June 2013 Final FRCA SOE – Thanks to all our candidates

LONG CASES
1. Patient for resection of lung mass

52 year old lady listed for resection of possible lung mass. Known to have COPD and Hiatus Hernia. Medications: Salmeterol
and Budesonide. PFTs FEV1 1.4 Pred 2.3, FVC reduced, FEV1/FVC reduced, DLCO reduced, FRC + TLC increased

• Preop assessment history and examination – what should we concentrate on?

• Features of lung CA – including extra pulmonary manifestations
• Comment on each investigation and describe each abnormality –systematic runthrough of CXR, ECG and PFTs
• Criteria for lung resection – how will this affect this lady? PPOFEV1 calculation
• What can we do to optimize her lung function prior to surgery? Effects of smoking?
• Why is HH important?
• Indications for one lung ventilation? Ventilatory parameters in OLV?
• What to do when there is desaturation in OLV?
• How can you perform OLV? How do you insert a
DLT? Normal sizes?
• In what circumstances can endobronchial blockers be useful?
• Postop management esp pain – what options?
• Compare and contrast thoracic epidural vs paravertebral block for this operation
• Paravertebral space anatomy
• How to do paravertabral block

2. Patient for laryngectomy

76 male, admitted for laryngectomy for laryngeal carcinoma. Recently noticed stridor, sleeping upright in chair Severe COPD,
HTN Meds: amilodipine, inhalers, diuretic

• Summarise
• Talk through investigations
• How would you optimise?
• What other tests? Wanted nasoendoscopy. Then showed a picture showing tumour & tracheal narrowing. How would you
rate his airway obstruction
• How would you anaesthetise?
• How would change the ETT for a tracheostomy interoperatively
• Critical incident: on ITU, becomes hypoxic, agitated, tachycardic. What are the differentials? Showed ECG with ischaemic
changes. How would you manage acute cardiac event?
• Is he likely to have cardiac problems?
• What tests?
• Like a MUGA scan? Would you really do that?
• What about CPEX testing? Would you do that?
• Ok so you’ve pre-optimised him and he’s now in the anaesthetic room, what are you going to do? How are you going to
anaesthetise him?
• So how would you do it? He’s in your anaesthetic room.
• Would you give him Clopidogrel given recent operation?

Questions:

3. Patient with Rheumatoid Arthritis for laminectomy

Rheumatoid arthritis , c3-c4 post stabilisation, AF, Thrombocytopenic, anaemic,CXR: lung fibrosis
The rheumatoid neck with unstable neurology

• The airway management options, including the process of an awake fibe-optic intubation.
• Ways by which the airway could be assessed and the effects of RA on the airway.
• The implications of coronary stents. Also the implications of anaesthetising a patient with ischaemic heart disease.
• The further investigations required (was asked to elaborate on lung function tests and what they might show in patient).
• How best to stabilise a c-spine perioperatively.
• The implications of the prone position in some detail but particularly focusing on how to manage the neck.
• Hyponatraemia and how to decide on potential differential diagnoses (eg: fluid status, urinary Na etc.).
• Then we discussed diuretics as a cause and their mechanism of action.
June 2013 Final FRCA SOE – Thanks to all our candidates
• Causes of anaemia, particularly focusing on RA-related anaemia (drugs, chronic disease etc.)
4. Patient with Gestational Diabetes presenting with DKA & infected hand wound

20 year old female, 30/40 pregnant. Diagnosed with DM., currently on long and short acting insulin. Very poorly controlled
DM, she claimed that she was using her father’s insulin as she had run out of her own insulin. She currently presents with
feeling generally unwell and swollen Right hand.

• Summarise the salient points in the history?

• What is anion gap?
• What causes raised anion gap in this patient?
• What is the treatment of DKA?
• How much insulin?
• When would I start K?
• What are the causes of swollen hand?
• Orthopaedic team wants the take this lady to theatre for surgery on her hand. What are my anaesthetic options?
• Then I was told, I decide to do an axillary block for this patient. How would i do this, shown U/S image to identify nerves and
vessel
• After injecting LA, patient has a seizure. How would I manage this?

