SAQ 2023.1

Question 1

SAQ List the branches of the coronary arteries and the myocardial territories and structures they supply. Outline the electrocardiograph (ECG) leads that correspond to the blood supply. Describe the ECG changes in a non-ST-elevation myocardial infarct (NSTEMI). Pass Rate 48.9%

Question 2

SAQ Outline the immediate management of an unconscious trauma patient in the emergency department who has a suspected cervical spine injury. Pass Rate 65.5%

Question 3

ENT / Airway - subglottic stenosis

SAQ 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. Pass Rate 74.0%

Question 4

Transphenoidal

SAQ Discuss the perioperative management of a previously well patient presenting for transsphenoidal resection of a non-secretory pituitary macroadenoma. Pass Rate 25.6%

Question 5

SAQ 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. Pass Rate 62.8%

Answer 5

Airway plan
North facing RAE/reinforced ETT –> convert to tracheostomy

RAFF -
blood supply

Prolonged procedure

1. airway management plan,
2. appreciation of long surgery and its implications,
3. a fluid management plan and optimization of conditions for flap survival.

Better answers were able to expand on these and add other relevant material.

Question 6

SAQ Discuss the implications of anticoagulation as well as an appropriate anticoagulant management strategy for a 25-year-old with a mechanical aortic valve for the duration of pregnancy delivery and the postpartum period. Pass Rate 43.9%

Answer 6

Warfarin embryopathy
Worst in T1
Enoxaparin in T1 and Warfarin T2 - T3
Risk vs benefit

1. Continuation of anticoagulation up until close to delivery
2. Potential effects of anticoagulation on the fetus, including teratogenicity and
   fetal loss risks due to haemorrhage *
3. Implications for neuraxial techniques * Risk of major bleeding
4. high risk pregnancies, with death and thromboembolic complications possible in the mother, and
5. the place of other therapeutic options pre- and post-delivery such as low molecular weight heparin.

Question 7

SAQ Describe your technique to provide caudal epidural analgesia for an infant weighing 10 kg undergoing hypospadias surgery. Pass Rate 43.9%

Answer 7

the correct surface anatomy, using correct anatomical terms.

Details for an appropriate safe technique, including positioning, monitoring, and personnel, as well as appropriate drugs and drug doses to be administered were also required for a pass to this question.

Many candidates simply referred to “ANZCA monitoring” or “as per PS18”. This was so prevalent that a pass mark was allowed if the answer met all other minimum criteria, however candidates are cautioned to avoid the use of such short-cuts in future answers.

Better answered also described the ultrasonographic anatomy, and provided some details of the potential complications and contraindications of caudal blocks.

Question 8

SAQ A 56-year-old patient with a phaeochromocytoma is scheduled for a laparoscopic adrenalectomy. Justify your preoperative investigations for this patient (30%). Discuss your goals for preoperative optimisation and how to achieve them (70%). Pass Rate 78.9%

Answer 8

OHA P.716

Knowledge concerning the perioperative care of patients with a range of medical conditions is often tested in the SAQ paper.

In this question the instructions limited answers to the preoperative anaesthesia considerations for phaeochromocytoma only.

To achieve a pass, candidates were required to

justify the use of preoperative echocardiography, ECG, and blood tests (FBC, U&E) at a minimum as part of an assessment of haemodynamic status.

A discussion of initial alpha blockade, with appropriate blood pressure and heart rate control,
volume status assessment and

pharmacological agents to achieve these goals was also required, as was the mention of anaesthesia as part of a multidisciplinary team approach to optimisation.

Question 9

SAQ Justify strategies used to mitigate postoperative delirium in an elderly patient requiring hip fracture fixation. Pass Rate 65.9%

Question 10

SAQ Describe the innervation relevant to the stages of labour (30%). Evaluate the regional analgesia options for each stage (70%). Pass Rate 60.1%

Question 11

SAQ Outline the major considerations for organ donation after circulatory death (DCD). Pass Rate 51.6%

Question 12

SAQ Outline the circumstances where the dosing of paracetamol requires modification (50%). Describe the management principles of paracetamol toxicity (50%). Pass Rate 56.1%

Question 13

SAQ Data regarding the conduct and outcomes of anaesthesia are now widely collected (e.g. National Anesthesia Clinical Outcomes Registry (NACOR)). Outline the benefits and the potential errors that can occur when using this data for research. Pass Rate 44.4%

Question 14

SAQ Discuss the preoperative elements of an Enhanced Recovery After Surgery (ERAS) program for a patient requiring major colorectal surgery. Pass Rate 62.3%

Question 15

SAQ A) Identify the axes A and B (with units)
and the points labelled C through H on the following spirometry loop: (normal spirometry loop provided) B) Outline how these spirometry parameters change in: * Chronic obstructive pulmonary disease * Idiopathic pulmonary fibrosis * Extrathoracic tracheal obstruction Pass Rate 75.8%