Primary FRCA exam January 2010 - · PDF filePrimary FRCA exam January 2010 5 OSCE Caudal block...
Transcript of Primary FRCA exam January 2010 - · PDF filePrimary FRCA exam January 2010 5 OSCE Caudal block...
Primary FRCA exam January 2010
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VIVA
Pharmacology
- Opiods and opiod receptors - where they are in the
body and how they work, side effects etc
- Beta Blockers - How they lower the blood pressure,
different characteristics, etc
- Metabolism - Phase 1 and Phase 2, differences and
purpose of metabolism, cytochrome P450
Physiology
- Cardiac cycle, LV pressure and volume curves
- Iron metabolism - storage, heamoglobin, absorption etc
- Water balance - "If you drink a litre of water what
will happen...", osmopreceptors, ADH
Physics
- Capnography, methods that can be used, different
capnography traces
- Infusion Pumps - Errors with them, safety features
- Fluid flow, pressure difference across tubes, laminar
and turbulent - somehow this lead onto cardiac output
measurement with doppler!
Clinical
40 year old in an RTA with a closed femoral fracture.
Questions on haemorrhage, further trauma management,
complications of blood transfusion, finally fat embolism
intra-operatively
OSCE
1 - Axillary nerve block - show position on an actor
2 - Anatomy of coronary arteries
3 - Communication - Consent a Jehovah's witness -
discuss options other than blood products
4 - Nerve injury - Stupid station - 6 different pictures
of positions on the operating table that can damage the
brachial plexus and 7 different parts of the plexus that
could be damaged - match them up. Went on to the
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consequences of radial and ulnar nerve injury.
5 - Defibrillator - had to defbrillate simman who had
gone into fast AF intraoperatively
6 - Checking A-line set
7 - CVS examination
8 - x-ray of neck with C2/3 fracture
9 - Resus scenario - just talking through asystolic
arrest
10 - History taking - Man for TURP, history of chronic
bronchitis
11 - Simman - Desaturating due to ETT in right main
bronchus
12 - Anatomy of trigeminal nerve
13 - Change of tracheostomy tube
14 - History taking - young woman with history of
rheumatic fever
15 - History follow on station
16 - x-ray - lateral chest x-ray
17 - Check a Bain circuit - few questions about fresh gas
flow
18 - Humidity - measurement, equipment and graphs
Set 2
OSCE
XR- upper lobe consolidation
How to insert LMA and contraindications
Hx for wisdom tooth extraction who has prev # nose and penicillin allergy
Picture of Fischer Paykel hot water humidifier
Severinghaus electrode
Caudal block
Anatomy of ribs and intercostal block
Comm skills - pt for arthroscopy who has URTI
Cross section anatomy at C6
Sim man- pulsed VT
Examination (on sim man) CVS- AS
Bradycardia in recovery (talk through) (evil examiner!)
Hx for Lap Steri (IVDU and suggestive of TB)
3D reconstruction of CT facial views (very random)
Examine peripheral pulses and take BP and measure CVP
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US images for IJV cannulation then questions on CVP waveform (didn't want you to draw it
though)
Vivas
Pharm
Factors affecting speed of onset of local anaesthetics
Receptors (focused on GPCRs)
Antibiotics- mainly penicillins then a bit on aminoglycosides
Physio
V:Q matching, west zones and effects of anaesthesia
Compare cardiac myocyte and pacemaker action potential
Compnents of blood then went on to ask about buffers (but other people got asked about
immunoglobulins)
Clinical
22year old with penetrating eye injury whilst drunk- discussion around sux and IOP
Critical incident- anaphylaxis after RSI
Then another critical incident re hypoventilation in recovery (differential diagnosis)
Physics
Isotherms for nitrous then oxygen, critical temp etc
Biological potentials, amplifiers, interference, CMRR, gain etc
Work, power, energy, force etc
Set 3
Pharmacology SOE
1. Name some classes of intravenous induction agent. Discuss the structure of thiopentone
and how it contributes to its action. Tell me about methohexitone (....aaargh!). Compare the
pharmacokinetics of Thiopentone with Propofol.
2. Pharmacokinetics. Tell me about steady state. What factors influence steady state. Context
sensitive half life.
3. Digoxin
Physiology SOE
1. CO2 dissociation curve, carriage, haldane effect. ODC.
2. Receptors: ion-channel linked, kinase-linked, G-protein linked, intracellular. Examples.
3. Stress response (focussed on neuroendocrine response).
Clinical SOE
54yo elective hernia repair, obese, HTN
-How would you assess this patient pre-operatively
-What are the risks?
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-Critical incident: high spinal - tube, cancel the surgery, go to ITU (was what they wanted to
hear!)
Physics SOE
1. Blood pressure measurement (focussed on non-invasive)
2. Lasers
3. Fibreoptic scope
OSCE
1. Humidification (wet/dry bulb hydrometer: MoA, definitions, dangers of
overhumidification)
2. Central line: internal jugular anatomy and landmarks, discuss technique and complications
3. Electrical safety. Symbols. Circuit diagram, asked to comment on (difficult station!)
4. Communication skills. Needle phobia, consent for sickle screen.
5. Resus 1: tracheostomy change
6. Resus 2: obstetric emergency: local anaesthetic toxicity
7. Spinal cord anatomy
8. History: TAH (fibroids), anaemia, previous PE/PONV
9. History: Lap chole, GORD, FHx sux apnoea
10. Cranial nerves III-XII
11. CXR - inhalation of foreign body
12. C-spine - patient for appendicectomy, looked like Ank Spond, questions about heart block
and aortic regurgitation
13. Giving set/Flow: flow rates through various cannulae, how to improve flow etc.
14. Airway anatomy/difficult intubation: how to improve a Grade III view, laryngeal nerve
supply, methods to detected oesophageal intubation
15. SVT
16. Capnography (abnormal traces, calibration)
17. Ankle block: distribution of nerve supply, demonstrated on model
Set 4
Phys/pharm
CO2 dissociation curve
Stress response to surgery
Receptors and neuromuscular transmission
Physics/ clinical
Non invasive BP measurement- how does DINAMAP work?
Picture of Bronchoscope- what parts, how does it work? How do you clean it?
Safety and Lasers
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OSCE
Caudal block
Anatomy C6 level
Broad complex tachy and defib
Anatomy of thorax and ribs
Humidification
CO2 electrode
Chest drains- what the different bits are for
Bradycardia and management
Set 5
SOE Pharmacology/Physiology
PHARM
1)IV Inductions agents, list what we use, structure of thio and differences between oxy and
thio barbiturates, keto/enol transformation, side effects of thio,
2)Pharmacokinetics of IV infusions, time to reach steady state, distribution half lives, context
sensitive half times, talked about remi Vs propofol
3)Digoxin, mechanism of action, negative chronotropy vs positive ionotropy, uses in AFib,
narrow therapeutic index ED50:LD50, treatment of overdose
PHYS
1)CO2 carriage in the blood, draw the graph (everyone else got given the graph to label, I had
to draw but did it VERY badly), draw the red cell, carbamino compounds, haldane effect and
chloride shift
2)Surgical stress response, neuroendocrine, hypothalamo-pituitary axis, glucagons and
insulin, nitrogen balance
3)Neuromuscular junction, Ach nicotinic receptor, draw it, other receptors, G protein with
examples of each type, intracellular steroid receptors, how they work, gene regulation
SOE Clinical/Physics
CLINICAL
54 year old obese man with hypertension on diuretics for inguinal hernia repair. BP
165/105mmHg on admission. Night before operation. Called to ward by nurse because of BP.