5. Patient presenting for dental clearance

54-year-old man with 29 year history of severe depression scheduled for dental clearance on your list. Has required multiple ECT
sessions in the past. Medications – Lithium, Flupenthixol depot injection, chlorpromazine, amlodipine.
He is a chronic heavy smoker, hypertension, obese.

• Summarise case.
• Go through investigations and point out abnormalities.
• Why is he polycythaemic? Does this affect us as anaesthetists? Why?
• What are the effects of chronic smoking? How does this affect an anaesthetic?
• Lithium – why measure levels? What are the problems associated with lithium therapy? How might it affect your
anaesthetic? What are the signs and symptoms of toxicity?
• Why is he on amlodipine? Why not an ACE? Should he be on an ACE?
• What is flupenthixol?
• What does his spirometry show?
• Any investigations you would like to see that aren’t here?
• How would you preoptimise him prior to surgery?
• How do you assess his airway?
• Discussed possibility of OSA – asked a bit about this. How would it change your anaesthetic management?
• How will you obtain consent?
• How would you anaesthetise him? GA vs LA. ETT vs LMA. Nasal vs oral ETT. Intraoperative considerations. What else would
you want intraoperatively?
• Discussed throat packs. Asked is there any guidance on throat packs? Talked through guideline.
• Analgesia options. What exactly would you use?
• DVT prophylaxis guidance. What would you do for him?
• Post-operatively you are called to recovery. He is not saturating well and very slow to wake up. Differential diagnosis?
Causes? How would you manage him? Went through systems. Eventually got to throat pack retention.
• Are you happy for him to go home? Turns out he lives alone. You are called later as the patient wants to leave against your
advice. How would you manage him? Issues regarding self discharge – what paperwork are you aware of?

6) Parturient with aortic stenosis

23 year old woman, 32 weeks pregnant attends A+E short of breath, chest pain and feeling dizzy. Background of bicuspid
aortic valve disease but has had no cardiology or antental input for fear of being told to have an abortion.

• How can you classify Aortic stenosis?

• What other conditions are associated with bicuspid AV?
• What signs might you see on CXR with Coarctation of the aorta? Why does rib notching occur?
• How would you anaesthetise her? What are your haemodynamic goals?
• What are your plans for post-op pain relief? Why is pain relief important in these patients?
June 2013 Final FRCA SOE – Thanks to all our candidates
• What are the signs and symptoms of severe AS? How is gradient measured on Echo. Compare valve gradients with cardiac
catheterisation and on Echo. How do the measured values differ?
• When would you perform a valve replacement on this lady?

7) Aspirated peanut

Long case: 15 month old with an aspirated peanut and not starved. CXR showed hyperinflation on one side. SpO2 93% in air and
grunting.

8) Alcoholic presenting for laparotomy

58 year old male patient was admitted with one day history of abdominal pain and vomiting. On examination, there is a
swelling in the region of he right groin. The surgeons want to take him up for an emergency laparotomy. Patient had been a
chronic smoker and alcoholic.

• Summary
• Comment on haematology, biochemistry, ECG, CXR.
• What are the present issues?
• How will you manage them/ preop optimisation?
• How will you manage the AF?
• What other investigations would you want to have?
• Type of monitoring?
• At what HR would you be satisfied to induce anaesthesia?
• How would you induce anaesthesia? drugs/doses/ reasons for each.
• Intraoperativelythis patient develops sudden hypotension, What could be the causes of this and how will you manage the
situation?
• What would be your ventilation parameters and why?
• Towards the end of the surgery, what would be your criteria for extubating this patient or not to extubate?
• Postoperatively, where would you manage this patient?
• What analgesic options are available? asked about epidural and its benefits in such a patient?
• How will you manage the fluid balance of this patient?
• The patient is in the HDU, at 4 AM, the nurse informs you that the patient has started desaturating and is getting
tachypnoeic. How will you manage this?
• Also, if this patient started getting anuric in the HDU, how will you manage this ?
June 2013 Final FRCA SOE – Thanks to all our candidates

