FINAL FRCA

THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

5th November 1996

9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A and Questions numbered 7 - 12 must be answered in Book B. Candidates who
fail to answer all twelve questions will not pass 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.

SECTION A (Book A)
1. How would you manage a case of accidental intra-arterial injection of thiopentone in the
upper limb?

2. Summarise the causes, effects, and prevention of aspiration pneumonitis.

3. List the likely causes of collapse in the dental chair of a patient undergoing a procedure
under local anaesthetic without sedation, with notes on the presenting signs and symptoms.
Briefly state what first-aid measures can be undertaken in each case.

4. What particular problems may occur during lower abdominal surgery in a patient who
suffered a traumatic transection of the spinal cord at C6 four weeks previously? Briefly
indicate how you would avoid or prevent the problems you describe.

5. Describe how you would carry out an axillary brachial plexus block

6. What is your choice of anaesthesia for pericardectomy in constrictive pericarditis? Give

reasons for your choice.

SECTION B (Book B)
7. A 40-year old man is admitted with an acute head injury. List the indications for intubation,
ventilation and referral to a neurosurgical unit.

8 Make a simple drawing, with labels, to show the trachea , main and segmental bronchi.

9. Outline your management of an adult patient brought into the A & E department in status
asthmaticus.

10. List, with a brief statement on the effectiveness of each one, the means available for
detecting awareness during anaesthesia.

11. What are the advantages and disadvantages of intravenous patient controlled analgesia for
post-operative pain control?

12. A 60-year old man is referred to you with reflex sympathetic dystrophy following an injury at
the elbow 6 months earlier. Outline the treatment.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

20th May 1997

9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A and Questions numbered 7 - 12 must be answered in Book B. Candidates who
fail to answer all twelve questions will not pass 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.

SECTION A (Book A)
1. List the dangers to the eye of general anaesthesia for elective intraocular operations. How are
these prevented?

2. What are the choices for post-operative analgesia for a child aged 4 years presenting for repair of
an inguinal hernia as a day case? State briefly the advantages and disadvantages of each method.

3. The first patient on your operating theatre list tomorrow morning has an implanted (permanent)
cardiac pacemaker. List, with reasons, the relevant factors in your preoperative assessment.

4. What are the types of anaesthetic that should be considered for fixation of a compound ankle
fracture in a patient who was briefly knocked unconscious at the accident? Outline the advantages
and disadvantages of each technique.

5. An 80 year old lady with a sub-capital fractured neck of femur requires surgical fixation. She is
found to be in fast atrial fibrillation. What are the important points in the preoperative preparation for
anaesthesia in this case?

6. Outline the problems involved in anaesthetising an intravenous heroin abuser needing urgent
surgery for incision of perianal abscess.

SECTION B (Book B)

7. You have been asked to anaesthetise a 60 year old woman for ligation and stripping of varicose
veins in one leg. She has a history of ischaemic heart disease. Explain briefly how suitability for her
management in a day-case facility is assessed.

8. A 62 year old man is admitted to the high dependency unit following a laparotomy to relieve a large
bowel obstruction. He has a urinary catheter in situ. Two hours later, he has only passed 25ml of
urine. List, with reasons, the likely causes. What is going to be your initial plan of management?

9. What measurements and derived values can be made from pulmonary artery catheters used in the
intensive care unit? Suggest a clinical application for each one.

10. What are the indications for performing a tracheostomy? List the complications of tracheostomy.

11. What are the problems of monitoring anaesthetised patients in the magnetic resonance imaging
unit?

12. Outline your management of a fit primagravida who suffers inadvertent dural puncture with a 16
gauge Tuohy needle during attempted epidural for pain relief in the first stage of labour (cervix 4cm
dilated).

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

4th November 1997

9.30am to 12.30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A and questions numbered 7 - 12 must be answered in Book B. Candidates who
fail to answer all twelve questions will not pass 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.

SECTION A (Book A)

1. A 70 yr old man with chronic obstructive airways disease requires a transurethral resection of the
prostate. Outline the advantages and disadvantages of intrathecal block for this patient.

