Fellowship Exam SAQ

Question 1

Outline the advantages and disadvantages of using the paediatric circle system and the Jackson-Rees modification of Ayre’s T-piece (Mapleson F) for anaesthesia in a 15 kg child.

Question 2

A 9-year-old girl with cerebral palsy is scheduled to undergo bilateral femoral varus derotation osteotomy and adductor lengthening. Outline the challenges of providing effective postoperative analgesia for her surgery and discuss the analgesia options available.

Question 3

“The following venous blood gas result of a five-week-old infant with pyloric stenosis
pH 7.50
pCO2 50
HCO3 38
Base excess +5
Sodium 129
Potassium 3.6
Chloride 92
Interpret this VBG. Discuss your preoperative resuscitation and justify your criteria for proceeding to surgery”

Question 4

Justify your perioperative management plan of a six-year-old child with a penetrating eye injury

Question 5

A 14-year-old with severe autism is rescheduled for dental surgery. The operation was previously abandoned due to their poor cooperation with the team. Justify your perioperative management plan.

Question 6

Discuss the issues relevant to the perioperative care of a seven-year-old child with Down Syndrome who has sustained a supracondylar fracture of the humerus.

Question 7

An infant born at 30 weeks gestation is booked for repair of bilateral inguinal herniae at 46 weeks post-conceptual age. Discuss the important issues when providing perioperative care for this infant

Question 8

A two-year-old boy scheduled for hypospadias repair is found to have a praecordial murmur. Justify your decision to proceed.

Question 9

A three year old child requires an adenotonsillectomy for obstructive sleep apnoea. Outline and justify your peri-operative management plan.

Question 10

An 8 week old baby is scheduled for an inguinal hernia repair on your list at a local general hospital tomorrow. a) Outline the important issues when providing anaesthesia care for this baby. (70%) b) Justify your decision to proceed with surgery at the local general hospital (30%)

Question 11

“A 7-year-old nonverbal girl with severe spastic cerebral palsy is scheduled for cystoscopy.a. Describe the important features of cerebral palsy relevant to planning anaesthesia for this procedure. (70%)b. What are the advantages and disadvantages of inhalational
induction in this child? (30%)”

Question 12

A child with active upper respiratory tract infection presents for general anaesthesia.a. Outline the factors that increase the rate of adverse respiratory events during anaesthesia. (50%)b. How can you reduce the risk of an adverse event occurring? (50%)

Question 13

“You hear a cardiac murmur in a two-year-old child presenting for elective minor surgery.(a) What are the features of the murmur that would differentiate an innocent from a pathological murmur? (50%)(b) How would you evaluate this child’s fitness for anaesthesia
from the cardiac perspective? (50%)”

Question 14

Compare the algorithms for advanced life support of adults and term newborns and explain the rationale for the differences

Question 15

Describe your assessment of a four-year-old child who has been rescued from a house fire

Question 16

A six-week-old term baby weighing 4.0 kg requires pyloromyotomy for pyloric stenosis. How would you assess the baby’s hydration status? (50%) Detail and justify your resuscitation regimen. (50%)

Question 17

A 3-year-old presents to the emergency department with a recent onset of stridor.a. List the differential diagnoses (30%)b. How do you differentiate between the potential causes of this stridor? (70%)

Question 18

“A 6-month-old boy presents with an acute abdomen. He is diagnosed with intussusception and booked for laparotomy after a failed attempt at reduction. His heart rate is 160bpm and BP is 75/45 mmHg.
His electrolyte profile is as shown:

Na⁺ 132 mmol/l (135 – 145)
K⁺ 2.7 mmol/l (3.5 – 5.5)
Cl⁻ 106 mmol/l (95 – 110)
Urea 3.3 mmol/l (3.5 – 8.5)
Creatinine 86 μmol/l (60 – 110)
Lactate 4.5 mmol/l (1.0 – 1.8)

(a) How would you determine his degree of dehydration and how severe is it likely to be? (40%)
(b) Describe your perioperative fluid management. (40%)
(c) When would you proceed to surgery and why? (20%)”

Question 19

a. Describe the factors that influence emergence delirium in children. (50%) b. How would you manage emergence delirium in a 3 year old child having had myringotomy tubes inserted under general anaesthesia? (50%)

Question 20

List methods to prevent hypothermia in paediatric patients during anaesthesia and surgery, commenting on the effectiveness of each.

