THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
20th May 2003
9:30am to 12:30pm
Candidates are required to answer all twelve questions.
Questions numbered 1 - 6 must be answered in Book A (Blue)
Questions numbered 7 - 12 must be answered in Book B (Pink).
Candidates who fail to answer all twelve questions will not pass the Examination.
SECTION A (Book A - Blue)
1. Discuss the principles of the management of a 25 year old patient with Down’s syndrome, who requires multiple dental extractions.
2. What is the mode of action of epidural opioids? Discuss the relative merits of epidural fentanyl and morphine.
3. Discuss the risks and benefits associated with intermittent positive pressure ventilation through a laryngeal mask airway.
4. What is evidence-based medicine? How would you apply the process to your clinical practice.
5. A patient presents to the pain clinic with low back pain. List the indicators (‘red flags’) that would alert you to the possibility of serious pathology? In their absence, what is the early management of simple mechanical low back pain?
6. What is ventilator-induced lung injury? Explain the relative importance of volutrauma and barotrauma. What is the practical importance of ventilator induced lung injury?
SECTION B (Book B - Pink)
7. Briefly describe the normal anatomy of the right internal jugular vein (including its important relationships). What anatomical abnormalities of this vein can make cannulation hazardous or impossible? Outline the risks associated with cannulation of this vessel and how they can be minimised.
8. Under what circumstances is myoglobin found in the urine? What are the implications of myoglobinuria and how is it managed?
9. List the patterns of peripheral nerve stimulation that may be used to monitor non-depolarising neuromuscular blockade during anaesthesia. How is each used in clinical practice?
10. A patient with aortic stenosis presents for non-cardiac surgery. What are the clinical features of aortic stenosis and how would preoperative investigations influence your perioperative management?
11. A 4 year old child who has been knocked unconscious by a blow from a cricket bat arrives at a paediatric neurosurgical centre. After initial appropriate management, a CT scan shows an extradural haematoma. There are no other injuries. Discuss the subsequent management.
12. How may unintended perioperative hypothermia harm patients?