fca(sa)_part_ii_past_papers_ 9

8/13/2019 FCA(SA)_Part_II_Past_Papers_ 9

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FCA(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICAIncorporated Association not for gain

Reg No 1955/000003/08

Part II Examination for the Fellowship of the

College of Anaesthetists of South Africa 22 March 2011

Paper 1 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more thanone is required for the one answer)

Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig isvir n vraag) geskryf word

1 A 65-year-old male with evident ischaemic heart disease is booked for an electiverepair of a 7cm suprarenal abdominal aortic aneurysm

a) List major predictors of postoperative cardiac complications in a patient for anelective resection of abdominal aortic aneurysm. (20)b) Discuss haemodynamic consequences of aortic cross-clamp placement. (40)c) Critically discuss your myocardial preservation strategies during aortic cross

clamping in this patient. (40)[100]

1 65-Jarige man met bewese isgemiese hartsiekte word bespreek vir die elektieweherstel van 7 cm suprarenale abdominale aorta-aneurismea) Lys die major voorspellers van postoperatiewe kardiale komplikasies in

pasint vir elektiewe reseksie van abdominale aorta-aneurisme. (20)b) Bespreek die hemodinamiese gevolge van aortakruisklemming. (40)

c) Bespreek krities miokardiale preserveringstrategie gedurendeaortakruisklemming in hierdie pasint.[100]

2 With regard to the conduct of anaesthesia, discuss in detail how the elderly differfrom the normal population. [100]

2 Bespreek in besonderhede hoe die bejaarde verskil van die normale bevolking metbetrekking tot die toediening van narkose. [100]

3 a) Write short notes on TRALI (Transfusion Related Acute Lung Injury). (50)b) A healthy 24-year-old sportsman requires anaesthesia for internal fixation of a

fractured distal tibia. Following an uneventful rapid sequence induction ofgeneral anaesthesia, he is given a 7mg dose of vecuronium and a 1g dose ofcefazolin for surgical wound prophylaxis. In the following 10 (ten) minutes hedevelops a tachycardia, his blood pressure drops by 30% and the end tidalCO 2 drops from 4.9kPa to 2.8kPai) What other features would assist in the diagnosis of an anaphylactic

reaction in this scenario? (5)ii) The clinical scenario develops and you are convinced that you are

dealing with a severe anaphylactic reaction with all the commonlydescribed complications. Describe in detail your management of ananaphylactic reaction in this 80kg patient. (45)

[100]


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3 a) Skryf kort notas oor TRALI (Transfusion Related Acute Lung Injury). (50)

b) Gesonde 24-jarige sportman benodig narkose vir die interne fiksasie van distale tibiafraktuur. Na ongekompliseerde spoedinduksie ontvang hy 7mgvekuronium en 1g kefasolien vir chirurgiese wondsepsisprofilakse. Gedurendedie volgende 10 (tien) minute ontwikkel hy tagikardie, sy bloeddruk daalmet 30% en die endgety-CO 2 daal van 4.9 kPa tot 2.8 kPai) Watter ander eienskappe sal in hierdie omstandighede help met die

diagnose van anafilaktiese reaksie? (5)

ii) Die kliniese beeld ontwikkel verder en u is oortuig dat u te doen hetmet erge anafilaktiese reaksie met al die algemeen-beskryfdekomplikasies. Beskryf in besonderhede u hantering van anafilaktiesereaksie in hierdie 80kg pasint. (45)

[100]

4 Write concise notes on perioperative lung protection. [100]

4 Skryf bondige notas oor perioperatiewe longbeskerming. [100]


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FCA(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICAIncorporated Association not for gain

Reg No 1955/000003/08

Part II Examination for the Fellowship of the

College of Anaesthetists of South Africa 23 March 2011

Paper 2 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more thanone is required for the one answer)

Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig isvir n vraag) geskryf word

1 a) What are the risk factors for perioperative pulmonary embolism? (25)b) What strategies can be employed to prevent a patient developing

perioperative pulmonary embolism? (35)c) Describe your management of a patient who presents with pulmonary

embolism intraoperatively. (40)[100]

1 a) Wat is die risikofaktore vir perioperatiewe pulmonale embolisme? (25)b) Watter strategie kan gebruik word om te voorkom dat pasint

perioperatiewe pulmonale embolisme ontwikkel? (35)c) Bespreek u hantering van pasint wat intraoperatief presenteer met

pulmonale embolisme. (40) [100]

2 Write notes on the followinga) Treatment of tricyclic antidepressant overdose. (25)b) Hypomagnesaemia. (25)c) Non-therapeutic hypothermia. (25)d) ICU management of traumatic brain injury. (25)