2. What immunological consequences may result from homologous blood transfusion?

3. Outline the effects of old age upon morbidity and mortality in anaesthesia.

4. What hazards does a patient encounter as a result of being placed in the lithotomy position for
surgery? What additional hazards are introduced by then tilting the operating table head-down?
Indicate briefly how you attempt to prevent these hazards.

5. A patient on the intensive care unit has a mean arterial pressure of 130 mmHg. What drugs might
be useful for reducing this to a safe level and what is the mechanism of action of each?

6. The plasma concentrations of a drug have been measured in 20 normal patients and in 20 patients
with renal failure. What simple statistical tests exist to determine whether these 2 sets of observations
differ at the 5% level? What assumptions are inherent in each test which you describe?

SECTION B (Book B)

7. What are the pathophysiological insults which exacerbate the primary brain injury following head
trauma? How can these effects be prevented or reduced?

8. What are the postoperative problems in the first 24 hrs after coronary artery bypass graft? How are
they prevented?

9. List, (with examples) the causes of neurogenic pain. What symptoms are produced? What
treatments are available?

10. Make a simple diagram, labelled to show the anatomical structures associated with the right
internal jugular vein. List the complications of cannulation of this vessel, mentioning how each may be
avoided.

11. Outline the possible reasons for the reduction, over the last decade, of maternal mortality
associated with anaesthesia.

12. List the risk factors for venous thromboembolism and classify the current methods of prevention,
with examples.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

19th May 1998

9.30am to 12.30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A and questions numbered 7 - 12 must be answered in Book B. Candidates who
fail to answer all twelve questions will not pass 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.

SECTION A (Book A)

1. Describe your procedure for cardiac life support in a child aged five years.

2. What methods are available for therapeutic nerve blockade? Explain the mechanism
of action for each method.

3. You are asked to anaesthetise an 87 year old lady for diathermy of her bladder tumour on a
day case basis. What are the potential problems of this case and how would you manage them?

4. What are the disadvantages of nitrous oxide in clinical practice?

5. How does a rotameter flowmeter work? Describe its advantages and limitations.

6. Describe in detail how you would accurately measure a patient’s peak expiratory flow rate.
What factors may give rise to erroneous readings?

SECTION B (Book B)

7. Draw a labelled diagram of the anatomy of the anterior aspect of the wrist. How may this
knowledge be used in anaesthetic practice?

8. List the factors associated with central venous catheter infections and suggest methods to
limit such infections.

9. A patient with a history of obstructive sleep apnoea presents for an elective cholecystectomy.
How would you assess the fitness for anaesthesia? What precautions would you take with your
anaesthetic management of this patient?

10 A 60 year old man presents for a hemicolectomy. How may choice of pain management
influence recovery from surgery?

11. Explain the importance of a high airway pressure alarm system during general anaesthesia.

12. List the pathophysiological and clinical features of HELLP syndrome. What are the diagnostic
laboratory findings and the priorities in management?

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

3rd November 1998

9.30am to 12.30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A and questions numbered 7 - 12 must be answered in Book B.

Candidates who fail to answer all twelve questions will not pass 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.

SECTION A (Book A)

1. List, with reasons, the factors which affect the incidence of perioperative myocardial infarction.

2. An adult patient is known to be severely difficult to intubate. Describe a technique of fibreoptic

intubation for this case.

3. Outline the methods for prophylaxis of venous thromboembolism in routine surgical practice.

4. What are the factors contributing to unplanned awareness during general anaesthesia?

5. What information would you wish to obtain from a patient at your postanaesthetic visit, the day after
a total hip replacement?

6. What solutions are available for the restoration of circulating volume in a patient suffering from
acute blood loss? Discuss the advantages and disadvantages of each.

SECTION B (Book B)

7. Outline the clinical features and management of bupivacaine toxicity.

8. Draw a labelled diagram of the anatomical relations of the stellate ganglion. How is it blocked and
what are the possible complications?

9. How would you determine the mixed venous oxygen content in the intensive care patient? What is
the usefulness of this measurement?

