March 2014

a) List the nuclei of the vagus nerve. (10%)

b) Describe the immediate relations of the right vagus nerve in the neck at C6 (15%) and thorax at T4.(15%)

c) List the branches of the vagus nerve. (30%)

d) Which clinical situations commonly produce vagal reflex bradycardia? (30%)
Pass Rate 44.4%

As in past years, knowledge of anatomy proved generally very poor. Candidates performed better in sections (c) and (d) which were most clinically orientated. Anatomical knowledge is clearly relevant to the invasive procedures undertaken in anaesthetic practice, and possibly vital to the interpretation of images generated by ultrasound devices. Candidates must understand that relevant anatomy will be tested throughout all parts of the Final FRCA examination and should not write the subject off. This question failed to discriminate between generally strong and generally weak candidates due to widely distributed ignorance of the subject matter within the cohort, as was seen with question 8.
March 2013

a) Describe the anatomy of the coeliac plexus. (35%)

b) What are the indications for coeliac plexus block? (15%)

c) List the anatomical approaches used for coeliac plexus block. (10%)

d) Which specific complications are associated with coeliac plexus block? (40%)
36.4% pass rate.

This question was the best discriminator of the paper and proved to be difficult. The anatomy of the coeliac plexus was almost universally answered poorly and one candidate misread the question and wrote an exposition on the cervical plexus! For two marks, any of the following approaches to the coeliac plexus were acceptable: Anterior (retro or transcrural), posterior, trans-aortic, transdiscal and paramedian. There were twelve specific complications of coeliac plexus block in the model answer and only eight were required for full marks.

Specific examples included:
Retroperitoneal bleeding due to aorta or inferior vena cava injury by the needle. Paraplegia from injecting phenol into spinal cord blood supply; CNS damage Intravascular injection into great vessels (should be prevented by checking the needle position with radio-opaque dye).
Generic answers such as local anaesthetic toxicity, painful injection, infection and bleeding were not accepted.
September 2012

a) Describe the innervation of the anterior abdominal wall. (20%)

b) In which types of surgery would a transversus abdominus plane (TAP) block be used and what are
the potential benefits? (25%)

c) Outline how you would perform a TAP block. (40%)

d) What are the specific complications of a TAP block? (15%)
Question 1: Anatomy (innervation of abdominal wall)/TAP block.

67.4% pass rate.

The question was relevant and topical. Many candidates had poor knowledge of the innervation of the anterior abdominal wall. Overall was answered well.
September 2011

a) Which nerves supply sensation to: i) the nasal air passages (10%) ii) the oropharynx (10%) iii) the
larynx? (10%)

b) Outline the techniques for achieving local anaesthesia of these areas? (15%)

c) What are the indications (15%) and contraindications (15%) for awake fibreoptic intubation?

d) List the complications of awake fibreoptic intubation. (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2011

a) Describe the anatomy of the cervical plexus. (40%)

b) How would you perform a superficial cervical plexus block? (25%)

c) A carotid endarterectomy is being performed using a superficial cervical plexus block. A few minutes
after clamping the carotid artery the patient becomes unresponsive to verbal command. Describe your management of this situation. (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

a) Describe the sensory distribution of the trigeminal nerve and outline the course of afferent fibres. (40%)

b) List the typical clinical features of trigeminal neuralgia. (20%)

c) How can trigeminal neuralgia be managed? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) Describe the anatomy of the thoracic paravertebral space. (35%)

b) What are the indications for paravertebral nerve blockade? (25%)

c) List the complications of a paravertebral nerve block. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) Describe the anatomy of an intercostal nerve. (25%)

b) How does this influence your technique of intercostal nerve blockade for a fractured rib? (35%)

c) List the complications that may arise and explain the anatomical reasons for these
complications. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2005

Describe, with the aid of a diagram if you wish, the anatomy of the anterior aspect of the wrist. (50%)
Describe how this knowledge is used to block the nerves on the anterior aspect of the wrist. (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2004

Describe two adjoining mid-lumbar vertebrae. Include the joints, their nerve supply and the ligaments.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

Describe the arterial blood supply to the spinal cord. How may it be compromised?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2003

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.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question