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title: Qbase Anaesthesia. Vol. 2, MCQs for the Final FRCA
author: Blunt, Mark.; Hammond, Edward.; McIndoe, Andrew.
publisher: Greenwich Medical Media Limited
isbn10 | asin: 1900151324
print isbn13: 9781900151320
ebook isbn13: 9780511043550
language: English
subject Anesthesia--Examinations, questions, etc.
publication date: 1997
lcc: RD82.3.Q23 1997eb
ddc: 617.9/6/076
subject: Anesthesia--Examinations, questions, etc.
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Page iii
QBase Anaesthesia:
2
MCQs for the Final FRCA
Edited by
Edward Hammond MA BM BCh MRCP FRCA
Shackleton Department of Anaesthetics
Southampton University Hospital NHS Trust
Andrew McIndoe MB ChB FRCA
Sir Humphry Davy Department of Anaesthesia
Bristol Royal Infirmary
Contributors
Mark Blunt
John Isaac
Ravi Gill
Mike Herbertson
Sundeep Karadia
Elfyn Thomas
Gareth Wrathall
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Page iv
Disclaimer:
This netLibrary eBook does not include the ancillary media that was packaged with the original printed version
of the book.
© 1997
Greenwich Medical Media Ltd.
219 The Linen Hall
162-168 Regent Street
London
W1R 5TB
ISBN 1 900151 324
First Published 1997
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted
under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or
transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the
case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright
Licensing Agency in the UK, or in accordance with the terms of the licences issued by the appropriate
Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated
here should be sent to the publishers at the London address printed above.
The right of Edward Hammond and Andrew McIndoe to be identified as authors of this Work has been
asserted by them in accordance with the Copyright, Design and Patents Act 1988.
The publisher makes no representation, express or implied, with regard to the accuracy of the information
contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that
may be made.
A catalogue record for this book is available from the British Library
Distributed worldwide by
Oxford University Press
Produced and Designed by
Derek Virtue, DataNet
Printed in Great Britain
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Page v
Contents
Foreword vii
Introduction ix
Exam 1 1
Answers 21
Exam 2 49
Answers 71
Exam 3 99
Answers 121
Exam 4 149
Answers 171
Exam 5 199
Answers 221
QBase Anaesthesia on CD-ROM
249
CD-ROM System Requirements and Installation Instructions
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Page vii
Foreword
What do we know? We know that organisations responsible for setting standards who are accountable to the
general public must be able to assess their trainees formally. One method is by the FRCA examination which
provides, from 1996, two (primary and final) opportunities for summative assessment to complete local
appraisal and assessment. These examinations may present significant hurdles in the shortened training
programme as only four attempts at each are allowed.
We also know that candidates may be unprepared for these hurdles. There is currently little excuse for this
predicament and many sources of help and advice are available from College Tutors, viva practice and writing
questions under examination conditions. More difficult perhaps is practice at MCQ papers which can be a
threatening test of breadth of knowledge.
First the candidate needs to learn and then test his knowledge and MCQ technique ideally in a way which
provides feedback leading to improved performance. Prospective candidates are fortunate. This book by Dr.
Andrew McIndoe and Dr. Edward Hammond supplies 5 well constructed MCQ examinations of 90 questions
covering the syllabus required for the Final FRCA examination. Not only that, explanations of the answers are
provided with references so the candidates can identify their areas of weakness and whether their guesswork is
a benefit or not. The accompanying interactive CD-ROM allows detailed structured analysis of performance
and exam technique targeted to identify gaps in knowledge which should be addressed.
I congratulate the authors. This book complements their earlier publication on the primary examination and
both provide a valuable learning experience for trainees. They should be used repeatedly to improve exam
technique in answering MCQ papers in order to ensure a good ma k in this part of the examination.
Practice makes perfect; we do at least know that practice with feedback will improve outcome.
SHEILA M. WILLATTS
CONSULTANT IN CHARGE ITU,
BRISTOL ROYAL INFIRMARY
VICE PRESIDENT
ROYAL COLLEGE OF ANAESTHETISTS
JUNE 1997
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Page ix
Introduction
The Examination
There are four sections to the Final FRCA examination: a 90 question MCQ paper; a three hour SAQ paper; a
fifty minute 'Clinical Anaesthesia' Viva and a thirty minute 'Clinical Science' Viva. Each is evaluated using a
four point close-marking system. 2+ is awarded for a good pass; 2 for a pass; 1+ a fail; and 1 is a poor fail. In
order to pass overall, a candidate must score 2,2,2,1+ or better and must attempt all the short questions. Thus,
relative success is required in all parts of the examination.
The MCQ
Three hours are allowed for the multiple choice paper. This equates to approximately two minutes per question.