10. A 20 year old patient, with sickle cell disease, was injured 12 hours ago. He has fractures of the
metacarpal bones on his dominant hand. Elective surgical reduction and fixation is planned.
Describe your anaesthetic management.

11. What safety features should be incorporated into a patient controlled analgesia (PCA) system and
what is the purpose of each? What instructions would you give to the nursing staff, having set up the
PCA?

12. Outline the anaesthetic management of a 2 yr old child who is scheduled for therapeutic
bronchoscopy following inhalation of a foreign body 2 days ago. The child does not exhibit any signs
of upper airway obstruction.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

18th May 1999

9.30am to 12.30pm

CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:

Questions numbered ONE TO SIX must be answered in Book A.
Questions numbered SEVEN TO TWELVE must be answered in Book B.

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)

1. Outline your perioperative management of a patient with a ruptured abdominal aortic aneurysm.

2. What are the physical principles of the capnograph? Discuss the applications of capnography in
anaesthetic practice.

3. A General Practitioner has contacted you for advice about a patient who may be susceptible to
malignant hyperthermia. Write a letter to the General Practitioner explaining the significance of this
condition for the patient and the relatives.

4. Outline the possible complications of anaesthesia with a patient in the prone position.

5. What is the normal glucocorticoid response to surgery? Outline, with reasons, your perioperative
corticosteroid regimens in patients:
a) taking steroids at the time of surgery;
b) who have stopped taking steroids several months previously.

6. How do you confirm that a double-lumen endobronchial tube has been placed correctly? Outline
the possible complications associated with the use of this equipment.

SECTION B (Book B)

7. What are the principles of cancer pain management?

8. Outline your technique for percutaneous tracheostomy with particular reference to the anatomy
involved. List the possible complications of this procedure.

9. A surgeon is attempting an inguinal herniorrhaphy in a fit obese young man under local anaesthetic
infiltration that is proving inadequate and asks for your help. What anaesthetic strategies are
available for managing this situation?

10 What are the principles of adult cardio-pulmonary bypass? What are the common complications of
this procedure?

11. What are the risks for patients associated with the administration of general anaesthesia in the
dental surgery? How may these risks be reduced?

12. Write short notes , with reasons, on your anaesthetic management of emergency Caesarean
section for cord-prolapse in a fit 21 year old primagravida.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

2nd November 1999

9.30am to 12.30pm

CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:

Questions numbered ONE TO SIX must be answered in Book A.
Questions numbered SEVEN TO TWELVE must be answered in Book B.

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)

1. A 70 year old man is to undergo an above knee amputation. What can be done to relieve any
pain he may experience thereafter?

2. A 27 year old man is admitted with a fracture of the cervical spine at C5/6. There are no other
injuries. Describe the management of this patient in the first 48 hours after injury.

3. What is the anaesthetic management of pyloric stenosis in a 6 week old child?

4. What are the risks of carotid endarterectomy? How may the anaesthetist reduce these risks?

5 You are asked to investigate the effectiveness of a new anti-emetic agent. Briefly outline the
priniciples which should guide the design of such a study

6. What would make you suspect that a patient had sustained an air embolus during an
anaesthetic? How should this situation be managed?

SECTION B (Book B)

7. What factors contribute to postoperative cognitive deficits in elderly surgical patients? How
may these risks be minimised?

8. What factors determine the rate of haemoglobin desaturation during a failed intubation? What
can be done to maintain oxygenation in this situation?

9. List the predisposing factors for aspiration of gastric contents during general anaesthesia.
How can the risk of this complication be minimised? How should it be treated?

10. What are the advantages of retaining motor power in a woman having an epidural for a
normal labour? How can this be achieved and what would you check before allowing the woman to
get out of bed?

11. Classify the types of heart block. Outline appropriate treatment in the intraoperative period.

12. How would you manage the transfer of a patient to a regional neurosurgical unit for
evacuation of an extradural haematoma?

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

18th May 2000

9.30am to 12.30pm
CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:
Questions numbered ONE TO SIX must be answered in Book A.
Questions numbered SEVEN TO TWELVE must be answered in Book B.

