THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
3rd November 1998
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, with reasons, the factors which affect the incidence of perioperative myocardial infarction.
2. An adult patient is known to be severely difficult to intubate. Describe a technique of fibreoptic intubation for this case.
3. Outline the methods for prophylaxis of venous thromboembolism in routine surgical practice.
4. What are the factors contributing to unplanned awareness during general anaesthesia?
5. What information would you wish to obtain from a patient at your postanaesthetic visit, the day after a total hip replacement?
6. What solutions are available for the restoration of circulating volume in a patient suffering from acute blood loss? Discuss the advantages and disadvantages of each.
SECTION B (Book B)
7. Outline the clinical features and management of bupivacaine toxicity.
8. Draw a labelled diagram of the anatomical relations of the stellate ganglion. How is it blocked and what are the possible complications?
9. How would you determine the mixed venous oxygen content in the intensive care patient? What is the usefulness of this measurement?
10. A 20 year old patient, with sickle cell disease, was injured 12 hours ago. He has fractures of the metacarpal bones on his dominant hand. Elective surgical reduction and fixation is planned. Describe your anaesthetic management.
11. What safety features should be incorporated into a patient controlled analgesia (PCA) system and what is the purpose of each? What instructions would you give to the nursing staff, having set up the PCA?
12. Outline the anaesthetic management of a 2 year old child who is scheduled for therapeutic bronchoscopy following inhalation of a foreign body 2 days ago. The child does not exhibit any signs of upper airway obstruction.