Short Cases

1. Post Tonsillectomy Bleed: in a 5 year old child

• Issues
• Assessment and management
• Assessment of blood loss in 5 yr old (told estimate is approx 300ml) – is it significant?
• Anaesthetic management/options
• Clotting screen comes back as APTT prolonged = what can be the

2. Collapsed Parturient: Collapsed labouring parturient after topping up with 20mls of 0.25% Bupivacaine causes?
• Differential diagnoses
• Initial management
• Told this was LA toxicity
• Mechanism of toxicity
• All aspects of resuscitation
• How would you deliver oxygen?
• How would you treat a seizure?
• Would you use intralipid to treat a seizure without cardiovascular collapse?
• What is the dosing regimen for intralipid?

3. Respiratory failure in COPD: Critical care outreach nurse calls you to see a 72 year old man on a respiratory ward who was
admitted with an exacerbation of COPD 3 weeks ago. Usual meds inhalers. Now breathless.
• Analysis of gases
• Initial management and assessment/investigations
• Treatment options
• What are the indications for non-invasive ventilation in COPD?

4. Neck stabbing: Young, Afro-Caribbean, high BMI male with a kitchen knife though his neck. Sitting up, GCS 15.
• How would you investigate him?
• X-ray showed knife through neck. No surgical emphysema.
• What are the anaesthetic concerns?
• How would you anaesthetise him?
• Patient refuses AFOI. What now?

5. Anaemia & hemicolectomy: Elderly lady with cardiac disease, OA, needing a right hemicolectomy for bowel Ca. Shown
blood results- microcytic anaemia.
• Causes of anaemia?
• How would you optimise?
• Timing of blood transfusion? Day before? Two days before? Why?
• How would you investigate her?
• Led onto CPEX testing. What equipment needed. How do you do it with arthritic knees? What results do you get and what
do they mean?
• Preoptimisation of blood: cell saver, haemodilution, hypotensive anaesthesia, Ferrinject, d/w haematology, would not
consider Epo Side effects of Ferrinject.
• What is enhanced recovery?

6. Management of IUD: Intrauterine death with signs of sepsis and DIC (shown blood results). How do you manage DIC.
• Analgesia options.
• Obstetricians decide to induce for NVD, what analgesia options. So regional technique is excluded due to DIC and sepsis,
PCA is feasible. What drugs would I use? Remifentanyl (pros and cons), Morphine, alfentanil, Pethidine and fentanyl…..
• What are the causes of intrauterine death?
• Would you put an epidural in this lady?
• How would you correct her clotting?
• She miscarried quite a few times before. Why? I mentioned the TORCH screen. Components please and clotting disorders
that would predispose to frequent IUDs.

7. PDPH: Dural tap during epidural placement.

June 2013 Final FRCA SOE – Thanks to all our candidates
• Incidence quoted.
• Options for managing. They wanted specific details of exactly how to manage the epidural catheter if you choose to resite
(dose, timings, whether you would be happy to connect a pump with a standard programme and when).
• Advantages and disadvantages of each.
• Management of PDPH including blood patch and exact process of performing this.

8. Weakness post-EVAR: thoracic EVAR, post op weakness

• Potential causes.
• Other examination findings you might elicit.
• Spinal artery syndrome pathophysiology and presentation.
• How you would manage it. This included investigations such as MRI but mainly focused on supportive management by
maintaining adequate MAP, O2, CO2 etc.
• Lumbar drains and their indications.

9. Muscular dystrophy
• Muscular dystrophy and Duchen's
• What is the difference , how do u anaesthetise
• Congenita myotonica and was asked to compare with duchennes and classify congenital neurological conditions. Myotonic
dystrophy
• Incidence, pattern of inheritance, pathophysiology and clinical findings
• Effects on conduct of anaesthesia with particular focus on the effects of sux and opiates.
• Post-operative plan including criteria for post-op ventilation/NIV.
• Comparisons with muscular dystrophy.
• The current thinking about MH and Beckers.