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1)What is obesity, BMI, Problems with obesity, physiological, cardio, resp, GI, metabolic,
type 2 dm causing gastric stasis, what is OSA and why is it a problem, post op with opiates
etc
2)would you take this BP at face value? No, need to repeat, check cuff size etc. BP now
150/90. Would you anaesthetise? Probably, not set rules RE BP and this may represent good
control for him
3)How would you anaesthetise, wanted spinal, then short of breath on table DD of this high
spinal, cardiac and resp causes. Causes of high spinal excess volume, excess dose AND put in
too high!
Then gets really short of breath so end up having to tube, where would you send him after?
When would you wake up? Wanted a specific time frame I said when cardiovasc stable and
controlled environment I said 6 hours.
PHYSICS
1)Non-invasive BP measurement, how they work, what is measured and what is derived, how
to calculate MAP, cuff sizes, when are they inaccurate, what complications can they cause,
wanted petechial haems, nerve damage, poor blood supply to distal extremities, pressure
sores
2)Fibreoptic bronchoscope, what is it used for, why do ENT surgeons use them pre-op,
wanted things like airway swelling in burns, epiglottitis etc, showed a picture, what each part
was (pointed to them for me), how is it cleaned and sterilised, what methods of sterilisation
do you know
3)Lasers, what precautions are taken in theatre, why, what does laser stand for and how does
it work, showed a picture of a lasing medium and asked how it produces the beam, where is
laser surgery used in hospital medicine, wanted general surgery/ENT and ophthalmology
OSCE
1)History taking watched by an examiner. Lady for lap chole. Cousin with anaesthetic
problem ?what. nothing else particularly different. Quite straight forward.
2)Resus sim man. Patient on ICU with perc trache done 48 hrs ago known to be a difficult
intubation. Tracheostomy just fallen out. Sats low 70s. Cant put trache back in. Can ventilate
with guedel and mask only when nurse puts finger over trache hole! Cant intubate cant see
anything. LM A didn’t work for me. Sats never came above 70 but not sure if they were
meant to. One person got sats of 95%! Help is coming.
3)Radiology Cxray. 2y old child SOB from a party. Complete whiteout left lung. 10 T/F
questions some were
Left haemothorax
Left collapse
Anaphylaxis
Inhaled foreign body
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Heimlich manoeuvre dangerous
Bronchoscopy indicated
Chest drain indicated
4)Cross section of spinal cord. Very hard. Knew id got some wrong as told later what they
were! Whats blood supply to the cord. Where does ant spinal artery arise. What happens in
ant spinal artery occlusion.
5)Given grade 3 layngoscopy picture. How could you improve the view. Clinical ways to
know of oesophageal intubation NOT capnography. Capnography traces from bain/circle and
rebeathing.
6) and 7)History from 42 y old with menorrhagia for TAH. Had previous GA as a child. Also
GA Csection with post op DVT and PE 12 yrs ago. Also had migraines and took aspirin
PRN. Taking iron tablets. Smoker. Cap to front tooth. No allergies. On the follow on station
was asked why she was having TAH and menorrhagia was not the answer! So i don’t know
because she told me it was for heavy periods. Also asked what else she did for migraines???
8)IV cannulae and maximal rates of flow. Differences between pink and grey. Not the colour.
Wanted 4 differences. IV giving sets how to improve the flow.can you entrain air through the
giving port?
9)Humidity. Different pictures of humifiers. What can achieve 100% humidity in the trachea.
What is humidity absolute/relative.
10)IJ cannulation landmark technique. Seldinger technique. Angle you go in
at.complications. post op care i.e., chest xray.
11)ankle block. Anantomy of nerves. How to block each nerve and doses of LA.course of
saphenous nerve in the leg.
12)cranial nerve exam excluding optic nerve.nothing difficult here
13)electricity (very hard!!) picture of patient attached to lots of monitoring in theatre and
questions about equipotential earths and mains frequency etc I just didn’t understand really.
Then asked to pick 2 electrical symbols from about 30 on a laminated sheet and say what
they were which was fine.
14)Resus SIMman. Obstetric PEA arrest. Just had epidural top up now unresponsive. DD
high spinal and IV LA. Was IV LA. ALS algorithm then asked questions on intralipid. Also
what else can be given???
15)SVT management. Rhythm strip given of SVT. Drugs. Vagal manoeuvres. Joules used for
cardioversion and how many times.then what other drugs?? I had already said amiodarone so
Im not sure if this is what she wanted again?
16)capnography. How does it work. What clinical info does it give you (3 things). Signs of
cardiac arrest, disconnection, COPD. Very straightforward.
17)radiology. Lateral C spine. Think it was ank spond. 10 TF questions
All cervical intervertebral disc spaces visible (C7 T1 was there so I said yes)
Obvious osteophyte formation
Signs of fusion
Cricoid pressure may fracture this neck
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Patient will have severely restricted mouth opening
Patient may have aortic regurg
Rare complication is cardiac conducting defects
Patient will have preserved VC
Patient likely to have chest wall involvement
Set 6
Pharmacology:
Tell me about isoflurane.
Tell me specifically about its effect on CVS.
Compare CVS effects with sevo, halothane, desflurane.
Tell me about routes of administration. What factors make it desirable to administer drugs by
S/L and transdermal routes? What drugs can be given by these routes?
Tell me about heparin. How does it work? Unfractionated vs LMWH.
Physiology:
Tell me about West's zones. Blood flow in each area.
Tell me about PVR. What factors affect it?
Tell me about temperature control and how body responds to low temperatures. Neural
pathways etc.
Tell me about a nerve cell membrane and what property allows conduction of electrical
activity. Nernst potential & Goldman-Field.
Physics:
What factors determine flow in a cannula? What are the desirable properties of an arterial
cannula & why? Pictures of art lines, IV lines, Tuohy, Stimuplex. Describe features. Quincke
vs pencilpoint for SAB. French gauge & SWG.
Defib - circuit, features. Factors influencing charge on capacitor. Factors influencing
discharge.
CPEX. What is it? How does it work? What does it measure? What info does it give?
Clinical:
37yr old lady with bad Crohn's, on steroids, sulphasalazine, azathioprine. Needs pan-
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proctocolectomy. Has had diarrhoea, abdo pain, pyrexia. What would your plan be for
preparation, anaesthesia & post-op? Epidural stops working - what do you do? Stops peeing -
what do you do? Pre-renal/renal/post-renal etc.
SET 7
Pharmacology
Local anaesthetics
- Structures including drawing
- Factors affecting speed of onset/potency/duration/venoconstriction
- Whether LA useful in infected tissue
- Henderson Hasselbach equation
Penicillins
- Structure
- Mechanism of action
- Spectrum of cover
- Resistance mechanisms
- Synergism with gentamicin
Sorry can’t remember the 3rd
topic!
