Primary FRCA OSCE Viva Questions May 2009 - MEDICAL ...

Primary FRCA OSCE Viva Questions May 2009 

Set 1, OSCES 

Station 4. Electrical safety, picture showing patient connected to the ECG monitor with bed, 

machine earthed, asked what was wrong (multiple earth), how to correct it there was a sign 

wit=n exclamation mark within it asked to identify what it was. Showed a page full of 

electrical signs and asked to identify any to I identified CF & BF 

Station 5 Resuscitation station patient for crash section, my colleague had just toped him up 

with 20mls of 0.5% Bupivaicaine. patient went into Pea Rate < 40Asked about the protocol 

of management of Non shockable rhythm, what are 4H’s & 4T’s,management of local 

anaesthetic toxicity , intralipid & doses 

Station 6 Resus scenario with Rhythm Strip for fine VF Detailed question about monophasic 

and Biphasic difference in power, Adrenaline strength used in cardiac arrest, Amiodarone 

strength used 

Station7 History station patient for elective lap cholecstectomy on htn and medication 

Station 8 Pulse oximetry, wavelength, isobestic point (asked to point it out on the graph and 

values), causes of error in pulse oximetry (any two), any two other physiological parameters 

we can measure from pulse oximetry. 

Station 9 Patient post inguinal repair aspirated intraperatively has been intubated and 

ventilated, now in ICU. Asked to examine the patient. SaO2


Station 11 Equipment station. Best position for bag masks ventilation. Required to show 

manoeuvres on mannequin. Showed a nasopharyngeal tube to list the complications of use of 

this tube. 

Station 12 Anatomy station. Spinal tract. Exactly same question as primary FRCA Royal 

college book. 

Station 13 History from a lady 40ish posted for hysterectomy. Had a previous history of 

surgery which was complicated by DVT, PE. Second surgery had discomfort because of the 

face mask. Smoker and profession school teacher. 

Station 14 Follow on station from previous history taking station. What was her 

haemoglobin (Did not know). What was the complication of previous surgery How was it 

treated How many cigarettes does she smoke per day What was her profession 

Station 15 Unmanned station CXR – findings hiatus hernia. Would you premedicate this 

patient with H2- receptor antagonists Would you insert a nasogastric tube in this patient preoperatively 

Is the right hemi diaphragm raised (No). 

Station 16 Equipment station. Airway devices. Asked to check devices on the table. ET tube 

(cuff was leaking); in the connector there was an obstruction. What are the equipments you 

would use for difficult intubations Asked questions about ambo bag. 

Station 17 Humidity. Asked difference between absolute and relative humidity. Picture to 

identify hair hygrometer, Renault’s hygrometer and Wet and dry hygrometer. Showed a 

graph and asked to calculate relative humidity from that. Asked about dew point. 

Station 18 neuromuscular monitoring station , asked about the point you would use to set up 

the neuromuscular monitoring asked about different modalities of monitoring , single twitch, 

Tetanic, post tetanic potentation asked about the position of the electrodes on the foot and 

what movement you would elicit( did not answer that) 

Station 18 base of skull , asked about cribiform fossa and 4 structures passing through it , 

asked about orbital nerve block and how you would perform it asked about the complication 

of this block other that retrorbital haemmorage (did not Know the answer) 

Station19 D/w daughter about father who has been taken to theatre for leaking AAA and your 

registrar is in theatre 

University Hospitals Coventry & Warwickshire NHS Trust 

Acknowledgement: many thanks to the candidates of April 2009 OSCE viva course Page 2


Station20 Cvs examination precordail examination and examination of the pulse asked about 

AF and the characteristic of pulse you would get. 

VIVA 1 

Physiology 

Define Hypoxia and the causes of Hypoxia, asked to write the formula for oxygen carrying 

capacity of the blood. Oxygen haemoglobin dissociation curve and name the three main 

points asked what will happen to the curve in hyper metabolic state ,increase in oxygen 

extraction and movement of the curve downward( in the beginning I went to the wrong path 

of leftward shift but was bought back by the examiner) 

Immunology what do you understand I classified them to acquired and inherited and in 

acquired mentioned skin, respiratory tract,GIT and tears acquired mentioned T& B 

lymphocytes asked about the immunoglobulin and the order in which it is inherited(i did not 

answer that question) 

Starling forced & values difference in arterial and venous forces what is the difference of 

values in pulmonary circulation and why is it physiologically important, to prevent 

pulmonary oedema 

Pharmacology VIVA 

Compare the action on the CXVS of Isoflurane, SEvoflurane and Desflurane, then asked to 

compare isoflurane and sevoflurane generally forget about the metabolic products then that 

asked about it in detail where particularly interested in compound A 

Pharmacokinetics Dose Response curve, Log Dose response curve with antagonist 

competitive and non competitive partial antagonist 

Digoxin Mechanism of action in dseatail digoxin toxicity and how to manage it particularly 

interested in haemo dialysis and at what serum concentration you would consider 

haemodialysis (did not know the answer) 

Clinical VIVA 

19 year old found collapsed in night club now in A/E resus 

ABCDE approach asked about the possible causes asked in details about the different drugs 

and their overdose symptoms 




Asked about the signs of chronic alcohol abuse 

Drugs of abuse and their s/E 

Cocaine _coronary vasospasm 

Amphetamine -electrolyte disturbance, 

All of them cause electrolyte disturbance 

Patient intubated and ventilated in CT scan develops Cushing signs management of raised 

intracranial pressure, principles, carbondioxde, Blood pressure, hypoxia, pharmacological 

methods of management of raised ICP, mannitol asked about the dose (did not know) 

Physics VIVA 

Gas laws 

Asked how long can we supply a patient at 4L/min from a 5litre cylinder I said I will not be 

able to calculate the value without knowing the pressure in the cylinder then he gave me a 

value after getting the volume in the cylinder using Boyles law he did not even want me to 

calculate the time!!!!! 

