Practice Single Best Answer Questions for the Final FRCA A

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cambridge university press
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no reproduction of any part may take place without
the written permission of Cambridge University Press.

First published 2013

Printed and bound in the United Kingdom by the MPG Books Group

A catalogue record for this publication is available from the British Library

Library of Congress Cataloguing in Publication data

Practice single best answer questions for the final FRCA : a revision
guide / edited by Hozefa Ebrahim . . . [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-107-67992-4 (pbk.)
I. Ebrahim, Hozefa.
[DNLM: 1. Anesthesia – methods – Examination Questions.
2. Anesthesia – adverse effects – Examination Questions. WO 218.2]
617.90 6076–dc23
2012013424

ISBN 978-1-107-67992-4 Paperback

Cambridge University Press has no responsibility for the persistence or

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Contents
List of contributors page vi
List of abbreviations viii
Classification of questions by topic xii
Foreword by Prof Hutton xv
Foreword by Prof Bion xvii
Introduction: angle of attack xix
Acknowledgements xxii

Paper A – Questions 1 Paper G – Questions 142

Paper A – Answers 10 Paper G – Answers 151
Paper B – Questions 25 Paper H – Questions 165
Paper B – Answers 34 Paper H – Answers 174
Paper C – Questions 49 Paper J – Questions 188
Paper C – Answers 58 Paper J – Answers 197
Paper D – Questions 74 Paper K – Questions 212
Paper D – Answers 83 Paper K – Answers 220
Paper E – Questions 96
Paper E – Answers 104
Paper F – Questions 118
Paper F – Answers 127
Index 235

v
 Principal contributors
Edward Copley Nicholas Crombie
Specialist Registrar in Anaesthesia Consultant Anaesthetist
West Midlands Deanery, Birmingham, UK Queen Elizabeth Hospital,
Birmingham, UK
Anna Pierson
Specialist Registrar in Anaesthesia Neil H Crooks
West Midlands Deanery, Birmingham, UK Specialist Registrar in Anaesthesia and
Intensive Care Medicine
Richard Pierson West Midlands Deanery,
Specialist Registrar in Anaesthesia Birmingham, UK
West Midlands Deanery, Birmingham, UK
Hozefa Ebrahim
Specialist Registrar in Anaesthesia and
Intensive Care Medicine
West Midlands Deanery,
Contributors Birmingham, UK

Ian Ewington
Michael Allan Specialist Registrar in Anaesthesia
Specialist Registrar in Anaesthesia and Intensive Care Medicine
West Midlands Deanery, Birmingham, UK West Midlands Deanery,
Birmingham, UK
Natish Bindal
Consultant Anaesthetist James Geoghegan
Queen Elizabeth Hospital, Birmingham, UK Consultant Anaesthetist
Queen Elizabeth Hospital,
Catriona Bentley Birmingham, UK
Specialist Registrar in Anaesthesia
West Midlands Deanery, Birmingham, UK Au-Chyun Nicole Goh
Clinical Fellow in Paediatric Intensive
Hannah Church Care Medicine
Consultant Anaesthetist Birmingham Children’s Hospital, UK
Queen Elizabeth Hospital,
Birmingham, UK Andrew G Haldane
Specialist Registrar in Anaesthesia
Michael B Clarke West Midlands Deanery, Birmingham, UK
Advanced Pain Trainee
Specialist Registrar in Anaesthesia Khalid Hasan
West Midlands Deanery, Consultant Anaesthetist and College Tutor
Birmingham, UK Queen Elizabeth Hospital, Birmingham, UK

