CRQs and SBAs for the Final FRCA: Questions and detailed answers

By Daniel Sumner, Catherine Allen, Andrew Feneley and Mehul Raithatha

Three complete mock exams, with answers, including the new-style CRQs

CRQs and SBAs for the Final FRCA combines CRQ (constructed response questions) with SBA (single best answer) questions to accurately mimic the structure and content of the new-style final FRCA exam.

The book is split into three mock exams, each comprising:

• 12 CRQ with 60 SBA questions
• detailed explanatory answers
• useful references to articles to allow readers to improve their knowledge
• an indication as to the degree of difficulty of each question.

The book is ideal for all candidates preparing to sit the final FRCA.

• Language: English
• Publisher: Scion Publishing
• Release date: May 20, 2022
• ISBN: 9781914961137

Book preview

Practice Paper 1

Constructed response questions

Single best answer questions

CRQ answers

SBA answers

PRACTICE PAPER 1

Sepsis is one of the most common reasons for inpatient morbidity and mortality in the UK.

Absorption (4 marks)

Distribution (3 marks)

Metabolism (1 mark)

Elimination (1 mark)

A 31-year-old woman presents to the hospital’s anaesthetic antenatal clinic. She is a Jehovah’s Witness and has a low-lying placenta. She has not had any previous surgeries, and is otherwise fit and well. She has previously stated that she would not accept a blood transfusion.

Pre-op

Pre-op

Intra-op

Intra-op

Advantage

Advantage

Advantage

Disadvantage

Disadvantage

Disadvantage

The patient presents at 38 weeks’ gestation for an elective caesarean section. During the procedure the patient becomes tachycardic and hypotensive. The surgical team states there has been 2 litres of blood loss so far. A sample is taken for analysis by thromboelastography.

A 46-year-old patient is admitted to the emergency department following a road traffic collision (RTC). He has sustained a head injury.

Advantage

Disadvantage

Timeframe

A 69-year-old patient presents for an elective right hemi-colectomy for colon cancer. Her past medical history includes rheumatoid arthritis, with limited neck movement. Upon review of her previous anaesthetic charts you notice she has a ‘known difficult airway’.

Indication

Indication

Contraindication

Contraindication

Contraindication

Contraindication

A 55-year-old woman presents to the pain clinic with new onset facial pain. She was referred by her GP, who has ruled out migraines, and she has had a CT head that demonstrates no intracranial pathology. You suspect she has trigeminal neuralgia.

Carbamazepine

Class

Receptor

Gabapentin

Class

Receptor

Amitriptyline

Class

Receptor

You have been called to assist in the delivery suite, as the neonatologists are managing a neonate in distress. The neonate was born at term via an uncomplicated vaginal delivery in the midwifery-led care area, due to the mother being low risk. The neonatologists suspect that the baby has a previously undiagnosed congenital diaphragmatic hernia (CDH).

A decision is made to proceed with surgical correction of the defect.

A 79-year-old woman is due to undergo an emergency hemi-arthroplasty following a fall at home. She has a background of ischaemic heart disease with a previous coronary artery bypass graft, COPD, current smoker, and has had a recent diagnosis of non-small cell lung cancer.

She receives a spinal anaesthetic and sedation with propofol (TCI). The surgeons wish to use bone cement to facilitate joint fixation.

The operating surgeon wishes to use a bone cement impregnated with antibiotics.

During the procedure the patient becomes agitated despite propofol sedation, hypoxic and tachycardic. The blood pressure cuff cycles but a reading is not displayed. You suspect bone cement implantation syndrome (BCIS).

Patient factor

Patient factor

Surgical factor

Surgical factor

Grade I

Grade II

Grade III

A patient has arrived at the accident and emergency department having been involved in a house fire, caused by a faulty electrical circuit. The patient was found unconscious in the living room – where the fire started – but regained consciousness when extracted by the fire service. He has visible burns across both arms and his entire chest. His head and neck have been spared. He is estimated to weigh around 90kg.

A 48-year-old patient returns from the cardiothoracic theatre with an intra-aortic balloon pump in situ. You have been asked to review them post-operatively.

Aorta

Left ventricle

Heart

Blood flow

You have been asked to see a patient in distress, whom you had anaesthetised a day ago for a laparoscopic hysterectomy. You remember that the procedure and anaesthetic had no complications. The patient says she was aware of what was going on throughout the procedure and wants to know why this has happened.