Asked about Charles law, Avogadro’s hypothesis, Daltons law and grahams law 

ECG 

CM5 lead what did that mean and how would you place the electrodes, why we would use it, 

the degree of diminution of the value of the RMP from the heart to the ECG did not know the 

answer but the examiner guided with the answer asked the RMP of heart -90mv, the potential 

on the electrolyte1mvper 10mm so there for the diminution was approximately 90 times 

asked to draw the eithoven triangle and axes 

Resuscitation equipment and ambu bag in detail none return valve Reuben valve mushroom 

valve, (drew them) 

LMA different sizes and what weights were used 

Set 2 

SOE1 – Physiology/Pharmacology 




pH – definition, buffers, compensatory mechanisms 

Pituitary gland – anatomy, hormones, ADH and osmolarity regulation in detail 

Ion channels – Nerst Equation, Gibbs-Donnan, Goldman Field equation 

Anticholinesterase - classification, side effects, organophosphate poisoning. Started with 

NMJ. 

Drug interaction in anaesthetics – general classification and then details on 

reversible/irreversible antagonism, dose-response curves 

SOE2 – Clinical and Physics 

‘Sux problem’ in patient requiring rapid sequence induction. General history, examination 

and investigations. Differential diagnosis of ‘problem’ – apnoea, anaphylaxis or MH. RSI 

with rocuronium was my suggestion. 

Flow, rotameter, Hagen-P equation, difference between laminar and turbulent 

Effects of altitude on PAO2 and vaporisers 

Pressure – units, measurements 

OSCE 

Anatomy – orbit, nerves, peribulbar blocks. Facial fractures. 

Anatomy – spinal cord and tracts. Exactly as in college primary guide book 

Simulation/resus – PEA arrest in pregnant woman. I thought this was a bit haphazard as the 

mannequin still had a pulse even when they insisted that there wasn’t a blood pressure. 

Equipment – humidity and definitions. Methods of measurement. More detail about 

Regnaults Hygrometer and interpretation of humidity curves. 

Equipment/Hazards – electrical symbols (nothing simple but still in the books). Definition of 

earth and equipotential. 

Clinical skills – NMB monitoring. Where to place electrodes on wrist and lower limb. Pattern 

of response for TOF. Differentiation between depolarising and non-depolarising blockade. 

Clinical examination – CVS in particular the arterial pulses. 




Machine – check equipment needed for RSI. Scope and ETT were faulty. Short discussion on 

CICV scenario. 

History – patient about to undergo AV fistula formation. Previous awareness under 

anaesthesia. 

Communication – AAA rupture as per course. 

History/Communication – 2 part station. TAH in patient with heavy periods. Hb check. 

Previous problems with GA – awareness during emergency C. Section and traumatic 

experience as child from face mask. 

Radiology – I think it was coarctation of aorta. The questions were leading that way but 

unconvinced by actual x-ray. 

Radiology – Large hiatus hernia. 

Simulation/Resus – ITU patient, intubated and ventilated as aspirated during induction. Low 

sats. Tube too far in and developing ARDS. PEEP suggested. 

Resus – talk with examiner about the management of VF. Very straight forward. 

Clinical skills – maintainging airway. Head position in adult and paeds. Nasopharyngeal 

airway. 

Set 3 

Pharmacology / physiology 

draw the arterial wave from, explain how if differs from 

aorta to radial artery 

draw a pressure volume loop and explain how it changes 

with increased contractility 

explain the ventilatory response to hypercapnia when 

rebreathing 

explain the ventilatory response to hypoxia 

tell me some of the functions of the liver 

explain liver blood flow 

draw the structure of the liver lobule and explain it 

tell me about commonly used iv induction agents 

tell me about thiopentone, can you draw it, what are 

structure activity relationships, 

tell me about ketamine 

tell me about classes of drugs used in asthma 

what variants are there in metabolism of anaesthetic drugs 

- sux apnea and porphyria 




clinical - a 65 year old man needs a laparotomy for a 

perforated viscus, INR is 5 because of warfarin for DVT, 

biochemically dehydrated 

what are your concerns 

what are you going to do 

discuss how to correct his coag 

how will you anaesthetise him 

critical incident - HR goes up tp 145, hypotensive - 

causes, how do you treat it 

physics 

identify these electrical symbols - electrical components 

what factors influence electrical resistanve 

what is ohms law, what is power 

severinghaus electrode, calibration graph 

features and faults of a syringe driver pump 


16 - XR of aortic coarctation 

15- check equipment for RSI and failed intubation routine 

14- questions on humidity 

13 - qs on nerve stimulator and patterns of block 

12 - qs on skull anatomy, eye block 

11- qs on electrical safety and symbols 

10- communication - aortic aneurysm relative 

9 - resus - pregnant woman, LA toxicity 

8- resus - ALS algorithm 

7 - history - previous awareness (CRF, new AV fistula) 

6 - critical incident SIM man - endobronchial intubation 

5 - paediatric resuscitation - differences between paeds 

airway and adult 

4 - XR - lateral chest with hiatus hernia 

3- hx - take hx from female for hysterectomy 

2- present hx / questions on hx gained 

1 - spinal cord anaomy and tracts 

Set 4 

Primary FRCA Questions MAY 2009 

Physiology viva: 




1) Frank –starlings law; cardiac cycle; pressure volume loops- with afterload and 

preload, along with definitions. 

2) Alveolar gas equation and its significance. 

3) Hormones and HPA, negative feedback mechanism 

Pharmacology Viva; 

1) Receptors and ligands, Types of receptors, steroids. 

2) NDMR, MOA and metabolism, Hoffmans and ester hydrolysis. 

3) Steroids and administration during surgery. 

Physics: 

1) Calibration ( 2 point, 3point) where used in practice. 

2) Magnets- where used in practice( spoke about paramagnetic analysers and MRI) 

Asked in details about MRI. 

3) Ventilators and its classification 

Clinical: 

75 yr old obese lady, on the list for strangulated umbilical hernia, is also a heavy smoker and 

type 2 diabetic on metformin. Discuss in regard to obesity. 

OSCE: 

1) Simman : tracheostomy out reinsertion not possible—went through DAS Guidelines 

2) History on an asian female with thalassemia. 

3) Vertebrae: axis –where does the vertebral artery lie.Denticulate ligament. Odontoid 

peg to be identified.Borders of the epidural space, where spinal cord ends in adults 

and kids. 

4) Art line set up with flaws to be identified. 

5) Bains Breathing system chaeck 

6) Intraosseus insertion. 

7) Cardiac angiography identify LCA- Circumflex and LAD. 

8) Counselling mum as child with sux apnea. 

9) Bradyarrthymias to be managed. 

10) Tachyarrthymias management with defib use 

11) Identify clarkes electrode and its parts. 

