CRQ’s Set 1

Question 1: Thyroidectomy

A 37 year old lady presents for a total thyroidectomy and is otherwise fit and well

a) Name 3 specific pre-operative investigations you wish to review and explain

why? (6 marks)

1. …………………………………………………………………………………………

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2. …………………………………………………………………………………………

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3. …………………………………………………………………………………………

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b) What does the anaesthetist need to consider when securing the airway? (2
marks)

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c) Name 2 options for securing the airway? (2 marks)

1. ………………………………………………………………………

2. ………………………………………………………………………

d) What factors should the anaesthetist consider intra-op and during extubation?
(6 marks)

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e) List 4 post-operative complications specific to thyroidectomies (4 marks)

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4. ………………………………………………………………………………………

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Question 2: MRI

a) Explain the meanings of these MRI safety terms (3 marks)

Term Definition
MRI conditional

MRI safe

MRI unsafe

b) Name 2 relative and 2 absolute contraindications of a patient/ personnel

entering an MRI scanner? (4 marks)

RELATIVE:

1. .………………………………………………………………………………………

2. .……………………………………………………………………………………...

ABSOLUTE:

3. ………………………………………………………………………………………

4. ………………………………………………………………………………………

c) Explain from first principles, how an MRI image is generated (6 marks)

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d) What are the issues that anaesthetists need to consider when giving general
anaesthesia for MRI? (7 marks)
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2 …………………………………………………………………………………

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Question 3: Phaeochromocytoma

A 40 year old female, who is known to have an adrenal phaeochromocytoma,

presents for her pre-operative assessment.

a) Which type of cells make up phaeochromocytomas? (1 mark)

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b) These cells are very biochemically active, which substances can they
secrete? (4 marks)

1. ……………………………………………………………………………………

2. ……………………………………………………………………………………

3. ……………………………………………………………………………………
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c) What symptoms or signs might she have? (4 marks)

1. ……………………………………………………………………………………

2. ……………………………………………………………………………………

3. ……………………………………………………………………………………

4. ……………………………………………………………………………………
d) Which investigations might be required to diagnose and plan treatment for this
patient? (3 marks)

1. ………………………………………………………………………………………

2. ………………………………………………………………………………………

3. ………………………………………………………………………………………
e) What are the possible pharmacological treatments that might be used pre-
operatively for this patient, what are their mechanisms of action? (6 marks)

Drug Mechanism of Action

f) In which order should these drugs be introduced and why? (2 marks)

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Question 4: Renal Transplant

“A patient is to receive a cadaveric renal transplant.”

a) List 3 common comorbidities associated with end-stage renal disease (3

marks)

1. ……………………………………………………………………………………

2. ……………………………………………………………………………………

3. ……………………………………………………………………………………
b) Why is a pre-operative ECG an essential investigation? (3 marks)

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c) What considerations must be made in anaesthetising a patient with an
existing A-V fistula? (4 marks)

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d) Why is intraoperative blood pressure control important? (2 marks)

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e) List 3 side effects which may occur if immunosuppressive agents are given in
theatre (3 marks)

1. ……………………………………………………………………………………

2. ……………………………………………………………………………………

3. ……………………………………………………………………………………

f) What are the implications of this patient’s renal disease for their post-
operative analgesia? (2 marks)

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g) What considerations need to be made if this patient requires

surgery/anaesthesia in future? (3 marks)

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Question 5: Splenectomy

A 35-year-old woman presents for splenectomy for idiopathic/immune thrombocytopenic

purpura which is not controlled with medical management

a) Which vaccinations should this patient receive (3 marks)

1. ……………………………………………………………………………………………………………………

2. ……………………………………………………………………………………………………………………

3. …………………………………………………………………………………………………………………..

b) When should they be given (2 marks)

1. ……………………………………………………………………………………………………………………

2. ……………………………………………………………………………………………………………………
c) List three immunological functions of the adult spleen (3 marks)

1. ……………………………………………………………………………………………………………………

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3. …………………………………………………………………………………………………………………..