Question 21

Describe your technique to provide caudal epidural analgesia for an infant weighing 10kg undergoing hypospadias surgery

Question 22

“You are asked to anaesthetise a two-year-old child for an eight-hour craniotomy. The child is susceptible to developing malignant hyperthermia.
Outine your strategies for obtaining intravenous access in this child. (50%)
Discuss the issues of using a total intravenous technique in this situation. (50%)”

Question 23

Describe the anatomy relevant to performing a caudal block in a two-year-old male.

Question 24

A 50-year-old man with a base of tongue cancer is scheduled for elective tracheostomy immediately followed by tumour resection. Discuss the issues involved with his airway management.

Question 25

List the essential equipment currently recommended to manage a difficult airway in an adult patient. (50%) Justify supplementary items you would recommend. (50%)

Question 26

“Describe the physiological principles underlying preoxygenation prior to the induction of anaesthesia. (50%) Discuss the advantages and disadvantages of using a high inspired oxygen concentration (>80%) during maintenance of anaesthesia.
(50%) “

Question 27

“A 40 year-old male is scheduled for elective bariatric surgery.For this patient: List the important features of history and examination that may identify a potentially difficult airway. (30%) How could you modify your anaesthetic technique to
minimise hypoxia at induction. (70%)”

Question 28

a. How is the need for manual in-line stabilisation of the neck determined? (50%) b. What are the implications of inline stabilisation for endotracheal intubation of the airway (50%).

Question 29

a. Describe the sensory innervation of the respiratory passage from the nostrils to, and including, the vocal cords (50%). b. List the indications and contraindications for nasal intubation (50%).

Question 30

A 68-year-old man in hospital awaiting definitive surgery for a supraglottic squamous cell carcinoma of the larynx has worsening stridor at rest. (a) How might his symptoms be improved in the preoperative period? (30%) (b) Describe your evaluation of his airway and how this will influence your intraoperative airway management plan. (70%)

Question 31

An adult patient who was intubated for tonsillectomy is noted to have an upper central incisor tooth missing in the Recovery Room after extubation. (a) List the predisposing factors for perioperative dental damage. (50%) (b) What is your management of this situation? (50%)

Question 32

a. What is the physiological basis of preoxygenation? (50%) b. Describe your method of preoxygenation including how you assess its adequacy. (50%)

Question 33

A 60-year-old man is anaesthetised for a rigid cystoscopy. You notice bile stained fluid in his classic laryngeal mask airway (LMA) during the procedure. Describe your management.

Question 34

An adult patient from the intensive care unit with severe adult respiratory distress syndrome (ARDS) requires a laparotomy for an acute abdomen.a. What are the features of ARDS? (30%)b. Explain your perioperative ventilation strategy (70%)

Question 35

You are called to anaesthetise a 70-year-old man with a perforated bowel for laparotomy, three days after colonoscopy.Outline the measures you will take to reduce the likelihood of this patient developing acute lung injury.

Question 36

(a) Describe the anatomy, including surface landmarks, relevant to performing cricothyroidotomy. (50%) (b) What are the complications of this procedure? (50%)

Question 37

Describe a technique for front of neck access to the airway in a ‘Can’t intubate, Can’t Oxygenation’ situation (50%). Outline the potential complications and limitations of this technique (50%).

Question 38

Compare and contrast first-generation and second-generation laryngeal mask airways.

Question 39

Describe the physiological effects of a high-flow nasal cannula device (HFNC) e.g. OptiflowTM or AirvoTM. (50%) Justify its use in an adult endoscopy suite. (50%)

Question 40

Considering the indications and limitations, compare the rationale for the use of: —Hudson masks —Non-rebreathing masks —Nasal prongs

Question 41

“A patient is undergoing revision parathyroidectomy. At the surgeon’s request, you have placed a Nerve Integrity Monitor (NIM) tube for monitoring recurrent laryngeal nerve function. The surgeon is unable to elicit a response from the monitor
when stimulating the recurrent laryngeal nerve. a. Explain how the NIM tube monitors nerve function? (30%) b. Outline the possible causes of being unable to elicit a response and how you would manage them? (70%) “

Question 42

With regard to oxygen therapy for patients in a general postoperative ward a. Describe the options available (30%) b. What are the justifications for your choice for a particular patient? (70%)

Question 43

Compare and contrast oxygen delivery by nasal prongs, simple facemask and Venturi mask.

Question 44

A patient has undergone an eight-hour elective cervical spine fusion involving both anterior and posterior approaches. Outline your approach to extubation of this patient.