An enormous amount of mystique surrounds the MCQ, partly because the College does not release past
examples of questions. So what is the best strategy to ensure success? First and foremost it is a test of breadth
of knowledge. Each paper poses 450 individual problems in the form of 90 questions with 5 parts. No other
form of examination is able to cover such ground within the time constraints of a three hour sitting. Thus, the
primary aim must be to cover the syllabus which is freely available from the College and forms the basis of this
book. Arguments against an MCQ examination system are that it fails to differentiate between rote learning and
conceptual appreciation. It has been claimed that the MCQ assessment itself generates cohorts of candidates
who have learned to perform well in that particular style of examination, failing in its intended role of assessing
competence. Whilst it is true that an examination should transparently reflect the abilities of the candidate
without prejudicing those not versed with the system of examination, the reality of the situation is that practice
of the technique undoubtedly improves performance. On the other hand the College claims to make every effort
to validate each portion of the examination by retrospectively streaming each year group and examining the
performance of each band on every question. Those questions that have poor discriminating power or a
tendency to invert the groupings are withdrawn. Consistency between year groups is maintained by the use of
tried and tested moderator questions that allow inter-year comparisons to be made before defining the cut-off
point between success and failure within an exam group. Thus, it is hoped that each candidates performance is
assessed objectively, independently and without bias. So what does this mean in terms of technique? Firstly
there can be no predetermined pass mark, or for that matter a predetermined pass ratio, since each year group is
examined against past year groups. This means that a calculated approach based on number of questions
answered correctly is fundamentally flawed. One should attempt as many questions as possible to ensure the
maximum chance of success. But what of guessing? The College employs a negative marking system which
reduces the potential benefits of guessing. Thus if
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the examination were presented in Ancient Greek, the majority of candidates would score zero overall. But it is
not presented in a foreign language and the dilemma of uncertainty is therefore difficult to negotiate
successfully. Few candidates are truly aware of the influences exerted by their own personalities on their
examination performance. The world is made up from wild gamblers, play safers and every shade of grey in
between these two extremes. It is perhaps surprising that few candidates attempt any form of self assessment
prior to tackling a negatively marked paper.
The CD-ROM
The unique interactive CD-ROM enclosed with this book allows detailed analyses of exam performance and
technique to be achieved at the push of a button. Examinations have been constructed in the College style using
material that covers the entire published syllabus. The 500 questions (each with 5 parts) on the CD can be
shuffled and reassembled in an infinite number of exam combinations allowing you to concentrate on specific
subjects or to create new exams in the College style. Each question is accompanied by explanatory notes and a
reference to an accepted and accessible revision source. When you have completed an exam, the paper is
marked before your eyes and your performance objectively assessed, with the option to jump straight to the
notes accompanying those questions you may have answered badly. Any exam can be saved to your hard disk
or you may simply print a report detailing your performance. The intention has been to construct a versatile
interactive safety net that can rapidly identify holes in knowledge that require further revision. Try not to
concentrate on the overall mark scored, it is the areas of weakness that matter more. Use of the unique
confidence option automates the time-honoured process of labelling answers with different coloured pens to
assess MCQ examination technique. Some will be surprised by their over confidence, most will be encouraged
by their intuitive skills. This is not merely an attempt to beat the system by playing the odds but rather a
positive step towards eliminating the negative effects of poor examination technique that the individual
candidate may not have been aware of. The preparation for Collegiate examinations is often a difficult juggling
act for trainees, all of whom are required to perform a service commitment and many of whom are coming to
terms with the domestic demands of a young family. With available revision time at a premium, Q-Base will
help you to rapidly identify areas of weakness and ensure that you approach the negatively marked MCQ
examination with a personalised technique least likely to result in failure.
QBase Anaesthesia on CD-ROM has been designed to be easy to use. No knowledge of computers is
necessary. It will help you maximise your score. The exam analysis in this version has been substantially
enhanced to give you a subject based as well as overall analysis. This new CD will automatically update the
version of the program released with QBase 1.
Good luck!
DR E. HAMMOND
DR A. MCINDOE
JULY 1997
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Page 1
Exam 1
Question 1
The initial management of a patient with suspected anaphylaxis during anaesthesia includes
A. 50% oxygen
B. 0.51.0 ml of adrenaline 1:10,000 intramuscularly
C. 0.51.0 mg of adrenaline intravenously at a rate of 0.5 mg/minute until a response is obtained
D. Chlorpheniramine 1020 mg by slow intravenous injection
E. Hydrocortisone 100300 mg intravenously
Question 2
Atmospheric pressure can be quoted as approximately
A. 76 cmHg
B. 15 lb/in2
C. 100 Nm
D. 1 bar
E. 7.6 mH2O
Question 3
In deep vein thrombosis
A. Platelets form the greatest bulk of the thrombus
B. Sickle cell anaemia is a cause
C. A positive Homan's sign is diagnostic
D. Pulmonary embolism is commonest with thromboses below the knee
E. Destruction of vein valves is accompanied by oedema
Question 4
The body's intracellular buffers consist primarily of
A. Haemoglobin
B. Proteins
C. Albumin
D. Creatinine
E. Polypeptides
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Question 5
For patients receiving anaesthesia at increased altitude
A. Atmospheric pressure decreases linearly with increasing altitude
B. Hyperpnoea enhances oxygen uptake in the lungs and its offloading in the tissues
C. At 10,000 feet 50% nitrous oxide will be less analgesic than at sea level
D. For the same minute ventilation, work of breathing will be reduced compared to sea-level
E. Halothane vapourisers will have to be manually adjusted to compensate for altered atmospheric pressure
Question 6
The following drugs should be administered at reduced dosages to patients with impaired renal function
A. Azaproprazone
B. Enalapril
C. Atenolol
D. Frusemide
E. Cefuroxime
Question 7
Cardioversion is indicated in
A. Ventricular tachycardia
B. Asystole
C. Atrial flutter
D. Digoxin toxicity
E. Bundle branch block
Question 8
A systolic murmur is classically present in
A. Mitral stenosis
B. Tricuspid stenosis
C. Atrial septal defect
D. Mitral regurgitation
E. Pulmonary hypertension
Question 9
Hyperglycaemia may result from the administration of
A. Adrenaline
B. Thyroid stimulating hormone
C. Beta blockers
D. Thiazide diuretics
E. Glucagon
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