10. Cord Prolapse: Pregnant 34/40 with cord prolapse on her way in via ambulance
• What do you do to prepare – theatres, seniors, obstetricians aware, drugs and look for notes
• What do you do when she is in – ABC, left side head down
• Going to theatre for emergency LSCS – management – options(GA vs Spinal)
• You decide for GA
• Pre-op - antacids
• Peri-op – discuss with Obs/Paeds if opioids used
• What is she at risk of
• What will you give her after the baby is delivered
• After delivery – what do you do – Analgesia

11. Tracheal tumour

• Was shown an CT scan of the neck. Asked what was wrong?
• Mentioned possible tracheal tumour.
• The picture they showed, I could see a tumour distal to the vocal cord. What symptoms would the patient have?
• The surgeon wants to take a biopsy of the lesion. How would I provide anaesthesia?
• I mentioned I would need to assess the length of the tumour and tracheal circumference.
• AFO would not be an optioned dude to cork in a bottle effect. So gas induction then rigid bronchoscopy. Ventilate through
the side arm and maintain anaesthesia with TIVA
• Or awake tracheostomy
• What are the indications for tracheostomy?
• I mentioned the usual list
• How do you perform a surgical tracheostomy?
• I mentioned about IV access, monitoring, ENT surgeon, and briefly described what the surgeon would do.

12. MH: 4 year old child for surgery. His Grandfather has MH
• What is the incidence of MH?
• What are the chances of his father having MH?
• What are the chances of the child having MH?
• They wanted to know which chromosome was affected and went through the molecular changes
• How is it diagnosed?
• I described genetic testing, Halothane/ caffeine test
• How does MH differ in children?
June 2013 Final FRCA SOE – Thanks to all our candidates
• He come for surgery, how would you proceed?

13. Patient with previous MI: Man present to your pre-assessment clinic for a laparoscopic inguinal hernia repair. He has a
history of previous MI and stents inserted 9 months ago. Tell me about his ECG at the time of his MI.
• Inferior MI. Bradycardia. 1st degree heart block.
• Why was he bradycardic?
• Which artery is affected?
• What drugs would this patient be on? How do statins work?
• What types of stents do you know about? What is the difference?
• What do drug eluting stents elute?
• What are the guidelines regarding surgery and stents?
• Shown second ECG from today.
• What does it show?
• 1st degree heart block. Q waves. RBBB.
• He has a good exercise tolerance and tells you he goes running a few times a week. Would you anaesthetise him? What else
would you want to know?

14. Unexpected mass on CXR: 72 year old lady with bunions presents for day surgery and you review CXR.
• Talk through CXR systematically.
• Would you anaesthetise her today?
• Differential diagnosis?
• What sorts of lung cancer do you know about?
• How might her lung cancer affect your anaesthetic?
• How would you proceed to work her up for surgery?
• What investigations would you want?
• How would you anaesthetise her?
• What sort of tube would you use? Why a left sided tube? How would you check its position? What are the options for
analgesia after a thoracotomy?

15. Dilated carotid: A renal patient has just had a neck haemodialysis catheter inserted and now has stridor and a swelling.
• How do you approach this patient?
• Who do you want to help you?
• What is stridor?
• How would you anaesthetise this patient?
• They asked what other considerations specific to this case you would want to think about.
• I said choose drugs that were suitable in renal failure. They said anything else? I looked blank and they said what about
coagulation problems in renal patients?
• They pushed me asking which exact pieces of difficult airway equipment would I want before starting. I said McCoy, bougie
and fibreoptic scope but they were looking for needle cricothyroidotomy kit. Why wouldn’t I do a gas induction?

16. Hip with cardiac history: 78 year old lady with severe IHD and previous MI is being assessed for Revision hip.
• How can you assess cardiac function?
• What are your perioperative considerations?
• How do you choose between a CSE/spinal/GA?
• What other considerations are there?
• What methods exist to reduce blood loss.

17. Day case with COPD: 50 for arthroscopy knee sever COPD and want spinal for day case
• What are criteria for day case surgery
• Showed an x ray for some one very hyper inflated lung and possible a shadow left upper lobe
• Are you gonna do her in day case?
• How much you give in spinal and what would you use and how you manage her.

