THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
23rd October 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) and Questions numbered 7 - 12 must be answered in
Book B (Pink).
Candidates who fail to answer all twelve questions will not pass the Examination.
Candidates are informed that one of the Examiners is present during the time allowed for the paper, for consultation in case any question should not appear clear.
SECTION A (Book A - Blue)
1. Describe the arterial blood supply to the spinal cord. How may it be compromised?
2. Describe how and why a vaporiser delivering desflurane is different from one delivering isoflurane.
3. You are called to the A and E department to review a 4 year old child who requires intubation. She has a clinical diagnosis of meningococcal sepsis. She has reduced consciousness and a petechial rash. Describe your immediate management.
4. What are the potential causes of delayed resumption of spontaneous ventilation after major intra-abdominal surgery with general anaesthesia? Discuss prevention, diagnosis and management.
5. What are the functions of cyclo-oxygenase (COX) enzymes? How are the side-effects of non-steroidal anti-inflammatory drugs related to inhibition of these enzymes?
6. What are the risks and benefits of thoracic epidural anaesthesia/analgesia for coronary artery surgery?
SECTION B (Book B - Pink)
7. List the bedside tests available to predict a difficult intubation. Comment on their usefulness.
8. Draw the following diagrams (with values): A spirometer trace showing normal lung volumes, FEV1/FVC graphs and flow-volume loops. How are these altered by the following diseases: asthma, emphysema, pulmonary fibrosis, chest wall restriction and respiratory muscle disease?
9. What are the limitations and risks of intra-arterial pressure monitoring in the critically ill? How may these be minimised?
10. What potential problems and risks do you consider when planning the anaesthetic management of the delivery of twins?
11. Relate the clinical use of thiopentone and propofol to their pharmacological properties.
12. Outline the pathology of acute coronary syndromes. What pharmacological treatments are available for patients with an acute coronary syndrome?