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

Primary FRCA OSCE-SOE exam January 2012
SOE set 7
Physiology:
1. Cerebral blood flow - factors affecting ICP, Monro-Kellie doctrine, curves for CBF
vs PaO2 & PaCO2, autoregulation & associated theories.
2. Thyroid - hormones produced, feedback mechanism, functions of hormones,
calcitonin & Ca2+ homeostasis
3. Showed picture of alveolus with adjacent pulmonary capillary. Asked to write
down alveolar partial pressures of CO2 & O2, then mixed venous pressures. What
happens during apnoea - changes in numbers. What happens if alveolus closed off,
what happens if alveolus left open to air? How can you increase the time of to
hypoxia during apnoea (essentially asking re. pre-oxygenation). What factors cause a
shorter time to hypoxia in apnoea (reduced FRC, increased O2 consumption, etc).
How can you manipulate this in anaesthetics?
Pharmacology :
1. Drugs that reverse NMB (anti-cholinesterases, Sugammadex). Classify. How do
they work? What are the SEs (muscarinic effects). How do we overcome this
(glycopyrrolate etc). Tell me more about Sugammadex, how does it work, can I use it
with vecuronium? What about atracurium? Why?
2. What is volume of distribution? How can it be measured. Draw concentration vs
time graph. What else can be derived from graph (t1/2, time constant)? What is
bioavailability? Demonstrate on graph how you can measure it (AUC).
3. Anti-emetics. Draw diagram of VC, CTZ and receptors involved. Tell me more
about different drugs on different receptors, effects. Indicate on diagram where
dexamethasone acts.
Physics
1. Peripheral nerve stimulator - components, supramaximal stimulus, which nerves
can you use, which site is most accurate, ToF (various examples given, difference in
patterns between non-depol & sux), what frequency & amplitude would you use.
2. Arterial tourniquet. Uses, components, max pressure used, max time allowed &
why. What if surgeon needs to keep tourniquet on for longer, what would you do?
Physiological changes during inflation & after deflation.
3. Given various equations and asked to draw curve. (y = mx + c, xy = constant).
When do we see these graphs in our anaesthetic practice? Shown various graphs and
asked to write equations for them.
Clinical scenario
19 year old boy brought into emergency department after falling down stairs outside
nightclub. He is confused & agitated.
Differential diagnoses, effects of alcohol & drugs on conscious level & diagnosis.
What investigations? He requires a CT - how would you manage? Cushing's reflex -
how would you treat. How do you reduce secondary brain injury. He now needs a
transfer to neurosurgical unit - how would you manage this.
Coventry collection: Many thanks to the candidates from January 2012
Course
6