FANZCA Practice and Application 2 — Questions and Answers
Question 1: A patient undergoing laparoscopic cholecystectomy develops sudden hypotension and raised end-tidal CO2 during insufflation. What is the most likely cause?
- CO2 embolism (Correct answer)
- Pneumothorax
- Anaphylaxis
- Aortic dissection
Correct answer: CO2 embolism
CO2 gas embolism during laparoscopic insufflation causes a characteristic rise in ETCO2 followed by a sudden fall as cardiac output drops, with concurrent hypotension.
Question 2: Which regional anaesthesia technique provides the best analgesia for a patient with fractured neck of femur awaiting surgical repair?
- Femoral nerve block
- Fascia iliaca compartment block (Correct answer)
- Obturator nerve block
- Lumbar plexus block
Correct answer: Fascia iliaca compartment block
The fascia iliaca compartment block reliably covers the femoral, lateral femoral cutaneous, and partially the obturator nerve, providing superior analgesia for femoral neck fractures.
Question 3: In a patient with severe mitral stenosis undergoing non-cardiac surgery, which haemodynamic goal is most important?
- Maintain high heart rate to increase cardiac output
- Avoid tachycardia to allow adequate ventricular filling (Correct answer)
- Reduce systemic vascular resistance aggressively
- Maintain low filling pressures to prevent pulmonary oedema
Correct answer: Avoid tachycardia to allow adequate ventricular filling
In mitral stenosis, tachycardia reduces diastolic filling time across the stenotic valve, causing a critical drop in cardiac output and pulmonary oedema.
Question 4: A 70 kg adult receives 2 mg/kg propofol for induction. Their blood pressure drops from 130/80 to 70/40 mmHg. What is the most appropriate immediate intervention?
- Administer noradrenaline infusion
- Give metaraminol 0.5–1 mg IV bolus (Correct answer)
- Start vasopressin infusion
- Administer phenylephrine 100 mcg IV bolus
Correct answer: Give metaraminol 0.5–1 mg IV bolus
Metaraminol 0.5–1 mg IV bolus is a practical first-line vasopressor for propofol-induced hypotension, restoring SVR rapidly without significant tachycardia.
Question 5: Which ventilation strategy is recommended during one-lung ventilation to minimise ventilator-induced lung injury?
- Tidal volume 10–12 mL/kg IBW, PEEP 0 cmH2O
- Tidal volume 4–6 mL/kg IBW, PEEP 5 cmH2O (Correct answer)
- Pressure control with high inspiratory pressure
- High-frequency jet ventilation at all times
Correct answer: Tidal volume 4–6 mL/kg IBW, PEEP 5 cmH2O
Lung-protective ventilation during one-lung ventilation uses low tidal volumes (4–6 mL/kg IBW) with moderate PEEP to reduce barotrauma and volutrauma.
Question 6: A patient has a plasma potassium of 6.8 mmol/L on preoperative bloods. Which ECG change is the most immediately life-threatening?
- Peaked T waves
- Prolonged PR interval
- Sine wave pattern (Correct answer)
- Widened QRS complex
Correct answer: Sine wave pattern
A sine wave pattern on ECG represents severe hyperkalaemia with fusion of widened QRS and peaked T waves, immediately preceding ventricular fibrillation.
Question 7: During rapid sequence induction with suxamethonium, the patient develops masseter muscle rigidity. What is the most appropriate next step?
- Proceed with intubation immediately
- Abandon the procedure and wake the patient
- Continue anaesthesia and monitor for malignant hyperthermia (Correct answer)
- Administer dantrolene prophylactically before signs develop
Correct answer: Continue anaesthesia and monitor for malignant hyperthermia
Masseter spasm after suxamethonium is a warning sign for malignant hyperthermia; the anaesthetist should maintain oxygenation, monitor temperature and ETCO2, and have dantrolene ready.
FANZCA Practice and Application 2
A patient undergoing laparoscopic cholecystectomy develops sudden hypotension and raised end-tidal CO2 during insufflation.
What is the most likely cause?