[100]

2 Skryf notas oor die volgendea) Behandeling van trisikliese antidepressant oordosering. (25)b) Hypomagnesemie. (25)c) Nie-terapeutiese hipotermie. (25)d) ISE-hantering van troumatiese breinbesering. (25)

[100]

3 An 18-month-old with Tetralogy of Fallot presents for incision and drainage of a hip- abscess. Describe your peri-operative management under the following headings

a) Pathophysiology of the syndrome and impact that anaesthesia may have. (20)b) Detail of the perioperative anaesthetic technique. (80)

[100]

3 Kind, 18-maande oud, met Tetralogie van Fallot presenteer vir insisie endreinasie van heupabses. Bespreek u perioperatiewe hantering onder dievolgende hoofdea) Patofisiologie van die sindroom en die moontlike impak van narkose. (20)b) Besonderhede van die perioperatiewe narkosetegniek. (80)

[100]


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4 A young, healthy woman develops a headache 18 hours after a spinal anaesthetic

for elective caesarean sectiona) Discuss the clinical features and diagnosis of a post-dural puncture headache.

(20)b) Describe in detail your approach to the management of this complication. (80)

[100]

4 Jong, gesonde vrou ontwikkel hoofpyn 18 ure na spinaalnarkose vir elektiewe

keisersnita) Bespreek die kliniese eienskappe en diagnose van postduraalpunksiehoofpyn. (20)

b) Beskryf in besonderhede u benadering tot die hantering van hierdiekomplikasie. (80)

[100]


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The Colleges of Medicine of South Africa Incorporated Association not for gain (Reg. No. 1955/000003/08 )

Nonprofit Organisation (Reg No 009-874 NPO)

27 Rhodes Ave, PARKTOWN WEST 2193Private Bag X23, BRAAMFONTEIN 2017

Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036

General: [email protected] Academic Registrar: [email protected]

Website: http://www.collegemedsa.ac.za

FCA(SA) Part II

DATA INTERPRETATION

Question 1 - 3

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


6/30

QUESTION 1 / V R A A G 1

a) Draw the pressure tracings of a normal adult heart that are seen when apulmonary artery flotation catheter is inserted, in the following order: rightatrium (RA), right ventricle (RV), pulmonary artery (PA) and pulmonarycapillary wedge pressure (PCWP). (5)

a) Teken die drukgrafiek van die normale volwasse hart soos gesien wanneer pulmonale arterie flotasiekateter geplaas word, in die volgende volgorde:

regter atrium (RA), regter ventrikel (RV), pulmonale arterie (PA) en pulmonalekapillre wigdruk (PCWP). (5)

b) What are the causes of an abnormal pulmonary capillary wedge pressure? (5)b) Wat is die oorsake van abnormale pulmonale kapillre wigdruk? (5)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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2 A 50-week-old male infant presents with a 3-day history of projectile vomiting.Following a test feed, a diagnosis of pyloric stenosis is made. The following serumelectrolytes are obtained.

2 50-week-oue manlike baba presenteer met geskiedenis van projektiele braking.Na voedingstoets word die diagnose van pilorusstenose gemaak. Die volgendeserum elektroliete word verkry.

Sodium = 128mmol/lPotassium = 2.9mmol/lBicarbonate = 35mmol/lChloride = 92.8mmol/lpH = 7.63BE = +10mmol/l

a) Describe the electrolyte abnormalities. (3)a) Beskryf die elektrolietabnormaliteite. (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) How would you correct these abnormalities prior to surgery? (5)b) Hoe sal u die abnormaliteite korrigeer voor chirurgie? (5)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) What levels would you consider acceptable before surgery? (2)c) Watter waardes beskou u as aanvaarbaar voor chirurgie? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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3.1 Complete the table below, giving the normal systolic, diastolic and mean bloodpressures for a neonate weighing 1000g, an infant of 12 months and a child of 6years. (5)

3.1 Voltooi die tabel hieronder en gee die normale sistoliese, diastoliese en gemiddeldebloeddruk van 1000g neonaat, 12 maande oue baba en 6-jarige kind. (5)

Neonate of 1000g Infant of 12months Child of 6 years

Systolic BPDiastolic BPMean BP

3.2 A premature infant of 2000g is being given anaesthesia for anal surgery. Blood gasanalysis shows a PaO 2 of 160mmHg. Prematuur 2000g baba ontvang narkose vir anale chirurgie. Bloedgasanalise wys PaO 2 van 160mmHg.

a) What complication may arise as a result of this PaO 2? (2)a) Watter komplikasie mag onstaan as gevolg van die PaO 2 ? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What would you consider optimal values of PaO 2 and SaO 2 for this infantduring anaesthesia? (3)

b) Wat sal u beskou as optimale waardes vir PaO 2 en SaO 2 by hierdie babagedurende narkose? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036



FCA(SA) Part II

DATA INTERPRETATION

Question 4 - 6

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


10/30


This is an electrocardiogram of a 50-year-old male booked for a total knee replacement.