Lloyd Craker Max Simon Hodges

Consultant Anaesthetist Specialist Registrar in Anaesthesia
North Staffordshire Hospital, UK West Midlands Deanery, Birmingham, UK

vi
 Principal contributors

Eric Hodgson Randeep Mullhi

Chief Specialist Anaesthesiologist, Specialist Registrar in Anaesthesia and
Inkosi Albert Luthui Central Hospital Intensive Care Medicine
Honorary Senior Lecturer, West Midlands Deanery, Birmingham, UK
Nelson R Mandela School of Medicine,
Durban, South Africa Rebecca Paris
Specialist Registrar in Anaesthesia
Asim Iqbal West Midlands Deanery, Birmingham, UK
Clinical Fellow in Hepatobiliary Anaesthesia
Specialist Registrar in Anaesthesia Sachin Rastogi
West Midlands Deanery, Birmingham, UK Pain Fellow
The Hospital for Sick Children,
Paul Jeanrenaud Toronto, Canada
Consultant in Intensive Care Medicine and
Anaesthesia Simon Smart
Whiston Hospital, Merseyside, UK Consultant Anaesthetist
Queen Elizabeth Hospital,
Emily Johnson Birmingham, UK
Specialist Registrar in Anaesthesia
West Midlands Deanery, Insiya Susnerwalla
Birmingham, UK Specialty Trainee in Anaesthesia
North Western Deanery, Manchester, UK
Deepak Joseph
Specialist Registrar in Anaesthesia Alifia Tameem
West Midlands Deanery, Specialist Registrar in Anaesthesia
Birmingham, UK West Midlands Deanery, Birmingham, UK

Michael McAlindon Mark Tindall

Specialist Registrar in Anaesthesia and Consultant Anaesthetist
Intensive Care Medicine Russells Hall Hospital, Dudley, UK
West Midlands Deanery,
Birmingham, UK Laura Tulloch
Specialist Registrar in Anaesthesia and
Craig McGrath Intensive Care Medicine
Consultant Anaesthetist West Midlands Deanery,
Queen Elizabeth Hospital, Birmingham, UK Birmingham, UK

vii
 Abbreviations
AAA abdominal aortic aneurysm
AChR acetylcholine receptor
ACT activated clotting time
ACTH adrenocorticotrophic hormone
ADH antidiuretic hormone
AIR anaesthesia-related rhabdomyolysis
AKI acute kidney injury
ALSG advanced life support group
ALI acute lung injury
APTT activated partial thromboplastin time
ARDS acute respiratory distress syndrome
ARF acute renal failure
BMI body mass index
BMS bare metal stent
BP blood pressure
CABG coronary artery bypass graft
CAS central anticholinergic syndrome
CDH congenital diaphragmatic hernia
CDI Clostridium difficile infection
CK creatine kinase
CMRO2 cerebral metabolic oxygen replacement
CNB central neuraxial block
CNS central nervous system
CO cardiac output
COHb carboxyhaemoglobin
CPB cardiopulmonary bypass
CPP chronic pelvic pain
CPSP chronic postsurgical pain
CRF chronic renal failure
CRPS complex regional pain syndrome
CSE combined spinal–epidural
CSF cerebrospinal fluid
CT computerized tomography
CTPA computerized tomography pulmonary angiogram
CRT cardiac resynchronization therapy
CSWS cerebral salt-wasting syndrome
CXR chest X-ray
DAPT dual antiplatelet therapy
DES drug-eluting stent
DI diabetes insipidus
DLT double lumen tube
DKA diabetic ketoacidosis

