|THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
17th May 2005
9:30am to 12:30pm
Candidates are required to answer all twelve questions. Questions numbered 1 - 3 must be answered in Book A (Blue), 4 - 6 in Book B (Pink), 7 - 9 in Book C (Green) and 10 - 12 in Book D (Yellow). Candidates who fail to answer all twelve questions will not pass the Examination. All 12 questions carry equal marks. In multipart questions, the examiners have indicated the way in which marks are allocated by providing the maximum percentage mark available at the end of the part. Candidates are advised to allocate their time following this guidance. Candidates are informed that an examiner will be present during the time allowed for this paper for consultation in case any question should not appear clear.
SECTION A (Book A - blue)
1. How is ventilator-associated pneumonia (VAP) diagnosed? (20%)
Explain the physical (50%), positional (15%) and pharmacological (15%) strategies that have been
advocated for its prevention?
2. What is the physiological basis of preoxygenation for anaesthesia? (40%)
Describe a method of preoxygenation and how you would assess its adequacy. (35%)
What are the advantages and disadvantages of preoxygenating a fit adult? (25%)
3. Describe two assessment tools used for the measurement of acute pain in adults. (30%)
Describe the McGill pain questionnaire used to assess chronic pain. (20%)
Include the strengths and weaknesses of each of the above. (30%)
Why do assessment tools used in acute and chronic pain differ? (20%)
SECTION B (Book B - pink)
4. List the nerves which supply the eye and its muscles. Briefly describe the relevant function of each
What specific considerations would you take into account when providing general anaesthesia for
adult vitreo-retinal surgery? (60%)
5. An otherwise fit patient requires nephrectomy for a large solitary renal tumour.
What surgical factors might influence your conduct of the anaesthetic?
6. What perioperative measures can be taken to minimize non-autologous red cell transfusion in a patient undergoing elective surgery?
SECTION C (Book C - Green)
7. What are the endocrine causes of secondary hypertension? (25%)
What is the pharmacological management of each of these endocrine conditions? (35%)
State the mechanism of action of each drug. (40%)
8. Which patients are at increased risk of infection related to an epidural catheter? (30%)
What symptoms and signs suggest the development of an epidural abscess? (30%)
What investigations would be definitive in initiating further management? (20%)
What should this be? (20%)
9. What are the important organisational (40%) and clinical (60%) factors which govern the anaesthetic management of patients over 80 years of age?
SECTION D (Book D - Yellow)
10. A one day old term neonate has arrived at your regional paediatric intensive care unit. A congenital diaphragmatic hernia has been diagnosed. The baby is already intubated and receiving artificial ventilation. Outline, with reasons the principles of preoperative management.
11. You are asked to see a 45 year old man in the Emergency Department who has suffered 30% burns.
What factors in the history would suggest that he has suffered a significant inhalational injury? (25%)
What symptoms, signs and results of laboratory tests would confirm your suspicions? (75%)
12. An adult patient requires insertion of a chest drain for management of a spontaneous
pneumothorax. The patient is not in acute distress.
Describe your technique for insertion of a chest drain in this patient. (50%)
The diagram shows an underwater seal device. Comment on its suitability for connection to the drain you have inserted. (50%)