Physiology
Functions of the blood
- Components and proportions
- Clotting cascade
- Red blood cells
- Hb structure, cooperativity etc
VQ
- Definitions
- Diagram
- FRC
- Factors affecting VQ
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Cardiac action potentials
- Pacemaker vs ventricular AP’s
Physics
Gas laws
- Cylinder pressures
- Bourdon gauge
- Measuring contents of N20/O2 etc
Biological potentials
- Compare and contrast ECG/EEG/EMG
- Black box concept
- Common mode rejection
Lots of definitions – Force etc and their applications to anaesthesia
Clinical
22 yr old man who had sustained a penetrating eye injury outside a nightclub
- Pre-op assessment
- Method of induction
- Critical incident – anaphylaxis
- Then discussed a pt in recover who has resp depression and possible causes and
how to approach management
OSCE
1. C6 transverse anatomy
2. Facial CT reconstruction – Frontal and maxillary fractures.
3. History station – young male for wisdom tooth extraction. Day case. Lives
alone and had driven to the hospital. Allergies.
4. Questions about 3
5. Humidifiers – why used, different types and problems associated with them
6. Severinghaus electrode – labelling parts (very odd diagram!) and talking about
the mechanism. Other methods of CO2 analysis
7. Demonstrate a caudal, calculate safe LA doses, mx of LA toxicity and it’s
recognition
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8. Rib anatomy – 1st rib and a thoracic rib. Demonstrate where subclavian a, v,
& brachial plexus cross. Neurovasc bundle. To demonstrate how you would
do a IC block. On a real person, show site of carina, needle decompression &
IC chest drain insertion
9. Peripheral arterial and venous examination, BP,
10. Sim man – Broad complex tachycardia with pulse. Compromised therefore
defib. Amiodarone.
11. Rhythm strip – sinus brady – management, risks of asystole
12. History taking (observed) – lap steri … pretty standard, not entirely sure what
I was meant to discover!
13. Explaining to a patient with a URTI for a knee op that he should be postponed
14. Sim man – Assess CVS system and take BP. Comment on likely diagnosis
and investigations. Why regional may be inappropriate
15. CXR – RUL collapse
16. LMA insertion and questions about appropriateness
Set 8
OSCE 11/1/10
1. History – 35 year old lady for lap. Sterilisation. Recent hx night sweats and weight
loss.
2. Simman – feel pulses, NIBP, auscultate heart – systolic murmur, questions on aortic
stenosis
3. Xray – postop cxr collapse RUL questions on management postop.(someone else
thought it was aspiration)
4. LMA – check equipment, insert on manikin, questions about contraindications and
safety
5. Anatomy – cross section of neck at C6, label diagram, route of EJV
6. History taking and follow-on –young fit man for dental extraction, broken nose so one
nostril patent only, allergy to penicillin, fhx anaesthetic problems
7. Radiology – CT 3D reconstruction of trauma to head and face. Questions on
management of head injury.
8. Equipment – humidifiers. Picture of hot water bath humidifiers, pros cons other types
of humidifier.
9. CO2 electrode – picture with labels, ways of measuring CO2 how is it transported in
the blood.
10. Caudal block in child – sacral anatomy, max dose local, show technique, what criteria
for going home.
11. Communication – patient for day case op with bad cold, cough and fever. Discuss
plan, pt having trouble getting time off work. Didn’t shout, actually quite compliant.
12. Chest drains – 2 underwater seal chest drain bottles, what are the parts, where do they
connect, how full, what height from pt, problems with transport.
13. Resus – pulsed VT but low BP, already intubated. Better after 1 shock synch.
14. Exam – Assess pts pulses, BP and JVP.
15. CVP line insertion – pictures of ultrasound views, questions of how deep, how to
know in correct place, where is correct place, why head down
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16. Resus – sinus brady requiring atropine, general run through of brady algorithm
17. Anatomy – 1st rib, other rib where is neurovasc bundle, where would you do
intercostals block, which attachments and grooves.
Set 9
PRIMARY FRCA EXAM QUESTIONS JAN 2010
OSCE STATIONS:
1. Simulation scenarios:
Anaphylaxis post induction
Can’t intubate can’t ventilate.
2. Resucitation stations (Actors as patient)
RTA with haemothrax pt in A&E(Q about initial assessment / chest
drain insertion/GCS).
ITU pt on vent with tension pnemothorax(Q about examination and
needle insertion and definitive treatment)
3. Resuscitation stations with manikin:
Cardiac arrest/?AAA rupture
VF arrest : algorithm
Bag & Mask ventilation/NP airway,FRC
4. Mono oral Stethoscope
5. Skin temp probe: define Kelvin,triple point water?,core temp?
6. Laryngeal blades+ Magill’s:
Compare disposable blade & straight blade
light bulb adv/disadv over FO light
reasons for brady cardia with straight blade
7. Anatomy trachea/Lung/Diaphragm
8. Anatomy orbit
9. Anatomy Laryngeal inlet
10. Anaesthetic machine with modified Jackson-Rees circuit;
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Q on efficiency/What happens if bag is completely torn?
What happens if reservoir tube length is doubled
Minimal gas flow in 25 kg
11. Labour Epidural skill demo
12. History stations:
Lady for Vaginal hysterectomy with significant PMH pre-eclamp/renal
failure /PPH in previous pregnancy
Pregnant lady with Ankylosing spondylitis
Diabetic /IHD pt for cataract surgery
20 yr old for tonsillectomy-peanut allergy/crown
13. Dynamap.
SOE:
Pharmacology:
Benzodiazepines
Route of adm of drugs/Bioavilability
Phenothiazines/antiemetics
Physiology:
Cardiac pacemaker cell AP
What are Hormones/classification
ABG (resp alkalosis) analysis
Clinical:
72 yr old with Rh Arthritis for Hemiarthroplasty hip.
About RA
CI : High spinal
Post-op analgesia
Physics:
Transport ventilator
Arterial trace and CO calc
Draw over vaperizors
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Set 10
Osces
1. Needlestick injury - what to do after needle stick, incidence of getting HIV (%), incidence
of HIV if take antiretroviral medications, who to report to, who do they report to, what do
they do after. do you take consent from the victim to take his blood.
2. Take BP of this lady - select the right cuff, why select that cuff, what sounds listen for
(diastolic and systolic), do men and women have same BP.
3. Eye - peribulbar block and how to do it on a skull, what is the sensory supply of the eye,
what is the motor supply, length of eye ball. complications of peribulbar block.
4. exam this mans pulse, precordium, and heart sounds. explain what you do as you do it.
5. resuscitation - 24 year old lady with ectopic pregnancy in pea - steps. who do you call.
6. History from lady for hysterectomy. she had an ITU experience which wasnt good before.
7. History and follow on - Young IDDM for tonsillectomy. last bout of tonsillitis 2 weeks
ago. cant open mouth wide with tonsillitis. lots of holiday due to recurrent bouts.
8. Temperature. Picture of thermistor, then graphs and which one corresponds to the picture -
and the other graphs are representing what device. why do kids loose temperature quicker.
how do you stop it.