12) Xray :seemed to be ARDS, so managed it as such 

13) Pulmonary angiogram of a pt with burns- showed a pneumothorax 

14) History taking of a pt for laprotomy and the next station was for the questions 




15) Laser tube with questions on safety with lasers 

16) Explain the suitability of a pt. for GA or SA who has preeclampsia. 

17) Axillary approach of brachial blockade 

Set 5 


- Communication: talk to a daughter of a man admitted for urgent AAA repair 

- History taking: Woman in her 5os for AV-fistula 

- History taking, two-step station: woman in her 40s for abdo hysterectomy 

- Resusc: PEA in preganant woman after a 20 ml 0.5% bupi epidural top up 

- Resusc: Collapse on the ward: VF 

- SIMMAN: low SpO2: recognise R endotracheal intubation 

- Physical examination: Pulse and heart examination 

- Equipment: check RSI equipment: various faults: leaking tube cuff, broken McGill, pieces 

of plastic in the connection. Add which other equipment will be needed: drugs, IV, fluids, 

suction, GEB, tipping trolley. 

- Skills: demonstrate bag-mask ventilation on a manikin and various questions about ambu 

bags, cricoid pressure, etc 

- Standard questions about pulsoxymeter 

- Neurostimulator: recognise various patterns, quastions about voltages, location of the 

electrodes on the wrist and ankle 

- Station on electrical safety and symbols 

- Anatomy: orbit with structures passing through optic canal, superior issure, lamina cribrosa, 

etc. 

- Anatomy: spinal cord: very similar to the one in the college book. 

- Chest X-ray: coarctation of the aorta 

- Chest X-Ray: hiaus hernia (Left lateral view) 

can't remember the last 4... 

VIVAs 

Physiology 

- Definition and classification of hypoxia, HB sissociation curve, CaO2, etc 

- Capillary bed hydrostatic/oncotic pressures in the systemic cirulation differences in the 

renal and pulmonary bed circulation 

- Immune system: classification, role of te different white cells, hypersensitivity reactions 

type I-V 

Pharmacology: 




- compare Sevo and Des 

- agonist antagonist curves 

- all about Digoxine 

Physics 

- Gas laws and their application to anaesthetics 

- ECG 

- Bag-valve mask: components, materials, differences btw paediatric and adult models. 

Clinical: 

- 19y old man fallen down the stairs in a night club at 2 am, brought to AE, discussion about 

intracranial haemorrage, raised ICP, monitoring and transfer, mannitol, RSI... 

Set 6 


1.Called to ITU @ 2:00 am doe desaturating 70 yr old gentleman; Tracheostomy tube 

out( inserted only 48 hrs ago) known difficult intubation. 

2.X-ray – pulmonary oedema 

3.Axillary block on actor n follow on questions 

4.History station 

5. Follow on questions 

6.CT chest on inhalational injury. 

7.Bains circiut check 

8. O2 electrodes – pictures n questions 

9.Intra ossious needle insertion 

10. Sux apnoea – communication to mother( mum was really bored n kept looking out of the 

window!!) 

11.ALS scenario – shockable ECG 

12.ECG rhytmn strip – SVT n questions 

13. Arterial line set up n faults 

14.History station 




15.Anatomy station –Vertebras 100 s of them – C1 n C2 as well(had not seen them since 

MBBS days) 

16.Anatomy of heart- Angiogram n questions 

17. Examine a pregnant lady for GA/ regional. You can ask for any results and equipment u 

to aid ur examination. 

VIVA – PHYSIO- PHARMAC 

PHYSIO- 

1. Adrenoreceptors. Differences b/n Adrenaline n Noradrenaline 

2. Structure of sarcomere both relaxed n contracted with all the lines. Excitationcontraction 

coupling 

3. Starvation n all the cycles(krebs) 

1. Diuretics 

2. Local anaesthetics 

3. Dose-response n log dose response curves 

1. Pressure n invasive arterial setup n principles 

2. Pulse oximetry n graphs( wanted graph of absorbance against time) 

3. Ventilators n graphs of flow/time n pressure/time 

PHARMAC- 

PHYSICS- 

CLINICAL- 

45 yr old for elective Abdominal hysterectomy with 2 finger mouth opening. Outline 

anaesthetic management. 

Set 7 

SOE1 

Physiology: 

arterial pressure trace, what can you tell from it Draw 

the pressure volume loop for the LV, what happens in 

failure 

The liver blood supply and metabolism 




What happens to minute volume when rebreathing CO2, draw a 

graph with MV and time. What effects would this have on 

the patient 

Pharmacology: 

IV induction agents. Draw thio or propofol and discuss 

differences generally 

How do different people handle drugs differently 

Drugs used in asthma - how do they work 

SOE 2 

Clinical: 

62 year old man, emergency laparotomy for perforated 

viscus, on warfarin for previous PE 6 months ago, INR 5.8 

mild ARF 

Management, fluid managment, management of INR and 

subsequent anticoagulation 

Patient becomes tachycardic and hypotensive on table 

Physics 

Identify electrical symbols. When do we use resistors 

Principles around resistors, pressure transducers. 

Electrical safety, how do we get electricity 

Capacitors, when do we use them, defibrillator. 

pumps, drip counters, problems and safety around pumps 

(awful) 


