SBA and MTF MCQs for the Final FRCA

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SBA and MTF MCQs for the Final FRCA
SBA and MTF MCQs
for the Final FRCA

The FRCAQ.com Writers Group

The Severn Deanery

Dr James Nickells
North Bristol NHS Trust

Dr Ben Walton
North Bristol NHS Trust
cambridge university press
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First published 2012

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Every effort has been made in preparing this book to provide accurate and up-to-date
information which is in accord with accepted standards and practice at the time of
publication. Although case histories are drawn from actual cases, every effort has been
made to disguise the identities of the individuals involved. Nevertheless, the authors,
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Contents

List of contributors page vi

Preface ix

QUESTION PAPERS
Paper 1 3

Paper 2 25

ANSWERS

Paper 1 49

Paper 2 50

EXPLANATIONS

Paper 1 53

Paper 2 138

Index 228

v
 Contributors

The FRCAQ.com Writing Group for the Final FRCAQ.com site are:
DR ROBERT AXE MBChB, FRCA, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR EMMA BELLCHAMBERS MRCP, BMBS(Hons), BMedSci(Hons), Anaesthetic
Trainee, Severn Deanery, Bristol, UK
DR JAMES BOWLER MA(OXON), MBBS, AICSM, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR TIM BOWLES BSc(Hons), MBBS, FRCA, Senior Registrar, Intensive Care Unit, Royal
Perth Hospital, Western Australia
DR ALICE BRAGA MBChB(Hons), MRCP, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR JULES BROWN BSc, MBChB, MRCP, FRCA, DICM, FICM, Consultant in Critical
Care and Anaesthesia, North Bristol NHS Trust, Bristol, UK
DR HELEN CAIN BMBS, BMedSci, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR AMY CREES BSc(Hons), MBChB, MRCP, Core Medical Trainee, Severn Deanery,
Bristol, UK
DR ALIA DARWEISH MBChB, MSc, DRCOG, MRCS(Eng), FRCA, Anaesthetic Trainee,
Severn Deanery, Bristol, UK
DR JAMES EVANS MBChB, MRCP, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR TOBIAS EVERETT MBChB, FRCA, Consultant Anaesthetist, The Hospital for Sick
Children, Toronto, Canada
DR ANDREW FOO BSc(Hons), MBBS, MRCS, FRCA, Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR DAN FRESHWATER-TURNER MA, MBBChir, MRCP, FRCA, Consultant in
Anaesthesia and Intensive Care, University Hospitals, Bristol NHS Foundation
Trust, Bristol, UK
vi
 MBChB, BSc(Hons), FRCA, DICM DIC, Consultant in Critical

Contributors
DR ANDY GEORGIOU
Care and Anaesthesia, Royal United Hospital, Bath, UK
DR JUAN GRATEROL Medico Cirujano, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR BEN GREATOREX BMBS, BMedSci, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR RUTH GREER BMBS, BMedSci, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR CLARE HOMMERS BMBS, MRCP, FRCA, DICM, Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR TIM HOOPER MBBS, FRCA, EDIC, Anaesthetic Trainee, Severn Deanery and
Defence Medical Services, Bristol, UK
DR TIM HOWES MBChB, FRCA, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR BEN HUNTLEY MBChB, FRCA, Consultant in Pain Medicine and Anaesthesia,
Barking, Havering and Redbridge NHS Foundation Trust, UK
DR IZREEN IQBAL MBChB, FRCA, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR DOM JANSSEN BA, BSc(Med), MBBS, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR IAN KERSLAKE BSc(Hons), FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR EMMA KING MBChB, FRCA, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR SIOBHAN KING FRCA, MRCP, MBBCh, BSc(Hons), Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR SARAH LANCASTER MBChB, MRCS(Eng), Orthopaedic Trainee, Severn Deanery,
Bristol, UK
DR ABBY LIND BSc, MBChB, MRCP, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR CLINTON LOBO BSc, MBChB, MRCP, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR HELEN MAKINS MBBS, FRCA, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR CHRIS MARSH MBChB, FRCA, PG Cert Adv HCP, Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR ALEX MIDDLEDITCH MBChB, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR HENRY MURDOCH BSc, MBBS, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR CHRIS NEWELL BSc(Hons), MBChB, MRCP(UK), Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR JAMES NICKELLS MBBS, FRCA, Consultant Anaesthetist, North Bristol NHS Trust,
Bristol, UK
DR SONJA PAYNE MD, MSc, BSc(Hons), Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR ANNABEL PEARSON BMedSci(Hons), BMBS, Anaesthetic Trainee, Severn Deanery,
Bristol, UK vii
 MRCP, FRCA, DICM, EDIC, PGCMEd, Consultant in
Contributors
DR KIERON ROONEY
Anaesthesia and Intensive Care, University Hospitals, Bristol NHS Foundation
Trust, Bristol, UK
DR SOPHIE SCUTT FRCA, MRCP, Anaesthetic Trainee, Severn Deanery, Bristol, UK
DR SIMON SLINN BSc(Hons), MBBCh, FRCA, Anaesthetic Trainee, Welsh Deanery, UK
DR JANINE TALBOT MBBS, BSc ,FRCA, PGCMEd, Anaesthetic Trainee, Severn
Deanery, Bristol, UK
DR HELEN TURNHAM MBChB(Hons), FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR BENJAMIN WALTON MBChB, MRCP, FRCA, Consultant in Critical Care and
Anaesthesia, North Bristol NHS Trust, Bristol, UK
DR SARAH WARWICKER BM, BCh, MA, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR MARK WIGGINTON MBBS, FRCA, Anaesthetic Trainee, Severn Deanery,
Bristol, UK
DR MARK YEATES BM, FRCA, MRCS, Anaesthetic Trainee, Severn Deanery,
Bristol, UK

