FCA(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Anaesthetists of South Africa
20 August 2012
Paper 1

(3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than
one 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 is
vir n vraag) geskryf word

a)
b)

a)
b)

What is meant by surgical site infection (SSI), and describe the factors that
play a role in SSI.
(30)
Discuss the role of the anaesthesiologist in the prevention of surgical site
infection (SSI).
(70)
[100]
Wat beteken die term chirurgiese lokus infeksie en beskryf die faktore wat n
rol speel in hierdie patologiese proses?
(30)
Bespreek die rol wat die narkotiseur het om te speel in die voorkoming van
chirurgiese lokus infeksie.
(70)
[100]

A 45-year-old woman with end-stage renal failure is scheduled for a living donor
renal transplant.
a)
Discuss the pathophysiological changes associated with chronic renal failure
which are of concern to the anaesthesiologist.
(60)
b)
Describe your intra-operative management of this patient for renal transplant
surgery.
(40)
[100]

n 45-Jarige dame met eindstadium nierversaking, is geskeduleer vir die ontvang van
n lewende donor nier.
a)
Bespreek die patofisiologiese veranderinge wat geassosieer is met chroniese
nierversaking wat van belang is vir u as narkotiseur.
(60)
b)
Beskryf die intraoperatiewe hantering van hierdie pasint vir haar
nieroorplanting chirurgie.
(40)
[100]

With reference to neuropathic pain:

a)
List the major aetiological categories for this condition and give examples for
each category.
(30)
b)
What are the symptoms of this condition? explain terms that are specific to
pain descriptors.
(15)
c)
What are the signs you should look for?
(10)
d)
Describe the screening tools and mention 2 that are in clinical use.
(5)
e)
Discuss the treatment options for this condition.
(40)
[100]
PTO/ Page 2 Question 3...

-23

Met verwysing na neuropatiese pyn:

a)
Lys die belangrike oorsaaklike kategorie vir die toestand en gee n voorbeeld
in elke kategorie.
(30)
b)
Wat is die simptome van die toestand? Verduidelik ook die terme wat
spesifiek is tot die pyn terminologie.
(15)
c)
Wat is die kliniese tekens waarvoor u sou soek by so n pasint?
(10)
d)
Bespreek die moontlike ondersoeke wat gedoen kan word om vir die toestand
te soek en noem twee wat huidig in kliniese gebruik is.
(5)
e)
Bespreek die behandelings opsies vir die toestand.
(40)
[100]

A one day old infant is presented to you for surgical repair of a lumbar
myelomeningocoele.
a)
Describe the anatomical defect present, and discuss the incidence and
associated problems.
(10)
b)
Describe your pre-operative concerns, and the peri-operative management for
the repair of the myelomeningocoele.
(90)
[100]

U word versoek om n een dag oue kindjie te hanteer vir die chirurgiese herstel van
n lumbale milomeningoseel.
a)
Beskryf die anatomiese defek van die toestand en bespreek die insidensie
sowel as die probleme geassosieer met die toestand.
(10)
b)
Bespreek die aspekte waaraan u in die preoperatiewe fase aan aandag sal
gee sowel as die perioperatiewe hantering van die pasint vir die herstel van
die milomeningoseel.
(90)

FCA(SA) Part II

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Final Examination for the Fellowship of the

College of Anaesthetists of South Africa
21 August 2012
Paper 2

(3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than
one 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 is
vir n vraag) geskryf word

a)
b)

What are the medical complications of alcohol abuse?

(30)
Discuss the peri-operative management of a patient with a history of chronic
alcohol abuse.
(70)
[100]

a)
b)

Wat is die mediese komplikasies geassosieer met alkoholmisbruik?

(30)
Bespreek u perioperatiewe hantering vir n pasint met n geskiedenis van
chroniese alkoholmisbruik.
(70)
[100]

A 3-year-old girl has a sterile brain abscess needing drainage. She was born with a
cyanotic congenital heart condition, is not growing well, and has been in and out of
hospital since birth.
a)
Discuss the pathophysiological consequences of cyanosis in cyanotic heart
disease.
(10)
b)
List the possible cardiac lesions and possible previous interventions.
(12)
c)
What associated abnormalities may be present?
(4)
d)
Discuss the peri-operative risks and considerations.
(24)
e)
Describe your peri-operative management of the patient.
(40)
f)
Discuss the pathophysiological consequences of a left to right shunt.
(10)
[100]