Examine the arterial pulse and the praecordium 

Base of skull, orbit and peribulbar blocks 

Diagram regarding electrical safety, identify symbols, say 

why patient doesn't get electrocuted by ECG 

principles behind pulse ox - the question straight from 

the college book 

Take a history from a woman having an AV fistula formed 

with previous history of awareness 

Resus 1: pregnant lady in PEA, probably IV LA injected 

Resus 2: discuss ALS guidelines, questions on algorithm 

Check equipment needed for RSI. Holes in cuff, no bougie, 

magills didn't open 

Sim man - tube in right main bronchus, questions on shunt 

Cross section of spinal cord, questions straight out of 

college book 




Humidity, questions on hygrometers 

History from woman for TAH with awareness - straight from 

college book too 

X ray 1: probably co arctation of aorta 

X ray 2: lateral chest showing hiatus hernia and further 

questions on this 

Airway adjuncts, NPA, emergency airways 

Communication: daughter of 82 year old man having 

emergency AAA repair 

Set 8 

Physiology viva 

1 Write down the normal values for CVP, HR, BP, CO. What happens to these 

values if 20% haemorrhage occurs What are the physiological responses to 20% 

blood loss if left untreated What neural and hormonal responses occur Tell me 

more detail about the hormonal responses that occur 

2 Write a table comparing the concentrations of various intracellular and 

extracellular ions. What are the functions of magnesium What are the functions 

of phosphate 

3 What is compliance Draw a diagram representing lung compliance (pressurevolume 

curve of lung). What are static and dynamic compliance, why do they 

differ What are the components of total compliance of the respiratory system 

Name some causes of altered compliance of the lung. What happens to 

compliance in paediatric respiratory distress syndrome! What is surfactant What 

is Laplace’s law 

Phamacology viva 

1 What are the factors affecting uptake of inhaled agents Draw a graph showing 

how low and high minute ventilation affect uptake. What is the blood-gas 

solubility coefficient 

2 Define volume of distribution. Why factors influence the differences in Vd of a 

drug. Give a couple of examples of drugs with high Vd and low Vd. Define 

clearance. How are Vd and clearance related 

3 What are the mechanisms by which drugs affect gastric pH Name some examples 

of each type of drug. Draw a gastric parietal cell and show the receptors these 

drugs act on. What exactly happens at the receptors (H+ proton pump and 

histamine H2 receptor) 




Clinical scenario 

30 year old primip with epidural in situ for labour pain relief is handed over to you. You are 

informed that she is failing to progress and will need C-section. 

1 How would you assess this woman for C-section. What would you check with the 

obs registrar What different categories of urgency are there for C-section. What 

category does this fall into How would you top up her epidural for LSCS 

2 During the section, after baby has been delivered, she starts to complain of severe 

abdominal pain. How would you manage this She declines GA, what would you 

do 

3 You go and see this lady 24 hours later. What would you tell her Specifically, 

what would you say regarding pain relief for future pregnancies What 

complications from her epidural would you be looking out for at this stage. What 

might be the causes of residual weakness How would you assess her What else 

might she complain of What is the cause of post-dural puncture headache How 

would you manage PDPH 

Everyone came out of this asking what the critical incident had been. It wasn’t your standard, 

‘ABC, 100% O2, I would call for help, alert my consultant etc’. It was much more like a 

discussion regarding what the options are for managing pain during LSCS if GA is refused. 

Discusion was regarding opiates (IV and epidural), use of local anaesthetics, what might the 

surgeons be doing, would you use midazolam. 

Physics viva 

1 What are the causes of heat loss from a patient in theatre, and in what proportion 

do these occur What is radiant heat loss What form of energy is this What is 

convective heat loss Why does this occur and how can it be minimised What is 

evaporative heat loss Where does this occur from What is the latent heat of 

vaporisation Why does it cause heat loss What is conductive heat loss Why is 

so much heat lost from the head and face What methods are there to limit heat 

loss during surgery 

2 With regard to blood pressure monitoring, what do you understand by static 

response and dynamic response (I asked around about this later – no candidate I 

spoke to felt they knew the answer to it, most mentioned static and dynamic 

measurement of lung compliance.) The examiner then drew axis for a pressure 

time curve and drew a rectangle (as if a flush was going through an art line): What 

is the pressure of the pressurised bag in a art line system What happens after the 

flush is released I then went on to draw the response seen under different 

damping conditions. What is Fourier analysis What is the fundamental 




Set 9 

frequency What are harmonics How many harmonics are necessary to formulate 

most biological signals 

3 Picture shown of 3 different ET tubes. What are all of these (normal Cuffed ETT, 

South-facing RAE tube and uncuffed paediatric tube). Take me through all the 

markings on the normal ETT. What length would you ask your ODP to cut the 

tube to What does RAE stand for What is this (Murphy eye). What is it for 

What is different about the paediatric tube Why no cuff What age child is this 

tube for (it was a size 4 tube) What else is unusual about the tube (8mm 

connectors) 

SCE 

- Communication: talk to a daughter of a man admitted for urgent AAA repair 

- History taking: Woman in her 5os for AV-fistula 

- History taking, two-step station: woman in her 40s for abdo hysterectomy 

- Resusc: PEA in preganant woman after a 20 ml 0.5% bupi epidural top up 

- Resusc: Collapse on the ward: VF 

- SIMMAN: low SpO2: recognise R endotracheal intubation 

- Physical examination: Pulse and heart examination 

- Equipment: check RSI equipment: various faults: leaking tube cuff, broken McGill, pieces 

of plastic in the connection. Add which other equipment will be needed: drugs, IV, fluids, 

suction, GEB, tipping trolley. 

- Skills: demonstrate bag-mask ventilation on a manikin and various questions about ambu 

bags, cricoid pressure, etc 

- Standard questions about pulsoxymeter 

- Neurostimulator: recognise various patterns, quastions about voltages, location of the 

electrodes on the wrist and ankle 

- Station on electrical safety and symbols 

- Anatomy: orbit with structures passing through optic canal, superior issure, lamina cribrosa, 

etc. 

- Anatomy: spinal cord: very similar to the one in the college book. 

- Chest X-ray: coarctation of the aorta 

- Chest X-Ray: hiaus hernia (Left lateral view) 

can't remember the last 4... 

VIVAs 

Physiology 

- Definition and classification of hypoxia, HB sissociation curve, CaO2, etc 




- Capillary bed hydrostatic/oncotic pressures in the systemic cirulation differences in the 

renal and pulmonary bed circulation 

- Immune system: classification, role of te different white cells, hypersensitivity reactions 

type I-V 

Pharmacology: 

- compare Sevo and Des 

- agonist antagonist curves 

- all about Digoxine 

Physics 

- Gas laws and their application to anaesthetics 

- ECG 

- Bag-valve mask: components, materials, differences btw paediatric and adult models. 

Clinical: 

- 19y old man fallen down the stairs in a night club at 2 am, brought to AE, discussion about 

intracranial haemorrage, raised ICP, monitoring and transfer, mannitol, RSI... 

Set 9 

SOE 

Pharmacology: 

-Define MAC. Types of MAC. Factors governing MAC. 

-Define Bioavailiblity. How do you measure it. Factors goverrening it. 

-What types of classification of anti-arrythmics are you aware of Draw a Cardiac action 

potential and show action of each of the clases of Vaughn Williams classification. 

-Discuss Indications, MOA, & S/E of Amiodarone 

Physiology: 

-Draw pressure changes in the Right ventricle durinng crdiac cycle. 

-Superimpose Pressure changes in Left ventrile on an arterial trace. 