Hierdie is elektrokardiogram van 50-jarige man wie bespreek is vir totaleknievervanging.

a) Determine the P-R interval. What is the diagnosis? (3)a) Bepaal die P-R-interval. Wat is u diagnose? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) Justify your answer with 3 classical criteria for the condition. (3)b) Regverdig u antwoord met 3 klassieke kriteria vir hierdie toestand. (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Describe any four anaesthetic considerations in a patient with this condition.(4)

c) Beskryf enige vier narkose-oorwegings by pasinte met hierdie toestand.(4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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QUESTION 5 / Vraag 5

This is a chest x-ray of a 35-year-old male who complains of pleuritic chest pain andshortness of breath following multiple unsuccessful attempts at inserting a subclavianvenous catheter on the right side.

Hierdie is borskas x-foto van 35-jarige man wat kla van pleuritiese borskaspyn enkortasemheid na veelvuldige onsuksesvolle pogings om subklaviese veneuse kateterregs te plaas.

a) Note the abnormalities on the CXR. (2)a) Noteer die abnormaliteite op die borskas x-foto. (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What is the diagnosis? (2)b) Wat is u diagnose? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) What are the clinical features of this condition? (3)c) Wat is die kliniese eienskappe van die toestand? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) What clinical features would differentiate it from cardiac tamponade? (2)d) Watter kliniese eienskappe sal dit onderskei van kardiale tamponade? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

e) How would you manage this condition? (1)e) Hoe sal u die toestand hanteer? (1)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Spirograms of a ventilated patient.

Spirogramme van geventileerde pasint.

a) What may cause the following abnormal shapes of pressure-volume loops?a) Wat kan die volgende abnormale druk-volumekurwelusse veroorsaak?

_________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

On assessing kidney functionMet evaluering van nierfunksieb) Indicate the formula for calculating % fractional excretion of sodium

(FENa +%). (1)b) Gee die formule vir die berekening van die % fraksionele ekskresie van

natrium (FENa +%). (1) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Name four conditions which may render FENa + unreliable in assessing renalfunction. (2)

c) Gee vier toestande wat FENa + onbetroubaar sal maak in die beoordeling vannierfunksie. (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) Mention four limitations in using serum creatinine to assess renal function. (2)d) Noen vier beperkings by die gebruik van serum-kreatinien in nierfunksie-

beoordeling. (2) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

[10]


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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036



FCA(SA) Part II

DATA INTERPRETATION

Question 7 - 9

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


14/30


Indicate your optimal ventilator settings for a patient with the conditions in the table below.

Gee u optimale ventilatorverstellings vir pasint met die toestande in die tabel hieronder.

COPD ARDSRespiratory rate (RR)

Tidal Volume (V T)

Mode of ventilation

PEEP

I:E

[10]


8 A 40-year-old is under anaesthesia for an exploratory laparotomy following bluntabdominal trauma. His arterial blood gas values on FiO 2=0.4 are as follows

8 40-Jarige is onder narkose vir eksploratiewe laparotomie na stomp buiktrouma.Sy arterile bloedgaswaardes op FiO 2 =0.4 is soos volg

pH = 7.28 PaO 2 = 45mmHgPaCO 2 = 90mmHg BE = -12

a) Define hypoxia and hypoxaemia. (2)a) Definieer hipoksie en hipoksemie. (2) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) List the pathophysiological mechanisms of his hypoxaemia. (4)b) Lys die patofisiologiese meganismes van sy hipoksie. (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Calculate his A-aO 2 gradient. (3)c) Bereken sy A-aO 2 gradint. (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) What is the most likely cause of his hypoxaemia? (1)d) Wat is die mees waarskynlikste oorsaak vir sy hipoksemie? (1)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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9 A 21-year-old patient is admitted to ICU with a depressed level of consciousnessfollowing a short illness. She is acidaemic and her PT is 108s. She is beingconsidered for an urgent liver transplant. She is intubated and mechanicallyventilated, yet her blood pressure falls progressively and she becomes anuric. Apulmonary artery catheter is inserted. The following haemodynamic measurementsand derived figures are obtained