n Drie-jaar-oue dogtertjie met n steriele brein abses, word geskeduleer vir dreinasie
van die abses. Sy is gebore met n sianotiese kongenitale hartletsel en haar fisiese
vordering is nie op standaard nie. Sy was al by herhaling toegelaat tot die hospitaal.
a)
Bespreek die patofisiologiese gevolge van sianose in n pasint met
sianotiese hartsiekte.
(10)
b)
Lys die moontlike hartletsels verantwoordelik vir die toestand en noem die
moontlike voorheen korrektiewe prosedures wat gedoen was.
(12)
c)
Watter geassosieerde abnormaliteite is soms ook teenwoordig?
(4)
d)
Bespreek die perioperatiewe risiko en aspekte waaraan u sal aandag gee.(24)
e)
Bespreek u perioperatiewe hantering van hierdie pasint.
(40)
f)
Bespreek die patofisiologiese gevolge van n links na regs intrakardiale
aftakking.
(10)
[100]
PTO/ Page 2 Question 3...

-23

Regarding the anaesthetic management of a patient for carotid endarterectomy,

discuss the following:
a.
List the indications for surgery in the treatment of carotid artery disease. (10)
b.
Discuss the rationale and options for monitoring intra-operative cerebral
ischaemia.
(30)
c.
What are the pertinent aspects of the pre-operative assessment?
(10)
d.
Discuss the choice of the anaesthetic technique.
(30)
e.
Describe the post-operative management.
(20)
[100]

Met verwysing na n pasint wie narkose moet ontvang vir n karotis

endarterektomie, bespreek die volgende:
a)
Lys die indikasies vir chirurgie in die behandeling van karotis arterie siekte.
(10)
b)
Bespreek die redes en die opsies vir die monitering van intraoperatiewe
serebrale isgemie.
(30)
c)
Watter aspekte is spesifiek van belang in u preoperatiewe evaluasie van die
pasint?
(10)
d)
Bespreek u keuse van n narkose tegniek.
(30)
e)
Bespreek u postoperatiewe hantering van hierdie pasint.
(20)
[100]

With respect to Abdominal Compartment Syndrome:

a)
What is meant by the Abdominal Compartment Syndrome?
(14)
b)
How is it diagnosed?
(10)
c)
How is it graded?
(6)
d)
What are the physiological effects of the Abdominal Compartment Syndrome?
(25)
e)
How may the patient with the syndrome present clinically?
(5)
f)
How should the condition be managed (prevented and treated) by way of
i)
Lowering intra-abdominal pressure without surgery?
(5)
ii)
Organ Support?
(12)
iii)
Surgery?
(3)
g)
What are the anaesthetic considerations in a patient scheduled for surgery for
the condition?
(20)
[100]
Met verwysing na Abdominale Kompartement Sindroom:
a)
Wat word bedoel met die term abdominale kompartement sindroom?
(14)
b)
Hoe word dit gediagnoseer?
10)
c)
Hoe word die toestand gegradeer?
(6)
d)
Wat is die fisiologiese effekte van die sindroom?
(25)
e)
Hoe kan die pasint, met die sindroom, kliniese presenteer?
(5)
f)
Hoe behoort die toestand hanteer word (voorkoming en behandeling) deur
middel van
i)
Verlaging van intra abdominale druk sonder chirurgie?
(5)
ii)
Ondersteuning van organe?
(12)
iii)
Chirurgie?
(3)
g)
Wat is die narkose oorwegings vir n pasint geskeduleer vir chirurgie vir die
toestand?
(20)
[100]

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Picture booklet

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

PTO/ Page 2 Question 5...

-2-

Question 5 / Vraag 5

(Figure1) CT scan for Question 5

Figuur 1 Hierdie rekenaartomografie skandering verwys na vraag 5

Question 7 / Vraag 7
This ultrasound image shows a section of the abdominal wall.
Hierdie ultrasoniese beeld verwys na die abdominale wand.

(Figure 2) Ultrasound picture for Question 7

(Figuur 2) Die ultrasonografiese prentjie is vir gebruik by vraag 7
PTO/ Page 3 Question 9...

-3Question 9 / Vraag 9

Paper speed 25mm/sec

(Figure 3) ECG trace for Question 9 a)

(Figuur 3) Die EKG verwys na vraag 9 a)

(Figure 4) ECG trace for question 9 b)

(Figuur 4) Hierdie EKG verwys na vraag 9 b)

PTO/ Page 4 Question 12...

