FANZCA Assessment and Evaluation 2 — Questions and Answers
Question 1: Which scoring system is most appropriate for assessing postoperative pain in a non-verbal adult patient in the ICU?
- Numeric Rating Scale (NRS)
- Behavioural Pain Scale (BPS) (Correct answer)
- Visual Analogue Scale (VAS)
- Wong-Baker FACES scale
Correct answer: Behavioural Pain Scale (BPS)
The Behavioural Pain Scale (BPS) uses observable behaviours such as facial expression, upper limb movements, and compliance with ventilation to assess pain in non-verbal ICU patients.
Question 2: When performing a pre-anaesthetic assessment, which feature of obstructive sleep apnoea (OSA) most increases perioperative risk?
- BMI > 30 kg/m²
- Apnoea-Hypopnoea Index (AHI) > 30 events/hour (Correct answer)
- Neck circumference > 40 cm
- Excessive daytime sleepiness
Correct answer: Apnoea-Hypopnoea Index (AHI) > 30 events/hour
A high AHI (>30 events/hour) indicates severe OSA and is most directly associated with increased perioperative risk including difficult airway, hypoxia, and cardiovascular complications.
Question 3: A 68-year-old patient is scheduled for elective total hip replacement. Which preoperative assessment tool best predicts postoperative delirium risk?
- ASA Physical Status Classification
- Mallampati Score
- Confusion Assessment Method (CAM) baseline (Correct answer)
- Revised Cardiac Risk Index (RCRI)
Correct answer: Confusion Assessment Method (CAM) baseline
Baseline cognitive assessment using tools such as CAM or the Mini-Mental State Examination identifies pre-existing cognitive impairment, which is the strongest independent predictor of postoperative delirium.
Question 4: Which intraoperative neurophysiological monitoring modality is most useful for detecting ischaemia in the spinal cord during descending thoracic aortic surgery?
- Electroencephalography (EEG)
- Motor Evoked Potentials (MEPs) (Correct answer)
- Bispectral Index (BIS)
- Somatosensory Evoked Potentials (SSEPs)
Correct answer: Motor Evoked Potentials (MEPs)
MEPs monitor the integrity of the corticospinal (motor) tract and are more sensitive than SSEPs for detecting anterior spinal cord ischaemia during aortic surgery.
Question 5: A patient undergoing shoulder arthroscopy in the beach-chair position develops sudden bradycardia and hypotension. Which monitor would have provided the earliest warning?
- End-tidal CO₂ (EtCO₂)
- Cerebral oximetry (NIRS) (Correct answer)
- Arterial blood pressure waveform
- Bispectral Index (BIS)
Correct answer: Cerebral oximetry (NIRS)
Near-infrared spectroscopy (NIRS) cerebral oximetry can detect cerebral hypoperfusion early in the beach-chair position, often before haemodynamic collapse is apparent on standard monitors.
Question 6: In the FANZCA examination context, which criterion is part of the Apfel score for predicting postoperative nausea and vomiting (PONV)?
- Age > 65 years
- History of PONV or motion sickness (Correct answer)
- Use of epidural analgesia
- Male sex
Correct answer: History of PONV or motion sickness
The Apfel simplified risk score includes: female sex, history of PONV or motion sickness, non-smoking status, and use of postoperative opioids.
Question 7: Which method most accurately determines fluid responsiveness in a mechanically ventilated patient with normal sinus rhythm?
- Central venous pressure (CVP) measurement
- Pulse pressure variation (PPV) > 13%
- Passive leg raise with cardiac output measurement (Correct answer)
- Urine output < 0.5 mL/kg/hr over 2 hours
Correct answer: Passive leg raise with cardiac output measurement
Passive leg raise (PLR) combined with real-time cardiac output measurement is the most reliable dynamic test for fluid responsiveness as it is independent of ventilator settings and valid in arrhythmias.