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)
1. A 70 year old man with chronic obstructive airways disease requires a transurethral resection
of the prostate. Outline the advantages and disadvantages of intrathecal block for this patient.

2. What are the problems of monitoring anaesthetised patients in the magnetic resonance
imaging unit?

3. What is the differential diagnosis of persistent headache in the puerperium of a woman who
has undergone a regional anaesthetic technique? Describe the distinguishing clinical features of
each cause.

4. How can jugular venous bulb oxygen saturation be measured? What factors cause its value
to increase or decrease?

5. How may coagulation be assessed in the perioperative period?

6. Describe the anatomy of the coeliac plexus. What are the indications for its therapeutic
blockade?
SECTION B (Book B)

7. What are the advantages and disadvantages of day case anaesthesia in patients aged more
than 80 years?

8. What is the role of the laryngeal mask airway in the management of difficult intubation?

9. A patient who is HIV sero-positive is scheduled to undergo a laparotomy. Discuss the factors
determining the risk of transmission to theatre staff. How can this risk be reduced?

10. Describe your procedure for cardiac life support of a child aged 5 years.

11. Outline your management of a patient with status asthmaticus who is brought into the A&E
Department.

12. List, with a brief statement on the effectiveness of each one, the methods described for
detecting awareness during anaesthesia.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

31st October 2000

9.30am to 12.30pm
CANDIDATES ARE REQUIRED TO ANSWER ALL TWELVE QUESTIONS:
Questions numbered ONE TO SIX must be answered in Book A.
Questions numbered SEVEN TO TWELVE must be answered in Book B.

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)

1. Outline the key points in the management of a patient with massive haemorrhage.

2. What diagnostic features would lead you to identify malignant hyperthermia during and
immediately after anaesthesia of an adolescent presenting for appendicectomy.

3. Write brief notes on the physiological responses that constitute the stress response to surgery.

4. How does a rotameter flowmeter work? Describe its advantages and limitations.

5. What safety features should be incorporated into an intravenous patient controlled analgesia
(PCA) system and what is the purpose of each? What instructions would you give to the nursing
staff, having set up the PCA?

6. 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.

SECTION B (Book B)

7. You anaesthetised a sixty-four year old man for removal of a protruding cervical disc C4/5. The
patient was found to be quadriplegic in recovery. Discuss the likelihood of this being a
consequence of your anaesthetic.

8. Discuss the perioperative management of the blood pressure of a patient undergoing removal of a
phaeochromocytoma.

9. What are the main points that you would include in a patient information leaflet that you would
submit to support an application to your local ethics committee to study a new non-depolarising
muscle relaxant?

10. Describe the diagnosis and immediate assessment of a patient with smoke inhalation injury.

11. Describe the anatomy of the nerves involved for neural conduction blockade at the ankle.

12. A sixty-five year old diabetic female is to undergo a total abdominal hysterectomy. She is
normally controlled by oral hypoglycaemic drugs. Describe your perioperative management
of her blood sugar.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

Tuesday 15th May 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.Describe the diagnosis and management of venous thromboembolism.

2. Outline the anaesthetic management of an adult patient who requires surgery for a strangulated
inguinal hernia. He suffers from obstructive sleep apnoea.
3. Outline the early management of a one year old child with 25% burns caused by scalding.

4. How would you recognise that a patient has regurgitated during an anaesthetic administered using
a laryngeal mask airway? How would you manage the problem?

5. What is an appropriate intervertebral space at which to insert a spinal needle to administer a

subarachnoid anaesthetic for a Caesarean section? Give your reasons and describe how you would
locate the space.

6. Outline the methods of estimation of arterial pCO2 and their limitations.

SECTION B (Book B - Pink)

7. What are the therapeutic uses of magnesium and how does it work?

8. What are the possible causes of intra-operative myocardial ischaemia in a 65 year old male
undergoing major intra-abdominal surgery? Outline how the incidence of these may be minimised.

9. How can ultrasound be useful in anaesthesia and intensive care medicine?

10. When obtaining consent for an epidural for a primigravida in labour, what complications do you
mention? Quote their incidence if known. What can be done to reduce the likelihood of these
problems?