-4Question 12 / Vraag 12

(Figure 5) X ray picture for Question 12

(Figuur 5) Die x-straal verwys na vraag 12
Question 14 / Vraag 14

(Figure 7) Neck X ray picture for Question 14

(Figuur 7) Die x-straal van die nek verwys na vraag 14
PTO/ Page 5 Question 15

-5-

Question 15 / Vraag 15

(Figure 8) Haemodynamic snapshot for Question 15

(Figuur 8) Hierdie hemodinamiese rekord verwys na vraag 15

PTO/ Page 6 Question 17

-6-

Question 17 / Vraag 17

(Figure 9) Echocardiograph for Question 17

(Figuur 9) Hierdie eggokardiografiese beeld is vir gebruik saam met vraag 17

Question 19 / Vraag 19

(Figure 10) ECG trace for Question 19

(Figuur 10) Die EKG verwys na vraag 19 van die vraestel

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 1 3 / Vraag 1 - 3

PTO/ Page 2 Question 1...

-2Question 1 / Vraag 1
A 70-year-old patient has a pre-operative PaO 2 of 10.5 kPa (78 mmHg) at sea level on
room air. Following a laparotomy, the PaO 2 is 7.8 kPa (58 mmHg) and the PaCO 2 is 6.5
kPa (49 mmHg), on a 35% oxygen facemask, in the high care unit
n 70 jaar oud pasint het n preoperatiewe PaO 2 van 10.5kPa (78mmHg) by seevlak op
kamerlug. Na n laparotomie is die PaO 2 7.8 kPa (58mmHg) en die PaCO 2 6.5 kPa (49
mmHg). Die pasint is op n 35% suurstof masker in die hosorg eenheid.
a)
What is your interpretation of these results?
(2)
a)
Hoe interpreteer u hierdie resultate?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)
b)

What are the most likely (pathophysiological) mechanisms for a low PaO 2 ?(4)
Wat is die mees waarskynlike (patofisiologiese) meganisme vir die verlaging in die
PaO 2 ?
(4)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)
c)

What do you think is the most likely mechanism mentioned in b), for the low PaO 2
and give reasons?
(4)
Wat dink u is die mees waarskynlike meganisme soos genoem in 1 b) vir die
verlaging in die PaO 2 ? Gee u redes.
(4)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

PTO/ Page 3 Question 2...

-3-

Question 2 / Vraag 2
The following blood results were obtained from a patient
Die volgende bloedresultate is verkry by n pasint
Patient values
Reference values
Die pasint se waardes
Verwysingswaardes
Sodium / Natrium = 140 mmol/l
135-147 mmol/l
Potassium / Kalium = 6.7 mmol/l
3.3-5.3 mmol/l
Urea / Ureum = 18 mmol/l
2.1-7.1 mmol/l
Creatinine / Kreatinien = 250 mol/l
49-90 mol/l
a)
a)

If this electrolyte abnormality is left untreated, what ECG changes will progressively
be seen?
(4)
Indien hierdie elektroliet abnormaliteit onbehandeld gelaat word, wat sal die
progressiewe veranderings op die EKG wees wat u sal waarneem?
(4)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)
b)

What are the (medical) treatment options of this electrolyte abnormality in a patient
who is haemodynamically stable?
(4)
Wat is die (mediese) behandelings opsies beskikbaar om die elektroliet
abnormaliteite in die pasint te behandel? Die pasint is hemodinamies nog stabiel.
(4)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)
c)

How would your treatment differ if this patient was haemodynamically unstable?
(2)
Hoe sou u behandeling verskil indien die pasint hemodinamies onstabiel is?
(2)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]
PTO/ Page 4 Question 3...
-4-

Question 3
The table below reflects water and electrolyte disturbances in neurosurgical patients.
Complete the table. Where appropriate simply indicate high (), normal (N) or low ()
Die onderstaande tabel noteer die water en elektroliet abnormaliteite wat in
neurochirurgiese pasinte voorkom. Voltooi die tabel. Waar van toepassing, wys n
verhoging met () normaal (N) of verlaging ().
(10)
Diabetes
Insipidus

Syndrome of
Inappropriate
Anti-Diuretic
Hormone
Ontoepaslike
antidiuretiese
hormoonsekresie

Cerebral Salt
Wasting Syndrome
Serebrale
soutverlies
sindroom

Pathophysiology
Patofisiologie

Urine
Uriene

Serum
Serum

Intravascular
volume
Intravaskulre
volume

Sodium / Natrium
(normal / normaal
=20meq/l)
(or N or )
Osmolality vs.
serum osmolality
(> or = or <)
Osmolaliteit
teenoor serum
osmolariteit
(> of = of <)
Sodium / Natrium
( or N or )
Osmolality /
Osmolaliteit
( or N or )
( or N or )

[10]

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 4 6 / Vraag 4 - 6

PTO/ Page 2 Question 1...

