the case, the patients SpO2 falls to 70%, having previously been 92% on FiO2=0.5.
BP is 95/60, pulse 100 bpm SR. You confirm that both lungs are ventilating satisfactorily. What would
be the most appropriate manoeuvre likely to increase oxygen saturation in this situation?
a.
b.
c.
d.
e.

increase the inspired oxygen to 100%

commence inhaled nitric oxide therapy
add 5cms H2O of PEEP to the ventilator setting
give a bolus of metaraminol
discontinue volatile anaesthesia and start TIVA with propofol

Q) A 64 year-old man is scheduled for phacoemulsification of a cataract and lens implantation under
subtenon block today. He is a type 2 diabetic and has had two strokes for which he is anticoagulated
with warfarin. His INR is 2.6. He is worried by the prospect of general anaesthesia and would prefer
to be awake for the surgery. Which is the single most appropriate management?
a.
b.
c.
d.
e.

advise the patient to have the operation under general anaesthesia today
stop the warfarin and proceed under subtenon block when INR<1.5
proceed with the operation using an extraconal rather than a subtenon block
give Vitamin K, recheck INR and proceed under subtenon block if INR<1.5
continue with the surgery as planned today under subtenon block

Q) A 49 year-old lady weighing 80 kg has under gone a right hemicolectomy. She has pre-existing
chronic renal disease with a creatinine of 450 mcmol/L. You have been called to HDU because her
urine output is 30 ml / hour for the past two hours. Her BP is now 120/80, HR 80 bpm. What would
be the next most appropriate action to take?
a. check her preoperative blood pressure

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Final FRCA exam MCQ-SBAs February 2012

b.
c.
d.
e.

infuse 1000mls of Hartmanns solution rapidly

flush the urinary catheter
omit her post-operative ACE inhibitor
administer 20mgs iv furosemide

Q) Following a difficult intubation but easy bag and mask ventilation in an obese lady you cannot
hand ventilate. What will you do first?
a.
b.
c.
d.
e.

take out ETT

look at capnograph trace
look at oxygen saturation
give nebuliser
give muscle relaxant

Q) 56 years female with CKD stage 4, on Haemodialysis, presents with DU perforation, with K of 6.0,
creatinine of 750micromol. BP of 120/80, pulse of 80. Waiting to go to theatre
a.
b.
c.
d.

Ask for haemodialysis before taking to theatre.

RSI with Thiopenton and Suxamethonium RSI
RSI with Thio and Rocuronium
Epidural anaesthesia

Q) A man is declared brain stem dead on the ITU. He is on the organ donation register and carries a
donor card but his family do not want to go ahead with donation. How do you best proceed?
a.
b.
c.
d.
e.

Take a blood sample for HLA typing

Discuss the case with the transplant surgeon
Respect the patients wish for donation
Respect the familys wishes
Refer the case to the Coroners office

Q) A previously well Afro-Carribean man presents for an inguinal hernia repair. He is in the
anaesthetic room and has been given 5mg midazolam when you realise that he has not been preoperatively screened for sickle cell anaemia. How do you best proceed?
a.
b.
c.
d.
e.

Treat him as though he is Sickle cell positive

Take a blood sample for screening and proceed
Observe him in recovery and perform blood tests when recovered from the midazolam
Postpone the operation
Proceed as normal since he is fit and well.

Q) A 55 year old lady is admitted through the A&E with severe community acquired pneumonia. She
is extremely agitated and combative. Her sats are 85% on a FiO2 of 0.6. A blood gas shows pO2=
7,pCO2= 8.6 and pH 7.28(I think). What would be the next most appropriate step?
a.
b.
c.
d.

IV Antibiotics according to hospital policy for CAP

Immediate Intubate and Ventilate
Apply CPAP
Increase FiO2 via Face mask

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Final FRCA exam MCQ-SBAs February 2012

e. Administer 0.9% saline 15 mls/kg
Q) At the end of general anaesthesia for open colectomy a 55 year old patient receives 2.5mg
neostigmine and 500mcg glycopyrrolate 25minutes since rocuronium 10mg. He also received 160mg
gentamycin for urinary catheterisation. Which mode of nerve stimulation would indicate adequate
reversal?
a.
b.
c.
d.
e.

Double burst
Post tetanic count
Single twitch
Tetanic stimulation
Train of four

Q) You attend a primigravida 34 week pregnant lady on LW who is in established labour. Her BP is
150/100, she has proteinuria (question didn't quantify how much), and platelet count of 90. Her
temp is 37.4 and her membranes ruptured 48 hrs ago, and she is on antibiotics. What is the best
analgesic modality?
a.
b.
c.
d.
e.