9 21-Jarige pasint word opgeneem in die ISE met onderdrukte bewussyn na kortsiekbed. Sy is asidoties en haar PT is 108s. Sy word oorweeg vir dringendeleweroorplanting. Sy is gentubeer en word meganies geventileer maar haarbloeddruk daal progressief en sy word anuries. Pulmonale arteriekateter wordgeplaas. Die volgende hemodinamiese bepalings word verkry met afgeleidewaardes

MAP = 52mmHgCVP = 12mmHgPCWP = 6mmHgCardiac index = 6.1l/min per m 2 Systemic vascular resistance = 340dyn s/cm 5

a) What haemodynamic abnormality is demonstrated? (4)a) Watter hemodinamiese abnormaliteite word aangetoon? (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) How should the patient be managed? (6)b) Hoe moet die pasint hanteer word? (6)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036



FCA(SA) Part II

DATA INTERPRETATION

Question 10 - 12

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


17/30

QUESTION 10 / V R A A G 1 0

10 The following 2 arterial blood gasses, A and B, were taken 45 minutes apart from a10 month old child.

10 Die volgende 2 bloedgasse, A en B, is 45 minute uitmekaar verkry van 10 maandebaba.

8:16am (A) 8:59am (B)

pH 7.009 7,293pCO 2 119.6 45,7pO 2 174.2 158,3HCO 3 18,8 21,7BE -6.4 -4,7Glucose 9.8 7,0Lactate 0,8 1,7

Anion Gap 6,2 8,1Sodium 139.4 138,6Potassium 4.44 4,42

a) What intra-operative pathology could produce blood gas A? (3)a) Watter intraoperatiewe patologie kon bloedgas A veroorsaak? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What treatment was given that achieved blood gas B? (4)b) Watter behandeling was toegedien om bloedgas B te verkry? (4)

_________________________________________________________________________ _________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) What post-operative management would be appropriate for this child? (3)c) Watter postoperatiewe hantering sal toepaslik wees vir hierdie kind? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Following are three commonly used TEE views

Hier volg drie algemeen gebruikte TEE-beelde

Aa) What view is this?a) Watter beeld is hierdie?

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ________________________________________________________________________

b) What is the sector scan in degrees? (3)b) Wat is die sektorskandering in grade? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Ba) What view is this?a) Watter beeld is hierdie?

________________________________________ _________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What is the sector scan in degrees? (3)b) Wat is die sektorskandering in grade? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Ca) What view is this?a) Watter beeld is hierdie?

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What is the sector scan in degrees? (4)b) Wat is sektorgradering in grade? (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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a) What pathology is evident on this PA CXR? (4)a) Wat is die patologie sigbaar op die PA borskasfoto? (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) List possible problems that you may encounter during anaesthesia. (6)b) Lys die moontlike probleme wat u mag ondervind gedurende narkose. (6)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036



FCA(SA) Part II

DATA INTERPRETATION

Question 13 - 15

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


21/30


Pacemaker

Pasaanger

a) With reference to the ECG, what is the most likely type of pacemaker that thispatient has? (1)

a) Met verwysing tot hierdie EKG, wat is die mees waarskynlikste tipe

pasaanger in die pasint? (1) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) Explain under what conditions will this type of pacemaker result in the biggestincrease in cardiac output? (2)

b) Verduidelik onder watter omstandighede sal hierdie tipe pasaanger diegrootste toename in kardiale uitwerp lewer? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) What are the intraoperative problems that anaesthesiologists may encounterwith rate responsive pacemakers? (3)

c) Wat is die intraoperatiewe probleme wat narkotiseurs mag tekom mettemporesponsiewe pasaangers? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) What are the anaesthetic considerations for patients with biventricularpacemakers? (4)

d) Wat is die narkose-oorwegings in pasinte met biventrikulre pasaangers? (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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QUESTIONS 14 / V R A A G 1 4

The following lung functions were obtained from an adult male patient

Die volgende longfunksies is verkry van volwasse manlike pasint

a) What is the type of lung disease illustrated by these lung function tests? (1)a) Watter tipe longsiekte word gellustreer deur hierdie longfunksietoets? (1)

_________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________

b) List 2 conditions typically associated with such a lung function test. (2)b) Lys 2 toestande tipies geassosieer met so longfunksietoets. (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Does the patient need postponement for preoperative bronchodilators orsteroid therapy? Explain your answer in one sentence or phrase. (2)

c) Moet die pasint uitgestel word vir brongodilatorterapie of steroedterapie?Verduidelik u antwoord in een kort sin of frase. (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Why is the residual volume -total lung capacity ratio 190% of predicted? (2)c) Waarom is die residuele volume-totale longkapasiteitverhouding 190% van

die voorspelde? (2) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) What ventilatory settings will you use intraoperatively? (3)d) Watter ventilatorstelling sal u intra-operatief gebruik? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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The following TEG tracing was obtained from an adult patient with a suspectedpostoperative non-surgical bleed