-2-

Question 4 / Vraag 4
A 75-year-old man undergoes transurethral resection of the prostate under general
anaesthesia. In recovery he is confused, with a pulse of 60 beats/min and a blood pressure
of 90/45 mmHg. His urea and electrolytes are as follows:
n 75-Jarige man ondergaan n transuretrale reseksie van die prostaat onder algemene
narkose. In die herstelkamer is hy verward, sy pols is 60 slae/minuut en bloeddruk
90/45mmHg. Die ureum en die elektroliete is as volg:

Na 114 mmol/l
K 3.1 mmol/l
Cl 94 mmol/l
Bicarbonate / Bikarbonaat 21 mmol/l

Urea / Ureum 3.2 mmol/l

Creatinine / Kreatinien 148mol/l

a)
What is the pathophysiology of this complication?
(3)
a)
Wat is die patofisiologie van die komplikasie?
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)
Describe the treatment of this complication.
(7)
b)
Beskryf u hantering van die komplikasie.
(7)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

PTO/ Page 3 Question 5...

-3-

Question 5 / Vraag 5
An adult male is found collapsed. In the emergency department he localises to pain with his
left arm but no movement is elicited from his right side. He groans and his eyes remain
closed on painful stimulation. His left pupil is slightly dilated and the response to light is
sluggish.
n Volwasse man word tot die noodeenheid toegelaat met die geskiedenis dat hy
ineengestort het. Hy lokaliseer pyn met sy linkerarm maar daar is geen beweging van die
regterarm nie. Hy kreun en sy o bly toe selfs na pynlike stimulasie. Die linker pupil is
effens dilateerd en die respons tot lig stadig.

a)
What does the CT scan show (Figure1)? (Please refer to picture booklet). (2)
a)
Wat wys die skandering (Figuur 1)? (Verwys asseblief na foto/figuur boek) (2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)
What is his Glasgow Coma Scale (show your calculation)?
(2)
b)
Wat is die pasint se Glasgow Koma Skaal (Wys asb. u berekening)?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

c)
c)

List the steps of your immediate management.

(6)
Lys die stappe wat onmiddellik gedoen moet word in die hantering van die
pasint.
(6)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

PTO/ Page 4 Question 6...

-4Question 6 / Vraag 6

An adult female is scheduled for an elective subtotal thyroidectomy. She gives a history of
intolerance to heat, palpitations, lethargy and weight loss. She had failed radio-iodine
therapy 3 years ago. Her current medications are carbimazole 20 mg daily, the oral
contraceptive pill and methylcellulose eye drops. Blood results on admission were as
follows: (normal values in brackets).
n Volwasse vroulike pasint is geskeduleer vir elektiewe subtotale tirodektomie. Sy gee n
geskiedenis dat sy hitte sleg verdra, ly aan hartkloppings , algemene moegheid en
gewigsverlies. Sy het radio aktiewe jodium terapie gehad drie jaar gelede wat as
onsuksesvol beskou is.
Haar huidige medikasie is Karbimazool 20mg/dag, orale
voorbehoedmiddel en metielsellulose oogdruppels. Die bloed uitslae by toelating wys die
volgende: (normale reikwydte in hakies).
i)
ii)
iii)
iv)
v)

Hb 10.2 g/dl (11- 16 g/dl)

WBC 3.2 x 109 (4 - 11 x 109)
T4 30.7 (10 22 pmol/l)
FT3 10.5 (2.8 7.1 pmol/l)
TSH 0.1 mU/l (0.34 4.6 mU/l)

a)
What do the blood results show?
(2)
a)
Hoe interpreteer u die bloedtoets hierbo opgesom?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)
What is the likely clinical diagnosis?
(2)
b)
Wat is die mees waarskynlike kliniese diagnose?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)
What is the most likely cause for her low haemoglobin?
(2)
c)
Wat is die mees waarskynlike verduideliking vir die lae hemoglobien?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
d)
What peri-operative complications may this patient develop?
(4)
d)
Watter perioperatiewe komplikasies kan hierdie pasint ontwikkel?
(4)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 7 8 / Vraag 7 - 8

PTO/ Page 2 Question 1...