-Show how an ECG relates to the graph showing the Pressure changes in Left ventrile during 

the cardiac cycle. 

-How is CO2 carried in the body Show how Co2 in transported at tissue level and at lungs. 

What is the Bohr effect What is the Haldane effect 

-Draw CO2 dissociation curve. Show the Haldane effect. 

Physics: 

-What types of Laryngoscopy blades are you aware of Indictions for each type. 

-How do you assess flow in Gases and Fluids Ficks principle. 




-What does Laser stand for How is it produced Types of Lasers ad their indications. 

Precautions during laser surgery. 

Clinical: 

6yr boy for an Elective Tonsillectomy for recurrent snorring at night. PMHx-Asthma on 

regular inhalers. Recent cold 6 days ago. 

-How would you assses. Points of concern. 

-ow would you asses the severity of OSA & asthma. Implitions of the same on your 

anaesthetic. 

-What are the indications for intubtion What type of tube, ventiltor support 

-Pain relief. Concerns for opiate use for the samme 

-Critical incident:Post-op hypoxia. 

-Mgm of bleeding post-op tonsillectomy. 

OSCE: 

1> Nerve stimulator: Where would you place the electrodes. Desribe features on graphs of - 

Single stimilus, TOF, Post-tetanic stimulation. 

2> Anatomy: Cribriform plate. Le forts fracture classification. Orbit and eye blocks. Superior 

orbital fissure and optic canal contents. Describe peri-bulbar block and its complications. 

3> History taking of a lady due for laproscopic cholecystectomy. Asthmatic. 

4> Cardiac arrest in labour post Bupivacaine epidural top-up. 

5> Examine Radial artery and auscultate precordium. 

6> ECG: VF. Treatment options. 

7> Electrical safety. Equipotential. Classification of instuments based on their design and 

maximum leakage current. 

8> Communication: Speak to daughter of a 82yr. old patient brought in with a ruptutred 

Abdominal Aortic Aneurysm. 

9> Simulation: Hypoxia in a patient on the ITU admitted following routine Appendicectomy 

who aspirated post-op. Endobronchial intubation. 

10> CXR: Coarctation of aorta (Very suttle rib notching noted) 

11> History taking: Lady booked for TAH. (55yr old teacher. PMHx- 

Anaemia,Migraine,PMHx:PE (Rx- IV and then some oral tablets given), Awareness during 

Emergency LSCS for foetal distress, Face-mask phobia. Smoker. Allergic to Penicillin. GP 

had taken bloods for Hb recently) 

12> Follow-on from the Hx station. 

13> Airway mantainence on a manequin. Position, airway adjuncts with their s/e. QuestionS 

on Cricoid pressure during RSI. 




14> Anatomy: Spinal cord, label parts on a diagram of spinal cord cross-section, blood 

supply, CSF production. 

15> CXR: Lateral CXR with hiatal hernia 

16> Anaethetic instruments needed for RSI (Suction, Bougie, Blades(Light not working), 

Magill forcep(did not open), tube connector(FB within), HME) 

17> Physics: Humidity (Define Absolute and Relative Humidity, what are the units. Describe 

Hair Hygrometer & Regnaults hygrometer. Shown a graph and asked how will you calculate 

Absolute and Relative Humidity from it) 

Set 11 

Physiology: 

starvation 

Muscle striated/cardiac 

bwta agonists - fx of norad and adrenaline on heart 

rate/BP 

Physics: 

Pressure - gauge/atmospheric 

Manometer 

Ventilator classificastion - time/flow/pressure cycled and 

xtics 

Pharm: 

local anaesthetics - action - pka, etc, toxicity 

Nephron and actions of diuretics 

Log dose response curves - agonist/antag etc 

Clin 

TAH and reduced mouth opening: Mx 

regional vs GA 

fibreoptic 

inhalational 

Clin incident - laryngospam in recovery - Mx 

Set12 

Cardiac cycle 

Given arterial trace unlabelled. 




Asked to label axes, put values and explain trace. 

Asked to superimpose LV pressure curve, and explain valvular openings/closures. 

Then was asked to add RV pressure curve explain difference (lower pressure). 

Add CVP trace, explain. 

Add 2 ECG’s. 

Heart sounds position on above. 

Monosynaptic reflex/Muscle spindle 

Define monosynaptic reflex (I defined and explained with diagram-went down well), 

Asked about muscle spindles- definition, role, afferents efferent fibres types, 

Role of monosynaptic reflex! 

Any other influence! Cortex. What happens if you do knee jerk with tight fists- reflex 

augmented! 

CO2 transport in blood 

How is CO2 transported in blood, give % for all 3 ways! 

Role of carbonic anhydrase, 

Draw a red cell and explain how CO2 is transported here. 

What is a buffer 

Tell me the qualities of an ideal buffer. 

Set 13 

Pharmacology Viva 

MAC/Volatiles 




Define MAC (MAC50), 

Give values for volatiles you use, including N20, 

What other MAC do you know- I did not know the answer to that. 

How does potency relate to MAC (graph), 

What factors influence MAC, then asked me about neonates vs bigger kids- lower/higher 

MAC. 

Bioavailability 

Define Bioavailability, graph. 

Factors that influence Bioavailability (list)! 

Routes of drug administration. 

Most important factor affecting Bioavailability- First Pass metabolism (gut wall-examples- 

GTN, liver). Factors that influence 1 st pass metabolism at liver. 

Factors that affect diffusion across membranes! 

Antiarrhythmics 

Classify antiarrhythmics- Vaughan Williams, very keen to know what ion channels they act 

on (Na, K, Ca). 

Draw me a quick (Ha Ha) cardiac action potential and show me the ion flux. 

Where does Amiodarone work 

Amiodarone side effects. 

Clinical VIVA 

6 year old for tonsillectomy, asthma on Becotide, URTI finished 1/52 ago (parents statement) 

How would you assess above pt (Very pleased I said I would have in mind patient risk 

factors, anaesthetic risk factors and surgical risk factors). 




Cancel or not in view of URTI! I stated is a difficult decision, I would look for ongoing 

sepsis and cancel if present, if no signs I would ask the opinion of a senior colleague. Was 

told… Fair enough. 

How do you assess URTI’s 

How do you assess asthma 

How would you induce this child Iv vs inhalational, one or both parents present 

Critical Incident! Hypoxia in recovery! Approach, causes, treatment! 

