Primary FRCA OSCE-SOE exam January 2012 Coventry collection ...

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Primary FRCA OSCE-SOE exam January 2012 - Buffers Clinical - Emergency laparotomy of 65 yo male, previous PE 6/12 ago (warfarinised), but otherwise fit and well. - INR now 5.8, ARF - Describe your immediate concerns - How would you proceed? - Discussion of pre-, peri-, post-operative management Physics & Measurement - Electrical Safety - Transducers - Scavenging SOE set 17 Pharmacology Propofol ,thio Statistics,type of errors,null hypothesis,formulas of errors,methods to minimise. Drugs for asthama,mechanism,leukotrienes inhibitors,aminophylline. Physiology Role of heart, why four chambers,role of atria,work done,why venous side not pulsatile.frank starling curves. Foetal circulation explain with diagram,oxygen%,what happens with first breath.how and why foraman ovale and ductus close. Clinical, 12 yr boy 65 kg,for post trauma,fall fro swing,for radius MIA,SOS playing past history of excema and penicillin allergy. All pediatric questions,critical incident,laryngospasm,aspiration and management. Physics Methods for blood warming,design your own device. Fibreoptic,working and principles Light measurment,definition,pulse ox.beer lamberts law.other methods where light principles are used Differential amplifier. Biological potentials.how are these measured,why different. SOE set 18 Pharmacology 1) The examiner began by asking for 3 clinical effects of Ketamine, which I gave her, but then when she went on to ask for more details about the pharmacology of ketamine, I drew blanks, I honestly did not revise this to sufficient detail that the answers took a while to come out with. Particularly, she had to prompt me about the receptors it acted on, and the side effects, and I couldn't answer the question fluently. 2) Name me the different types of receptors. This was a much better question and I managed to show and draw the 4 different receptor types. Coventry collection: Many thanks to the candidates from January 2012 Course 12
Primary FRCA OSCE-SOE exam January 2012 3) Classify anti-angina drugs. Again I was let down by my lack of knowledge. I could only recall Nitrates, and tried to steer the discussion towards antihypertensives and heart failure medications, but she was having none of it. Physiology 1) The examiner asked me what contributes to resting membrane potential in nerve cells. I wanted to write out the Nernst equation but he didn't want me to use that to explain it. Then I said the Goldman Field equation, but again he didn't want me to reproduce that. In the end he seemed rather annoyed and I offered the answer of intra and extra cellular concentrations of ions. He then asked why the concentrations were different and I said it was the Na/K ATPase pump, but he said why then does the potassium ion contribute more to the membrane potential. I realised after a while that he wanted me to say the Gibbs Donnan effect. But by this point the miscommunication caused alot of time to be wasted. He asked me to draw an action potential and explain how it worked, which I reproduced. All in all, quite frustrating that we seemed not to be meeting across the table 2) He asked what Basal metabolic rate was, which I didn't have a good definition for, and I offered something to the effect of basal oxygen requirements and the amount of work done by the body to maintain homeostasis. Unprepared for this question and it was quite painful 3) He asked what happens when we breathe in 100% oxygen in the alveolus, and wrote out the Alveolar oxygen equation. Thought that this question wasn't too bad, at least I could use the equation to answer his hypothetical scenarios. He asked what happens at altitude and what happens at high bariatric pressures. Clinical Patient 28 yrs old with Diabetes for appendicectomy. Temperature of 38 degrees and BM of 28. I thought this question went quite well, and was confident about my answers Physics 1) Asked what was alveolar dead space, which I responded by saying it parts of the airway which is ventilated but not perfused. Then asked how we measure anatomical deadspace, which I responded with Fowler's method and drew the graph and explained it. Then he asked how we measure physiological deadspace, which I used the Bohr equation to answer. but he tried to trick me by saying isn't Vt tidal volume and not total lung volume. Asked me to show how to derive it, it started to derive it by drawing out the lung and labelling Vt and Vd and Vt-Vd, but when he confused me with tidal volume versus total lung volume, I apologised and said I couldn't derive it there and then. 2) Showed me a piece of paper with a number of different electrical symbols and asked what some of them were, which I answered. Then asked what devices we can find capacitors in, I used the defib as an example. Asked me to draw the circuit, which I did, then asked me what the inductor in the circuit was for, and I drew the 2 current versus time curves and explained the inductor slows the discharge of the energy. 3) Asked me what a vacuum was, and asked where we might have vacuums in anaesthetic practice, I answered scavenging and suction. He asked me about active scavenging. Coventry collection: Many thanks to the candidates from January 2012 Course 13
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