The Final FRCA Short Answer Questions: A Practical Study Guide PDF
Preview The Final FRCA Short Answer Questions: A Practical Study Guide
The Final FRCA Short Answer Questions A Practical Study Guide Elizabeth Combeer Consultant Anaesthetist Frimley Health NHS Foundation Trust Illustrations by Paul Hatton CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2019 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-138-49932-4 (Paperback); 978-1-138-49939-3 (Hardcover) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the valid- ity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including pho- tocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright .com (http:// www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com CONTENTS LIST OF ABBREVIATIONS v PASSING THE FINAL SAQ ix ACKNOWLEDGEMENTS xiii 1. Neurosurgery, neuroradiology and neurocritical care 1 2. Cardiothoracic surgery 23 3. Airway management 47 4. Critical incidents 53 5. Day surgery 73 6. General, urological and gynaecological surgery 77 7. Head, neck, maxillo-facial and dental surgery 99 8. Management of respiratory and cardiac arrest 109 9. Non-theatre 111 10. Orthopaedic surgery 117 11. Perioperative medicine 121 12. Regional anaesthesia 141 13. Sedation 153 14. Trauma and stabilisation 155 15. Intensive care medicine 165 16. Obstetrics 197 17. Paediatrics 223 18. Pain medicine 245 19. Ophthalmic 267 20. Plastics and burns 269 21. Vascular surgery 273 22. Anatomy 281 23. Applied clinical pharmacology 283 24. Applied physiology and biochemistry 293 25. Physics and clinical measurement 309 26. Statistical basis of trial management 325 Index 327 iii http://taylorandfrancis.com LIST OF ABBREVIATIONS 2,3DPG 2,3 diphosphoglycerate A-a Alveolar-arterial AAA Abdominal aortic aneurysm AAGBI Association of Anaesthetists of Great Britain and Ireland ABG Arterial blood gas ACE Angiotensin converting enzyme ADP Adenosine diphosphate ALS Adult life support ALT Alanine transaminase APL Adjustable pressure limiting ARDS Acute respiratory distress syndrome ASA American Society of Anesthesiologists ATP Adenosine triphosphate AVPU Alert, voice, pain, unresponsive BIS Bispectral index BJA British Journal of Anaesthesia BMI Body mass index BP Blood pressure bpm Beats per minute cAMP Cyclic adenosine monophosphate CBG Capillary blood glucose CCT Certificate of Completion of Training CEACCP Continuing Education in Anaesthesia, Critical Care & Pain CICO Can’t intubate, can’t oxygenate CK Creatine kinase CKD Chronic kidney disease CMV Cytomegalovirus CNS Central nervous system CO Cardiac output COETT Cuffed oral endotracheal tube COX Cyclic oxygenase CPAP Continuous positive airway pressure CRP C-reactive protein CSF Cerebrospinal fluid CT Computed tomography CVC Central venous catheter CVP Central venous pressure CXR Chest radiograph DAS Difficult Airway Society DIC Disseminated intravascular coagulation DVT Deep vein thrombosis EBV Epstein–Barr virus v List of AbbreviAtions ECG Electrocardiogram Echo Echocardiogram ECMO Extracorporeal membrane oxygenation EEG Electroencephalogram eGFR Estimated glomerular filtration rate ENT Ear, nose and throat ERCP Endoscopic retrograde cholangiopancreatography ESR Erythrocyte sedimentation rate etCO End-tidal carbon dioxide 2 ETT Endotracheal tube EVAR Endovascular aneurysm repair FEV Forced expiratory volume in 1 second 1 FiO Fraction of inspired oxygen 2 FRC Functional residual capacity GA General anaesthetic GCS Glasgow Coma Scale GGT Gamma-glutamyl transferase GMC General Medical Council HIV Human immunodeficiency virus HSV Herpes simplex virus IASP International Association for the Study of Pain ICP Intracranial pressure ICU Intensive care unit INR International normalised ratio IQ Intelligence quotient iv Intravenous IVC Inferior vena cava ivi Intravenous infusion JVP Jugular venous pressure LMA Laryngeal mask airway LSCS Lower segment caesarean section LVEDP Left ventricular end-diastolic pressure M&M Morbidity and mortality MAC Minimum alveolar concentration MAP Mean arterial pressure MDI Metered dose inhaler MEOWS Modified Early Obstetric Warning Score MRI Magnetic resonance imaging NHS National Health Service NICE National Institute for Health and Care Excellence NMBD Neuromuscular blocking drug NMDA