9. Two laryngoscope blades - straight and curved. one plastic and one metal. advantages of
plastic. pressor response to laryngoscopy and why get bradycardia sometimes. what nerve
responsible. The showed magills forceps - what used for.
10. Resuscianni - what head position for ventilation. give the manikin 5 breaths.
disadvantages of nasopharygeal airway.
11. Resuscitation - MH.
12. Picture of stethescope and earpeice (hearing aid) attached to it. what used for. advantages.
for kids or adults. when use it. what respiratory and cvs sounds can you hear with it that you
want to.
13.
14.
15.
16.
17.
Physiology/ Pharmacology viva
- ODC. draw it and mark on points. what shifts it to left/ right. why is this useful. how
measure oxygen content blood.
- calcium - use in body. why get tetany and explain it in terms of calcium.
- muscarinic receptors in body. where, what type. draw receptor. what acts on it. name
muscarinic agonist.
- colloids - what are they. why use.
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Physics/ Clinical
- clinical was 24 year old 38 weeks pregnant with severe fetal bradycardia. management -
catagory of c section. explain anaesthetic technique. is regional CI. say you anaesthetise -
then CICV. mx.
physics - what is a vacuum. where do we use them. draw scavenging system. explain why
high flow low pressure. where is low flow high pressure used in anaesthetics. draw a graph of
temperature decline with anaesthetised patient. what do we do to stop decline. how efficient
is it.
Set11
Physics
- Mapleson circuits, efficiency during controlled and SV and why this is the case (inspiration,
expiration, expiratory pauses etc.)
- Oxygen measurement - different types, explain in detail galvanic fuel cell electrode
including equations at both anode and cathode, explain the mechanism of paramagnetic
analyzer
- Symbols on anaesthetic equipment. Very small print stuff - symbols for manufacture date,
symbol for expiry date, symbols for different types of sterilisation. Didn't know a single one
of them but the examiner was very patient and guided me through (e.g. what does this look
like? an egg timer, oh it's probably expiry date then)
Clinical
Young motorcycle RTC victim, compound tib fib no other injuries but may be hepatitis
positive.
- First question mostly regarding preop assessment and how you would anaesthetise him
- Second question - develops high airway pressures and hypotensiobn. Differentials.
Treatment of anaphylaxis
- Third question - talk me through what you would do following a needlestick injury from
this patient
Pharmacology
- Draw a dose response curve, semi log plot, definitions of agonists and antagonists and their
dose response curves
- Volatiles - compare sevo and des in terms of physical properties and how this affects their
action
- Drugs acting on platelet function - I asked and was allowed to eat up some time by
describing steps in platelet plug formation. Spoke about aspirin and NSAIDs. I couldn't recall
how clopidogrel worked and couldn't recall a name for a GIIb/IIIa inhibitor (tirofiban was
what I was after).
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Physiology
- What is an enzyme, Michaelis Menten kinetics, which enzyme systems are we interested in
as anaesthetists, talk about acetylcholinesterase and pharmacogenetic variability
- Physiology of ascent to altitude, control of respiration, alveolar gas equation
- Pressure volume loops in the left ventricle in minute detail, demonstrating stroke volume,
myocardial work, changes in contractility, changes in afterload
OSCE
13. Anatomy - spinal cord - LA volumes to block one level in epidural, total CSF volume,
name the tracts on the diagram (which confusingly had ascending and descending all on the
same side rather than how it is normally illustrated). Which tracts do which, blood supply to
cord, affect of anterior artery ischaemia.
14 History taking - woman for TAH. Elicited hx of awareness during GA section, traumatic
gas induction plus all the usual bits including a cap on tooth.
15 Follow on station - questions I couldnt answer there: what is the patients Hb on the blood
test GP did, when was the patient's PE which she didn't have the courtesy to disclose
16 C-spine X-ray from patient with history of severe arthritis. Looked arthritic. Questions
including is the patients FVC likely to be reduced, is mouth opening likely to be impaired, do
they need an echo to rule out AR.
17 Fluid flow. Appalling station, absolutely godawful. Given a pink venflon and a grey
venflon - name 4 differences (not including the coloured cap), what is the flow rate for each.
Shown a blood giving set - what happens to flow when diameter doubled, why doesn't it
actually achieve this 16x increase. What is the ball valve in the giving set for. What fluid is
used to calibrate flow rates in venflons (???)
18 Hazards - humidity - absolute vs relative, identify types of hygrometer from pcitures. Why
is the wet thermometer at lower temperature. How is humidity read from a wet and dry bulb
hygrometer. What is humidity maintained at in theatre, two reasons why this is beneficial.
Name 3 types of humidifier that allow 100% humidification in a breathing circuit.
1 Technical. CVP insertion. Landmarks for IJ, contents of sheath, talk through the procedure
with equipment on table, post procedure management, 5 common or serious complications
2 Anatomy/ technical - ankle block on an actor. Nerves supplying ankle joint, how would you
block deep peroneal and tibial. Describe course of saphenous nerve. Point out area supplied
by saphenous, area supplied by tibial
3. Examination - cranial nerves III-XII inc Rinne and Weber tests
4 Communication station - young man for elective arthroscopy. Afro-Carribean and refusing
sickle cell testing as needle phobic.
5 Resus - called to labour suite after SHO has given 20mls marcain down epidural. Pt
arrested, PEA on monitor. Got BLS started, wedged, called for help. Practical side stopped
then asked questions - what are two most likely causes (total spinal, intravenous), what would
you do now that BLS has been started (doses of adrenaline and atropine, when they are
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repeated, doses of intralipid, need for section). All straightforward - other candidates said that
examiner didn't hide his disappointment well when they didn't know the dose of intralipid,
apparnetly asked one if he'd every administered local anaesthetics!)
6 Hazards - electrical safety showing very confusing diagram of patient connected to CVP
line and ECG monitoring, types of earth, differences in earth potentials. Really hard to follow
what was wanted. Finished with a grid of about 20 symbols and asked to pick two and name
them.
7 Equpiment - capnography - information provided, what happens at each stage in a
capnograph trace, causes of abnormal traces
8 Critical incident - managing a narrow complex tachycardia, doses of adenosine, action if
adenosine fails, energy used for cardioversion, doses of adrenaline,
9 History taking - patient for interval lap chole.
10 Resus - recently inserted trache falls out on AICU, nurse bagging without O2. difficult to
bag, better with two person technique, sats not improving markedly, reinsertion fails, unable
to intubate from top. Options now.
11 Radiology - Child sudden breathless at birthday paty. X ray shows almost complete
whiteout on left with mediastinal shift to left (i.e. collapse). Straightforward questions the
theme being is it aspiration or foreign body and collapse
12 Difficult intubation - identify this laryngoscopic grade, techniques to improve it, clinical
and objective signs of oesophageal vs tracheal intubation. Identify 3 capnograph traces from
choice of 4 - oseophageal intubation, tracheal intubation in a Bain and in a circle.