Anaesthetic with neuromuscular blocker

Anaesthetic without neuromuscular blocker

All general anaesthetics

You are the anaesthetist for a day surgery dental list in paediatrics. The list includes a 16-year-old girl with autism spectrum disorder (ASD) who has not had any previous medical procedures. The patient’s parents are very anxious regarding their daughter’s care and have asked for more information on what to expect.

You are assessing a patient prior to a routine general surgical inguinal hernia repair. The patient takes antidepressant medication and has been doing some research about their anaesthetic prior to attending hospital. They have been reading about the condition serotonin syndrome and wish to know more.

Synthesised

Location

Location

Location

A 30-year-old 7 day post-partum woman presents to the labour ward with a worsening headache over the last 4 days. The headache is 10/10 in severity and particularly feels like pressure behind both eyes, with some blurred vision. She had an uneventful caesarean section, but was found to be anaemic post-operatively, requiring transfusion of 1 unit packed red cells. She is otherwise fit and well.

What would be the most appropriate investigation for this patient?

A.No further investigation needed – conservative management only

B.No further investigation needed – book patient for epidural blood patch

C.CT head

D.CT venogram of head

E.MRI brain

Which of these conditions presents the highest risk for malignant hyperthermia under anaesthesia?

A.Myasthenia gravis

B.Duchenne muscular dystrophy

C.Guillain–Barré syndrome

D.Central core myopathy

E.Muscular dystrophy

Which of the following is an absolute indication for one-lung ventilation?

A.Pneumonectomy

B.Lung volume reduction surgery

C.Upper lobectomy

D.Mediastinal mass reduction

E.Single lung lavage in cystic fibrosis

An 18-year-old patient presents for an ulnar ORIF following a motorbike accident 3 days prior. He is requesting a regional anaesthetic technique rather than a general anaesthetic technique.

What is the most appropriate regional anaesthetic block to perform on this patient?

A.Interscalene block

B.Supraclavicular block

C.Infraclavicular block

D.Axillary block

E.Direct block of the ulnar nerve

Which of the following is not true regarding the anatomy of the autonomic nervous system?

A.Preganglionic fibres in the sympathetic nervous system originate from cell bodies in the grey matter of the lateral horn of the spinal cord

B.The paravertebral sympathetic chain is divided into four parts

C.The thoracic paravertebral sympathetic chain consists of ganglia from T1–T7

D.Cranial parasympathetic fibres arise from the 3rd, 7th, 9th and 10th cranial nerves

E.Preganglionic fibres are myelinated and post-ganglionic fibres are unmyelinated, in both the sympathetic and parasympathetic nervous systems

A 56-year-old woman is undergoing a right-sided mastectomy and sentinel lymph node biopsy following a diagnosis of breast cancer. She has no other past medical history and has previously had a general anaesthetic for a hysteroscopy without any complications. She is intubated and ventilated and the surgical time-out has been performed. The surgeons inject patent blue dye and the patient becomes tachycardic at a rate of 150bpm and hypotensive to 48/23mmHg.

What is the immediate management of the patient?

A.IV adrenaline 50mcg

B.IM adrenaline 0.5mg

C.Start 500ml NaCl 0.9% IV

D.Hydrocortisone 100mg IV

E.Commence CPR

A 56-year-old man is transferred to the intensive care unit following an elective AAA repair. He has a history of heavy smoking and hypertension but is otherwise well. A chest X-ray performed following the procedure to check the position of an internal jugular line shows a pneumothorax, measuring 1.5cm at the level of the hilum.

What is the management required for this pneumothorax?

A.Apply 100% O2 and repeat chest X-ray in 24 hours

B.Aspirate with 16–18G cannula

C.Insertion of 8–14Fr Seldinger chest drain

D.Insertion of surgical chest drain

E.Observation only

A 4-week-old baby boy presents with recurrent projectile vomiting after feeding. He has been diagnosed with pyloric stenosis and is scheduled to undergo a pyloromyotomy.

Which of the following factors makes pyloric stenosis more likely?

A.Female gender

B.White ethnicity

C.Pre-term delivery

D.Maternal Helicobacter pylori infection

E.Forceps delivery

A 79-year-old man with severe vascular disease has been listed for a right below-knee amputation. He has previously had a below-knee amputation of his left leg and recalls severe stump pain, and continues to have phantom limb pain.

What would be the optimum pain relief strategy to prevent phantom limb pain after this operation?

A.Femoral and popliteal block with perineural catheters inserted and post-operative infusion of local anaesthetic

B.Epidural anaesthesia with bupivacaine and fentanyl

C.IV