18. Circumcision: 1 year old for circumcision – analgesic options

19. Enucleation with cardiac history: 72 year old gentleman posted for enucleation of eye. He had a cardiac history 5 years ago,
following which a stent was put in. At this point, I was given an ECG to interpret. ( it showed 1st degree HB + old lateral wall
ischaemic changes).
June 2013 Final FRCA SOE – Thanks to all our candidates
• Asked about Drug eluting stents?

• Antiplatelets given along with it?

• Other medications that this patient should be on?
• Would I proceed with this surgery?
June 2013 Final FRCA SOE – Thanks to all our candidates

Basic Sciences

1) Limb ischaemia
• Symptoms and signs of acute limb ischaemia
• Assessment and management of lower limb ischaemia on ITU
• Anatomy of arterial supply of lower limb
• Arterial supply of lower limb.
• Causes of ischemia of lower limb
• Signs and symptoms
• Management of an ischaemic limb following removal of a picc line.
• Management of a patient for elective peripheral vascular surgery.
• GA versus regional technique – advantages, disadvantages.

2) High spinal injury

• Anaesthetic implications of high spinal cord injury
• Pathophysiology of autonomic dysreflexia
• Anaesthetic management of a patient coming for urinary catheterization
• High cervical spine injury- autonomic dysreflexia, signs and symptoms, management
• Other issues
• Changes that occur with a high spinal injury.
• Pathophysiology of spinal shock, and autonomic dysrhythmia.
• Effects on respiratory system.

3) Glycaemic control
• Perioperative issues with glycaemic control
• Reasons for hyper and hypoglycaemia
• Insulin – secretion, pharmacology, short and long acting
• Pharmacology of oral hypoglycaemics
• Oral Hypoglycemic drugs, mechanism of action
• Hypo and hyperglycaemia intra-operatively. Causes and management of each.
• Pharmacology of insulin.

4) Cardiac output monitoring

• Cardiac output monitoring How to assess the effectiveness of fluid therapy?
• Clinical, arterial line – trace, components etc
• Oesophageal Doppler – trace, measured variables, how is it used
• LidCO – principles, measurements
• NICE and DoH guidelines for use of CO monitoring
• If you were the clinical director and were going to buy some equipment for the department, how would you go about doing
it?
• Stroke volume and pulse pressure variability.

5) Trigeminal nerve
• Anatomy Course of the trigeminal nerve.
• Symptoms of trigeminal neuralgia.
• Causes and treatment.
• Shown pictures of dermatomes of head.
• Asked to describe distribution of trigeminal nerve. Asked what occiput and back of neck supplied by.
• Complications of surgey / RF ablation.

6) Gastric emptying
• Physiology Gastric emptying. Causes of delay? Implications of delay?
• Incidence of aspiration? What determines the severity of aspiration?
• How to manage prior to anaesthesia?
• Starvation times for fluids, food and breast milk.
• What drugs do we use for gastric dysmotility?
• What is the guidance for starvation times?
• What about chewing gum?
June 2013 Final FRCA SOE – Thanks to all our candidates
7) Anticoagulants
• What drugs affecting coagulation do you know of?
• Tell me about heparin?
• What are the advantages and disadvantages of unfractionated heparin vs LMWH?
• What is warfarin? How does it act?
• What are the half-lives of different clotting factors?
• How would you treat someone with INR of 5.0 presenting for NOF?
• They didn’t seem interested much in beriplex or FFP but more in vitamin K and how it worked. Problems of giving vitamin K
to someone on warfarin.
• What is dibagatran?

8) ICU scoring systems

• Clinical measurement ICUS scoring systems. Asked to list lots.
• APACHE 2 in more depth. What does it tell us? What are the different variables?
• Asked about SOFA, MEWS, Child-Pugh.
• What is SOFA score?
• What is ICNARC?
• What is the use of standardized hospital mortality ratios? What do they tell us?