Die volgende TEG-verslag is verkry vanaf volwasse man met vermoedelik postoperatiewenie-chirurgiese bloeding

a) Is there a clotting abnormality according to this TEG? (1)

a) Is daar stollingsabnormaliteit volgens hierdie TEG? (1) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What are the predominant clotting problems, if any, indicated by this TEG? (2)b) Wat is die oorwegende stolprobleme, indien enige, aangetoon deur hierdie

TEG? (2) _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) List 2 possible causes of this type of clotting abnormality. (2)c) Lys 2 moontlike oorsake vir hierdie tipe stollingsabnormaliteit. (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) List the treatment or management options. (5)d) Lys die behandeling of hanterings opsies. (5)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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FCA(SA) Part II

DATA INTERPRETATION

Question 16 - 17

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


25/30


This is an ECG of a patient with delayed awakening following general anaesthesia.Hierdie is die EKG van pasint met vertraagde ontwaking na algemene narkose.

a) Identify the part of the wave that is shaded. (2)a) Identifiseer die deel van die golf wat gemerk is. (2)

_________________________________________________________________________ _________________________________________________________________________

_________________________________________________________________________ _________________________________________________________________________

b) What is the possible cause of the delayed recovery, as deduced from thisECG? (2)

b) Wat is die moontlike oorsake van vertraagde ontwaking, soos afgelei van dieEKG? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) How do you manage this patient? (6)c) Hoe hanteer u hierdie pasint? (6)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Given the followingGegee is die volgende

Mean arterial pressure 70 mmHgHeart rate 100/minCentral venous pressure 10 mmHgPulmonary artery pressure (mean) 30 mmHg

Pulmonary artery occlusion pressure 12 mmHgCardiac output 4 l/minBody surface area 2.5 m 2

a) Calculate the total systemic peripheral resistance (TPR). Indicate units. (4)a) Bereken die totale sistemiese perifere weerstand (TPR). Gee die eenhede. (4)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) Calculate pulmonary vascular resistance (PVR). Indicate units. (3)b) Bereken die pulmonale vaskulre weerstand (PVR). Gee die eenhede. (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) Calculate the stroke index (SI). (3)c) Bereken die slagindeks (SI). (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036



FCA(SA) Part II

DATA INTERPRETATION

Question 18 - 20

24 MARCH 2011

Time: 3 hours

CANDIDATE NUMBER


28/30


29/30


A 25-year-old woman is involved in a motor vehicle accident. She sustains a severe headinjury with significant cerebral oedema which is confirmed on CT scan. After 12 hours in theintensive care unit, her urine output gradually increases to above 200ml/hour (>4ml/kg/h).

25-Jarige vrou is betrokke in karongeluk. Sy doen ernstige hoofbesering op metbetekenisvolle serebrale edeem, soos bevestig met CT-skandering. Na 12 ure in dieintensiewe sorgeenheid styg haar urienuitskeiding geleidelik tot net meer dan 200ml/uur

(>4ml/kg/h).

a) What is your differential diagnosis? (2)a) Wat is die differensile diagnose? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

b) What is the underlying pathological process? (2)b) Wat is die onderliggende patologiese proses? (2)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

c) What confirmatory tests should be done? (3)c) Watter bevestigende toetse moet gedoen word? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

d) What treatment should be considered? (3)d) Watter hantering moet oorweeg word? (3)

_________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

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The above was obtained from a 70-year-old male patient undergoing right hip arthroplasty.

Die bo genoemde was verkry van n 70-jarige manlike pasint wat regter heup artroplastiekondergaan.

Sodium = 125mmol/lPotassium = 6.6mmol/l

Chloride = 100mmol/lUrea = 9.8mmol/lCreatinine = 126 mol/lRandom blood glucose = 40mmol/l

ABGs:pH = 7.01P aCO 2 = 2.6kPaP aO 2 = 15kPa (room air)Bicarbonate = 8mmol/lBE = -18.9mmol/l

a) What is your immediate diagnosis? (2)a) Wat is u onmiddelike diagnose? (2)

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b) Calculate the anion gap. (2)b) Bereken die anioongaping. (2)

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c) What is your immediate treatment in the first hour? (6)c) Wat is u onmiddelike behandeling in die eerste uur? (6)

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fca(sa)_part_ii_past_papers_ 9

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