-2-

Question 7 / Vraag 7

a)

Name the anatomical structures labelled 1, 2 and 3 in (Figure 2). (Please refer
to picture booklet).
(1.5)
a)
Benoem die anatomiese strukture wat gemerk is as 1, 2 en 3 in (Figuur 2). (Verwys
asseblief na foto/figuur boek).
(1.5)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)

What ultrasound probe is best suited for this view and where should it be placed?
(2)
b)
Watter ultrasoniese monitor kop is die mees geskikte tipe vir hierdie aansig en waar
behoort dit geplaas te word?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

c)

What ultrasound-guided block can be performed using this view, and what nerves
are blocked?
(2.5)
c)
Watter ultrasonies gerigte senuweeblok kan gedoen word deur gebruik te maak van
hierdie spesifieke aansig? Watter senuwees word geblok?
(2.5)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

d)
For what procedures is it suitable?
(2)
d)
Vir welke prosedures is hierdie blok geskik?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

e)
List 4 complications of the block.
(2)
e)
Lys 4 komplikasies van die blok.
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]
PTO/ Page 3 Question 8...
-3Question 8 / Vraag 8

A 2-day-old term neonate weighing 3 kg undergoes an emergency initial repair of a bladder

exstrophy, during which the surgeon causes a significant haemorrhage. The baby has no
other abnormalities detected pre-operatively. The duration of the anaesthetic is 280
minutes.
n 2-Dag-oue volterm neonaat, wie 3 kg weeg, ondergaan n aanvanklike nood herstel van
blaasekstrofie. Gedurende die prosedure veroorsaak die chirurg betekenisvolle bloeding.
Die baba is andersins as normaal genoteer by die preoperatiewe ondersoek. Die totale
duur van die narkose was 280 minute.
a)

What is the babys blood volume and at what stage would you consider a blood
transfusion?
(3)
a)
Wat is die baba se bloedvolume en op watter stadium sal u oorweeg om n
bloedtransfusie te begin?
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)

Within what parameters should you aim to keep the babys blood pressure and pulse
rate?
(2)
b)
Wat is die reikwydtes waarbinne u sal poog om die baba se bloeddruk en polsspoed
te hou?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)
c)

What should the depth marking of the endotracheal tube at the nostril be? (1)
By watter diepte, gemerk by die neusvleuel, behoort die endotrageale buis geplaas
te wees?
(1)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
d)
Which and how much crystalloid fluid would you use?
(2)
d)
Watter tipe en hoeveel kristalloede vog sou u gebruik?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
e)
e)

What doses of the Atracurium, Neostigmine and Glycopyrrolate would you use? (2)
Wat is die doserings van Atrakurium, Neostigmien en Glikopirrolaat wat u sou
gebruik?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 12 14 / Vraag 12 - 14

PTO/ Page 2 Question 1...

-2Question 12
A 63-year-old man presents for an emergency laparotomy. Attached is his pre-operative
chest x-ray (Figure 5). (Please refer to picture booklet)
n 63 jarige man moet n nood laparotomie ondergaan. Die preoperatiewe x-straal is Figuur
5 van u foto/figuur boek.

a)
What is implanted and what is its indication?
(2)
a)
Wat is in hierdie pasint ingesit en wat is die indikasie daarvoor?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)
Where is it positioned?
(1)
b)
Waar is dit geposisioneer?
(1)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

c)

What are the intra-operative implications and how should you manage this device
intra-operatively?
(3)
c)
Wat is die intraoperatiewe implikasies en hoe sou u hierdie apparaat intraoperatief
hanteer?
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

d)
What other medications may this patient be taking?
(4)
d)
Op watter ander medikasie mag die pasint dalk wees?
(4)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

PTO/ Page 3 Question 13...

-3-

Question 13
Figure 6 demonstrates a flow volume loop of a patient booked for elective surgery.
Figuur 6 wys n vloei-volume lus van n pasint wat geskeduleer is vir elektiewe chirurgie.

(Figure 6) Flow Volume loop

a)
Interpret the flow volume loop in (Figure 6).
(6)
a)
Interpreteer die vloei-volume lus (Figuur 6).
(6)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)
Would you accept the patient for elective surgery? Give reasons.
(2)
b)
Sal u hierdie pasint aanvaar vir elektiewe chirurgie? Gee u redes.
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)
c)

Indicate on the flow volume loop (Figure 6 above) which is the effort independent
part of expiration.
(2)
Wys op die vloei-volume lus (Figuur 6 hierbo) watter deel is die poging onafhanklike
deel van ekspirasie.
(2)
[10]
PTO/ Page 4 Question 14...
-4-

Question 14

An adult female presents to theatre for debridement of a compound fractured humerus

following a motor vehicle accident.
n Volwasse vroulike pasint moet n debridement ondergaan van n gekompliseerde
humerus fraktuur. Sy was in n motorvoertuig ongeluk.
a)

