FANZCA Assessment and Evaluation 5

Question 1

Which echocardiographic parameter is most useful for assessing diastolic dysfunction in the preoperative evaluation of a patient with heart failure with preserved ejection fraction (HFpEF)?

Accepted Answer

E/e' ratio > 14

Answer

An E/e' ratio >14 (ratio of mitral inflow E-wave velocity to tissue Doppler e' velocity) indicates elevated left ventricular filling pressures, characteristic of significant diastolic dysfunction.

Question 2

In a child undergoing preoperative assessment, which finding on the FLACC scale would score 2 in the 'Face' category?

Accepted Answer

Frequent to constant furrowed brow, clenched jaw or quivering chin

Answer

In the FLACC scale, a Face score of 2 is assigned for frequent to constant furrowed brow, clenched jaw, or quivering chin, indicating severe pain behaviour.

Question 3

A patient presents for pre-anaesthetic assessment with a serum creatinine of 185 µmol/L. Using the CKD-EPI equation, which GFR category most influences the choice of neuromuscular blocking agent?

Accepted Answer

GFR < 30 mL/min (G4/G5)

Answer

GFR <30 mL/min (stages G4/G5) significantly prolongs the action of renally-excreted NMBAs such as pancuronium and rocuronium (without sugammadex reversal), necessitating careful agent selection.

Question 4

Which validated score is used perioperatively to assess the risk of acute kidney injury (AKI) after cardiac surgery?

Accepted Answer

Cleveland Clinic Score

Answer

The Cleveland Clinic Score uses preoperative variables (age, sex, LVEF, creatinine, diabetes, IABP, valve surgery, emergency operation) to predict AKI requiring dialysis after cardiac surgery.

Question 5

A 45-year-old woman undergoing thyroid surgery develops sudden onset stridor and respiratory distress 30 minutes postoperatively. What is the first step in assessment and management?

Accepted Answer

Open the wound at the bedside to relieve haematoma compression

Answer

Post-thyroidectomy airway compromise from expanding haematoma is a surgical emergency; wound opening at the bedside to decompress the haematoma is the immediate life-saving manoeuvre.

(FANZCA) Fellowship of the Australian and New Zealand College of Anaesthetists Practice Test

(FANZCA) Fellowship of the Australian and New Zealand College of Anaesthetists Practice Test

FANZCA Assessment and Evaluation 5