Set 12
SOE Pharmacology and physiology
Pharmacology
1. Antibiotics; Fluclocaxillin and other penicillins difference and indications for use, moved
onto gentamicin with reference to indications for use and therapeutic index and finished up
with antibiotic resistance and penicillins
Receptors- classification and types and moved on to g protein coupled receptors
Local anaesthetics- what affects speed of onset of local anaesthetics pka, lipid solubility and
protein binding, moved onto pKa of lignocaine, bupivicaine and toxicity and treatment and
IVRa and why prilocaine is used.
Physiology
Shunt and V/q mismatch and V/q ratio of upper lung to lower lung west zones and how
anaesthesia affects V/Q
Components of blood and the pH of blood, HB WCC platelets - speaking to other candidates
they moved on to buffers which I did not
Primary FRCA exam January 2010
18
Action potentials- cardiac VS pacemaker potentials, differences and why, things that affect
the pacemaker cell potential and why
Physics
Cylinders and the differences between oxygen and nitrous cylinder and why is this
Isotherms and N20
Biological potentialsECG interference and Common mode rejection, amplifiers and gain
Clinical
22 year old male post penetrating eye injury, was standing outside a night club and how
would you assess this patient- ABCDE trauma could he have drugs as well as alcohol on
board
what other investigations would you request and how would you anaesthetise this patient- i.e
RSI but Sux would increase IOP, what else could you do to reduce IOP?
Turned into critical incident about anaphylaxis but what other differentials could there be
how would you manage this situation
Another clinical incident about some one desaturating post op and opioids and residual
Neuromuscular blockade
OSCE stations:
Electrical Hazards- symbols safety and earth
Communication station- sickle cell anaemia and needle phobia
Landmark technique for Internal jugular vein cannulation
Ankle block nerves and areas supplied as well as veins that run with the nerves
History taking - TAH menorrhagia, reduced haemoglobin and migraines
Fluids and giving set - cannula sizes and how could you increase the speed of the infusion
SVT ECG and management
Capnography traces and principles
Pregnant lady - cardiac arrest post epidural top up
History taking lap chole with Reflux
Critical incident tracy fallen out COPD with difficult intubation
X rays- collapse lung after inhaled foreign body in a child
C spine x ray in arthritic
Spinal cord anatomy and tracts
Airway mallampati scoring and Laryngoscopy grades and what could you do to improve the
view in a difficult intubation
Humidification - definitions measurement and types
Examination of cranial nerves 3-12
Set 13
Primary Viva Jan 2010
Primary FRCA exam January 2010
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Pharmacology
1) Tell me how NSAIDS work?
Drew diagram of pathway. Effects. Uses. Side effects. Why does aspirin’s antiplatelet
effect last 7 days?
2) What are Ach receptors? What types. Where are they found.?
Discussed nicotinic Ach Rs in the autonomic ganglia and NMJ, and muscarinic Ach Rs
in the PNS. How do they work (Ligand gated ion channels/ GPCRs). Different ligands- eg
atropine. Ipratropium. Uses and effects.
3) What are the characteristics of the ideal colloid? Colloids vs crystalloids. Starches vs
gelatins.
Physiology
1) Given a drawing of the Oxygen dissociation curve. Mark on 3 points- arterial blood
(with normal pKa range), mixed venous blood and p50. What is the purpose of the
p50 value. What causes right shift? Had to calculate O2 content of blood and O2
delivery. What is huffners constant? To calculate dissolved O2 in blood, why do we
multiply PaO2 by 0.0225? What happens to O2 content at altitude? What happens in
hyperbaric situation eg 10m below sea level.
2) What is the role of Ca2+ in the body? How is it regulated? Vitamin, PTH
3) How is blood pressure controlled? What is the body’s response to losing 15%
circulating volume blood
Clinical scenario
25 year old primigravida 39/40. Sudden foetal distress. Had not required epidural up until
then. Discussed management options. How would I anaesthetise this pt for emergency
LSCS. Physiological changes in pregnancy/special considerations. Critical incident:
difficult intubation. Sats drop afterwards- possible causes. Management of aspiration.
Physics
Primary FRCA exam January 2010
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1) What is suction/Vacuum? What are the features of medical suction? What pressures?
What flow rates? (vs scavenging) How is the vacuum created? What are the
complications of suctioning?
2) Types of heat loss under anaesthesia. Ways of minimising heat loss by radiation.
What are the 3 phases of heat loss during a 3 hr operation? (I didn’t know this- graph
of temp vs time)
3) Dead space- what is it? Fowlers method. Derive the Bohr equation.
Primary FRCA OSCE 13th
January 2010
1) Equipment: shown a monoauricular stethoscope- what is this? Uses.
2) Base of skull anatomy (name foramen) and orbit anatomy- discuss peri bulbar eye
block. Whats special about the needle. Complications.
3) History station. See elderly obese with obstructive sleep apnoea man in preop
assessement who wants hernia repair next week as day case. You need to advise him
to stay in overnight- he gets angry. Concerned about leaving his wife alone.
4) Resus SIM MAN- called to A and E. Lady with ectopic pregnancy- unresponsive.
BLS- ALS. PEA arrest- lead scenario.
5) History station- See a 39 yo lady pre op assessment for hysterectomy.
6) Examination- examine a patient’s cardiovascular system. Peripheral pulses.
Praecordium- ?aortic stenosis
7) Resus- talk through. Cardiac arrest on medical ward. Shown a rhythm strip with fine
VF. ALS
8) Theatre SIM MAN. Fit well young man just been given drugs for RSI for
appendicectomy. Drugs given, you walk in and take over. Anaphalaxis- CICV
scenario (swollen tongue- unable to open mouth). Desaturates- emergency needle
cricothyrotomy.
9) Xray station- CXR ?coarctation- rib notching
10) Talk through anatomy of thorax, hilum, diaphragm
11) Paeds- 2 yo to bag-mask ventilate. Optimum positioning.
12) Xray- barium swallow with pharyngeal pouch. Management
13) History with follow on station- young man type 1 diabetes pre tonsillectomy.
14) Equipment: plastic MacCoy blade vs metal straight blade. Innervation of larynx
15) Equipment: Axillary thermometer. How does it work? Name graphs (resistance vs
time) for platinum resistance wire, thermocouple and thermistor.
Primary FRCA exam January 2010
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16) BP measurement- actually measure BP using sphyg. Cuff size. What is MAP? What
happens to BP as get older. Male vs female.
Set14
Pharmacology
Neuromuscular blockers
o Structure of vecuronium
o Structure of the nAChR and vecuronium binding site
o Compare and contrast vec and roc
o Why is roc faster acting?
o What are the non-NMJ actions of rocuronium
Statistics
o How do we design a study?
o What types of error do you know?
o How do we minimise the risk of type I errors?
o How do we calculate power?
Vasodilators
o Pt in theatre has a BP of 230/120. What would you do?
o Draw a table of drugs the reduce BP
o How do beta-blockers work?
o What alpha-blocker do you know?
Physiology
Preoxygenation
o What are the physiological principles of preoxygenation?
o How does [N2] change in the lungs?
o Draw the oxyhaemaglobin dissociation curve
o What is the blood content of oxygen?
o How can we increase the oxygen content?