What is the most obvious finding on this lateral neck x-ray (Figure 7) that will alert
you to a potentially serious neck injury? (Please refer to picture booklet)
(1)
a)
Wat is die mees opvallende bevinding op die laterale nek x-straal (Figuur 7) wat u
aandag sal vestig op n potensile ernstige nekbesering. (Verwys asseblief na die
foto/figuur boek).
(1)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)

What other clinical signs will you look for indicating a potentially serious neck injury?
(4)
b)
Vir watter ander kliniese tekens sal u soek as aanduidend van n potensiel ernstige
nekbesering?
(4)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)

What other special investigations will you request relevant to the neck injury?
(3)
c)
Watter ander spesiaal ondersoek sal u vra (relevant tot die nekbesering)? (3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
d)

Is this an acceptable film to comment on and give reasons for your answer? (Figure
7). (Please refer to picture booklet)
(2)
d)
Is die x-straal in (Figuur 7) n aanvaarbare ondersoek vir u om op kommentaar te
lewer? Gee redes vir u antwoord. (Verwys asseblief na die foto/figuur boek).
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 15 17 / Vraag 15 - 17

PTO/ Page 2 Question 1...

-2Question 15 / Vraag 15
A patient coming off bypass has the following snapshot (Figure 8). (Please refer to picture
booklet).
n Pasint is so pas afgehaal van kardiopulmonre omleiding. (Sien Figuur 8 van die
foto/figuur boek).

a)

Describe the arterial waveform in (Figure 8). (Please refer to picture booklet).
(2)
a)
Beskryf die arterile golfvorm (Figuur 8). (Verwys asseblief na die foto/figuur
boek).
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)

Describe the haemodynamic effects of what is seen in the arterial waveform in

(Figure 8). (Please refer to picture booklet).
(8)
b)
Beskryf die hemodinamiese effek van wat u sien op die arterile golfvorm in
(Figuur 8). (Verwys asseblief na die foto/figuur boek).
(8)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

PTO/ Page 3 Question 16

-3Question 16 / Vraag 16
An adult black female is found unconscious. A blood test performed on admission shows
the following results:
n Volwasse, swart vroulike pasint is bewusteloos gevind. n Bloedondersoek is gedoen
by toelating en wys die volgende:
Plasma
Na+ - 133 mmol/l
HCO3-- 8 mmol/l

K+-2.5 mmol/l
Urea/ Ureum -14.6
mmol/l

Cl-- 97 mmol/l
Creatinine / Kreatinien 105 mol/l

Glucose / Glukose - 38 g/dl

a)
What is the most likely diagnosis in this patient?
(1)
a)
Wat is die mees waarskynlike diagnose in die pasint?
(1)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)

Comment on this patients renal function and calculate the estimated glomerular
filtration rate.
(3)
b)
Gee kommentaar oor die pasint se nierfunksie en bereken die geskatte glomerulre
filtrasiespoed.
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
c)

Calculate this patients expected potassium deficit and describe how you would
replace it.
(3)
c)
Bereken die pasint se kaliumtekort en verduidelik hoe u die kaliumtekort sou
vervang.
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
d)
Calculate the anion gap.
(3)
d)
Bereken die anioon gaping.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]
Note: where calculations are asked for, simply fill in values in the formula.
Nota: waar berekeninge gevra word, sit slegs die waardes in die vergelyking.
PTO/ Page 4 Question 17
-4-

Question 17 / Vraag 17
An adult female patient presents for mitral valve replacement surgery and has this transesophageal echo picture (Figure 9). (Please refer to picture booklet).
n Volwasse vroulike pasint presenteer vir n mitraalklepvervanging en haar
transoesofageale eggobeeld verskyn in (Figuur 9). (Verwys asseblief na die foto/figuur
boek).

a)
a)

What view is this in (Figure 9)? (Please refer to picture booklet)

(1)
Watter aansig is gebruik in (Figuur 9)? (Verwys asseblief na die foto/figuur
boek).
(1)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)

List at least three major structures seen in this picture (Figure 9). (Please refer to
picture booklet).
(3)
b)
Lys ten minste drie belangrike strukture sigbaar in hierdie beeld (Figuur 9). (Verwys
asseblief na die foto/figuur boek).
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

c)

What are the obvious abnormalities in (Figure 9)? (Please refer to picture booklet).
(3)
c)
Wat is die opvallende abnormaliteite wat u opmerk in hierdie beeld (Figuur 9)?
(Verwys asseblief na die foto/figuur boek).
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

d)

What is the coronary vascular supply to the areas marked 1-3 in (Figure 9)? (Please
refer to picture booklet).
(3)
d)
Wat is die koronre bloedvoorsiening na die area gemerk 13 in (Figuur.9)?
(Verwys asseblief na die foto/figuur boek).
(3)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 18 20 / Vraag 18 - 20

PTO/ Page 2 Question 1...