11. Describe the criteria and tests for brain stem death. Briefly indicate the neurological basis for
each test.

12. How would you provide optimal pain relief for a 60 year old man undergoing shoulder
replacement?

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

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.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

Tuesday 30th April 2002

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. Draw a diagram of the lumbar plexus. Outline the anatomical basis of a ‘3 in 1’ block. Explain
why the block may fail to provide reliable analgesia for hip surgery?

2. Describe the principles involved in pulse oximetry. What are its limitations in clinical practice?

3. What aims and strategies are emphasised in a "Pain Management Programme"?

4. Discuss methods of applying non-invasive ventilation. What are its uses and benefits?

5. What is meta-analysis? Outline the methodology. How are the results usually presented?

6. A 78 year old male heavy smoker is admitted for laparotomy for his rectal cancer. He is treated
with bendrofluazide and atenolol for hypertension (160/90mm Hg on admission). What specific
actions would you take to improve the chances of a successful outcome.

SECTION B (Book B - Pink)

7. Describe the anaesthetic management of a penetrating eye injury in a screaming 5 year old child.

8. Discuss the reasons for and against the use of nitrous oxide in anaesthetic practice.

9. What is disseminated intravascular coagulation. Discuss its management in the critically ill patient.

10. Write a guideline for reducing and treating post-operative nausea and vomiting.

11. Discuss the principles underlying the anaesthetic management of carotid endarterectomy.

12. List the key clinical features, and commonest causative agents of severe anaphylaxis occurring
during general anaesthesia. Outline its management.

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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION
29th October 2002
9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A(Blue) and Questions numbered 7 - 12 must be answered in
Book B (Pink). Candidates who fail to answer all twelve questions will not pass 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.

SECTION A (Book A - Blue)

1. List the three commonest causes of direct maternal deaths in the United
Kingdom. What anatomical and physiological changes of pregnancy affect your ability to resuscitate a
woman who has suffered cardiovascular collapse at full term?

2. What is pulmonary surfactant? Discuss its production in the lung, mechanism of action and
function. What would be the effect of insufficient pulmonary surfactant?

3. Define contractility. Outline the methods available to the clinician to assess myocardial contractility
in the peri-operative period.

4. A 60 year old smoker requires non-laser surgery to the vocal cords. Outline the various
anaesthetic techniques available, listing advantages and disadvantages of each.

5. Define pressure. List the methods available for measuring systemic arterial blood pressure. Outline
the principles involved in one of the methods listed.

7. Outline the nerve pathways involved in the transmission and perception of a painful stimulus from
the foot.
8.

SECTION B (Book B - Pink)

7. What are the possible deleterious consequences of cardiopulmonary bypass when used in
coronary artery surgery? How may these be reduced?

8. Summarise the peri-operative anaesthetic management of a patient who requires plating of his jaw
fractured in a fight?

9. What are the principles of pain relief after surgery in a drug abuser dependent on opioids?

10. What are the indications for a pre-operative chest radiograph.

11. What do you understand by the term critical incident? Following a critical incident what information
should be recorded? What sequence of events should ensue?

12. Discuss the causes of muscle weakness in a critically ill patient. How would you investigate
them?
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THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION
20th May 2003
9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A(Blue) and Questions numbered 7 - 12 must be answered in
Book B (Pink). Candidates who fail to answer all twelve questions will not pass 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.

SECTION A (Book A - Blue)

1. Discuss the principles of the management of a 25 year old patient with Down’s syndrome, who
requires multiple dental extractions.

2. What is the mode of action of epidural opioids? Discuss the relative merits of epidural fentanyl and
morphine.

3. Discuss the risks and benefits associated with intermittent positive pressure ventilation through a
laryngeal mask airway.

4. What is evidence-based medicine? How would you apply the process to your clinical practice?

5. A patient presents to the pain clinic with low back pain. List the indicators (‘red flags’) that would
alert you to the possibility of serious pathology? In their absence what is the early management of
simple mechanical low back pain?

6. What is ventilator induced lung injury? Explain the relative importance of volutrauma and
barotrauma. What is the practical importance of ventilator induced lung injury?