9) Pain pathways
• Describe the pain pathway? What neurotransmitters? How is pain modulated (gate theory), what neurotransmitters and
what pathways.
• How to assess pain?
• Then take a Hx of pain
• Various scales to assess pain
• Magill questionnaire
• Mechanism of analgesia:NSAIDs, Paracetamol, Gabapentin, Local anaesthetics, Opioids, Ketamine, etc (wanted receptors or
mechanism)

10) Pulmonary hypertension

• Patient with pulmonary hypertension that required a hip replacement
• What is pulmonary HTN. What is WHO definition?
• I mentioned that it is defined as PA pressure >30mmhg.
• How is it diagnosed
• Causes, pathophysiology of how obstructive sleep apnoea cases it
• Specific symptoms
• How would you anaesthetise a man with pulmonary hypertension for a TKR?
• What is the treatment for pulmonary hypertension?

11) Magnesium
• What is the role of Mg in the body?
• Where is it found?
• How is it stored on the extracellular space?
• When would you give Mg? / How and where?

12) Safety features of Anaes machine

• What are the safety features on the anaesthetic workspace?
• Anaesthetic machine, suction, scavenging
• Wanted to know more about the oxygen alarm, how it works, what happens to gas flows
• What is the flow rate of the O2 flush (said 50 l/min, they had 35-75 on their paper so accepted it)
• Tell me about scavenging and the built in safety features of that
• How do you check your anaesthetic machine

13) Anatomy of central veins

• The course of the internal jugular vein.
• External landmarks for cannulation.
• Indications for IJ vein cannulation (they wanted lots and wouldn’t let it go until I’d covered everything).
• Complications of IJ cannulation.
June 2013 Final FRCA SOE – Thanks to all our candidates
• Other sites of cannulation.

14) Flaps
• Types of flaps in plastics (free vs pedicle).
• Causes of flap failure.
• Methods of maintaining flap perfusion including simple measures such as temperature regulation and avoiding pressure
and drugs (including those to avoid).
• Post-operative management.
• Use of dopexamine and how it works.
• Methods of maintaining adequate MAP without vasoconstricting.

15) Massive transfusion

• The pharmacology of blood loss.
• Calcium,
• Tranexamic acid with crash 2 study,
• Factor 7, factor concentrates
• Duration of their action.
• Fibrinolytic pathways.
• What is in a unit of blood

16) Temperature
• The physics of temperature -electrical non electrical.
• What is heat? What is temperature.
• How can we cool patients, why cool. Evidence in neurosurgery,
• Temperature loss – causes under ga and their percentages.
• Temperature measurement including electrical : thermistor, thermocouple and resistance

17) Awake fibreoptic

• What are the indications for fibreoptic intubation? You have a case of a man with a mandibular fracture who requires
fibreoptic intubation.
• Talk me through how you would do a fibreoptic intubation.
• What sort of tube would you use? Why?
• What is the nerve supply to the nose?
• How would you ensure airway adequately anaesthetised?
• Tell me about the anatomy of the trachea. Relations, blood supply, nervous supply?
• Talked about two levels at C6 and T4. Can you draw the anatomy of the lungs below the carina? Simple line diagram R + L.
• What’s the difference between the R and L immediately distal to carina? Why is this important?
• How would you check the position of a DLT?

18) Sodium
• How is sodium controlled in the body? What is normal? Intracellular and extracellular? How much do we need every day?
• How many bags of fluid is that? Talked about different composition of various fluids.
• What is hyponatraemia? What are the causes? What are the symptoms?
• What is SIADH? What are the causes?
• What is cerebral saltwasting syndrome?
• When would you be worried about hyponatraemia?
• How would you treat hyponatraemia? How fast would you replace it? What concentrations of hypertonic saline are there?
• What is the risk of treating it too quickly?
• What drugs can cause hyponatraemia?

19) AChE
• What is acetylcholinesterase? Whereabouts is it found? Tell me what happens at the neuromuscular junction.
• Where else is it found?
• What other cholinesterases do you know about?
• What drugs do they break down?
• Why do we have plasma cholinesterases in our body?
• What anticholinesterases can you tell me about?
• Can you tell me about how the different types work?
June 2013 Final FRCA SOE – Thanks to all our candidates
• What is the Tensilon test?
• What do you know about organophosphate poisoning? Who does it affect?
• What bond is formed? Is it reversible? What are the symptoms? How is it managed?
• What treatment do you know about?