Where would you discharge this patient to 

How much would this patient weigh. What size tube what tube cuffed vs uncuffed. Would the 

surgeon influence your decision 

What analgesia (including doses per Kg) 

How would you extubate 

Physics viva 

LASERS 

How do lasers work I’ve drown the diagram whilst talking. 

Beam characteristics. 

What types of lasers do you know Classify, explain the differences between them. 

Safety measures! 

Measurement of FLOW 

How do we measure flow 

Describe flow meter. I knew this well so they did not interrupt me. 




How does Wright respirometer work 

How do pneumotachographs work Basic principles! 

She then asked me about the USS way of measuring flow which I did not know. 

Laryngoscopes 

Examples, once I told them they asked me to identify them on a photo (just MAC and 

McCoy). We then talked about use of short handle one. 

Identify image (fibroscope). 

Identify components. How does it work, how many optic glass fibres…… 

How do you clean it Do you autoclave it (NO) Asked me about the substance used to clean 

it…didn’t know. 

LMA types 

How do you sterilise them 

Describe Igel LMA (I brought the subject up) 

Set 13 

My OSCEs included - testing a Bain's circuit, checking an 

arterial line, Chest Xray of bronchiectasis, pictures to 

discuss of polargraphic, Clarke and paramagnetic O2 

analysers. Intraossius infusions, management of 

bradycardia, tracheostomy that had fallen out of a patient 

who was a grade four intubation, lumbar anatomy, axillary 

nerve block, examining a patient to ascertain whether she 

would be suitable for a GA or RA for LSCS, 

OSCE - NSAIDs, ACEi, intraplueral pressure changes in IPPV 

and spont ventilation, thyroid hormone, muscle spindles, 

withdrawl reflex, nociceptive pathway. 




OSCE- appendicectomy on a 25yr old diabetic with a temp of 

38.5 and a blood glucose of 25. Fluid warmers, ph and Hion 

concentrations relationships - graph of log pH and 

concentration H+, power as watts and generation of heat by 

power. 

Set 14 

Bain circuit check 

qs on oxygen measurement 

2 history stations 

Manninkin on VF 

STATION ON ARRYTHMIAS SVT 

Communication for Sux apnoea 

scenario of tracheostomy falling out in ITU on Manninkin 

Qs on Needle stick injury 

Introsseus needle insertion 

anatomy coronary circulation 

Vertebra anatomy 

Exam of pregnant patient for GA/Epidural /spinal 

CXR -pulmonary edema 

CT chest of pneumothorax 

Viva physio/pharm 

Intracellelar ions 

lung compliance 

Vd and Clearance 

PPI 

Physics/clinical 

Epidural topup for LSCS and then into PDPH management 

Static and dynamic compliance in BP ..... I have not heard or seen about this 

Heat loss and prevention 

Set15 

PHYSIOLOGY 




1) Can you draw and compare the graphs of how HR and Systolic and Diastolic BP changes 

with Adrenaline and Noradrenaline infusions. 

2) Adrenergic receptors in details 

3) Physiology of starvation in detail.....Wanted to know about the exact steps at which Amino 

acids and glycerol enter the gluconeogesis pathway. 

4) drw a sarcomere. Excitation contraction coupling 

Pharmacology 

1) Local anaesthetics structure and comparison.How do PPbinding etc alter the activity 

2) Dose response Curves 

3)Cant remember the third one 

Physics 

1)what is pressure. what are SI units. compare the various units. Showed picture of a 

barometer and manometer. Asked to compare. Then asked what relative pressure is....and 

how it is different from Gauge pressure! 

2)Classify ventilators. Principle of Oxylog and compare various graphs for flow and pressure 

generators as well as for various cyclings! 

3) Spectrophotometry. Easy 


1) Needle stick injury 

what will u do. what are seroconversion rates. Post exposure prophylaxis 

2)Simman....tachycardia algorithms....eventually needed defibrillation 

3) Simman.....Bradycardia algorithm!! 

4) Another arrythmia station...PSVT 

5) History taking....asian lady with thallasemia....also cough and fever following visit to 

bangladesh. 

6) Simman....very tough.....Tracheostomised man ..known difficult intubation. recent 

tracheostomy. now tube out ....cant intubate cant ventilate. 

last minute I occluded the trachi with gauge and saw the chest moving....phew!! 

7)Axillary block. What nerves blocked. what spared. qustions on nerve stimulator 

8) Chest Xray: Pulm edema i think 

9)Ct chest: loculated pneumothorax I think 

vague questions of fluid replacement ..patient had a burn! 

10) Bains circuit check 

11)Pictures of electrodes...clark, fuel cell to label 

12) History folllow on....guy ahd all the diseases under the sun....and the examiner asked 

me....how did his brother die!! 

13) intraosseous...demonstartion and questions 

14) Cardiac angiogram and standard questions 

15) sux apnoea....communication with Mum 

Set 16 




Pharmacology Viva: 

Discuss the main advantages of using desflurane and 

sevoflurane over isoflurane - was wanting blood/gas 

coefficients - definition/values for each agent and why 

onset of anaesthesia was faster with low coefficients. 

Wash-in curves for the above agents, factors affecting 

shape of curves, effect of nitrous oxide. 

Digoxin - draw structure of it.......hhmmm (apparently a 

steroid nucleus); mechanism of action. Draw action 

potential traces of pacemaker and normal myocyte cells and 

explain digoxin effect on trace. 

Dose response curves and definitions of 

affinity/efficacy/potency/inverse agonist. 

Physiology Viva: 

Define hypoxia. What are the different types of hypoxia 

that you know. Draw the oxygen dissociation curve and 

explain what hapens to the arterial and venous points with 

the different types of hypoxia. 

Immunity - define, types of. How many types of 

hypersensitivity do you know. What is the immunological 

basis for each of them. Give a clinical example of delayed 

hypersensitivity reaction. 

Starling's forces at a normal capillary bed, alveolar 

capillary and renal glomerulus. 

Clinical Viva: 

Scenario: 19 year old male, fall down stairs in a 

nightclub. Brought in by ambulance crew with confusion and 

agitation. 

Viva followed a discussion on the possible differential 

diagnoses of the presentation. Focus on management of 

intra-cranial injury - use of AVPU score over GCS. When 

would I consider intubation for a trip to the CT scanner 

How to prepare for a RSI. 