SECTION B (Book B - Pink)

7. Briefly describe the normal anatomy of the right internal jugular vein (including its important
relationships). What anatomical abnormalities of this vein can make cannulation hazardous or
impossible? Outline the risks associated with cannulation of this vessel and how they can be
minimised.

8. Under what circumstances is myoglobin found in the urine? What are the implications of
myoglobinuria and how is it managed?

9. List the patterns of peripheral nerve stimulation that may be used to monitor non-depolarising
neuro-muscular blockade during anaesthesia. How is each used in clinical practice?

10. A patient with aortic stenosis presents for non-cardiac surgery. What are the clinical features of
aortic stenosis and how would pre-operative investigations influence your peri-operative
management?

11. A 4 year old child who has been knocked unconscious by a blow from a cricket bat arrives at a
paediatric neurosurgical centre. After initial appropriate management a CT scan shows an extradural
haematoma. There are no other injuries. Discuss the subsequent management.

12. How may unintended peri-operative hypothermia harm patients?

FINAL FRCA
THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION
23rd October 2003
9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 6 must be
answered in Book A(Blue) and Questions numbered 7 - 12 must be answered in
Book B (Pink). Candidates who fail to answer all twelve questions will not pass 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.

Section A (Book A Blue)

1 Describe the arterial blood supply to the spinal cord. How may it be compromised?

2 Describe how and why a vaporiser delivering desflurane is different from one delivering
isoflurane.

3 You are called to the A and E department to review a 4 year old child who requires intubation.
She has a clinical diagnosis of meningococcal sepsis. She has reduced consciousness and a
petechial rash. Describe your immediate management.

4 What are the potential causes of delayed resumption of spontaneous ventilation after major intra-
abdominal surgery with general anaesthesia? Discuss prevention, diagnosis and management.

5 What are the functions of cyclo-oxygenase (COX) enzymes? How are the side effects of
nonsteroidal anti inflammatory drugs related to inhibition of these enzymes?

6 What are the risks and benefits of thoracic epidural anaesthesia/analgesia for coronary artery
surgery?

Section B (Book B Pink)

7 List the bedside tests available to predict a difficult intubation. Comment on their usefulness.

8 Draw the following diagrams (with values): A spirometer trace showing normal lung volumes,
FEV1/FVC graphs and flow volume loops. How are these altered by the following diseases:
asthma, emphysema, pulmonary fibrosis, chest wall restriction and respiratory muscle disease?

9 What are the limitations and risks of intra-arterial pressure monitoring in the critically ill? How may
these be minimised?

10 What potential problems and risks do you consider when planning the anaesthetic management
of the delivery of twins?

11 Relate the clinical use of thiopentone and propofol to their pharmacological properties.

12. Outline the pathology of acute coronary syndromes. What pharmacological treatments are
available for patients with an acute coronary syndrome?
FINAL FRCA
THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION
11th May 2004
9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 3 must be
answered in Book A(Blue), Questions numbered 4 - 6 must be answered in Book B (Pink),
Questions 7 - 9 in Book C(Green)and Question 10 - 12 in Book D(Yellow). Candidates who fail to
answer all twelve questions will not pass the Examination.
An Examiners will be present during the time allowed for the paper, for consultation in case any
question should not appear clear.

SECTION A (Book A - Blue)

1. Describe two adjoining mid-lumbar vertebrae. Include the joints, their nerve supply and the
ligaments.

2. Describe the pre-operative assessment and preparation specific to an adult patient who
requires a thoraco-abdominal oesophagectomy ? Describe your anaesthetic plan for this
operation.

3. What are the indications and contra-indications for the use of an arterial tourniquet?
What complications may arise from the use of such a tourniquet ?

SECTION B(Book B - Pink)

4. Define capnography.
Draw and label a normal capnograph trace.
Why is capnography useful during general anaesthesia ?
Give examples of abnormal traces and their causes.

5. What procedures are associated with venous gas embolism ?

How can it be detected?
What are the effects of a large venous gas embolus? Describe its management.

6. What advice, for and against, would you give a primagravida who is asking if she might eat
and drink during her labour ?
Give reasons.

