The Final FRCA Structured Oral Examination : A Complete Guide

435 Pages·2016·21.019 MB·English

by  Bobby Krishnachetty, Darshinder Sethi

The Final
FRCa
Structured Oral examination – a Complete Guide
BOBBy KRiShnaCheTTy
and
DaRShinDeR SeThi
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CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2016 by Bobby Krishnachetty and Darshinder Sethi
CRC Press is an imprint of Taylor & Francis Group, an Informa business
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Printed on acid-free paper
Version Date: 20150710
International Standard Book Number-13: 978-1-909368-25-5
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The information or guidance contained in this book is intended for use by medical, scientific or health-
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CoNTENTS
FoREWoRD vii
PREFACE ix
LIST oF CoNTRIBUToRS xi
ACKNoWLEDGEMENT xii
INTRoDUCTIoN xiii
section 01
clinical Viva 1
01.1 Long case: Epilepsy and learning difficulties 2
01.2 Short case: Complete heart block 7
01.3 Short case: Nutrition in ICU 11
01.4 Short case: Electroconvulsive therapy 14
Basic science Viva 19
01.5 Anatomy: Liver and spleen 20
01.6 Physiology: Brainstem death 26
01.7 Pharmacology: Anaesthesia in Parkinson’s disease 30
01.8 Physics: Magnetic resonance imaging 33
section 02
clinical Viva 37
02.1 Long case: Foreign body aspiration in a child 38
02.2 Short case: Anaesthesia for lung resection 42
02.3 Short case: Amniotic fluid embolism 45
02.4 Short case: Postoperative eye pain 47
Basic science Viva 51
02.5 Anatomy: Spinal cord blood supply 52
02.6 Physiology: Pneumoperitoneum 56
02.7 Pharmacology: Drugs used in malignancy 58
02.8 Physics: Sodalime 61
section 03
clinical Viva 65
03.1 Long case: Pregnant woman with diabetic ketoacidosis 66
03.2 Short case: ICU weakness 72
03.3 Short case: Consent issues 75
03.4 Short case: WPW syndrome 78
iii
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CONTENTS
Basic science Viva 81
03.5 Anatomy: Cranial nerve monitoring 82
03.6 Physiology: Apnoea physiology 85
03.7 Pharmacology: Comparing volatile agents 87
03.8 Physics: Intracranial pressure monitoring 89
section 04
clinical Viva 93
04.1 Long case: Guillain Barre syndrome 94
04.2 Short case: Intrauterine fetal death 99
04.3 Short case: Eisenmenger’s syndrome 101
04.4 Short case: Myotonic dystrophy 104
Basic science Viva 107
04.5 Anatomy: Mediastinum 108
04.6 Physiology: Cerebral circulation 110
04.7 Pharmacology: Serotonin 112
04.8 Physics: Monitoring in scoliosis surgery 115
section 05
clinical Viva 119
05.1 Long case: Abdominal aortic aneurysm for EVAR 120
05.2 Short case: Fracture mandible 127
05.3 Short case: Rheumatoid arthritis 130
05.4 Short case: Inadvertent dural puncture 134
Basic science Viva 137
05.5 Anatomy: Caudal block 138
05.6 Physiology: Preeclampsia 142
05.7 Pharmacology: Tricyclic antidepressants 147
05.8 Physics: osmolarity 149
section 06
clinical Viva 151
06.1 Long case: Pregnant woman with aortic stenosis 152
06.2 Short case: Hoarseness and microlaryngoscopy 161
06.3 Short case: Head injury 164
06.4 Short case: Chronic obstructive pulmonary disease 168
Basic science Viva 171
06.5 Anatomy: Coronary circulation 172
06.6 Physiology: Liver disease 177
06.7 Pharmacology: Drugs used for secondary prevention 180
06.8 Physics: Scavenging 182
iv
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CONTENTS
section 07
clinical Viva 185
07.1 Long case: Child for fundoplication 186
07.2 Short case: Epidural abscess 192
07.3 Short case: Cardiomyopathy 194
07.4 Short case: Autonomic dysreflexia 200
Basic science Viva 203
07.5 Anatomy: Pleura 204
07.6 Physiology: Denervated heart 209
07.7 Pharmacology: Hypotensive drugs 213
07.8 Physics: Renal replacement therapy 217
section 08
clinical Viva 221
08.1 Long case: Patient with valve replacements for urgent surgery 222
08.2 Short case: Supraventricular tachycardia 230
08.3 Short case: Cystic fibrosis 233
08.4 Short case: Pneumothorax 236
Basic science Viva 239
08.5 Anatomy: Pituitary 240
08.6 Physiology: Ventilator associated pneumonia 247
08.7 Pharmacology: Anticholinesterase 250
08.8 Physics: Humidity/temperature 253
section 09
clinical Viva 257
09.1 Long case: Acute cervical spine subluxation 258
09.2 Short case: Diseases of red cell morphology 264
09.3 Short case: Permanent pacemaker 269
09.4 Short case: Bleeding tonsil 271
Basic science Viva 275
09.5 Anatomy: Paravertebral block 276
09.6 Physiology: Pulmonary hypertension 282
09.7 Pharmacology: Target controlled infusion 285
09.8 Physics: Cardiac output monitoring 289
section 10
clinical Viva 293
10.1 Long case: Mediastinal mass 294
10.2 Short case: Preoperative anaemia 301
10.3 Short case: Cholesteatoma 304
10.4 Short case: Cardiac risk stratification 306
v
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CONTENTS