Autonomic nervous system
o Compare and contrast the sympathetic and parasympathetic nervous system
(anatomy, chemistry, functions)
Capillary dynamics
o What properties of blood determine flow?
o Describe the movement of fluid across the capilliary wall
o What are the functions of lymph?
Clinical
Primary FRCA exam January 2010
22
You are asked to anaesthetise a 13yo afro-caribean male who presented with a painful
testicle.
o Lots of discussion about sickle cell – his Hb is 11 when you ask for it.
o How do you test for sickle cell disease?
o Anaesthetic management for RSI
o Particular focus on pain management
Post-op analgesia regime including drug doses
Regional anaesthesia
Critical incident: severe laryngospasm on extubation
Physics
Humidification
o Humidity definitions
o Measuring relative and absolute humidity, concentrating on wet and dry bulb
hygrometer and its limitations
o Methods of humidification in anaesthesia
Pressure
o Definitions of force and pressure
o Measuring atmospheric pressure
o Torricellian vacuum
Monitoring
o What are the AAGBI standards?
o How would you detect disconnection?
o Awareness – who’s at risk, prevention
Primary FRCA exam January 2010
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OSCE
MONITORING
o Assemble this Bain circuit
o Talk about examples of EtCO2 traces, eg obstructed, rebreathing
ALS
o Pt with stable VT in recovery – focus on management
o VT is refractory to amiodarone and cardioversion – what do you do?
HISTORY
o Pregnant patient with ankylosing spondyllitis.
SimMan
o Anaphylaxis
EQUIMENT AND PROCEDURES
o Epidural technique, landmarks, LA dose, epidural adrenaline dose
ANATOMY
o Spinal cord blood supply, spinal tracts + functions, CSF volume, CSF specific
gravity
RADIOLOGY
o CXR – sarcoidosis (probably....!)
o Steroid replacement
HISTORY + FOLLOW ON
o Elderly woman for phaeco with angina and diabetes
o End organ damage in diabetes
EQUIPMENT
o Mapleson F – test the circuit – the reservoir bag had a leak
o What are the minimum gas flows for 20kg kid if spontaneously / mechanically
ventilating.
o What is the maximum weight for use?
RADIOLOGY
o Cardiomegaly and PPM
o Questoions about PPM modes and implication for anaesthesia
EQUIPMENT
o DYNAMAP
o Graph of cuff pressure vs oscillations. How are sBP, MAP and dBP
calculated?
COMMUNICATION
o Explain MH to this trainee ODP, who saw a case today and felt out of his
depth. What can he do to help in a crisis?
EXAMINATION / PROCEDURE
Primary FRCA exam January 2010
24
o Diagnosis of tension pneumothorax and insertion of needle thoracostomy and
ICD.
o Complications of ICD insertion
EXAMINATION AND MANAGEMENT
o ATLS scenario
o Pt has a haemothorax and is hypovalaemic
ANATOMY
o Structure, muscles and innervations of the larynx
CRITICAL INCIDENT
o Lead a VF arrest
o Perform BLS correctly
o Defibrillate safely
o ALS drug doses
Set 15
Viva -
Physiology - 1. ABG trace with pH 7.0, pCO2 1.3 kPa, pO2
17 kPa - questions were about dignosis and compensation
including role of CSF, chemoreceptors in compensation. 2.
effects of 1000 ml NS infusion rapidly. 3. CSF -
formation, absorption and differences with plasma. Monroe-
Kelly doctrine and questions on ICP.
Pharmacology - 1. LA- mechanism of action, pKa, lipid
solubility and protein binding principles and d/d between
ester and amide and then lignocaine and bupivacaine. 2.
Liver in drug metabolism- phase 1 & 2 reactions and
examples of each of them with details of P450. 3.
Pharmacogenetics - sux apnoea, MH.
Physics - 1.freezing point, boiling point, SVP and
colligative property. 2. N2O SVP and cylinder pressure,
latent heat of evaporation, fusion, specific heat. 3 temp
time graph, differences between laminar and turbulant
flow, Hagen- Poisell. equation, reynold's no. Zeroeing &
calibration, 2point & 3 point calibration & application.
Damping & resonance.
Clinical - 68 year old insulin dependent DM for emergency
below knee amputation, temp 38.5, BM 27 mmols. DM and its
complications, GA, regional advantages & disadvantages,
pain relief, Post-op seizures in recovery, d/d & mx.
OSCE -
1. Diagram showing ECG leads, CVP line and questions on
Primary FRCA exam January 2010
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leakage current, potentials, equipotential and identify
two from the diagram.
2. Ankle block - all five nerves and their supply in
details.
3. IV canuula - d/d between 16 & 20 gauge and d/d between
IV and arterial cannula. Giving set, fature flow rate and
funtion of 3-way tap.
4.Sim man- dislodgement of tracheostomy tube and
management.
5. Resuscitation- Cardiac arrest in pregnant patient, LA
toxicity and dose of intralipid.
6.Equipment - Humidity and identification of hair, dry&
wet & Regnault's Hygrometers.
7. Capnograph traces and questions.
8.IJV cannulation.
9.History taking - For Hysterectomy.
10. History follow-on- For elective Lap-cholecystectomy.
11.Communication- Afro-Caribbean for Blood test for Sickle
cell disease.
12.ECG - Narrow complex tachycardia, SVT.
13. X-ray -a. Collapse lung, b.
14.Section of spinal cord- different tracts(very confusing
diagram, all tracts on one side).
15.endotracheal intubation- Diagram showing Cormack-L
classification 3.
16.
Set 16
Pharmacology
Classify induction agents
Draw barbituric acid
What are the different physicochemical properties of thiopentone and
propofol?
What classes of drugs affect gut motility?
What are the differences between metoclpramide and domperidone and
droperidol?
Draw a concentration time curve for an IV drug
What is meant by bioavailability?
How can we relate clearance, Vd and T1/2?
Physiology
What is the body's response to 500ml blood loss?
Can you draw a nerve action potential?
Why are there gaps in the myelin sheath?
Primary FRCA exam January 2010
26
What determines the resting membrane potential?
How does the kidney produce a concentrated urine?
Explain the countercurrent mutiplier mechanism
Clinical
6 year old girl for squint surgery. What would you like to discuss
with the mother?
Critical incident: MH and its management
Physics
Pick one from 6 logarithmic graphs. What is its equation? Give a
clinical example?
How can you work out the exact angle between the x axis and a straight
line?
What is a time constant? What is a rate constant?
How do vaporisers work?
How is a desflurane vaporiser different?
OSCE
Sacral anatomy and caudal epidural talk-through
Pre-op history from a really miserable woman
History of young man due for wisdom tooth extraction and follow-on
station with an examiner
Sim-Man: patient on table with VT and BP <90 mmHg. You are called to
assist a junior colleague.
Sim-Man: CVS examination including manual BP and ECG interpreation.
Obvious murmur. What other investigations would you request?
ECG interpretation: sinus bradycardia and management
Anatomy: cross section of neck at C6 (drawing)
Anatomy: shown ribs (1st and 12th) asked to identify groove for NV
bundle. What is the order of vein, artery and nerve? What are the
structures attaching and crossing over 1st rib and where? Asked to
demonstrate on actor where to insert chest drain and needle
thoracocentesis.