-2-

Question 18 / Vraag 18
A patient is being assessed for elective closure of an abdomen left open after a laparotomy
for perforated duodenal ulcer. The patient has been on a ventilator for 5 days and is being
fed by nasogastric tube.
Current settings in Synchronised Intermittent Mandatory Ventilation (SIMV) mode are
Inflation pressure:
Positive end expiratory pressure (PEEP):
Pressure Support:
Set Respiratory rate:
Measured Respiratory rate:
The arterial blood gas results are as follows
Ph: 7.55
PO 2 : 14kPa (105mmHg)
Bicarbonate: 32mmol/l
Lactate: 1.2mmol/l

24cmH 2 O
12cmH 2 O
20cmH 2 O
12 breaths/min
18 breaths/min
PCO 2 :5kPa (37.5 mmHg)

n Pasint het voorheen n laparotomie gehad vir n geperforeerde duodenale ulkus. Na die
chirurgie is die abdomen oop gelos en die pasint is nou geskeduleer vir n elektiewe
sluiting van die abdomen. Die pasint was op n ventilator vir vyf dae en word gevoed via n
nasogastriese buis.
Die ventilator stelling is gesinchroniseerde intermitterende verpligte ventilasie
Inflasiedruk:
Positiewe end ekspiratoriese druk:
Inspiratoriese druk ondersteuning:
Gestelde respiratoriese spoed:
Gemete asemhalingspoed:
Die arterile bloedgas wys die volgende
pH 7.55
PaO 2 :14kPa (105mmHg)
Bikarbonaat: 32mmol/
Laktaat 1.2mmol/l.

24cmH 2 O
12cmH 2 O
20cmH 2 O
12 asems/minuut
18 asems/minuut
PaCO 2 5 kPa (37.5mmHg)

a)
Explain these results.
(8)
a)
Verduidelik die resultate.
(8)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
b)
Is the patient fit for the proposed operation?
(2)
b)
Is die pasint geskik vir die beoogde prosedure?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]
PTO/ Page 3 Question 19...
-3-

Question 19
A 68-year-old poorly compliant hypertensive with a 40 pack-year smoking history presents
three days after an uneventful laparoscopic cholecystectomy with an ECG as shown in
(Figure 10). (Please refer to picture booklet).
His blood pressure is 150/90 mmHg, heart rate is 110 beats/min and N-Terminal Pro-BNP
is 2800mmol/l.

n 68-Jarige pasint wat bekend is met hipertensie en n 40 pak jare rook geskiedenis,
presenteer drie dae na n roetine laparoskopiese cholesistektomie. Die verdere geskiedenis
is dat die pasint nie instruksies of medikasie gereeld neem nie en n EKG is geneem
(Figuur 10). (Verwys asseblief na die foto/figuur boek).
Sy bloeddruk is 150/90mmHg, hartspoed is 110 slae/minuut en NproBNP is 2800mmol/L.

a)

Describe the abnormalities on this ECG trace (Figure 10). (Please refer to
picture booklet). What is the diagnosis?
(2)
a)
Beskryf die abnormaliteite wat u oplet op die EKG (Figuur 10). (Verwys
asseblief na die foto/figuur boek). Wat is die diagnose?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)
Describe your initial management.
(8)
b)
Beskryf u aanvanklike hantering.
(8)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]
PTO/ Page 4 Question 20...

-4Question 20

An endurance athlete presents to ICU with a change in mental status after a six hour, 80km
race. The urea and electrolytes are as follows:
n Langafstand atleet het n 80km wedloop voltooi. Ses uur na die wedloop presenteer hy
by die intensiewe sorg eenheid met n verandering in sy bewussyn. Die ureum en
elektroliete lyk as volg:
Na: 112mmol/l
K: 3.4mmol/l
Urea / Ureum: 3.5mmol/l

Cl: 94mmol/l
Bicarbonate / Bikarbonaat: 18mmol/l
Creatinine / Kreatinien: 55 mol/l

a)
What is the diagnosis?
(2)
a)
Wat is die diagnose?
(2)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

b)
Briefly outline your management.
(8)
b)
Bespreek kortliks u hantering.
(8)
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
[10]

FCA(SA) Part II
THE COLLEGES OF MEDICINE OF SOUTH AFRICA
Incorporated Association not for gain
Reg No 1955/000003/08
Final Examination for the Fellowship of the
College of Anaesthetists of South Africa
22 August 2012
Paper 3

Data Interpretation

(3 hours)

All questions are to be answered.

