THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS 20th May 1997
9:30am to 12:30pm
Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be answered in Book A and Questions numbered 7 - 12 must be answered in Book B. 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)
1. List the dangers to the eye of general anaesthesia for elective intraocular operations. How are these prevented?
2. What are the choices for postoperative analgesia for a child aged 4 years presenting for repair of an inguinal hernia as a day case? State briefly the advantages and disadvantages of each method.
3. The first patient on your operating theatre list tomorrow morning has an implanted (permanent) cardiac pacemaker. List, with reasons, the relevant factors in your preoperative assessment.
4. What are the types of anaesthetic that should be considered for fixation of a compound ankle fracture in a patient who was briefly knocked unconscious at the accident? Outline the advantages and disadvantages of each technique.
5. An 80 year old lady with a sub-capital fractured neck of femur requires surgical fixation. She is found to be in fast atrial fibrillation. What are the important points in the preoperative preparation for anaesthesia in this case?
6. Outline the problems involved in anaesthetising an intravenous heroin abuser needing urgent surgery for incision of perianal abscess.
SECTION B (Book B)
7. You have been asked to anaesthetise a 60 year old woman for ligation and stripping of varicose veins in one leg. She has a history of ischaemic heart disease. Explain briefly how suitability for her management in a day-case facility is assessed.
8. A 62 year old man is admitted to the high dependency unit following a laparotomy to relieve a large bowel obstruction. He has a urinary catheter in situ. Two hours later, he has only passed 25 ml of urine. List, with reasons, the likely causes. What is going to be your initial plan of management?
9. What measurements and derived values can be made from pulmonary artery catheters used in the intensive care unit? Suggest a clinical application for each one.
10. What are the indications for performing a tracheostomy? List the complications of tracheostomy.
11. What are the problems of monitoring anaesthetised patients in the magnetic resonance imaging unit?
12. Outline your management of a fit primagravida who suffers inadvertent dural puncture with a 16 gauge Tuohy needle during attempted epidural for pain relief in the first stage of labour (cervix 4 cm dilated).