viii
Preface

You are currently holding a book containing 180 MCQ questions designed to help
you revise for the written component of the Final FRCA exam set by the Royal
College of Anaesthetists. The book provides two papers, each consisting of 90 ques-
tions, with 60 multiple true false questions (MTF) followed by 30 single best answer
questions (SBA). The split of question topic areas covers all those tested by the
College. These topic areas are basic sciences, medicine and surgery, intensive care
medicine, clinical anaesthesia and pain medicine. The papers in this book have the
correct ratio of questions from all these five disciplines and the correct proportion of
SBAs and MTFs across these disciplines. For example, each paper has five SBAs in
pain and five MTFs in pain as per the real Final FRCA paper. After the question
papers, the second section of the book provides answers and explanations for the
questions. Each question has both a short explanation that should allow the user to
determine, at a glance, why they may have selected an answer incorrectly and a long
explanation which provides more in-depth information on the topic area. The ques-
tions have been prepared by anaesthetists or experts in areas of tested knowledge
who have either recently sat the Final FRCA or have been involved in training
candidates for the exam. This book represents 180 question files from the highly
popular and successful FRCAQ.com website. This website has over 2600 question
files available, covering all areas of the Final FRCA syllabus. Access to the website is
available with a subscription at www.FRCAQ.com.
It is our experience that candidates are still more comfortable and familiar with
answering MTF questions compared to the SBA questions. SBAs were introduced in
to the Final exam in September 2010 with the idea that they test an area of under-
standing at a higher level than an MTF question. Traditionally, MTFs have been used
to test points of knowledge. They often have the structure of making a statement
about a specific area and asking you whether it is true or false. You have a fifty:fifty
chance of getting the answer right or wrong if you knew nothing and had a wild
guess. A typical pass mark for an MTF component of the Final FRCA MCQ paper
is 75–80%. The SBA section usually involves a clinical scenario followed by the
candidate being asked to select a best option. For example, this may be ‘Select the
best management plan’ or ‘What investigation should you perform next?’ In SBAs,
typically most of the available options are interrelated and plausible; it’s just that one
of the options is best. The pass mark for the SBA component of the exam is typically
50–55%. This should allow the mathematically astute candidate to realise that on
average you are not being asked to select the best answer. You are being asked to
ix
 whittle the list of five options down to two and then have a guess between the last
Preface
two. Rather than Single Best Answer questions, they could be called ‘Discount the
Least Good Three Answers’ questions. In training people for sitting these questions,
this mindset has allowed us to teach people a very useful tactic for approaching these
questions. The key is to discount the more ridiculous options and try to pare the
options down to a small group (ideally a group of one, but two or occasionally three is
not a disaster). Once a smaller group has been identified, an educated guess within
that group will usually be sufficient to achieve an adequate score. When we first
heard the news that SBAs were being launched for anaesthetic exams we thought that
the answers would have to be based on emphatic knowledge and therefore guessed
that questions would be drawn from areas of anaesthesia in which firm guidelines
existed (such as resuscitation or the management of anaphylaxis). Subsequently it
seems that this has not been the case, with the College content to examine areas in
which controversy or differences of opinion occur. The criterion for determining the
‘correct’ answer is based on what the majority of a group of experienced anaesthetists
would choose. The controversial nature of the SBA content and the fact that only 20%
will be scored by wild guessing means that a user getting over 55% on this section of
the paper is doing extremely well.
Each part of an MTF question counts for one mark in your final score. Sixty questions
with five marks available for each contributes 300 marks to the final score. Four marks
are given for each correct SBA question, so 30 questions contributes 120 marks to the final
total of 420 available marks. If the pass mark for the SBA paper is around 50–55% and for
the MTF section is 75–80%, the combined pass mark is usually around 70%.
Our general advice for using this book would be, in the first instance, to try to sit the
two papers under as close to exam conditions as possible. Following an initial attempt
at the questions, a review of the explanations will not only act as a revision aid, but also
give some insight into how and why questions are set. If using this book has proved
valuable, please come and visit us at www.FRCAQ.com, where we have nearly fifteen
times the amount of content in this book for you to explore.
Good luck – and we look forward to seeing you at www.FRCAQ.com soon.