Al die vrae moet beantwoord word

CANDIDATE NUMBER

Question 9 11 / Vraag 9 - 11

PTO/ Page 2 Question 1...

-2Question 9 / Vraag 9
a)
a)

This is the ECG (Figure 3) of a 45-year-old man who is for elective endoscopic
surgery for chronic sinusitis. (Please refer to picture booklet).
Hierdie EKG (Figuur 3) is geneem van n 45 jarige oue man wie geskeduleer is vir
elektiewe endoskopiese chirurgie vir chroniese sinusitis. (Verwys asseblief na
foto/figuur boek).
i)

List the abnormalities on this ECG (Figure 3). (Paper speed 25mm/s).
(2)
i)
Lys die abnormaliteite wat u oplet op die EKG (Figuur 3). (Die EKG is
afgeneem teen 25mm/sekondes).
(2)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
ii)
ii)

What is the diagnosis and how would you confirm this diagnosis? (3)
Wat is die diagnose en hoe sal u te werk gaan om die diagnose te bevestig?
(3)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
b)
b)

This is the ECG (Figure 4) of a slim 40-year-old man. He exercises regularly with no
problems. (Please refer to picture booklet).
Hierdie EKG (Figuur 4) is verkry by n skraal, 40 jarige man. Hy oefen gereeld en
het geen kliniese simptome nie. (Verwys asseblief na foto/figuur boek).
i)

List the abnormalities on this ECG (Figure 4). (Paper speed 25mm/s).
(2)
i)
Lys die abnormaliteite wat u oplet op die EKG (Figuur 4). (Die EKG is
afgeneem teen 25mm/sekondes).
(2)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
ii)
ii)

What is the diagnosis and how would you confirm this diagnosis? (3)
Wat is die diagnose en hoe sou u te werk gaan om die diagnose te bevestig?
(3)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
PTO/ Page 3 Question 10...
-3-

Question 10
A 70-year-old lady has a haemoglobin value of 9.2g/dl and a MCV (mean corpuscular
volume) of 109 fL.
n 70-Jarige dame het n hemoglobien van 9.2g/dL en n GKV (gemiddelde korpuskulre
volume) van 109fL.

a)
a)

What are the causes of a raised MCV?

Wat is die oorsake van n verhoogde GKV?

(5)
(5)

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

b)
b)

What tests would you use to investigate these causes of a raised MCV?
(5)
Watter toetse sou u doen om die oorsake van die verhoogde GKV te ondersoek?
(5)

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
[10]

PTO/ Page 4 Question 11...

-4-

Question 11
A 60-year-old man is referred to the pain clinic for treatment of low back pain. He has felt
lethargic recently and has lost 6kg in weight in the last 3 months. Blood tests results are as
follows:
n 60 Jarige manlike pasint word verwys na die pynkliniek vir hantering van lae rugpyn. Die
pasint gee n geskiedenis van algemene swakheid en moegheid van onlangse aankoms en
het 6kg gewig verloor in die laaste drie maande. Die bloed uitslae wys die volgende:

Hb 9g/dl, ESR 90mm/hr, Sodium 136mmol/l, Potassium 4.8mmol/l, Chloride 101mmol/l, Nonionised Calcium (corrected) 3.1mmol/l, Total Protein 90g/l, Albumin 32g/l.
Hb 9g/dl, ESR 90mm/uur, Natrium 136mmol/l, Kalium 4.8mmol/l, Chloried 101mmol/l, Nieioniseerde kalsium (gekorrigeerd) 3.1mmol/l, Totale proteen 90g/l, Albumien 32g/l
a)
a)

What serious condition does this patient need to be investigated for?

(1)
Vir watter ernstige toestand behoort hierdie pasint verder ondersoek te word?
(1)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
b)

Which particular electrolyte is raised in this patient? Give one way of correcting this
electrolyte abnormality pre-operatively.
(3)
b)
Watter van die elektroliete hierbo genoem is verhoog? Gee een manier hoe om die
elektroliet abnormaliteite te korrigeer in die preoperatiewe fase.
(3)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
c)
c)

List further investigations for this patient and give reasons for your choices. (6)
Lys verdere ondersoeke wat u sou aanvra op hierdie pasint en gee die redes vir u
keuses.
(6)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
[10]