SBA and MTF MCQs for the Final FRCA SBA and MTF MCQs for the Final FRCA TheFRCAQ.comWritersGroup TheSevernDeanery DrJamesNickells NorthBristolNHSTrust DrBenWalton NorthBristolNHSTrust cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown, Singapore,SãoPaulo,Delhi,Tokyo,MexicoCity CambridgeUniversityPress TheEdinburghBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/9781107620537 ©CambridgeUniversityPress2012 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2012 PrintedandboundintheUnitedKingdombytheMPGBooksGroup AcataloguerecordforthispublicationisavailablefromtheBritishLibrary ISBN978-1-10762053-7Paperback CambridgeUniversityPresshasnoresponsibilityforthepersistenceor accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto inthispublication,anddoesnotguaranteethatanycontentonsuch websitesis,orwillremain,accurateorappropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-date informationwhichisinaccordwithacceptedstandardsandpracticeatthetimeof publication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthasbeen madetodisguisetheidentitiesoftheindividualsinvolved.Nevertheless,theauthors, editorsandpublisherscanmakenowarrantiesthattheinformationcontainedhereinis totallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychangingthrough researchandregulation.Theauthors,editorsandpublishersthereforedisclaimallliability fordirectorconsequentialdamagesresultingfromtheuseofmaterialcontainedinthis book.Readersarestronglyadvisedtopaycarefulattentiontoinformationprovidedbythe manufacturerofanydrugsorequipmentthattheyplantouse. Contents Listofcontributors pagevi Preface ix QUESTIONPAPERS Paper1 3 Paper2 25 ANSWERS Paper1 49 Paper2 50 EXPLANATIONS Paper1 53 Paper2 138 Index 228 v Contributors TheFRCAQ.comWritingGroupfortheFinalFRCAQ.comsiteare: DR ROBERT AXE MBChB,FRCA,AnaestheticTrainee,SevernDeanery,Bristol,UK DR EMMA BELLCHAMBERS MRCP,BMBS(Hons),BMedSci(Hons),Anaesthetic Trainee,SevernDeanery,Bristol,UK DRJAMESBOWLER MA(OXON),MBBS,AICSM,AnaestheticTrainee,SevernDeanery, Bristol,UK DRTIMBOWLES BSc(Hons),MBBS,FRCA,SeniorRegistrar,IntensiveCareUnit,Royal PerthHospital,WesternAustralia DRALICEBRAGA MBChB(Hons),MRCP,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR JULES BROWN BSc,MBChB,MRCP,FRCA,DICM,FICM,ConsultantinCritical CareandAnaesthesia,NorthBristolNHSTrust,Bristol,UK DR HELEN CAIN BMBS,BMedSci,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR AMY CREES BSc(Hons),MBChB,MRCP,CoreMedicalTrainee,SevernDeanery, Bristol,UK DR ALIA DARWEISH MBChB,MSc,DRCOG,MRCS(Eng),FRCA,AnaestheticTrainee, SevernDeanery,Bristol,UK DR JAMES EVANS MBChB,MRCP,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR TOBIAS EVERETT MBChB,FRCA,ConsultantAnaesthetist,TheHospitalforSick Children,Toronto,Canada DR ANDREW FOO BSc(Hons),MBBS,MRCS,FRCA,AnaestheticTrainee,Severn Deanery,Bristol,UK DR DAN FRESHWATER-TURNER MA,MBBChir,MRCP,FRCA,Consultantin Anaesthesia and Intensive Care, University Hospitals, Bristol NHS Foundation Trust,Bristol,UK vi DR ANDY GEORGIOU MBChB,BSc(Hons),FRCA,DICMDIC,ConsultantinCritical C o CareandAnaesthesia,RoyalUnitedHospital,Bath,UK n t r DR JUAN GRATEROL MedicoCirujano,FRCA,AnaestheticTrainee,SevernDeanery, ib u Bristol,UK t o r DR BEN GREATOREX BMBS,BMedSci,FRCA,AnaestheticTrainee,SevernDeanery, s Bristol,UK DR RUTH GREER BMBS,BMedSci,AnaestheticTrainee,SevernDeanery,Bristol,UK DR CLARE HOMMERS BMBS,MRCP,FRCA,DICM,AnaestheticTrainee,Severn Deanery,Bristol,UK DR TIM HOOPER MBBS,FRCA,EDIC,AnaestheticTrainee,SevernDeaneryand DefenceMedicalServices,Bristol,UK DR TIM HOWES MBChB,FRCA,AnaestheticTrainee,SevernDeanery,Bristol,UK DR BEN HUNTLEY MBChB,FRCA,ConsultantinPainMedicineandAnaesthesia, Barking,HaveringandRedbridgeNHSFoundationTrust,UK DR IZREEN IQBAL MBChB,FRCA,AnaestheticTrainee,SevernDeanery,Bristol,UK DR DOM JANSSEN BA,BSc(Med),MBBS,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR IAN KERSLAKE BSc(Hons),FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR EMMA KING MBChB,FRCA,AnaestheticTrainee,SevernDeanery,Bristol,UK DR SIOBHAN KING FRCA,MRCP,MBBCh,BSc(Hons),AnaestheticTrainee,Severn Deanery,Bristol,UK DR SARAH LANCASTER MBChB,MRCS(Eng),OrthopaedicTrainee,SevernDeanery, Bristol,UK DR ABBY LIND BSc,MBChB,MRCP,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DRCLINTONLOBO BSc,MBChB,MRCP,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR HELEN MAKINS MBBS,FRCA,AnaestheticTrainee,SevernDeanery,Bristol,UK DR CHRIS MARSH MBChB,FRCA,PGCertAdvHCP,AnaestheticTrainee,Severn Deanery,Bristol,UK DR ALEX MIDDLEDITCH MBChB,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR HENRY MURDOCH BSc,MBBS,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR CHRIS NEWELL BSc(Hons),MBChB,MRCP(UK),AnaestheticTrainee,Severn Deanery,Bristol,UK DRJAMESNICKELLS MBBS,FRCA,ConsultantAnaesthetist,NorthBristolNHSTrust, Bristol,UK DR SONJA PAYNE MD,MSc,BSc(Hons),AnaestheticTrainee,SevernDeanery, Bristol,UK DR ANNABEL PEARSON BMedSci(Hons),BMBS,AnaestheticTrainee,SevernDeanery, Bristol,UK vii rs DR KIERON ROONEY MRCP,FRCA,DICM,EDIC,PGCMEd,Consultantin o Anaesthesia and Intensive Care, University Hospitals, Bristol NHS Foundation t u b Trust,Bristol,UK ri nt DR SOPHIE SCUTT FRCA,MRCP,AnaestheticTrainee,SevernDeanery,Bristol,UK o C DRSIMONSLINN BSc(Hons),MBBCh,FRCA,AnaestheticTrainee,WelshDeanery,UK DR JANINE TALBOT MBBS,BSc,FRCA,PGCMEd,AnaestheticTrainee,Severn Deanery,Bristol,UK DR HELEN TURNHAM MBChB(Hons),FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR BENJAMIN WALTON MBChB,MRCP,FRCA,ConsultantinCriticalCareand Anaesthesia,NorthBristolNHSTrust,Bristol,UK DR SARAH WARWICKER BM,BCh,MA,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR MARK WIGGINTON MBBS,FRCA,AnaestheticTrainee,SevernDeanery, Bristol,UK DR MARK YEATES BM,FRCA,MRCS,AnaestheticTrainee,SevernDeanery, Bristol,UK viii