Development of Cushing's reflex during CT scanning - how 

would you proceed. 

What do you need to prepare for an inter-hospital 




transfer. 

Which IV fluids would you use and why 

Physics Viva: 

How do you calculate how much oxygen is left in an oxygen 

cylinder Same for nitrous oxide. 

Ideal gas laws. 

Mechanism of action of Ambu bag valve/mushroom valve. 

OSCE Stations. 

Schematic diagram of plenum vaporiser - questions on 

function/safety features. 

ECG - fast AF - what else could it be/how would you check 

What investigations would you like to perform. When would 

you electrically cardiovert this patient How man joules 

would you use. When would you not cardiovert the patient. 

What pharmacologicaloptions are there for rate control and 

cardioversion 

History-taking - mastectomy/breast reconstruction in a 

patient post chemo for breast ca. 

History-taking & follow-on questions Re: hx - 21 year old 

type 1 DM for tonsillectomy with features of OSAS. Lots of 

marks for thorough diabetic history. 

Resusc 1 - called to ED for collapsed 33yr old female just 

diagnosed with ectopic - asystole algorithm. 

Resusc 2 - called by junior SHO for a patient who is 

developing anaphylactic shock post ceftriaxone. 

Anatomy - underside of diaphragm, labelling key parts, 

distinguishing levels of entry of IVC/oesophagus/aorta. 

Diaphragmatic sensory/motor innervation. 

Anatomy - sacrum - identifying sacral 

cornua/sacrococcygeal membrane....describe how to perfom a 

caudal block in a 5yr old for orchidopexy - where does 

dural sac end in a 5yr old, how big is the caudal sac in 

this age group, what quantity of LA would you use, 

describe angle of entry of needle. 

Equpiment - LMAs - demonstrate 

selection/preparation/insertion/checking of LMA. 2 

contraindications to LMA other than full stomach and 




pregnancy. 

Equipment - anaesthetic machine check - absent blanking 

yokes where cylinders absent, oxygen analyser not working, 

vaporiser not filled. 

Equipment - schematic diagrams of null deflection 

paramagnetic analysers/Clark electrode and galvanic fuel 

cell and questions pertaining to each system. 

Anaesthetic hazards - photograph on patient's elbow lying 

on a metal edge - risk of ulnar nerve injury, clinical 

symptoms, examination findings and treatment. Another 

photograph with arm abducted to 90 degrees against a metal 

bar - questions about circumflex nerve injury. 

Communication - discuss the pros and cons of PCA vs 

epidural forpost-operative analgesia in a female 

undergoing elective TAH. The woman was worried about N&V 

with a PCA which her friend had experienced. He had also 

had experience of an epidural for labour analgesia. 

Eventually plumped for an epidural. 

CXR 1 - single lead pacemaker - questions on classifying 

pacemaker, use of diathermy. 

CXR 2 - CTPA with filling defects bilaterally. 

Set 16 


1. Base of skull 

a. Orbital fissures and optic canal 

b. Cribriform plate 

c. Types of facial fracture 

2. Electrical safety 

a. Diagram with ECG and CVP attached to patient 

b. Details of currents that cause macro and microshock 

c. Details of how macro and micro shock can be prevented. 

d. Equipotential earth. 

e. Various safety symbols to identify e. AP, APG, CF etc 

f. Discussion of pulse oximetry 

3. Nerve stimulator 

a. Placement of electrodes and nerves that can be stimulated 

b. Currents and frequency of stimulation 

c. Diagram with TOF, Tetanic, PTC patterns for depolarising and non 

depolarising block. 

4. Communication skills 

a. Talking to daughter of patient in theatre with a ruptured AAA 

5. Resus: 




a. Pregnant (term) lady for c-section-. Another junior has topped up epidural and 

patient has become unstable. Likely IA injection of epidural injection. 

Descended into a PEA arrest Various points: 

i. To connect oxygen to ambu bag 

ii. Remember to ask for wedge 

iii. Remember to ask surgeons to remove baby 

iv. Grilled about intralipid (inc. doses) 

6. History station 1: 

a. Observed, marked history by examiner in room (may have been one of the 

trial stations) 

b. I think it was for a lap chole-. Allergic to penicillin. 

7. History station 2: 

a. Total abdominal hysterectomy with prev GA 

b. Points quizzed on: 

i. Occupation 

ii. How she was treated for PE post c-section 

iii. Dentition 

iv. Allergies 

v. Whether she was anaemic, whether it had been checked by the GP, 

when and what the value was. Was she symptomatic 

8. Cross section spine and columns (ascending and descending) 

9. Equipment check prior to RSI 

a. No battery in laryngoscope 

b. Filter had condensation within it suggesting previous use. 

c. Magills not opening properly 

d. Tube cuff with hole in it. 

e. Catheter mount had a foreign body hidden within it. 

f. Asked what other equipment I would want 

10. Humidity 

a. Definitions 

b. Diagrams of wet and dry bulbs, regnaults hygrometer and hair. 

c. Asked discuss how Regnaults works 

d. Asked about importance of humidity in theatre. 

11. Critical incident scenario (simulator) 

a. Patient on ITU with aspiration. Need to take over from F1 who has called you 

because of desaturation. 

b. Go through scenario- ETT endobronchial. 

c. Asked about differential and other ways of treating aspiration (bronchoscopy 

and suction) 

12. Airway management 

a. Asked to demonstrate ideal position for bag valve ventilation (nb. Pillow 

present at side of room) 

b. Asked how position, equipment and technique would differ for a child. 

c. Asked to insufflate 5 breaths. 

d. Asked about a nasopharyngeal tube and contraindications. 




13. X-rays: 

a. Coaractation 

b. Hiatus Hernia 

PHYSIOLOGY/ PHARM VIVA 

1. Coronary circulation and determinants of it 

2. Autoregulation graph 

3. Factors that alter MRO2 

4. Factors that affect flux across the placenta. 

5. Body fluid compartments 

6. How body responds to 500ml of blood loss. 

7. IV induction agents and classification 

8. Asked to draw thiopentone and propofol 

9. Asked how the various IV induction agents are presented 

10. Short discussion on importance of ionization 

11. Asked in detail about hypoglycaemic drugs and how they work and side effects 

(Metformin, sulphonylureas, thiozolidindiones, acarbose and insulin) 

CLINICAL/ PHYSICS 

1. 72 year old admitted with cholecystitis 2 days ago. Now septic with abdominal pain 

presumed from a perforated gall bladder. Jaundiced 

a. initial discussion on causes of jaundice and sequellae of liver failure. 

b. Then movement onto assessment, optimization, intraop and post op 

management. 

