THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
4th November 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. A 70 yr old man with chronic obstructive airways disease requires a transurethral resection of the prostate. Outline the advantages and disadvantages of intrathecal block for this patient.
2. What immunological consequences may result from homologous blood transfusion?
3. Outline the effects of old age upon morbidity and mortality in anaesthesia.
4. What hazards does a patient encounter as a result of being placed in the lithotomy position for surgery? What additional hazards are introduced by then tilting the operating table head-down? Indicate briefly how you attempt to prevent these hazards.
5. A patient on the intensive care unit has a mean arterial pressure of 130 mmHg. What drugs might be useful for reducing this to a safe level and what is the mechanism of action of each?
6. The plasma concentrations of a drug have been measured in 20 normal patients and in 20 patients with renal failure. What simple statistical tests exist to determine whether these 2 sets of observations differ at the 5% level? What assumptions are inherent in each test which you describe?
SECTION B (Book B)
7. What are the pathophysiological insults which exacerbate the primary brain injury following head trauma? How can these effects be prevented or reduced?
8. What are the postoperative problems in the first 24 hours after coronary artery bypass graft? How are they prevented?
9. List, with examples, the causes of neurogenic pain. What symptoms are produced? What treatments are available?
10. Make a simple diagram, labelled to show the anatomical structures associated with the right internal jugular vein. List the complications of cannulation of this vessel, mentioning how each may be avoided.
11. Outline the possible reasons for the reduction, over the last decade, of maternal mortality associated with anaesthesia.
12. List the risk factors for venous thromboembolism and classify the current methods of prevention, with examples.