THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
2nd November 1999
9.30am to 12.30pm
CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:
Questions numbered ONE TO SIX must be answered in Book A.
Questions numbered SEVEN TO TWELVE must be answered in Book B.
Candidates must attempt all twelve questions or they will fail 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. Candidates are advised to spend approximately the same amount of time on each question and ensure that the important issues are included in their answers
SECTION A (Book A)
1. A 70 year old man is to undergo an above knee amputation. What can be done to relieve any pain he may experience thereafter?
2. A 27 year old man is admitted with a fracture of the cervical spine at C5/6. There are no other injuries. Describe the management of this patient in the first 48 hours after injury.
3. What is the anaesthetic management of pyloric stenosis in a 6 week old child?
4. What are the risks of carotid endarterectomy? How may the anaesthetist reduce these risks?
5. You are asked to investigate the effectiveness of a new anti-emetic agent. Briefly outline the priniciples which should guide the design of such a study.
6. What would make you suspect that a patient had sustained an air embolus during an anaesthetic? How should this situation be managed?
SECTION B (Book B)
7. What factors contribute to postoperative cognitive deficits in elderly surgical patients? How may these risks be minimised?
8. What factors determine the rate of haemoglobin desaturation during a failed intubation? What can be done to maintain oxygenation in this situation?
9. List the predisposing factors for aspiration of gastric contents during general anaesthesia. How can the risk of this complication be minimised? How should it be treated?
10. What are the advantages of retaining motor power in a woman having an epidural for a normal labour? How can this be achieved and what would you check before allowing the woman to get out of bed?
11. Classify the types of heart block. Outline appropriate treatment in the intraoperative period.
12. How would you manage the transfer of a patient to a regional neurosurgical unit for evacuation of an extradural haematoma?