20) Spinal cord monitoring

• You have a 13-year-old on your list for scoliosis surgery.
• What are the issues with this type of surgery?
• What disorders are associated with scoliosis?
• What is Duchenne’s?
• Tell me about your pre-operative work up for this patient.
• How will you anaesthetise him?
• What are your concerns intraoperatively?
• Asked about air embolism management.
• Why might the spinal cord be at risk in this type of surgery?
• What is the blood supply to the spinal cord?
• How do we minimise the risk of ischaemia?
• Then went on to discuss spinal cord monitoring – sensory evoked potentials. How do they work? What does it involve? Have
you seen this?
• Have you heard of awake testing to monitor spinal cord function? Is this appropriate in this patient?

21) Arterial line

• What are the elements of best practice for insertion of arterial lines.
• Describe how you do an allen’s test. How sensitive is the allens test?
• Describe the formation of the radial artery starting from aorta.
• Which artery contributes predominantly to the deep palmar arch and which to the superficial palmer arch.
• Describe the characteristics of an ideal IABP monitoring system.
• What are the complications of Arterial line insertion.
• What safety precautions or safety steps do you take when you insert an arterial cannula. What safety features exist within
the connections and measurement systems?

22) Transfusion reaction

• Tell me about the signs and symptoms of a haemolytic transfusion reaction.
• What is the pathophysiology behind the symptoms. Apart from antigen antibody reactions any other pathophysiological
mechanisms.
• How frequent are haemolytic transfusion reactions?
• What is the most common cause of a reaction to blood transfusion?
• Where can errors occur between taking blood from donor and administration to recipient?
• What checks should be performed before giving blood to patients?

23) Muscle relaxants

• What decisions influence your choice of muscle relaxant?
• Atracurium, Cisatracurium and Vecuronium: tell me how each are metabolised?
• How does Liver failure affect their metabolism?
• How does renal failure affect their metabolism?
• What is the exact breakdown of vecuronium?
• What happens to 11,17 dihydroxy vecuronium after it has been formed?
• Tell me about sugammadex. What are the contraindications?
• How does it compare to Neostigmine? What is the cost of Sugammadex.
• What is the dose? Any situations that you wouldn’t want to use Sugammadex

24) Renal replacement

• Tell me what types of renal replacement exist.
• What are the main mechanisms behind Haemofiltration and Haemodialysis?
• What are the complications?
• What is osmosis and what is diffusion.
• What are the indications for haemofiltration?
June 2013 Final FRCA SOE – Thanks to all our candidates
25) Ankle block
• Elderly gentleman with COPD for hallux valgus surgery. What are the options for regional block for this procedure?
• How would I take consent for ankle block?
• Which supplies which dermatome (shown on picture)
• How do you block them

26) Cardiac tamponade

• What is cardiac tamponade?
• What are the causes of cardiac tamponade?
• What is Beck's triad?
• How will the patient present?
• What is pulsus paradoxus?
• What investigations can be performed?
• What is the pathophysiology of cardiac tamponade?
• How will it interfere with the coronary perfusion?

27) TCI
• Asked about TIVA pump.
• Causes of light plane of anaesthesia in a patient who is on TCI propofol.
• Any means of monitoring a patient for awareness in this patient.?
• Any guidelines?
• Asked about different drug delivery models.
• Asked about 3 compartment model.
• Asked about effect site and plasma site concentrations?
• TIVA pharmacokinetics: Marsh and Schneider

28) Agent monitoring

• How is the delivery of volatile agents monitored intraoperatively?
I mentioned the various methods, out of which the examiners were interested in
• Infrared spectrometry. Mechanism?
• On what factors does the uptake of volatile agents depend on?
• Asked about partition coefficient? Blood /gas and oil/gas
• Some values of each.
• What factors affect speed of onset of volatile agent?