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Clinical Scenarios For The Final FRCA/FFA
All tutorials located on this site are the property of Patrick Neligan and are for personal study purposes only. They are not peer reviewed and no responsibility is taken for inaccuracies. These tutorials must not be reproduced without permission or used in any other publication.
The patient going for anaesthesia with X problem.
Here are some examples of the type of clinical scenarios that you may be asked in the Final FFA/FRCA exam. The answers are not always black and white, so what matters is a compelling arguement. Try to develop your own technique for answering the questions. At some stage I will add suggested answers.
1. Define the problem
2. Develop the discussion by going into the scientific background, why it's important a) to clinicians & b) to anaesthetists, and what the implications are for anaesthesia.
3. Discuss the anaesthetic.
4. Discuss the pros and cons of the various interventions.
5. Discuss any new or future developments in this field.
6. Summarise and draw conclusions
70 year old male for TURP. Background of COPD, MI x 2 years. Now has chest pain on exertion. He is on diuretics and digoxin. BP 140/80. Pulse 74. RR 16. Hb 16. K2.8. urea 35. How would you manage this patient?
7 year old male, moderate to severe asthma, loud audible wheeze. Supracondylar fracture, fullstomach, needs urgent repair as neurovascular bundle is compromised. Discuss anaesthetic management.
Discuss the management of a 72 year old male with Aortic Stenosis with acute ischaemic lower limb. Discuss anaesthetic management.
Discuss the management of a woman who is 32 weeks pregnant with worsening pre-eclampsia for caesarian section.
Discuss the management of a 23 year old female with myasthenia gravis for thymectomy.
Discuss the management of a 4 week old baby with pyeloric stenosis.
Discuss the management of a 47 year old male caught in an indoor fire with 40% burns and inspiratory stridor.
Discuss the management of a 56 year old male presenting with an incarcerated hernia and a blood glucose level of 56 mmol/l.
You are asked to assess a patient with a tracheostomy which has fallen out. The site is bleeding profusely. The patient is distressed. Discuss your management.
A 67 year old female with chronic rheumatoid arthritis is admitted for an orthopaedic procedure on her left hand. A tourniquet technique is planned. She complains of dyspnoea on one flight of stairs. Bloods are normal. Discuss anaesthetic management.
Discuss the management of a 44 year old lady for elective clipping of a berry aneurysm. Background history of angina on moderated exertion. Discuss anaesthetic management.
Compare and contrast the anaesthetic management of acute epiglottitis and croup.
A 2 year old child is admitted for a posterior fossa craniotomy for removal of a brain tumour. He was active and playful last night and now has a runny nose, is irritable and coughing. How would you manage this patient.
A 77 year old male presents for elective repair of an abdominal aortic anaeurysm (8 cm in diameter). He had a myocardial infarction 9 months ago, and complains of chest pain on moderate exertion. How would you manage this patient?
74 year old male for total hip replacement. He has COPD and has been treated with phenelazine (MAOI) for 15 years. Discuss anaesthetic management.
A 26 year old female presents for caesarian section at 38 weeks complaining of increasing shortness of breath and haemoptysis. She has a diagnosis of mitral stenosis. She has been on digoxin for three years and is currently on diuretics. Discuss anaesthetic management.
A 56 year old male presents for right sided thoracotomy for carcinoma. He had an MI 3 months ago, treated with atenolol and aspirin. He has a loud left sided carotid bruit. How would you prepare this man for anaesthesia.
A 24 year old female presents for excision of a phaeochromocytoma. Discuss anaesthesia preparation and management.
52 year old male. Dislocated elbow, requires urgent MUA. History alcohol abuse. Presents drunk. Discuss anaesthetic management.
64 year old female for carotid endarterectomy. History of recurrent TIAs. History of angina at 50 yeads. History NIDDM and glaucoma. K 2.8, creat 290.
7 year old. Emergency appendicectomy. Anorexia and vomiting x 3 days. First cousin has history of "problem with an anaesthetic", the family were tested. The outcome is unknown.
30 year old male 80 kg, involved in RTA. He has a fractured humerus, scalp laceration, head injury. Right pupil fixed and dilated.
33 year old with a history of epilepsy, history of renal failure. For Tenchkoff (peritoneal dialysis) catheter.
A patient with jaundice for laparoscopic cholecystectomy.
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