Question 45

Outline extubation strategies for anticipated difficult extubation of an adult.

Question 46

An 82-year-old patient is booked for excision of a floor of mouth squamous cell carcinoma and neck dissection, with radial forearm free flap reconstruction. Discuss the issues relevant to the intraoperative anaesthetic management for this procedure

Question 47

A 30-year-old patient is scheduled for laser resection of a subglottic mass to relieve mild stridor. Justify your intraoperative anaesthetic management of this case.

Question 48

What are the issues associated with jet ventilation?

Question 49

Discuss your considerations when anaesthetising a patient for functional endoscopic sinus surgery.

Question 50

A patient presents for a microlaryngoscopy and laser of a 5 mm nodule on his left vocal cord. (a) Outline the risks associated with the use of lasers in airway surgery. (50%) (b) Discuss the precautions that should be taken to manage these. (50%)

Question 51

Discuss the key areas of concern in your preoperative assessment of a patient for excision of a large tonsillar mass.

Question 52

“A 35-year-old female is booked for thyroidectomy. Her blood results are as follows.Thyroid stimulating hormone (TSH, thyrotropin) 0.1 (N 0.3 – 3 mIU/l)Total Thyroxine (Total T4) 20 (N 4 – 11 μg/dl)Free Thyroxine (Free T4) 4 (N 0.7 – 1.8 ng/dl)
Free Tri-iodothyronine (Free T3) 120 (N 60 – 175 ng/dl)a. Interpret the thyroid function tests (10%)b. Justify when you would proceed to thyroidectomy in this patient (50%)c. What is the management of an intraoperative thyrotoxic crisis? (40%)”

Question 53

A young adult male is assaulted and sustains a maxillary fracture. He is scheduled for an open reduction and internal fixation (ORIF) of the maxillary fracture on the emergency list. Outline the relevant anaesthetic considerations.

Question 54

Justify your choice and dosing of drugs when providing anaesthesia for electroconvulsive therapy (ECT)

Question 55

Describe the physiological responses to electroconvulsive therapy (ECT). (50%) Discuss how these affect your anaesthetic management of a patient undergoing ECT. (50%)

Question 56

You are asked to give a practical tutorial on paediatric airway management to Emergency Department registrars at a large hospital. What are the important aspects of paediatric airway management that you would present to them?

Question 57

Outline the steps you would take to ensure the safe introduction of elective paediatric surgery at your local private hospital.

Question 58

A 6yo girl with severe spastic cerebral palsy presents for orthopaedic surgery to correct lower limb deformities. Outline the implications of cerebral palsy for anaesthesia management for this operation.

Question 59

You are asked to provide assistance to resuscitate a baby. One minute after birth the baby is apnoeic, grey/blue all over, floppy and unresponsive to stimulation, with a pulse felt at the umbilical stump of 60/min. What is this baby’s APGAR score? Describe your resuscitation of the baby.

Question 60

You are the anaesthetist at a childrens’ hospital. A 3yo schedules for dental restoration and extractions is found to have a systolic murmur during your preoperative assessment on the day of surgery. They have been on a waiting list for 6 months and have had a dental abscess that settled with antibiotics. Describe how you would evaluate the significance of this murmur and how this decision would affect your decision to proceed or not with surgery.

Question 61

“A 3 week old male infant who was born by uncomplicated vaginal delivery at term presents with projectile vomiting for 2 weeks. His weight is now 2.8 kg from a birth weight of 3.1kg. His presumed diagnosis is pyloric stenosis. His blood chemistry results are: Measured Normal Range
Na 129 mmol/L 135-145 mmol/L
K 3.0 mmol/L 3.5-5.5 mmol/L
Cl 84 mmol/L 95-110 mmol/L
HCO3 36 mmol/L 18-25 mmol/L
Creatinine 69 μmol/L 20-75 mmol/L
Glucose 3.0 mmol/L 2.5-5.5 mmol/L
Explain how these abnormal results come about.
Describe an appropriate fluid resuscitation regime for this infant.
List the laboratory criteria by which you would consider him sufficiently resuscitated for surgery.”

Question 62

A 2 year old child has burns to lower body from immersion into a hot bath. Describe your assessment and management of pain and fluid requirements in the first 2 hours following injury.

Question 63

Discuss in detail the technique of rapid sequence induction with cricoid pressure in a child. Include the reasons for your choice of relaxant.