CXR: RUL collapse and Spo2 of 89% T/F questions on management e.g
bronchoscopy? antibiotics? Unmanned.
Examine "peripheral arterial pressure and venous pressure". Also
peripheral pulses
Discuss chest drains. Purpose of water in bottle. How much? Any
problem if overfilled? How high above bottle should patient be?
Discuss humidification. Shown hot water bath humidifier. Purpose.
Other methods.
LMA placement and confirmation of correct position
3D skull reconstruction. Frontal view. Vertical fracture through
frontal sinus, orbit and maxilla. T/F questions. Unmanned.
Management plan for man with high temperature and cough due for knee
Primary FRCA exam January 2010
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arthroscopy. Unwilling to have op postponed. Convince him!
PHARMACOLOGY:
They started all the vivas gently but they got harder as
the 15 minutes went on and the pace was really fast so if
you said you didnt know something they moved on. I did
feel that the questions were repeated rather than asked in
a different way.
1. They asked me to talk about the mechanism of action of
NSAID. They wanted the pathways drawn from arachidonic
acid and all the end products and enzymes involved.
What is the difference between COX1 and COX2 when do they
act?
Why do we want selective inhibitors? What problems were
found in their use?
What does each product of the COX reaction so and where?
Asked about types of prostaglandins and the side effects
of their production being inhibited.
2. Cholinergic receptors and their agonists. What
muscarinic receptor types exist and where are they
present? What agonists do you know? What antagonists do
you know? When are they used in anaesthesia? What
effects do they have? we talked about teritary and
quaternary structures and the BBB.
Otheres were asked to draw the muscarinic receptor. I
was asked about organophosphates and then briefly about
their action and effects.
3. Colloids, what are they and what types exist and why
are they useful? Which ones are in my hospital and what
types they are. I was then asked to compare gelatin
colloids from starch colloids. Where and how each are
metabolised. Why do colloids stay in the intravascular
space. What happens when they are infused. Describe the
ideal colloid or intravenous fluid. What are the side
efffects or complications of their use.
Primary FRCA exam January 2010
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PHYSIOLOGY
1. Draw the oxygen haemoglobin dissociation curve. Why
is it that shape? What is the significance of the 50%,
75% and 100% saturation points? What is the oxygen content
of blood? What the value per 100ml of blood for venous
and arterial blood and they expected me to do a bit of
mental arithmetic from the equation to work it out, but
in the heat of the viva I found that quite difficult and
he was happy with the normal values written in the
equation and as a result. What would happen in altitude
and draw this on the graph.
2. Tell me about BP response. We discussed baroreceptors
and the Renin angiotensin aldosterone system. I described
the process with high and low BP and the effects. He
asked where the hormones were produced. What would happen
in I litre of saline was rapidly infused. What is the
Bainbridge reflex and why does BP sometimes go up and
sometimes down with tachycardia?
We also talked about osmoreceptors and hypothalamus. He
was very encouraging and corrected little mistakes eg
missing out the factor of 10 in the oxygen content
equation or mentioning the bainbridge reflex. When I said
I did not know he said thats fine and moved on.
3. Tell me about calcium. He let me talk and appeared
satisfied with the direction it was going. He asked why
it was important and where present and how controlled.
Which organs and which hormones are important and what are
their effect. What happens when you hyperventilate? Why
does tetany occur? We talked about alkalosis causing
increased unionized calcium and making the cells more
excitable and that alkalosis causes increased in the
binding affinity to albumin.
CLINICAL
We all started together in a room and were given a
laminated sheet with a description of a case. A 25 year
old primigravida 39/40 fit and well with severe fetal
distress. Prolonged bradycardia on CTG. What do you do?
Primary FRCA exam January 2010
29
He seemed uninterested and huffed and puffed a bit and
was frustrated when I skirted around any issues by saying
I would discuss with a senior anaesthetist in repsonse to
some of his question yet still gave me a good mark at the
end!
He wanted a description of each category of section and
when I was not clear enough made me clarify what the
difference was between 2 and 3. I said I would discuss
with tsurgeon but that this was a category 1 section and
therefore would need a RSI. He wanted to know what
equipment I would need and then what clinical changes
occur in pregnancy eg difficult intubation. What is the
incidence of difficult intubation in the pregnant
population compared to non pregnant and why I thought this
may be. What I could do about this and different
larynogscope blades and handles. He wanted percentages
when discussing changes eg FRC and blood volumes. We
discussed aortocaval compression and left sided tilt and
as I took a while to remember this he hinted and was fine
when I mentioned it.
When the RSI occurred it is was a grade 4 view and he
wanted to know what I would do. We went throught the DAS
and he then basically wanted me to make a decision whether
to wake the patient up or continue.
PHYSICS
1. What is dead space? How can it be measured and I
explained and drew Fowlers method/ graph and then they
wanted me to derive the Bohr equation. Why is it
important in clinical practice.
2. Define a vacuum? Why is it important in clinical
practice? What is the difference between suction and
scavenging? What are the components? They wanted values
too. Could I draw the components?
3. Heat loss in theatre. what is important. they showed me
a diagram of a person lying on a table with arrows for
radiation, conduction, evaporation and respiration and
convection.
Primary FRCA exam January 2010
30
What percentages do they contribute to overall heat loss.
What can be done to prevent each loss? what is
hypothermia? Why is it problematic? Warming methods.
OSCE
1. Anatomy of the larynx. yes/ no and true/ false of
diagrams I had not seen but were similar to the A-Z
pictures. muscles, nerve, blood supply and lymph drainage
2. Resuscitation station ALS algorithm and shock patietns
3. history taking for elective CS
4. critical incident anaphylaxis on sim man.
5. put together a coaxial D circuit and name. How long is
it and the diameters of the tubing. how to check it
6. epidural technique on mannequin and LOR and then
calculate adrenaline and lignocaine doses and how to make
up solutions. anatomy of epidural space
7. histoy taking an then questions on this. Diabetic.
8. Diathermy frequency and recognition of diagrams eg
blending.
9. tension pneumothorax and management and placement of
chest drain.
10. cross section of spinal cord and description of tracts
and their function.
11. dinamap, what is the principle. what values are
calculated and which are measured and what they would
correlate with on their diagram of oscillations
12. X ray station of PCP
13. X ray station of sail sign
14. X ray staion of C spine fracture
15. Mapleson F circuit check would I use it? small hole in
balloon. what is the minimum FGF for 3 year old?
16. explain to trainee ODP about Malignant hyperthermia
and treatment and what they should know.
My questions for the OSCE were: (and apologies for scanty
details, it all goes by in such a flash):
1) 2 chest drains differently filled - complications of
overfilling, how far should the tube go into the water,
Primary FRCA exam January 2010
31
how far below the pt, if lifted what would happen - I said
it would flow back into pt but they seemed to want more??
2) 2 photos of neck as if looking through US probe -
?side, ?vessels, ?causes of increased/decreased size of
vessels or intrathoracic/cerebral volume.
