Fca 2018

Question 1

Question 2
a) Summarise the arachidonic acid pathway that leads to the generation of prostaglandins
involved with pain, inflammation and fever.

Question 2

b) Explain how non-steroidal anti-inflammatory drugs work to treat pain.

Question 3

c) Explain the mechanism of ‘aspirin-induced asthma’.

Question 4

Question 3
Discuss the role of the following micronutrients in the management of the septic patient in the
intensive care unit
a) Glutamine. b) Omega-3-fatty acids. c) Selenium.

Question 5

Question 4
A 64-year-old man is planned for a multidisciplinary procedure to correct a complex fistula post
prostatectomy which he had a year earlier. The procedure is expected to be prolonged. He has
Type 2 Diabetes and is using insulin. He is also treated with three agents for hypertension. The
patient had an ST elevation myocardial infarction 5 years ago for which a stent was inserted in the
left circumflex coronary artery. He was on anticoagulation treatment for 3-months. The patient
defaulted on Cardiology follow up because he was asymptomatic. On examination he is able to
climb two flights of stairs unassisted and his pre-operative ECG reveals a Mobitz Type 2 block
a) Discuss this patient’s pre-operative cardiac risk. (5)
b) What precautions will you take before embarking on the anaesthetic for this patient? (5)

Question 6

Question 5
A 58-year-old woman is booked for an elective cholecystectomy and suffers a cardiac arrest
during the procedure. Following 30 minutes of appropriate resuscitation the patient is declared
dead on the operating table
a) What is a procedure-related death? (3)
b) List the actions that should be taken following this patient’s death. (7)

Question 7

Question 6
A 75-year-old woman had a general anaesthetic for an uneventful right open hemicolectomy. The
patient declined a neuraxial anaesthetic
a) Outline your post-operative analgesic strategy for this patient. (5)
Twelve hours post-operatively the patient is found to be delirious
b) List 5 possible causes for delirium in this patient. (5)

Question 8

Question 7
A 55-year-old patient is involved in a high-speed motor vehicle collision as an unrestrained driver.
He smokes 30 cigarettes/day and has poorly controlled hypertension. He sustains bilateral lung
contusions, a cardiac contusion and extensive facial fractures. After seven days of mechanical
ventilation his facial fractures are fixed. After a further two days you are called to assist with his
extubation
a) What parameters should be assessed prior to extubation? (4)
b) Describe your approach to extubating this patient. (6)