Continuous epidural infusion

Remifentanil PCA
Fentanyl PCA
Regular IM pethidine
Entonox

Q) A 70 year old man arrives in A & E with tearing retrosternal chest pain. His left radial pulse is
markedly weaker than the right. BP 160/100, HR 110, SpO2 94% on air, tachypnoeic, alert /
oriented. His ECG is normal; widened mediastinum on CXR. What is the most appropriate initial
management?
a.
b.
c.
d.
e.

SNP infusion
Esmolol infusion
Immediate transfer to a cardiothoracic centre
iv fluid resuscitation
Urgent cross matching of blood products

Q) A 72 year old is booked for elective open AAA repair. He smokes 10 / day, is on antihypertensives
and his ECG shows Q waves in V4-V6. FBC and biochemistry are within normal limits. What potential
peri-operative complication poses the greatest risk of mortality?
a.
b.
c.
d.
e.

Acute MI
Acute renal failure
Respiratory failure
Massive blood loss
CVA

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Final FRCA exam MCQ-SBAs February 2012

Q) A 11 year old girl scheduled for pinnaplasty (ear correction) under GA. On arrival in the
anaesthetic room, accompanied by her father, she says she does not want to undergo the surgery.
On further discussion, she becomes very upset. The most appropriate next step a.
b.
c.
d.
e.

Ask her father to restrain her so that you can proceed with anaesthesia
Respect her wishes and postpone the surgery
Move her to recovery and allow her to calm down
Administer a sedative premedication and shift her to ward till it takes effect
Call the surgeon to talk to her in the anaesthetic room

Q) A 59 year old obese man with 7 cm infra renal abdominal aortic aneurysm. He smokes 10
cigarettes a day. Has shortness of breath on walking 1 flight of stairs. ECG shows Q waves in leads V2
and V3. Blood results are normal. He is scheduled for open repair of AAA. Which of these is most
likely to be the cause of mortality in this patient?
a.
b.
c.
d.
e.

Acute respiratory failure

acute MI
acute renal failure
haemorrhage
?

Q) A 35 year old woman is due to have foot surgery (valgux repair). She has a history of panic
attacks with palpitations and headaches. Her HR is 100 and BP is 160/105. What would you do?
a.
b.
c.
d.
e.

ECG, bloods, CXR - if normal proceed as planned

Start atenolol 50mg od and reschedule
Postpone and re-refer to GP
Give a benzodiazepine anxiolytic premed and if BP settles proceed with GA
Give benzodiazepine premed and if BP settles proceed with spinal

Q) A 10 month apparently well infant presents for religious circumcision under GA. Routine
examination revels a soft systolic murmur, rest of examination was normal. The most appropriate
action to take is:
a.
b.
c.
d.
e.

postpone surgery and obtain an urgent echo

postpone surgery and refer the child back to GP
proceed with anaesthesia because this is an "innocent" murmur
proceed with anaesthetic giving antibiotic cover
proceed with surgery under LA

Q) A 45 year old man in a house fire is taken to A and E. He is already intubated and ventilated. On
ABG's his pH is 7.29, pO2 7.5, pCO2 5.7, BE -5. He is being ventilated with FiO2 of 1.0, minute
volume is 6L/min, and PEEP is 5. His carboxyhaemoglobin is 35%. What is your respiratory strategy?
a) Drop the FiO2 to 0.7 to avoid injury from too much oxygen
b) Reduce the FiO2 when his carboxyhaemoglobin is 10%
c) Keep him on 100% for 48 hrs
d) Increase his PEEP as guided by his ABG's
e) Hyperbaric oxygen therapy

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Final FRCA exam MCQ-SBAs February 2012

Q) A patient in the pain clinic is diagnosed with CRPS 1. The best management strategy would be:
a.
b.
c.
d.
e.

Cognitive behavioural therapy

Functional Restoration programme
Opioids
Physiotherapy
Sympathetic blockade

Q) A type 2 diabetic patient underwent TURP under GA. Most likely cause of him failure to wake up
post op?
a. Blood Glucose 2.9mmol/l
b. Na 119
c. PCO2 9
d. PO2 7
e. 10mg Morphine IV given in recovery
Q) A patient following trauma, is being treated on ITU for the last 8 days for ARDS. He is still on
vasopressors , pyrexial (temp=38 degree Celsius) with an elevated WCC. His oxygenation has
improved in the last 2 days & the FiO2 has now come down to 0.55. He is still heavily sedated. What
would you consider next, in the early management plan for this patient ?
a.
b.
c.
d.
e.

Wean him off to ASB/PS mode

Sedation hold, trial of extubation after a T piece trial
Continue same ventilator settings for the next 48 hours
Put him on CPAP
Perform a tracheostomy

Coventry collection: Many thanks to the candidates from March 2012 Course