Primary FRCA SOE October 2008 - MEDICAL EDUCATION at ...

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University Hospitals Coventry & Warwickshire NHS trustPharmacology1. ketamine etc.- they really went to town on this,wanting to know in particular about structure of the NMDAreceptor and agonist, its molecular effects, ion channelopening, downstream second-messanger effects.2. ways in which drugs may have different effects ondifferent populations.ClinicalScenario was a chap with IDDM, scheduled for emergencyBKA, with temperatures, high BMs. Questions on what couldbe going on, how to plan the anaesthetic, what kind ofanaesthetic would be preferable (they seemed to want torule out spinal because of potential sepsis). He laterstarted fitting post-op, and they wanted to know reasons,and how to manage fitting.Physics1. Ventilators - ways of classifying, advs and disadvs ofeach flow-generators vs pressure-generators.2. pressure-regulating valves.3. "what is a vaccuum" "how can we make use of it"4. Physics behind neuromuscular monitors.5. body plethysmography and underlying principles.32
University Hospitals Coventry & Warwickshire NHS trustSet 18Clinical case: 60 year old Asthmatic for retinal detachment surgery.Longterm steroid use.We discussed Markers of severity in asthma/ Pain/Analgesia options/PONV/Oculocardiacreflex/Critical incident: Failure to breath in recoveryThird question was on criteria for who you decide to give prophylaxis for PONV.Riskstratification for PONV.Physics was more physiology:Measurement of dead space/Bohr equation/Shown graph for FowlerKs method axes notlabelled/ asked to explain how it all works.Decontamination/disinfection/Sterilisation.They asked pretty much everything including howto sterilise a flexible bronchoscope.Blood warmers,types and principles ehind how they work.Shown picture and asked to explainhow that particular type operated.Asked to explain how countercurrent flow mechanismworks.Pharmacology:Local anaesthetics I everything you can think of including relating structure to function .Wasasked to draw the structure of an amide as well as that of an ester and to name examples.Wasasked about Henderson Hasselach equation and was asked to write it down in refernce to LA.Acid production.Receptors and transmitters involved.Why we need to control acid secretion/which patient etc.Explain how you would manage a pregnant patient and explain your choiceof drugs for this patient.Asked why we cannot use anticholinergic drugs to reduce acidproduction and which type of Ach receptors are involved in acid productionInter-patient variability to drug response.Give examples by organ system.Asked aboutcodeine and sux.Also asked about how pregnancy changes response to drugs.Physiology:Control of respiration.Asked to draw diagrams showing the structures involved and theafferent and efferent pathways.Asked to draw graphs for RR vs PaCO2 and PaO2.Vomiting reflex.Receptors,mediators.triggers the works.Asked about antiemetics that do not work via theCTZ (Dex,propofol)Draw graphs for infusion of Adrenaline/Noradrenaline. HOUR vs Time and MAP vsTime.Discussed baroreceptors etc.Set 1933
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