The Structured Oral Examination in Clinical Anaesthesia PDF
Preview The Structured Oral Examination in Clinical Anaesthesia
FRCA viva cover.qxd 03/04/2009 14:36 Page 1 T h e S t This book comprises ten complete sets of examination papers, each of which ru c tu The Structured Oral includes structured questions in clinical anaesthesia and clinical science. The re d clinical anaesthesia section is composed of one long case and three short O ra cases. For each long case clear candidate information and relevant clinical l E x Examination in Clinical a material have been presented. The clinical science section is composed of m in four key topics, one each from applied anatomy, physiology, pharmacology a t io and clinical measurement. Within the basic science component there is an n in ANAESTHESIA emphasis on application to clinical practice. C lin ic a Clinical scenarios are included as an introduction to questions in all sections, l A n a enabling the candidates to assess their problem-solving ability. In both e s t h sections the answers are presented clearly and thoroughly, and explained with e s ia simple illustrations and many tables. - P ra c t ic This book is essential study material for candidates sitting senior anaesthetic e e x postgraduate examinations, and enables them to understand their strengths a m and weaknesses in areas of clinical knowledge, clinical skills, technical skills, in a t problem solving, organisation and planning. With thorough revision of this io n p book, candidates can enter these exams with confidence. It is an invaluable a p e educational resource for all anaesthetists, and especially so for those involved rs with training. Practice examination papers ISBN 978-1-903378-68-7 f Cyprian Mendonca, Carl Hillermann t m 9 781903 378687 Josephine James, GS Anil Kumar prelims_prelims.qxd 19-04-2013 19:15 Page i i The Structured Oral Examination in Clinical A N A E S T H E S I A Practice examination papers Cyprian Mendonca, Carl Hillermann Josephine James, GS Anil Kumar prelims_prelims.qxd 19-04-2013 19:15 Page ii ii The Structured Oral Examination in Clinical Anaesthesia Practice examination papers tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5 6LX, UK. Tel: +44 (0)1952 510061; Fax: +44 (0)1952 510192 E-mail: [email protected]; Web site: www.tfmpublishing.com Design & Typesetting: Nikki Bramhill BSc Hons Dip Law First Edition: © May 2009 Background cover image© Comstock Inc., www.comstock.com Paperback ISBN: 978-1-903378-68-7 E-book editions: 2013 ePub ISBN: 978-1-908986-45-0 Mobi ISBN: 978-1-908986-46-7 Web pdf ISBN: 978-1-908986-47-4 The entire contents of ‘The Structured Oral Examination in Clinical Anaesthesia Practice examination papers’ is copyright tfm Publishing Ltd. Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, digital, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher. Neither the authors nor the publisher can accept responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein. Neither can they accept any responsibility for errors, omissions or misrepresentations, howsoever caused. Whilst every care is taken by the authors and the publisher to ensure that all information and data in this book are as accurate as possible at the time of going to press, it is recommended that readers seek independent verification of advice on drug or other product usage, surgical techniques and clinical processes prior to their use. The authors and publisher gratefully acknowledge the permission granted to reproduce the copyright material where applicable in this book. Every effort has been made to trace copyright holders and to obtain their permission for the use of copyright material. The publisher apologizes for any errors or omissions and would be grateful if notified of any corrections that should be incorporated in future