2. Identification of electrical signal symbols (eg. Resistors, inductor) 

3. Identification of defibrillator circuit 

4. Discussion of supraglottic airway devices (LMA, ILMA, Proseal LMA) and 

combitube. 

5. Picture of BP cuff and discussion about cuff sizes and sources of error 

6. Discussion about cuff pressures. 

Set17 

OSCE MAY 2009 

1. CT thorax scan on pt with burn injuries and needing appendicectomy. T/F questions. 

2. Check Bains circuit and questions. 

3. O2 electrodes – Clarke, Polargraphic and Paramagnetic with diagram and questions. 




4. Insertion of intraosseous needle. Demonstrate how to do it + questions 

5. Communication – Sux apnoea 

6. Examination – Pregnant pt – suitability for GA or Regional technique with any 

investigations 

7. Anatomy – Coronary circulation – from Royal college book 

8. Resus – Bradyarrythmia and performing a synchronised shock 

9. Safety – check A-line set up 

10. Needlestick injury with question on what to do, rates of transmission 

11. Resus – mx SVT and cardioversion with rhythm strip 

12. History – elective hysterectomy 

13. Simulation station – ITU pt desaturating due to obstructed trachy 

14. Radiology – CXR Pulmonary oedema – T/F questions 

15. Anatomy – Axillary nerve block – position pt then questions 

16. Anatomy – Spine – thoracic with ligament attachments etc 

17. History follow on station 

VIVA MAY 2009 

Physiology 

Normal ranges for CO, HR, CVP, SV 

What happens to above with IPPV 

What happens if lose 20% blood volume 

Lung compliance – definition and value 

Difference between static and dynamic compliance 

Draw lung compliance curve and explain 




What are the main intracellular and extracellular ions with figures for each 

Mg – what happens with hypomagnesaemia – signs and symptoms 

Pharmacology 

What pt factors influence the uptake of volatiles 

Draw the uptake curve for volatile agents and explain 

Explain the 2 nd gas effect with N2O 

What is Vd – definition 

What influences Vd 

Give egs of drugs with large and small Vd. 

Why are they large and small 

Tell me about drugs that influence gastric acid 

Why do we use sodium citrate for obstetric patients 

Draw the Parietal cell and explain where ranitidine and omeprazole work 

Clinical 

Obstetric pt with epidural in situ. Now needs a C-section. 

What would you do 

What are the options for C-section 

How urgent do you need to do this – classification of urgency 




Towards the end of the procedure she develops pain 

What could this be due to – ie differential diagnosis 

What are the options 

What can the surgeon do 

What are you as the anaesthetist most at risk of – ie litigation 

What are the complications of a regional technique 

Post dural headache and management 

Nerve damage 

Physics 

How do pt’s lose heat during a GA 

What is the amount lost by radiation and how can it be minimised, via 

convection and how is it minimised, evaporation and how is it minimised. 

Describe drift – static and dynamic 

How do we minimise it – 2 point calibration and graph 

Where do we take the 2 points 

How do you design a machine to measure arterial bp directly – 1 st harmonic 

being HR etc 

Physiology VIVA 

Equipment – photo of 3 types of ETT – describe one in detail. 

Discussion about cuff pressures and advantages/disadvantages of low/high 

pressure cuff and markings on the tubes. 

1. Starvation: how does the body adapt. How long does a person survive What is the 

cause of death What are the hormonal changes 




2. Muscle physiology: excitation contraction coupling. Structure of sarcomere. 

Difference between cardiac and skeletal muscle. 

Pharmacology VIVA 

1. G-protein receptors: Types with examples. MOA. Response to stimulation of α, β 

and dopaminergic receptors 

2. Dose response curve: Describe log D-R curve. Importance of semilog. scale. 

Changes in the presence of partial agonist, competitive and non competitive 

antagonist. Effect of tramadol on morphine D-R curve 

3. Diuretics: Classify. Explain countercurrent mechanism. Describe MOA of 

furosemide and the side effects. 

Physics VIVA 

1. Pulse oxymeter: principles, working, draw isobestic point diagram 

2. Pressure: methods of measurement. Method of measuring atmospheric pressure. 

Picture of a U-tube filled with mercury with the mercury level different in the two 

limbs – asked to describe the device 

3. Ventilators: classify. Difference between Manley’s and Nuffield ventilators with 

regards to peak pressure and volumes delivered. 

Clinical VIVA 

1. Patient with 2 finger mouth opening for abdominal hysterectomy. She wants a general 

anaesthetic only. How will you manage her 

2. Patient in recovery. Recently extubated. Develops stridors. Differential diagnosis and 

management. 

OSCEs 

1. COMMUNICATION: explain awake fibreoptic intubation to an anxious patient with 

previous difficult intubation. 




2. SKILL: cardioversion in a patient with AF. Demonstrate on a biphasic defibrillator 

3. EXAMINATION: CVS. Concentrate on radial pulse and precordium 

4. ALS: ECG rhythm strip showing asystole. Describe algorhythm for asystole (not a 

simulator station) 

5. HISTORY: patient for lap chole with past history of suxamethonium apnoea 

6. SIMULATOR: can’t intubate - can’t ventilate a patient after RSI. Lock jaw. Ends 

with needle cricothyrodotomy 

7. SKILL: BP taking with anaeroid BP machine. Questions related to cuff size, errors 

etc 

8. CXR: Mitral stenosis 

9. CXR: cervical spondylitis 

10. FOLLOW ON STATION: 20yr male for CT brain under GA. History of poorly 

controlled asthma, migraine. 

11. MACHINE CHECK: with identification of faults 

12. EQUIPTMENT: pH electrode 

13. SKILL: epidural. Demonstrate on mannequin 

14. SKULL: trigeminal nerve. Describe nuclei, identify openings in skull base for the 

different branches. Causes of trigeminal neuralgia 

15. ANATOMY: trachea 




16. EQUIPTMENT: assemble and check Bain’s circuit. 

17. EQUIPTMENT: laser tube. Difference between laser and ordinary tube. How does 

the protective eyewear work Name different types of laser. 

.

Primary FRCA OSCE Viva Questions May 2009 - MEDICAL ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?