SECTION C (Book C - Green)

7. Outline the pharmacology and clinical use of low molecular weight heparins for prophylaxis
against deep vein thrombosis.

8. List the causes of perioperative atrial fibrillation.

What are the dangers of acute onset atrial fibrillation.?
How would you manage acute atrial fibrillation in the postoperative period?

9. What problems are associated with anaesthesia for elective surgery in a patient with dialysis-
dependent renal failure ?

SECTION D (Book D - Yellow)

10. List the indications and contraindications for Transcutaneous Electrical Nerve Stimulation
(TENS) ?
What does the patient need to know when using a TENS machine ?

11. Outline, with reasons, your peri-operative management of an otherwise healthy 4 year old
admitted for tonsillectomy.

12. Define transfusion related acute lung injury (TRALI)?

Discuss its pathogenesis, presentation, management and outcome.
FINAL FRCA

THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS
FINAL EXAMINATION
26th October 2004
9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 3 must be
answered in Book A (Blue), 4 - 6 in Book B(Pink), 7 - 9 in Book C (Green) and 10 - 12 in Book D
(Yellow). Candidates who fail to answer all twelve questions will not pass the Examination. All
12 questions carry equal marks. In multipart questions, the examiners have indicated the way in which
marks are allocated by providing the maximum percentage mark available at the end of the part.
Candidates are advised to allocate their time following this guidance. Candidates are informed that an
examiner will be present during the time allowed for this paper, for consultation in case any question
should not appear clear.

SECTION A (Book A - blue)

Q 1] A patient is mechanically ventilated for acute lung injury in the ICU. Explain what practical
steps you would take to turn the patient from the supine to the prone position. (70%)
List three common acute complications of the prone position. (30%)

Q 2] A comatose, ventilated patient who has a head injury has an intracranial pressure of 35
mmHg. His CT scan excludes a surgically reversible cause. What immediate steps would you
take to assess and treat the patient?

Q 3] List the radiological investigations that are available to help exclude an unstable cervical spine
injury in an unconscious, ventilated adult with multiple severe injuries. (25%)
What are the limitations of each technique? (75%)

SECTION B (Book B - pink)

Q 4] What are the indications for a popliteal fossa block? (10%)

List the nerves that are affected and describe their cutaneous innervation. (35%)
What responses would you get on stimulating these nerves? (25%)
Briefly describe one technique for performing this block. (30%)

Q 5] Compare the electrolyte content and osmolality of 0.9% sodium chloride (Normal Saline) and
compound sodium lactate solution (Hartmann’s). (40%)
Why might compound sodium lactate solution be a better crystalloid replacement fluid than
0.9% sodium chloride? (40%)
Explain the effects of a large infusion of 0.9% sodium chloride on acid base balance and
electrolytes. (20%)

Q 6] An obese 70 year old man underwent an emergency abdominal aortic aneurysm repair
yesterday evening. He is known to be a heavy smoker and is a treated hypertensive. He has
been cardiovascularly stable overnight and is responding appropriately. Propofol and morphine
infusions are stopped with a view to extubation. Agitation, tachycardia (heart rate 130) and
hypertension develop (250/90 mmHg).
List the factors that could be important in precipitating this response. (40%)
Briefly outline your further management in ICU of these factors. (60%)

cont.overleaf
 SECTION C (Book C - green)

Q 7] List the classes, with an example of each, of a) anticoagulants (20%) and b) antiplatelet drugs
(20%) in current clinical practice.
How would you minimise the incidence of bleeding and haematoma formation associated with
epidural anaesthesia in patients taking each of these drugs? (60%)

Q 8] A patient on the ICU, who had cardiac surgery completed 3 hours ago, is still intubated.
What clinical features might suggest the development of acute cardiac tamponade? (55%)
How might you confirm the diagnosis? (5%)
Outline your management of acute cardiac tamponade? (40%)

Q 9] You are asked to anaesthetise an 5 year old child (weight 20 kg) for an emergency
appendicectomy. Describe in detail the induction of anaesthesia with special reference to:-
Fluid management (20%)
The airway (50%)
Drug management, including doses (30%)