reprints or editions of this book. Printed by Gutenberg Press Ltd., Gudja Road, Tarxien, PLA 19, Malta. Tel: +356 21897037; Fax: +356 21800069. prelims_prelims.qxd 19-04-2013 19:15 Page iii iii Contents Page ix Preface x Acknowledgements xii Abbreviations SOE 1 1 Clinical Anaesthesia Long case 1 Postoperative hypoxia and renal failure following 1 abdominal aortic aneurysm repair Short cases 1.1: Pyloric stenosis 14 1.2: Difficult airway 20 1.3: Tension pneumothorax 29 Clinical Science Applied anatomy 1.1: Anatomy for ophthalmic anaesthesia 36 Applied physiology 1.2: Pulmonary vascular resistance 44 Applied pharmacology 1.3: Calcium channel blockers 51 Equipment, clinical measurement and monitoring 1.4: Ayre’s T piece 56 prelims_prelims.qxd 19-04-2013 19:15 Page iv iv The Structured Oral Examination in Clinical Anaesthesia Practice examination papers SOE 2 61 Clinical Anaesthesia Long case 2 Peri-operative myocardial infarction in a patient 61 scheduled for a hip hemi-arthroplasty Short cases 2.1: Jehovah’s Witness 75 2.2: Aspiration under general anaesthesia 81 2.3: Emergency Caesarean section 86 Clinical Science Applied anatomy 2.1: Anatomy of the epidural space 91 Applied physiology 2.2: Arterial tourniquet 98 Applied pharmacology 2.3: Patient-controlled analgesia 103 Equipment, clinical measurement and monitoring 2.4: Defibrillator 107 SOE 3 111 Clinical Anaesthesia Long case 3 An elderly lady with cervical spondylosis, rheumatoid arthritis and 111 obstructive sleep apnoea scheduled for a posterior cervical fusion Short cases 3.1: Down’s syndrome 127 3.2: Transurethral resection of the prostate (TURP) 132 3.3: Head injury 141 Clinical Science Applied anatomy 3.1: Pain pathways 147 Applied physiology 3.2: Oxygen delivery 151 Applied pharmacology 3.3: Neuromuscular blocking drugs 160 Equipment, clinical measurement and monitoring 3.4: Capnometry 166 prelims_prelims.qxd 19-04-2013 19:15 Page v v Contents SOE 4 173 Clinical Anaesthesia Long case 4 A young female patient with hyperthyroidism and sickle 173 cell disease scheduled for a subtotal thyroidectomy Short cases 4.1: Latex allergy 189 4.2: Wolff-Parkinson-White (WPW) syndrome 194 4.3: Post-tonsillectomy bleeding 199 Clinical Science Applied anatomy 4.1: Blood supply to the spinal cord 203 Applied physiology 4.2: Physiology of pregnancy 208 Applied pharmacology 4.3: Non-steroidal anti-inflammatory 213 drugs (NSAIDs) Equipment, clinical measurement and monitoring 4.4: 219 Invasive blood pressure measurement SOE 5 227 Clinical Anaesthesia Long case 5 Elective craniotomy for clipping of a cerebral 227 aneurysm in an obese patient Short cases 5.1: Malignant hyperthermia 242 5.2: Guillain-Barre syndrome 247 5.3: Dental anaesthesia 252 Clinical Science Applied anatomy 5.1: Phrenic nerve 258 Applied physiology 5.2: Pre-eclampsia 264 Applied pharmacology 5.3: Remifentanil 271 Equipment, clinical measurement and monitoring 5.4: 276 Monitoring the depth of anaesthesia prelims_prelims.qxd 19-04-2013 19:15 Page vi vi The Structured Oral Examination in Clinical Anaesthesia Practice examination papers SOE 6 283 Clinical Anaesthesia Long case 6 A patient with anaemia and chronic alcohol 283 abuse scheduled for a hernia repair Short cases 6.1: Septic shock 295 6.2: Myasthenia gravis 300 6.3: Epidural abscess 305 Clinical Science Applied anatomy 6.1: Coeliac plexus block 309 Applied physiology 6.2: Cerebral circulation 312 Applied pharmacology 6.3: Respiratory pharmacology 319 Equipment, clinical measurement and monitoring 6.4: 324 Magnetic resonance imaging SOE 7 329 Clinical Anaesthesia Long case 7 A middle-aged man with mania/depression 329 scheduled for a full dental clearance Short cases 7.1: Carotid endarterectomy 341 7.2: Trifascicular heart block 348 7.3: Burns 355 Clinical Science Applied anatomy 7.1: Anatomy of the nose 