Basic science Viva 309
10.5 Anatomy: Intraosseous anatomy 310
10.6 Physiology: Chronic regional pain syndrome 314
10.7 Pharmacology: Anticoagulants and bridging 317
10.8 Physics: Peripheral nerve monitoring 319
Appendix 1 323
Appendix 2 345
Appendix 3 373
Appendix 4 379
Appendix 5 383
Appendix 6 391
index 399
vi
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FoREWoRD
The Structured oral Examination (SoE) has undergone considerable development since
it was introduced more than a decade ago. It is intended to test an understanding of safe
practice of anaesthesia. This component of the FRCA examination process combines a vast
curriculum of clinical anaesthesia with the clinical application of basic sciences. Add the
daunting task of facing unknown examiners in the viva, and this proves to certainly be the
biggest professional challenge that any aspiring anaesthetist would have been confronted
with, up to that stage in their career.
Good preparation for the examination is crucial to a successful outcome. Answering
intimidating questions while thinking on one’s feet, does not come naturally for any
candidate, and has to be practiced. This exam preparation book, The Final FRCA Structured
Oral Exam – a Complete Guide, is exactly what its name says. This is an excellent guide to
polish the candidate who has successfully passed their written exams.
The editors of this book, Bobby Krishnachetty and Darshinder Sethi, are both College
Tutors for the Royal College of Anaesthetists, and are well-experienced leaders in trainee
education and preparation of candidates for FRCA Exams. In addition, the other contributors
to the book are all young anaesthetists who have recently been exposed to the challenge
of the FRCA SoE. This group is therefore perfectly equipped to share their important
examination preparation experience.
Together they have compiled this book comprising ten sections, over a wide range of
possible examination topics. Each section starts with a long clinical case followed by three
different short scenarios. A viva section then follows, with four topics covering applied
anatomy, physiology, pharmacology, and physics/monitoring. The case scenarios as well
as the viva topics are problem-based and supported by evidence. All the section topics
are presented with numerous possible examination questions, accompanied by well-
prepared answers. Plenty of basic diagrams and special investigations are included, which if
reproduced during the real exam, will definitely impress any examiner.
A real valuable resource is the six appendices covering such important areas like ECG
interpretation, patient risk scoring systems, as well as risk stratification indices, and blood
result interpretation. In addition there is one appendix with a list and short explanation of
recent important clinical trials, which when quoted during the exam, will definitely have a
positive influence on examiner judgment!
The SoE arrives rapidly after the FRCA written examination and time to revise the full
syllabus is limited. I believe that the educational material in this book is up-to-date, and
presented in such a way that it will identify gaps in areas of clinical knowledge. It provides the
candidate with the important practice of answering appropriate, but uncomfortable questions.
I can strongly recommend this book to both teacher and candidate preparing for the FCA SoE.
Justiaan swanevelder
Professor and Head of Department of Anaesthesia
Health Sciences Faculty
University of Cape Town
South Africa
Previous Examiner for Royal College of Anaesthesia Primary and
Final Examinations – 2003–2012
Present Examiner for the Faculty of Anaesthesia,
College of Medicine of South Africa – 2012–present
vii
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PREFACE
We have conducted the Darent Final FRCA course in Kent for 3 years, and it was during this
period that we felt motivated to write this book as a way of contributing to a wider audience
preparing for the exam. We have collected a vast database of questions from our trainees
who sit the exam, and the book reflects a variety of commonly asked themes.
The style of questions mimics the exam, and we have added tutorials for ECG
interpretation and radiology, which will benefit trainees immensely in their preparation.
We have spent several months researching the subject material in an effort to make it as
evidence-based and the references as up-to-date as possible. We would like to express
our gratitude and appreciation to our colleagues who have contributed to the publication of
this book.
We sincerely hope this book will be a valuable addition to the FRCA exam preparation and
that anaesthetic trainees will find the book highly useful.
BK
DSS
ix
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