3) Explained to pt unwell with fever decisions re elective
arthroscopy - I went down line of not in best interests,
but identified that he would lose his job soon if couldn't
go to work. Said could consider WCC/CXR and if ok consider
proceeding under spinal as long as pt acknowledged risk
and discussed with consultant/surgeon.
4) Simman - feel pulse, manual BP, auscultate heart,
identify AS, describe implications.
5) Hx for lap chole.
6) Hot water bath picture - asked what %relative humidity
it would provide, advantages and disadvantages, few more
details.
7&8) Hx for wisdom teeth & follow on - general things in
fit young man but lost points as didn't know his job, he
had had previous GAs with no probs but his sister ahd had
a reaction which I didn't have time to go into and they
wanted more details on despite him being a bit evasive?
Last question they wanted to know what could obstruct his
airway after? I just listed stuff and clearly wasn't
saying what she wanted - I wonder if it was throat pack??
I had said bld, foreign bodies, collpased airway etc etc.
9) 2x xrays - one looked ok?? One generally abit shadowy,
nothing obvious. Details were that pt was post-op for
colitis and had lower than normal sats during ob but was
now fine. Asked if he should have antibiotics and whether
he had aspirated but there was nothing in the history to
say there was any periop problems so I just guessed that
it was some CXR finding that happens with people with
colitis and answered accordingly, no idea.
10) 3D facial #'s - questions whether should go straight
to neuro unit, is ICP 'invaluable', what #'s they were - I
think it was through one of the orbits.
11) Fake sacrum - question re anatomy, how to go about
caudal block & demonstrate, how far to go into space.
12) Pick size of LMA for mannikin, demonstrate insertion,
balloon, hom many mls it needs etc. Talk about
Primary FRCA exam January 2010
32
complications other than pregnancy/full stomach.
13) 2 pictures - pick one that can we use to measure
gases. I picked what I recognised as the CO2 electrode
(speaking to someone after he thought one was CO2
electrode and the other was all O2, CO2 and pH as part of
ABG machine so both were ok as long as you could answer
questions on whichever you chose). Question: what does the
2 electrodes with the electrolyte in between form? What
other methods can we use to measure CO2?
14) Pick 1st rib out of selection on table, answer 1st rib
anatomy but they asked about all the bits that are not the
labelled bits in my book. Also anatomy of it and where you
would find bifurc of trachea and aorta on an actor on the
bed and some other related question that I can't remember.
15) Simman - pt on table by your junior colleague, walk
in, pt goes into VT - compromised, they seemed to want us
to ignore A&B, went straight for DC cardioversion and he
stabilised, then reassessed. What tests would you do
after?
16) Bradycardia post op - many questions on causes,
management, wanted adrenaline infusion with doses.
17) Asked to examine periph pulses on an actor then do
manual BP, asked about Korotkoffs sounds and which to take
as diastolic BP.
18) ? - sorry.
Vivas:
Pharmacology:
Asked how NDMRs work.
Isomers: was fairly standard other than they wanted me to
talk more about thio in that context.
Anti-emetics: again was ok but wanted to know more about
where each receptor was and about their crossover ie.
cyclizine being H1 and muscarinic antagonist.
Physiology:
Starlings forces/CO/add L atrium trace and aortic trace to
LV trace on cardiac cycle.
Primary FRCA exam January 2010
33
Control of UO - I started with kidney itself, talked about
ADH & other hormones.
Buffers - what is one? How can we classify - I talked
about open & closed systems, we then talked about
different ones and so they suggested that I reclassify
what I said into intracellular & extracellular based on
what I said. Finally they moved onto 'what are buffer
titration curves' and I think we may have been heading
towards drawing one but I was saved by the bell.
FRCA Primary OSCE/VIVA Exam Sitting January 2010
VIVA
Pharmacology:
Comapare cardiovascular effects of isoflurane and enflurane
Heparins
Transdermal drugs
Physiology:
V/Q and West Zones
Cell membrane structure, membrane potentials, Nernst Equation, transport
mechanisms.
Pulmonary vascular resistance
Clinical:
Inflammatory bowel patient with current illness for panproctocolectomy.
o Discussion re: anaesthetic considerations, RSI, steroids (role), analgesia,
immunosuppressant medications.
o Epidural – assessment, management, top-up.
o IV resuscitation post-op.
Physics:
Different needles
Primary FRCA exam January 2010
34
o 16g Tuohy
o 14g intravenous needle (discussion french gauge vs wire gauge)
o 20g abocath (discussion re damping etc.)
o Peripheral nerve stimulator
CPEX testing
Defibrillator
Primary FRCA exam January 2010
35
OSCE
1. Technical Skills 1
a. Trauma patient
i. Discussion re: surgical chest drain insertion
2. Anatomy 1
a. Larynx
3. Communication
a. Explain malignant hyperthermia to a trainee ODP
4. Anaesthetic Hazards
a. Electrical safety
i. In operating theatre
ii. Diathermy
5. Physical Exam
a. Head injury patient
i. reduced GCS patient
ii. Haemothorax
6. Interactive Resuscitation 1
a. Defibrilation and ALS algorithm
i. Safe defibrillation of patient
7. Monitoring Equipment
a. Capngraphy
i. Side stream bain circuit
8. Resuscitation Skills 2
a. Tachyarrythmia algorithm
9. History-taking
a. Communication skills – history taking
i. Ank spond
ii. Previous difficult airway + PONV
10. Simulation
a. SIMMAN
i. Anaphylaxis
11. Radiology 1
a. CXR – Cystic fibrosis
12. Technical skills 2
a. Epidural
i. Insertion, Safe practice, Analgesia
13. Anatomy 2
a. Anatomy
i. Spinal cord anatomy (Asc + desc tracts)
ii. Cord lesions
14. Radiology 2
a. CXR – indwelling pacemaker
15. Anaesthetic equipment
Primary FRCA exam January 2010
36
a. Mapelson F
i. Check system and identify problem
16. Measurement
a. DINAMAP
i. BP measurement, Calculated vs observed readings, Cuff sizing
Not included in mark scheme:
17. Hx from patient
a. Eye operation
i. Local anaesthetic options
ii. CVS/RS co-morbidities
18. Report history taking to Consultant
Physics:
Asked all sorts of facts about cylinders, what is the
range of sizes, the colours of all the different gases,
the volume of cylinders of different sizes containing this
gas/that gas and the pressures etc etc. Other
distinguising features. I only knew abit about nitrous and
oxygen in size E and they wanted much more than this.
Pressure: wanted all different units of measurement and
what they all are when equivalent to 1 bar. What is a
Newton, how could it be calculated from cubic metres etc??
Cardiac output monitoring: just got started and classified
into invasive/semi-invasive/non-invasive and we ran out of
time.
Clinical:
Given paragraph about 15yr old with known asthma, needing
appendicectomy, questions relating to optimisation,
questions need to ask and why. Difficulty ventilating
peri-op, differentials, what to do? Thought i was ok but
they looked very quizzical when I said that we could give
nebulised salb via the catheter mount which is something
I'd just read so I don't know why and I also mentioned IV
so? Then we moved onto management of anaphylaxis.
Primary FRCA exam January 2010
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