THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
11th May 2004
9:30am to 12:30pm
Candidates are required to answer all twelve questions. Questions numbered 1 - 3 must be answered in Book A (Blue), Questions numbered 4 - 6 must be answered in Book B (Pink), Questions 7 - 9 in Book C (Green) and Question 10 - 12 in Book D (Yellow). Candidates who fail to answer all twelve questions will not pass the Examination.
An Examiner will be 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 two adjoining mid-lumbar vertebrae. Include the joints, their nerve supply and the ligaments.
2. Describe the preoperative assessment and preparation specific to an adult patient who requires a thoraco-abdominal oesophagectomy. Describe your anaesthetic plan for this operation.
3. What are the indications and contraindications for the use of an arterial tourniquet?
What complications may arise from the use of such a tourniquet ?
SECTION B (Book B - Pink)
4. Define capnography. Draw and label a normal capnograph trace. Why is capnography useful during general anaesthesia? Give examples of abnormal traces and their causes.
5. What procedures are associated with venous gas embolism? How can it be detected?
What are the effects of a large venous gas embolus? Describe its management.
6. What advice, for and against, would you give a primagravida who is asking if she might eat and drink during her labour? Give reasons.
SECTION C (Book C - Green)
7. Outline the pharmacology and clinical use of low molecular weight heparins for prophylaxis against deep vein thrombosis.
8. List the causes of perioperative atrial fibrillation. What are the dangers of acute onset atrial fibrillation? How would you manage acute atrial fibrillation in the postoperative period?
9. What problems are associated with anaesthesia for elective surgery in a patient with dialysis-dependent renal failure?
SECTION D (Book D - Yellow)
10. List the indications and contraindications for Transcutaneous Electrical Nerve Stimulation (TENS)? What does the patient need to know when using a TENS machine ?
11. Outline, with reasons, your perioperative management of an otherwise healthy 4 year old admitted for tonsillectomy.
12. Define transfusion related acute lung injury (TRALI). Discuss its pathogenesis, presentation, management and outcome.