362 Applied physiology 7.2: Haemorrhagic shock 372 Applied pharmacology 7.3: Alpha-adrenergic blockers 377 Equipment, clinical measurement and monitoring 7.4: 386 Temperature measurement prelims_prelims.qxd 19-04-2013 19:15 Page vii vii Contents SOE 8 393 Clinical Anaesthesia Long case 8 Post partum haemorrhage and postoperative 393 acute respiratory distress syndrome Short cases 8.1: Carcinoid syndrome 405 8.2: Heart transplant 409 8.3: Postoperative confusion 414 Clinical Science Applied anatomy 8.1: Ankle block 418 Applied physiology 8.2: Weaning from ventilation 423 Applied pharmacology 8.3: Post-herpetic neuralgia 428 Equipment, clinical measurement and monitoring 8.4: 433 Measurement of blood gases SOE 9 441 Clinical Anaesthesia Long case 9 An elderly lady with ischaemic heart disease 441 scheduled for an extended colectomy Short cases 9.1: Ulcerative colitis 453 9.2: Intravenous drug abuse 459 9.3: Ruptured abdominal aortic aneurysm (AAA) 464 Clinical Science Applied anatomy 9.1: Brachial plexus block 468 Applied physiology 9.2: Coagulation cascade 475 Applied pharmacology 9.3: Insulin and hypoglycaemic drugs 481 Equipment, clinical measurement and monitoring 9.4: 489 Fibreoptic bronchoscope and sterilisation prelims_prelims.qxd 19-04-2013 19:15 Page viii viii The Structured Oral Examination in Clinical Anaesthesia Practice examination papers SOE 10 497 Clinical Anaesthesia Long case 10 An elderly man with chronic obstructive airway disease 497 (COAD) scheduled for a total knee replacement Short cases 10.1: Aortic stenosis 510 10.2: Laparoscopic Nissen fundoplication 516 10.3: Penetrating eye injury 522 Clinical Science Applied anatomy 10.1: Arterial system of the hand 525 Applied physiology 10.2: Postoperative nausea and vomiting (PONV) 530 Applied pharmacology 10.3: Conscious sedation 536 Equipment, clinical measurement and monitoring 10.4: 541 Physics of ultrasound 549 Section index prelims_prelims.qxd 19-04-2013 19:15 Page ix ix Preface This book consists of ten complete sets of structured oral examination (SOE) papers. Each set is subdivided into two sections: clinical anaesthesia and clinical science. Each clinical anaesthesia section is composed of one long case and three short cases. For each long case clear candidate information and relevant clinical material have been presented. The clinical science section is composed of four key topics, one each from applied anatomy, applied physiology, applied pharmacology and the physics of equipment used in anaesthetic practice. In order to provide additional breadth and depth of knowledge, a further tutorial on the key topic is included. The aim of this book is to help trainees who are sitting their anaesthetic examinations. The book enables candidates to assess their knowledge and skills within certain time limits. A thorough revision of the book should enable the trainee to understand their strengths and weaknesses in areas of clinical knowledge, clinical skills, technical skills, problem solving, organisaton and planning. We are grateful for the feedback and suggestions provided by trainees who attended the examination preparation courses at Coventry. We sincerely hope that the information in this book will be beneficial to trainees in their preparation for postgraduate examinations and competency assessments. We wish you good luck with your revision and the exam. Cyprian Mendonca MD, FRCA, Consultant Anaesthetist University Hospitals Coventry and Warwickshire, Coventry, UK Carl Hillermann FRCA, Consultant Anaesthetist University Hospitals Coventry and Warwickshire, Coventry, UK Josephine James FRCA, Consultant Anaesthetist Heart of England Foundation Trust, Birmingham, UK GS Anil Kumar FCARCSI, Specialist Registrar Warwickshire School of Anaesthesia, UK
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