N-methyl-D-aspartate NPSA National Patient Safety Agency NSAIDs Non-steroidal anti-inflammatory drugs OAA Obstetric Anaesthetists’ Association ODP Operating Department Practitioner PaCO Partial pressure of carbon dioxide in arterial blood 2 PACU Post-anaesthetic care unit PaO Partial pressure of oxygen in arterial blood 2 PCA Patient controlled analgesia PCR Polymerase chain reaction PEA Pulseless electrical activity vvii List of AbbreviAtions PEEP Positive end-expiratory pressure PEG Percutaneous endoscopic gastrostomy PEJ Percutaneous endoscopic jejunostomy PONV Postoperative nausea and vomiting RSI Rapid sequence induction S1Q3T3 S wave in lead 1, Q wave and inverted T wave in lead 3 SAD Supraglottic airway device SIRS Systemic inflammatory response syndrome SVR Systemic vascular resistance SVRI Systemic vascular resistance index TCI Target controlled infusion TENS Transcutaneous electrical nerve stimulation TIVA Total intravenous anaesthesia TNF Tumour necrosis factor VATER Syndrome of vertebral, cardiac, renal and limb anomalies, tracheo-oesophageal fistula, and anal atresia vCJD Variant Creutzfeldt–Jakob disease VF Ventricular fibrillation VRIII Variable rate intravenous insulin infusion VT Ventricular tachycardia V/Q Ventilation:perfusion WHO World Health Organisation vviiii http://taylorandfrancis.com PASSING THE FINAL SAQ These are my top tips for approaching the Final SAQ. They are based on what I find myself saying repeatedly at weekly teaching with the trainees at Frimley. Print Off a Copy of the Syllabus Both basic and intermediate-level syllabi are tested in the Final. I know these are dauntingly large documents, but it really is important that you understand the breadth of what you need to learn, and looking at these helps you direct your reading. Revision for subspecialties such as burns, cardiothoracics, neuro, paediatrics and obstetrics can largely be covered by searching for CEACCP/BJA Education articles that relate to the specified learning objectives. In this way, you will be learning the College-approved facts on the subject. There is also a very strong link between topics addressed in the exam and topics that have been featured in these articles within the preceding two years. Every time you do some revision that relates to something in the syllabus, cross it off. Remember that a broad understanding is more important than learning a few topics in great detail. Three Types of Questions There are three main types of questions in the Final SAQ. Firstly, there are those that relate to new guidance or reports (such as National Audit Projects or National Institute for Health and Care Excellence guidance). Secondly, there are the questions that test knowledge of the manner of anaesthesia provision for specific operations or in particular situations. The third group assesses knowledge of how particular patient conditions impact on anaesthesia management. Make sure you decide what group each question you encounter falls into as it will impact on your approach to answering it. Questions Relating to New Guidance or Reports Questions based on these topics tend to appear within two years of their publication. Search the likely websites (Royal College of Anaesthetists, Difficult Airway Society, Obstetric Anaesthetists’ Association, NICE, Association of Anaesthetists of Great Britain and Ireland) and be aware of new national guidelines that are implemented in your place of work. Also, be aware of topical causes of medical error, such as new additions to the list of never events that are relevant to anaesthesia, and statements and alerts from the Safe Anaesthesia Liaison Group. Think about the impact of these guidelines at the organisational level, not just at the point of delivery of anaesthesia. Questions Relating to Anaesthetic Management of a Specific Operation or Situation This includes questions about nerve blocks as well. Nerve blocks have peaks of popularity, and the timing of inclusion of questions about them in the SAQ reflects this. Remember to learn the specific complications of such blocks, not just ‘bleeding, infection, nerve damage.’ It is by listing the specific complications that you demonstrate that you actually know the relevant anatomy. ix
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