FANZCA Practice and Application 5

Question 1

A patient develops bronchospasm intraoperatively with SpO2 falling to 88%. Initial management includes 100% O2 and deepening anaesthesia. What is the next pharmacological step?

Accepted Answer

Salbutamol via MDI through the breathing circuit

Answer

Inhaled salbutamol delivered via metered-dose inhaler through the circuit is the first-line bronchodilator for intraoperative bronchospasm.

Question 2

Which coagulation test best reflects the integrity of the extrinsic pathway and is used to monitor warfarin therapy?

Accepted Answer

Prothrombin time / INR

Answer

The prothrombin time (expressed as INR) measures the extrinsic pathway (factor VII) and is the standard monitor for warfarin anticoagulation.

Question 3

A patient undergoing total hip arthroplasty under spinal anaesthesia develops sudden hypotension, tachycardia, and bronchospasm after bone cement insertion. What is the most likely diagnosis?

Accepted Answer

Bone cement implantation syndrome

Answer

Bone cement implantation syndrome occurs when cement monomers and fat embolise from the femoral canal during pressurisation, causing hypotension, hypoxia, and arrhythmias.

Question 4

In managing a patient with raised intracranial pressure intraoperatively, which ventilation target is most appropriate?

Accepted Answer

PaCO2 30–35 mmHg as a temporising measure

Answer

Mild hyperventilation to PaCO2 30–35 mmHg is used as a short-term ICP-lowering manoeuvre; sustained hypocapnia below 30 mmHg causes ischaemic vasoconstriction.

Question 5

A 30-year-old woman at 32 weeks gestation requires emergency appendicectomy. Which position best prevents aortocaval compression during surgery?

Accepted Answer

15–30° left lateral tilt

Answer

A 15–30° left lateral tilt displaces the gravid uterus off the inferior vena cava and aorta, maintaining maternal cardiac output and uteroplacental perfusion.

(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 Practice and Application 5