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d) What are the pre-operative considerations related to this patient’s condition?

(8 marks)

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8. ……………………………………………………………………………………………………………………

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e) Describe the rationale for (1 mark) and principles of (3 marks) conservative

management for traumatic splenic rupture

Principles of conservative management

Rationale
Question 6: Acromegaly

A 59 year old male with acromegaly presents for trans-sphenoidal hypophysectomy.

a) What is Acromegaly? (2 marks)

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b) How may a pituitary mass present? (4 marks)

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 c) List the clinical features of acromegaly that are of interest to the
anaesthetist?

AIRWAY: (3 marks)

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CVR: (3 marks)

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ENDOCRINE: (2 marks)

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d) What post-operative considerations are applicable following a trans-

sphenoidal approach? (2 marks)

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e) Name 4 possible complications of pituitary surgery? (2 marks)

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f) Why might the surgeon request a lumbar drain insertion? (2 marks)

1) …………………………………………………………………………………………………………………

2) …………………………………………………………………………………………………………………

Question 7: Obesity

A 54 year-old female presents on the morning of surgery for a laparoscopic gastric

band. She weighs 112kg and is 174cm tall. She has type 2 diabetes for which she
takes metformin & pioglitazone, hypertension for which she takes ramipril and has a
STOPBANG score of 6.

a) What is her BMI? (1 mark)

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b) What problems with respiratory physiology might you need to consider in the
perioperative period? (3 marks)

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c) What steps would you take to aid induction of and emergence from
anaesthesia in this patient? (5 marks)
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d) Twenty minutes into the case you notice the patient’s SpO 2 has dropped from
96% to 88% despite an FiO2 of 40%. What steps might you be able to take to
improve oxygenation? (4 marks)

1. …………………………………………………………………………

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e) What steps could be taken to ensure adequate management of the patient’s

blood glucose in the perioperative period? (3 marks)

1. ………………………………………………………………………………

2. ……………………………………………………………………………..

3. ………………………………………………………………………………

f) She has been given intramuscular morphine 2 hourly overnight. She is

hypoxic with a SpO2 of 87% on room air. Her respiratory rate is 8 breaths per
minute. What is your diagnosis and action plan? (4 marks)

DIAGNOSIS:

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MANAGEMENT:

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Question 8:

A 27 year old female smoker, Angela, is presenting for an elective diagnostic

laparoscopic investigation of ovarian cysts. On the pre-operative assessment, she
informs you that she has a long history of anxiety and after her last operations she
has been sick in recovery.

a) The definition of post-operative nausea and vomiting (PONV) is any

nausea, wretching or vomiting that occurs within what time frame for an
inpatient post operatively? (1 mark)

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b) What are the components of the simplified Apfel score (2 marks) and what
is this patient’s simplified Apfel score? (1 mark)

APFEL:
1)
2)
3)
4)

PATIENT SCORE …………………………………………………………

c) List 4 Anaesthetic factors that can contribute to PONV. (4 marks)

1. …………………………………………………………………………

2. …………………………………………………………………………

3. …………………………………………………………………………

4. …………………………………………………………………………
 d) List the 4 components of the Post Operative Vomiting in Children (POVOC)
Score? (4 marks)

1. …………………………………………………………………………

2. …………………………………………………………………………

3. …………………………………………………………………………

4. …………………………………………………………………………

Angela is in the recovery after having received appropriate preventative measures

for PONV. Despite this, she experiences PONV.

e) What drug has been shown to be no more effective than a placebo if given
as rescue therapy if the patient has already received the drug as
prophylaxis? (1 mark) and what is its mechanism of action (1 mark)

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f) List 3 other anti-emetics not including your answer in (e) and include the
receptor activity/site of action of the drug in PONV. (6 marks)

Drug Receptor site/ site of action