Question 64

What are the indications for tracheal intubation in a 3 year old who presents with “croup”? Describe your technique for intubation.

Question 65

“Working in a small obstetric unit you are asked to attend at the birth of a child where there is meconium stained liquor. How will you manage the infant’s resuscitation?

Describe the characteristics of a ventilator suitable for neonates.”

Question 66

A 4 yo boy weighing 15kg presents for day surgery repair of a left inguinal hernia for which you plan general anaesthesia and caudal block. He has no significant past history, and is well. Justify your choice of agent(s) for caudal injection for this child.

Question 67

“A four week old infant presents for bilateral inguinal herniotomy at a free-standing day surgery unit with a siginificant paediatric caseload. This infant is to have a gerneral anaesthestic. The parents wish to return to the country that evening.
1. Is the use of a laryngeal mask an acceptable option for airway management? Justify your answer.
2. How would you provide post-operative analgesia for this infant? Include information on dosage and routes of administration.
3. On what basis would you decided if it is appropriate for this infant to return to the country that evening?”

Question 68

“You discover a heart murmur, which has not been noted before, in a 3 yo child presenting for elective inguinal hernia repair.
1. How would you assess this child at the bedside with respect to this murmur, and what findings would prompt you to refer this child to a cardiologist prior to surgery?
2. A cardiological opinion is sought, and echocardiography is advised. The child becomes extremely upset, and the paediatrician and parents ask you to sedate him for the procedure. How will you manage this?
3. The echocardiogram is reported as normal and the cardiological opinion is that the murmur is physiological and of no concern. Outline and justify your plan for postoperative analgesia following the hernia repair, including after discharge.”

Question 69

“An 8 month old, 10 kg infant presents for laparotomy following failed barium enema reduction of an intussusception.
7. Describe and justify your perioperative fluid management.
8. At the completion of surgery the haemoglobin is measured at 70g/L. Would you transfuse this patient? Justify your answer.
9. In what circumstances would it be reasonable to provide continuous epidural analgesia for postoperative pain relief in this child?”

Question 70

List the anatomical differences between the neonatal and adult airway. Include the significance of each difference.

Question 71

“A three year old child is being assessed for insertion of middle ear drainage tubes. On examination you discover that the child has a precordial murmur.
10. What information would you be seeking in your assessment of this child to decide if the murmur is innocent?
11. If the child is found to have a ventricular septal defect, but is otherwise well, how will this influence your anaesthetic management?
12. Describe the pharmacokinetics and dosing schedule of paracetamol for post op analagesia.”

Question 72

“A nine year old child with spina bifida presenting for a tendon transfer procedure is said to have multiple allergies including latex and antibiotics.
10. How would you decide whether or not the child has latex allergy?
11. If the child does have latex allergy, describe the precautions that should be taken peri-operatively to prevent this child developing a latex reaction?
12. What would you advise the parents regarding the risks that latex allergy adds to the perioperative period?”

Question 73

“A 4 yo boy weighing 15kg presents for day surgery repair of a left inguinal hernia for which you plan GA and a caudal block. He has no significant past history and is well.
4. Describe how you would perform a caudal injection for this child.
5. Justify your choice of agent(s) for caudal injection for this child.
6. If his parents express concern about caudal analgesia, what alternative analgesia options would you offer? Include a brief comment on their particular advantages and disadvantages.”

Question 74

Compare propofol with sevoflurane as the sole anaesthetic general anaesthetic agent for a 3 yo child requiring insertion of drainage tubes for chronic otitis media.

Question 75

“A 14yo girl, 130cm tall, with idiopathic scoliosis is scheduled for corrective fixation via a thoracotomy. Controlled hypotension will be used.
7. What are the options available for providing collapse of the right lung?
8. Two hours into the operation the urine output is measured as 5 ml (in two hours). How would you manage this?
9. At the time of skin closure her core temperature is 34.1 degrees celcius. How would you manage this?”

Question 76

“A 3 year old child presents with respiratory distress associated with a respiratory tract infection
13. How would you assess the need for tracheal intubation?
14. Describe the facilities you require when you decide to intubate the trachea.
15. What are the possible causes of cardiac arrest in this child one hour after intubation?”

Question 77

What are your views on the statement: “Children having a tonsillectomy should not be prescribed narcotic analgesics post-operatively”?

Question 78

“a. What is the physiological basis of preoxygenation? (50%)
b. Describe your method of preoxygenation including how you assess its adequacy. (50%)”

Question 79

How do you assess an otherwise well patient with regard to difficulty of intubation at the bedside? How accurate is such an assessment?

