FANZCA Practice and Application 3 — Questions and Answers
Question 1: A patient with known difficult airway presents for elective surgery. The previous anaesthetic record documents 'grade 3 view, bougie-assisted intubation.' Which initial approach is most appropriate?
- Standard rapid sequence induction
- Awake fibreoptic intubation (Correct answer)
- Intubation via video laryngoscope after induction
- Supraglottic airway as definitive technique
Correct answer: Awake fibreoptic intubation
A grade 3 view on prior laryngoscopy with the need for adjuncts indicates a genuinely difficult airway; awake fibreoptic intubation maintains spontaneous ventilation and is the safest strategy.
Question 2: Which agent is the preferred reversal for rocuronium-induced neuromuscular blockade in a patient with renal failure?
- Neostigmine with glycopyrrolate
- Sugammadex (Correct answer)
- Edrophonium
- Pyridostigmine
Correct answer: Sugammadex
Sugammadex encapsulates rocuronium and is effective regardless of renal function, though the complex may accumulate; it remains preferred over neostigmine which requires ACh esterase activity.
Question 3: A child weighing 20 kg requires endotracheal intubation. Using the Cole formula, what is the correct uncuffed ETT size?
- 4.0 mm
- 4.5 mm
- 5.0 mm (Correct answer)
- 5.5 mm
Correct answer: 5.0 mm
The Cole formula (age/4 + 4) for a 20 kg child typically corresponds to approximately 5 years of age, giving a tube size of 5.0 mm.
Question 4: Which parameter most accurately reflects adequacy of neuromuscular reversal before extubation?
- Clinical head lift for 5 seconds
- Train-of-four ratio ≥0.9 by acceleromyography (Correct answer)
- Sustained tetanus at 50 Hz
- Grip strength assessment
Correct answer: Train-of-four ratio ≥0.9 by acceleromyography
A TOF ratio ≥0.9 measured by quantitative acceleromyography is the most reliable indicator of adequate neuromuscular recovery and protects against residual paralysis.
Question 5: A patient on long-term opioid therapy for chronic pain presents for elective bowel resection. Perioperatively, which analgesic strategy is most appropriate?
- Discontinue opioids preoperatively to reset tolerance
- Continue baseline opioid dose and use multimodal analgesia (Correct answer)
- Use only regional anaesthesia without systemic opioids
- Increase opioid dose by 50% to cover surgical pain
Correct answer: Continue baseline opioid dose and use multimodal analgesia
Patients on chronic opioids should continue their baseline dose to prevent withdrawal, supplemented by multimodal analgesia including regional techniques.
Question 6: During spinal anaesthesia for Caesarean section, the patient develops hypotension to 70/40 mmHg and nausea. What is the first-line treatment?
- Adrenaline 100 mcg IV bolus
- Phenylephrine 100 mcg IV bolus or noradrenaline infusion (Correct answer)
- Ephedrine 50 mg IV bolus
- IV fluid bolus 1 litre crystalloid
Correct answer: Phenylephrine 100 mcg IV bolus or noradrenaline infusion
Current evidence favours vasopressors (phenylephrine or noradrenaline) over ephedrine as first-line for spinal hypotension in obstetrics due to better foetal acid-base outcomes.
Question 7: When performing an interscalene brachial plexus block, which structure is most at risk of injury from needle placement?
- Subclavian artery
- Internal jugular vein
- Phrenic nerve (Correct answer)
- Recurrent laryngeal nerve
Correct answer: Phrenic nerve
The phrenic nerve runs adjacent to the brachial plexus at the interscalene level and is blocked in nearly 100% of cases, causing ipsilateral hemidiaphragm paresis.
FANZCA Practice and Application 3
A patient with known difficult airway presents for elective surgery.
The previous anaesthetic record documents 'grade 3 view, bougie-assisted intubation.' Which initial approach is most appropriate?