FANZCA Assessment and Evaluation 3 — Questions and Answers
Question 1: Which electrocardiographic finding during preoperative assessment represents an absolute contraindication to elective non-cardiac surgery without further investigation?
- First-degree atrioventricular block
- New left bundle branch block (LBBB) (Correct answer)
- Bifascicular block with normal PR interval
- Sinus bradycardia at 52 bpm
Correct answer: New left bundle branch block (LBBB)
A new LBBB may indicate acute myocardial ischaemia or cardiomyopathy and mandates urgent cardiology evaluation before elective surgery.
Question 2: A patient with a known pheochromocytoma requires assessment before adrenalectomy. Which biochemical marker is the most sensitive indicator of catecholamine excess?
- Urinary vanillylmandelic acid (VMA)
- Plasma metanephrines (Correct answer)
- Serum catecholamines
- 24-hour urinary catecholamines
Correct answer: Plasma metanephrines
Plasma free metanephrines have a sensitivity >95% for phaeochromocytoma and are the preferred first-line biochemical test.
Question 3: When assessing depth of anaesthesia using the Bispectral Index (BIS), which range is targeted to minimise the risk of awareness while avoiding excessive depth?
- 20–40
- 40–60 (Correct answer)
- 60–80
- 80–100
Correct answer: 40–60
A BIS of 40–60 corresponds to an adequate depth of general anaesthesia, balancing the risks of intraoperative awareness and excessive anaesthetic depth.
Question 4: In a patient with severe mitral stenosis, which haemodynamic goal is most critical during the perioperative period?
- High heart rate to increase cardiac output
- Controlled heart rate to optimise diastolic filling time (Correct answer)
- Aggressive volume loading to increase preload
- Systemic vasodilation to reduce afterload
Correct answer: Controlled heart rate to optimise diastolic filling time
In mitral stenosis, a controlled (slow) heart rate is essential to allow adequate time for ventricular filling across the stenosed valve and maintain cardiac output.
Question 5: Which preoperative pulmonary function test result best predicts increased risk of postoperative pulmonary complications after thoracic surgery?
- FEV1/FVC ratio < 0.7
- Predicted postoperative FEV1 (ppoFEV1) < 40% (Correct answer)
- DLCO < 80% predicted
- Peak expiratory flow rate < 300 L/min
Correct answer: Predicted postoperative FEV1 (ppoFEV1) < 40%
A ppoFEV1 <40% after planned resection is a major predictor of postoperative respiratory insufficiency and mortality in thoracic surgery.
Question 6: Which clinical finding during airway assessment is most specifically associated with potential difficulty with supraglottic airway device insertion?
- Mallampati class III
- Limited mouth opening (< 2 cm interincisor distance) (Correct answer)
- Reduced thyromental distance
- Fixed flexion deformity of the cervical spine
Correct answer: Limited mouth opening (< 2 cm interincisor distance)
Severely limited mouth opening (<2 cm) impairs both direct laryngoscopy and insertion of supraglottic airway devices such as LMAs.
Question 7: A 55-year-old male presents for preoperative evaluation before vascular surgery. His RCRI score is 3. According to the Lee Revised Cardiac Risk Index, what is the approximate risk of major adverse cardiac events (MACE)?
- < 1%
- 1%
- ~3–7% (Correct answer)
- > 11%
Correct answer: ~3–7%
An RCRI score of 3 corresponds to approximately 3–7% risk of major adverse cardiac events, placing the patient in a high-risk category warranting further evaluation.
FANZCA Assessment and Evaluation 3
Which electrocardiographic finding during preoperative assessment represents an absolute contraindication to elective non-cardiac surgery without further investigation?