Craniofacial, Cervical, and Airway Anatomy and Regional Blocks — WACS Viva & Clinical Scenarios (Anatomy, Applied Anatomy and Regional Anaesthesia)

Exam-style craniofacial, cervical, and airway anatomy and regional blocks viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 56-year-old male with severe stridor, massive anterior neck goitre, and fixed vocal cord displacement is scheduled for awake flexible endoscopic intubation. Detail the complete sensory and motor innervation of the upper airway from the nasal mucosa down to the subglottic trachea. Describe your technique, anatomical landmarks, needle trajectories, and drug doses for blocking the glossopharyngeal, superior laryngeal, and recurrent laryngeal nerves.
• SCENARIO 2: A 68-year-old female with severe coronary artery disease and chronic renal failure is scheduled for left carotid endarterectomy under regional anaesthesia. Describe the formation, anatomical course, and cervical fascial relationships of the cervical plexus. Detail the techniques, landmarks, and relative risks of deep versus intermediate versus superficial cervical plexus blocks.
• SCENARIO 3: A 42-year-old male is scheduled for an awake craniotomy for excision of an intractable epileptogenic focus in the left frontal lobe. You are tasked with providing complete scalp anaesthesia. Identify all six pairs of nerves supplying the scalp, their precise anatomical origins and trajectories, and your systematic injection strategy, including the safe application of the Mayfield skull clamp.
• SCENARIO 4: A 6-year-old child presents with a severe upper lip laceration and anterior maxillary alveolar fracture following a road crash. The patient has a full stomach, and emergency suturing is required. Describe the origin, exit foramen, landmark localization, and execution of bilateral infraorbital and mental nerve blocks to provide surgical anaesthesia while avoiding general anaesthesia.
• SCENARIO 5: A candidate performs a landmark-guided deep cervical plexus block at the C3 transverse process level for a thyroidectomy. Immediately following the injection of 10 mL of 0.5% bupivacaine, the patient becomes unresponsive, develops generalized tonic-clonic seizures, followed by complete apnoea and fixed dilated pupils. What is the precise anatomical route of this complication, and how will you immediately manage the patient?