viii
 List of abbreviations

DMD Duchenne’s muscular dystrophy

DMSO dimethyl sulphoxide
DVT deep vein thrombosis
ECMO extracorporeal membrane oxygenation
ECT electroconvulsive therapy
EPO erythropoietin
ERCP endoscopic retrograde cholangiopancreatography
ETT endotracheal tube
EVAR endovascular aortic aneurysm repair
EVLWI extravascular lung water index
FEV1 forced expiratory volume in 1 second
FES fat embolism syndrome
FFP fresh frozen plasma
GA general anaesthetic
GABA gamma amino-butyric acid
GBS Guillain–Barré syndrome
GCS Glasgow coma score
GFR glomerular filtration rate
GI gastrointestinal
HCAI healthcare-associated infection
HDU high-dependency unit
HFOV high-frequency oscillatory ventilation
HITT heparin-induced thrombotic thrombocytopenia
HLHS hypoplastic left heart syndrome
HR heart rate
IABP intra-aortic balloon pump
IBW ideal body weight
ICDSC intensive care delirium screening checklist
ICP intracranial pressure
ICS intraoperative cell salvage
ICU intensive care unit
ID internal diameter
INR international normalized ratio
LBBB left bundle branch block
LBW lean body weight
LMA laryngeal mask airway
LMWH low molecular weight heparin
LRTI lower respiratory tract infection
LV left ventricle
MAC minimum alveolar concentration
MAOI monoamine oxidase inhibitor
MELD model for end-stage liver disease
MEN multiple endocrine neoplasia
MG myasthenia gravis
MPM mortality prediction model
MR magnetic resonance

ix
 List of abbreviations

MRI magnetic resonance imaging

MVR mitral valve replacement
NCA nurse-controlled analgesia
NIBP non-invasive blood pressure
NPV negative predictive value
NSAID non-steroidal anti-inflammatory drug
OLV one-lung ventilation
OSA obstructive sleep apnoea
PA pulmonary artery
PAC pulmonary artery catheter
PAFC pulmonary artery flotation catheter
PCA patient-controlled analgesia
PCI percutaneous coronary intervention
PD Parkinson’s disease
PDPH postdural puncture headache
PEEP positive end-expiratory pressure
PICU paediatric intensive care unit
POCD postoperative cognitive dysfunction
PONV postoperative nausea and vomiting
PPH postpartum haemorrhage
PPV positive predictive value
PRIS propofol-related infusion syndrome
PT prothrombin time
PTC post-tetanic count
PTE pulmonary thromboembolism
PVL-SA Panton–Valentine leukocidin-producing Staphylococcus aureus
RA right atrium
RASS Richmond Agitation Sedation Score
RSI rapid sequence induction
RV right ventricle
SAH subarachnoid haemorrhage
SAPS simplified acute physiology score
SBE subacute bacterial endocarditis
SIADH syndrome of inappropriate antidiuretic hormone
SJW St John’s wort
SNRI serotonin and noradrenaline reuptake inhibitor
SSRI selective serotonin reuptake inhibitor
SUNCT short-lasting, unilateral neuralgiform headache
TACO transfusion-associated circulatory overload
TAP transversus abdominis plane
TBI traumatic brain injury
TBSA total body surface area
TBW total body weight
TCA tricyclic antidepressant
TCI target-controlled infusion
TEG thrombo-elastograph

x
 List of abbreviations

TENS transcutaneous electrical nerve stimulation

TIVA total intravenous anaesthesia
TLS tumour lysis syndrome
TMJ temporomandibular joint
TOE transoesophageal echocardiogram
TOF train of four
TRALI transfusion-related acute lung injury
TSH thyroid stimulating hormone
TTE transthoracic echocardiogram
UFH unfractionated heparin
URTI upper respiratory tract infection
vCJD variant Creutzfeldt–Jakob disease
VAE venous air embolism
VC vital capacity
VF ventricular fibrillation
VT ventricular tachycardia
VTE venous thromboembolism
vWF von Willebrand’s factor
WP widespread pain index

xi
 Classification of questions by topic

Category

Basic sciences A23, B9 D2, D22 F16 H22

K15

Cardiac and D25 E2, E8, E9, E10, E13 F7, F21 G28 H5, H7, H9
thoracic B3, B4, B13, A28, C24 J25, J28
anaesthesia and B20
intensive care
medicine

Burns and A12, B25 K3, K11

trauma

Equipment and D1, D5 G30

clinical
measurement

General A2, A3, A4, A5, C2, C3, C4, C21, C26, F12, F18, G2, G3, H4, H8,
anaesthetic A6, A25, A26, C28, C29, C30, C1 F20, F22, G4, G17, H11, H16,
practice A27, A30 F23, F25, G21, G23, H26
F26, F28, G26, G27,
F29, F30 G29
B11, B12, B14, E1, E3, E4, E6, E7, E11, J2, J12, J13, K1, K16,
B15, B18 E30 J16, J17, K 21, K 24,
J18, J22, K 25, K 27,
J29, J30 K 29, K 30
D3, D4, D25,
D27, D28, D30