James Nickells and Ben Walton

Editors, FRCAQ.com

x
Question Papers
 Paper 1
MTF Question 1
With regard to measurement of humidity, which of the following statements are correct?
a) Most instruments measure absolute humidity
b) Regnault’s hygrometer has a silver tube containing ether
c) Absolute humidity can be measured by transducers
d) The hair hygrometer works on the principle that hair shortens as humidity increases
e) The wet and dry bulb hygrometer relies on the cooling effect by loss of latent heat of
vaporisation for its function

MTF Question 2
Which of the following statements regarding ketamine are true?
a) Ketamine causes analgesia through its activity at opioid receptors
b) NMDA receptor antagonism is the main mechanism of ketamine effect
c) Ketamine blocks the release of glutamate in the CNS
d) Ketamine blocks activity at muscarinic receptors in the central nervous system
e) Like all general anaesthetic agents, ketamine has activity at the GABAA receptor

MTF Question 3
Causes of hypokalaemia include:
a) Pyloric stenosis
b) Villous adenoma of rectum
c) Conn’s syndrome
d) Theophylline poisoning
e) Renal tubular acidosis

MTF Question 4
The physiological features of severe anorexia nervosa include:
a) Cardiomyopathy
b) Proteinuria
c) Bradycardia 3
 d) Gastric dilation
Paper 1
e) Panhypopituitarism

MTF Question 5
Regarding the use of targeted temperature management after cardiac arrest:
a) The ideal target temperature is 30 °C
b) J waves are a common finding on the ECG of a patient at 31 °C
c) At the end of the cooling period, passive rewarming should be allowed
d) A heart rate of 38 beats per minute when the patient’s temperature is 32 °C is an
indication for rewarming
e) Shivering should preferentially be treated with a non-depolarising neuromuscular
blocking drug (NMBD)

MTF Question 6
Regarding gabapentin, which of the following statements are true?
a) Gabapentin is an agonist at the γ-aminobutyric acid (GABA)A receptor
b) Gabapentin is metabolised by the CYP3A4 isoenzyme
c) Gabapentin is available in a transdermal drug delivery patch
d) Gabapentin can be used for the treatment of acute pain
e) Gabapentin enhances the action of morphine

MTF Question 7
Regarding the neuromuscular junction:
a) The synaptic cleft is 5 nanometres wide
b) There are 10 acetylcholine receptors for every molecule of acetylcholine released in
a conducted impulse
c) Nerve fibres converge on the motor end-plate of the muscle fibre
d) The terminal portion of the motor neurone is unmyelinated
e) Prejunctional acetylcholine receptors have the same morphology as the
postjunctional ones

MTF Question 8
Regarding the porphyrias:
a) They are rare acquired disorders of haem biosynthesis
b) They are rare genetic disorders of haem breakdown
c) Acute intermittent porphyria presents with neurovisceral crises and cutaneous
manifestations
d) Urine porphobilinogens are not raised between attacks in acute intermittent porphyria
e) Treatment of an acute attack includes a low-carbohydrate diet

MTF Question 9
Regarding urinary tract infection:
a) Gram-negative organisms are usually involved
b) It rarely causes sepsis
4 c) More than 100 000 organisms/mm3 on urinary microscopy is significant