CRQs in Anaesthesia - Constructed Response Questions for Exams

Vasu, Thanthullu, Kodivalasa, Mahesh, Ingle, Pradeep Mukund, Ahson, Mehar

• Publisher: tfm Publishing Ltd
• Year: 2019
• Print ISBN: 9781910079799
• eBook ISBN: 9781910079805
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The Royal College of Anaesthetists has introduced Constructed Response Questions (CRQs) as an innovative way of testing trainees, in the fields of anaesthesia and intensive care medicine, in their final FRCA examinations from September 2019. CRQs are a more structured way of assessing knowledge and understanding; they also assess the application of knowledge, evaluation and judgement. This book categorises questions based on the Royal College model, with six mandatory sections of training and two separate sections on general duties and optional units. It is an ideal companion for candidates who are preparing for their final exams in anaesthesia and will help to assess their preparation and guide appropriate revision. The topics are pertinent for other anaesthetic exams worldwide, including the European exams, Australian and New Zealand fellowships and the Indian DNB exams. The authors have extensive experience in anaesthetic teaching and lead anaesthetic intermediate teaching in the UK, running regular and successfully attended courses. This book will help candidates to adapt to the recent exam changes and revise in an efficient manner. It will not only be an invaluable educational resource for trainee anaesthetists but also for practising anaesthetists. Medical students and junior doctors, who are about to embark on a career in anaesthesia or intensive care medicine, will also find the book to be a useful educational tool.

Section 1

Questions

Chapter 1

Neuroanaesthesia

QUESTIONS

Q1 — Cerebrospinal fluid physiology

3 marksa) Describe the production and circulation of cerebrospinal fluid (CSF).

2 marksb) How does the intracranial pressure affect the production and absorption of CSF?

5 marksc) Give five differentiating features of CSF vs. plasma with regards to its biochemistry.

4 marksd) List any four indications for lumbar puncture.

6 markse) Name any six factors that predispose to the development of a postdural puncture headache after lumbar puncture.

Q2 — Brainstem death and organ donation

A 20-year-old patient in a neurointensive care unit satisfies the criteria for brainstem death and has been accepted as an organ donor.

5 marksa) List the main adverse cardiovascular changes associated with brainstem death.

7 marksb) What are the physiological goals (with values) required to ensure optimisation of this donor?

5 marksc) Outline the measures that may be used to achieve the needed goals.

3 marksd) Name any three medications that you might use to optimise the endocrine system.

Q3 — Status epilepticus

You are asked to review a 27-year-old male who is a known epileptic in convulsive status epilepticus.

2 marksa) Name two opioids contraindicated in seizures.

2 marksb) What are the implications of neuromuscular blocking drugs in epileptic patients?

1 mark c) Define convulsive status epilepticus.

5 marksd) What drugs, including doses, are used during the various stages of status epilepticus?

Premonitory stage:
(prehospital or <5 minutes)

Early stage:
(5-10 minutes)

Established stage:
(0-60 minutes)

2 markse) What investigations would you consider in a patient with status epilepticus?

5 marksf) Sixty minutes after your initial management, the patient continues to be in status epilepticus. What would be your further management?

3 marksg) What are the complications associated with refractory convulsive status epilepticus?

Q4 — Delirium in critical care

2 marksa) Define delirium.

4 marksb) List the key clinical features that are used to diagnose delirium in critical care.

3 marksc) List any six risk factors for delirium in an intensive care patient.

1 mark d) List some methods of diagnosis and assessment of delirium.

3 markse) In a delirious critical care patient, what are the most common environmental factors that are potentially treatable?

3 marksf) What medical factors would you correct to treat/prevent delirium?

4 marksg) When is pharmacological treatment indicated and which classes of drugs can be used?

Q5 — Near-drowning

A 20-year-old man is brought to the emergency department having been pulled from a river following a near-drowning.

2 marksa) What are the effects of near-drowning on the respiratory and cardiovascular systems?

1 mark b) What are the effects on other systems?

3 marksc) List the relevant features in the history that you would elicit in this patient.

3 marksd) List the investigations that you would perform in this particular patient.

4 markse) How would you treat hypothermia in this patient?

4 marksf) What are the considerations for ventilatory strategies for this patient?

3 marksg) Outline your neuroprotective strategies for this patient.

Q6 — Acromegaly and hypophysectomy

A 54-year-old male with acromegaly presents for a transsphenoidal hypophysectomy.

1 mark a) What is acromegaly?

3 marksb) List the clinical features of acromegaly which are of relevance to the anaesthetist.

Airway:

Respiratory system:

Cardiovascular syste...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface
• Foreword
• Contributors
• Acknowledgements
• Abbreviations
• Section 1 Questions
• Section 2 Answers
• Afterword
• Backcover