Intensive care C5, C9, C13, D6, D14, D15, A1, A7, F1, F4, F9 G5, G8, H1, H12,
medicine C17, C7, C12, A9, A10, A11, A17, G11, G12, H17, H30
C15, C27, E24 A19, A29, B1, B2, B5, G13, G25
B6, B7, B22, B26, B28,
B30
J3, J7, J11, K2, K6, K9,
J23, J26 K10, K14,
K17, K24,
K25

Liver E19 F11 G14, G16 H18, K17, J18

anaesthesia and K21
medicine

xii
 Classification of questions by topic

Category

Neuro- E28 H10, H14, J5, J8

anaesthesia and H25, H28
intensive care
medicine

Obstetric D19, D23 E14, E18 F17 G18, G20, H2, H6,
anaesthesia G22 H19
A20, A24 J4, J19, J27 K18, K22,
K26
B8, B17, C18,
C22

Paediatric D12, D16, E12, E17, E21, E26, E27 F5, F13, F14 G6, G9, H3, H15,
anaesthesia and D20, D24 H20, H24
intensive care A13, A16, A21 J9, J14, K7, K12,
medicine J20, J24 K19, K23,
K28
B16, B24
C10, C14, C19,
C23

Acute and D9, D13, D17, E5, E15, E16, E20, E25 F3, F6, F10, G7, G10, H21, H23,
chronic pain D21 F15, F19 G15 H27
management A14, A18, A22 J1, J6, J10, K8, K13,
J14, J15, K20
J21
B10, B19, B27
C8, C11, C16,
C20

Regional D7 E29 F2, F8 G19, G24 H29,

anaesthesia A8, B23, B29, K4, K5
C6, C25

Trauma and D10, D11, D26 E23 G1 H13

orthopaedics

Transplant D18 E22

surgery

Vascular D29 F24, F27

anaesthesia

xiii
Foreword
Since man has existed there has been a basic, innate human drive to help the sick and,
whenever possible, to return them to health. Superimposed on this constancy of intent has
been a steady and progressive improvement in the ways of managing illness. Anaesthesia and
its related specialties of intensive care medicine and pain management have been instru-
mental in allowing these developments to occur. In so doing they too have had to meet and
overcome new problems. These range from those posed by rapid recovery case anaesthesia
via safer childbirth to the management of increasingly complex patients with reduced
physiological reserves.
Through its Charter, the Royal College of Anaesthetists has a public responsibility to
ensure that this clinical progress is not only maintained, but also that the knowledge to
achieve it is both taught and examined. It is to the credit of the specialty that for many years it
has led the way in preparing trainees and fellows for the task ahead. Over time, the College
examinations have undergone huge changes: the ones I sat in the late 1970s were very
different from those of today. Throughout, however, the college has maintained a constant
theme of making the examinations fit for purpose in the context of current and future
practice. Whilst frustrating the many who have had to cope with this change, the effect has
been of enormous public benefit.
This book has been produced in response to the recent variation of educational strategy in
the Final Examination: the introduction of the scenario-based single best answer question.
For me its publication is welcome on two grounds. Firstly, there is no doubt it will help those
preparing for the examination: the coverage goes across the whole syllabus, the clinical
settings are relevant and it encourages learning based in the reality of the clinical environ-
ment. Secondly, it is a book generated and completed by the energy of young anaesthetists,
both trainees and consultants. With such enthusiasm in the ranks, the future of the specialty
looks bright.
I wish the book, its authors and all those who read it the very best of luck for the future.

Peter Hutton PhD, FRCA, FRCP, FInst Mech E, Consultant Anaesthetist and Hon Professor,
UHB FT and University of Birmingham

xv