THE ROYAL COLLEGE OF ANAESTHETISTS
DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
Tuesday 30th October 2001
9.30am to 12.30pm
CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:
Questions numbered ONE TO SIX must be answered in Book A. (Blue)
Questions numbered SEVEN TO TWELVE must be answered in Book B. (Pink)
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 - Blue)
1. Formulate a guideline for the peroperative administration of blood, explaining the reasons for your recommendations.
2. What tests may be done to evaluate the adequacy of pulmonary oxygen transfer? Briefly describe how you would interpret the results.
3. A 70 year old man presents for a total hip replacement. He has no significant past medical history. At the anaesthetic assessment clinic he is noted to have a grade III ejection systolic murmur at the right sternal edge, radiating to his neck.
Describe, with reasons, what investigations should be undertaken on this patient and explain how the results would affect your anaesthetic management.
4. Describe the features and management of phantom limb pain.
5. Discuss briefly the complications of placing a jugular central venous line. Where should the tip of a left internal jugular line lie and why ?
6. What are the anaesthetic considerations in a patient with autonomic neuropathy?
SECTION B (Book B - Pink)
7. Draw a nephron with its blood supply. Where and how do the following exert their effects: loop diuretics, thiazide diuretics and aldosterone antagonists?
8. A patient who has undergone a heart transplant requires non-cardiac surgery. What problems may this present for the anaesthetist?
9. Discuss the ventilatory management of an adult with ARDS.
10. What nationally based audits in the UK include an examination of anaesthetic practice? Outline the methodology and recommendations of two recent reports.
11. A ten week old male infant weighing 3.5 kg is scheduled for inguinal hernia repair. He was delivered prematurely at thirty-four weeks. List the risk factors and state how these can be minimised.
12. Describe the features of the anaesthetic machine which are intended to prevent the delivery of a hypoxic mixture to the patient.