Question 80

Draw flow volume loops associated with a) Fixed upper airway obstruction b) Variable extrathoracic airway obstruction c) Variable intrathoracic airway obstruction. Explain briefly the physiological reasons for the shape of these loops

Question 81

Discuss the risks and benefits associated with intermittent positive pressure ventilation through proseal ® laryngeal mask airway for a patient undergoing laparoscopic cholecystectomy.

Question 82

What is the physiological basis of preoxygenation? Describe your method of preoxygenation including how you assess its adequacy.

Question 83

What is the role of a laryngeal mask airway in a failed intubation for laparotomy? Also 2002b15/1995b4

Question 84

Justify the use of a laryngeal mask airway in a 25 yo, 80kg man having general anaesthesia for removal of 4 molar teeth.

Question 85

Describe the technique of applying cricoid pressure to prevent regurgitation of gastric contents.

Question 86

Discuss the presence of morbid obesity as a predictor of difficult intubation.

Question 87

Discuss the role of the LMA in the management of a difficult intubation

Question 88

A morbidly obese patient (160kg, 165cm) with sleep apnoea requiring the use of CPAP mask develops acute cholecystitis. He is febrile and sweaty, with warm peripheries. Blood pressure is 110/70. Heart rate is 110/min. He is scheduled for urgent cholecystectomy. His saturation on arrival in the operating theatre is 93% on O2 (nasal prongs 2l/min). Discuss the advantages and disadvantages of an awake intubation in this patient.

Question 89

A 17 year-old trail bike rider was struck on the neck by a low branch and thrown from his bike. He presents to your casualty with a hoarse voice, stridor and subcutaneous emphysema of the neck. Discuss your plan to secure this patient’s airway.

Question 90

What are the arguments for and against leaving a laryngeal mask airway in place for unsupervised removal by recovery room nurses?

Question 91

List the anatomical differences between the neonatal and adult airway. Include the significance of each difference.

Question 92

A healthy 25 yo, 80kg man had general anaesthesia for the elective removal of 4 molar teeth. The anaesthetist uses a laryngeal mask airway (LMA). Justify the use of a LMA for this procedure. Halfway through surgery, the capnograph trace becomes flat. Describe your management. Discuss methods of postoperative analgesia for this surgery.

Question 93

“A 50 yo man with gastro-oesophageal reflux and occasional nocturnal pharyngeal reflux is to have knee arthroscopy under general anaesthesia. What are the methods which could be used to minimise the risk of aspiration of gastric contents?

What are the adverse effects of the pharmacological agents which could be used for this purpose (to minimise the risks of aspiration of gastric contents)? Exclude any considerations of anaesthetic agents or muscle relaxants.

Despite your best management the patient does regurgitate and aspirate at induction. How would you manage this?”

Question 94

What are the arguments for and against the use of a laryngeal mask airway for general anaesthesia for laparoscopic tubal ligation?

Question 95

Explain your bedside assessment of the airway in an adult who has a history of a difficult tracheal intubation.

Question 96

Outline the role of a laryngeal mask airway in managing an unanticipated failed tracheal intubation in a patient who was having an elective laparotomy?

Question 97

“A 68-year-old man in hospital awaiting definitive surgery for a supraglottic squamous cell carcinoma of the larynx has worsening stridor at rest.
(a) How might his symptoms be improved in the preoperative period? (30%)
(b) Describe your evaluation of his airway and how this will influence your intraoperative airway management plan (70%)”

Question 98

Describe your management of a patient who has had a total thyroidectomy who develops respiratory distress in the recovery room.

Question 99

An 18yr old, otherwise healthy female, is to have 2 impacted wisdom teeth surgically removed as a day stay patient. Describe and justify features of your anaesthetic technique that may help prevent the common postoperative problems you would anticipate in this patient.

Question 100

How can recurrent laryngeal nerve function be assessed in the postoperative period?

Question 101

Discuss the issues specific to GA for myringoplasty

Question 102

A 55 yo adult is to have nasal polypectomy under general anaesthesia. The patient has nocturnal oesophageal reflux and extensive fixed uppper dental prostheses.How would you reduce the risk of perioperative dental damage? How can problems associated with the use of vasoconstrictors in nasal surgery be prevented? Describe the management of systemic toxicity resulting from the use of vasoconstrictors in nasal surgery.