SECTION D (BOOK D - yellow)

Q 10] Define primary post partum haemorrhage (10%)

List the pharmacological agents that may be used post partum to reduce uterine atony and
any precautions with their use. (50%)
Outline the management of a significant primary postpartum haemorrhage. (40%)

Q 11] What factors contribute to intravenous drug errors in anaesthetic practice? (40%)
What strategies are available to reduce the incidence of such errors? (60%)

Q 12) What are the presenting clinical features of infective endocarditis? (40%)
What are the principles that guide the use of antibiotics as prophylaxis against this condition
during surgery? (60%)
FINAL FRCA

THE ROYAL COLLEGE OF ANAESTHETISTS

DIPLOMA OF FELLOW OF THE ROYAL COLLEGE OF ANAESTHETISTS

FINAL EXAMINATION

17th May 2005

9:30am to 12:30pm

Candidates are required to answer all twelve questions. Questions numbered 1 - 3 must be
answered in Book A (Blue), 4 - 6 in Book B (Pink), 7 - 9 in Book C (Green) and 10 - 12 in Book D
(Yellow). Candidates who fail to answer all twelve questions will not pass the Examination. All
12 questions carry equal marks. In multipart questions, the examiners have indicated the way in which
marks are allocated by providing the maximum percentage mark available at the end of the part.
Candidates are advised to allocate their time following this guidance. Candidates are informed that an
examiner will be present during the time allowed for this paper for consultation in case any question
should not appear clear.

SECTION A (Book A - blue)

1. How is ventilator-associated pneumonia (VAP) diagnosed? (20%)

Explain the physical (50%), positional (15%) and pharmacological (15%) strategies that have been
advocated for its prevention?

2. What is the physiological basis of preoxygenation for anaesthesia? (40%)

Describe a method of preoxygenation and how you would assess its adequacy. (35%)
What are the advantages and disadvantages of preoxygenating a fit adult? (25%)

3. Describe two assessment tools used for the measurement of acute pain in adults. (30%)
Describe the McGill pain questionnaire used to assess chronic pain. (20%)
Include the strengths and weaknesses of each of the above. (30%)
Why do assessment tools used in acute and chronic pain differ? (20%)

SECTION B (Book B - pink)

4. List the nerves which supply the eye and its muscles. Briefly describe the relevant function of each
nerve. (40%)
What specific considerations would you take into account when providing general anaesthesia for
adult vitreo-retinal surgery? (60%)

5. An otherwise fit patient requires nephrectomy for a large solitary renal tumour.
What surgical factors might influence your conduct of the anaesthetic?

6. What perioperative measures can be taken to minimize non-autologous red cell transfusion in a
patient undergoing elective surgery?

SECTION C (Book C - Green)

7. What are the endocrine causes of secondary hypertension? (25%)
What is the pharmacological management of each of these endocrine conditions? (35%)
State the mechanism of action of each drug. (40%)

8. Which patients are at increased risk of infection related to an epidural catheter? (30%)
What symptoms and signs suggest the development of an epidural abscess? (30%)
What investigations would be definitive in initiating further management? (20%)
What should this be? (20%)
9. What are the important organisational (40%) and clinical (60%) factors which govern the
anaesthetic management of patients over 80 years of age?

SECTION D (Book D - Yellow)

10. A one day old term neonate has arrived at your regional paediatric intensive care unit. A
congenital diaphragmatic hernia has been diagnosed. The baby is already intubated and receiving
artificial ventilation.
Outline, with reasons the principles of preoperative management.

11. You are asked to see a 45 year old man in the Emergency Department who has suffered 30%
burns.
What factors in the history would suggest that he has suffered a significant inhalational injury? (25%)
What symptoms, signs and results of laboratory tests would confirm your suspicions? (75%)

12. An adult patient requires insertion of a chest drain for management of a spontaneous
pneumothorax. The patient is not in acute distress.
Describe your technique for insertion of a chest drain in this patient. (50%)
The diagram shows an underwater seal device. Comment on its suitability for connection to the drain
you have inserted. (50%)

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