March 2017

  • (a) List the patient related (7 marks) and anaesthetic related (3 marks) risk factors for postoperative nausea and vomiting (PONV) in adult patients.
    (b) What are the unwanted effects of PONV in adults? (6 marks)
    (c) Which non-pharmacological interventions have been shown to be effective in reducing PONV in adults? (2 marks)
    (d) Briefly explain the proposed mechanisms of action of 5HT3 antagonists such as ondansetron when used as anti-emetics. (2 marks)

Pass rate 68.3%
This was one of the 2 easy questions and the pass rate was the second highest overall, as might be expected given the frequency with which PONV occurs. Despite this many candidates had insufficient knowledge of risk factors for PONV and of the non- pharmacological methods that may be used to reduce it. Candidates who scored well had a sensible structured approach to this common problem.
March 2016

  • a)  What are the site of action and the intra and extracellular mechanisms of analgesic effect within the spinal cord following the administration of intrathecal (IT) opioids? (6 marks)
  • b)  List the principal side effects of IT opioids. (7 marks)
  • c)  What factors may increase the risk of postoperative respiratory depression following administration of
    IT opioids? (7 marks)
Pass rate 31.7% It was anticipated that candidates would find this question difficult, and this proved to be the case. Intrathecal opioids are used widely in anaesthetic practice but candidates’ knowledge of their use was poor. Advanced sciences are part of the intermediate curriculum so knowledge of applied pharmacology is expected. Some candidates failed to read part (b) of the question and gave the side effects of intravenous opioids or intrathecal local anaesthetic in their answer.
March 2015

  • a)  Outline the mechanisms of spontaneous recovery from neuromuscular blockade following the administration of rocuronium. (2 marks)
  • b)  Which classes of drugs can be used to antagonise the action of rocuronium (2 marks) and how do they work? (5 marks)
  • c)  What are the advantages and disadvantages of these antagonist drugs? (11 marks)
  • Neuromuscular blockade
    Pass Rate 52.7%, 10.9% of candidates received a poor fail
    The pass rate is disappointing as these agents are “meat and drink” to the profession. The mechanisms by which the action of rocuronium spontaneously degrades were poorly understood. Sugammadex may not be readily available in some Trusts but it is reasonable to expect specialist trainee anaesthetists to understand its pharmacology and clinical usage.
March 2014

´┐╝An adult patient is to receive a target controlled infusion (TCI) of propofol.

a) Detail how TCI devices ensure a steady state blood concentration. (50%)

b) What additional pharmacokinetic data is required to allow effect-site targeting? (20%)

c) What are the advantages of a TCI device compared to a manual propofol infusion regime? (30%)
Pass Rate 17.5%

This was the most poorly answered question of the paper. The written answers reflected a "black-box" mentality from the majority of candidates, with little real understanding of how infusion devices work or of the underlying pharmacokinetics. In particular, effect site targeting was poorly understood. This question failed to discriminate between generally strong and generally weak candidates due to widely distributed ignorance of the subject matter within the cohort. It is of some consolation that a few candidates could reproduce the recommendations of the Safe Anaesthesia Liaison Group regarding total intravenous anaesthesia even though such details were not asked for. Given that the administration of TCI propofol is used nationwide, the poor performance observed must reflect a paucity of formal teaching of the subject within Schools of Anaesthesia.
March 2013

a) What are the indications for anti-platelet drugs in clinical practice? (25%)

b) List the agents currently in clinical use and their underlying mechanisms of action. (50%)

c) How may active bleeding be managed following administration of one of these agents? (25%)
66.1% pass rate.

This was a straightforward question that is very topical. This was reflected by a good pass rate.
September 2011

a) What types of infusion control devices are used in clinical settings? (15%)

b) What are the general (35%) and specific (20%) characteristics of pumps used for target controlled infusion (TCI) anaesthesia?

c) What precautions should be undertaken to guarantee drug delivery when administering total intravenous anaesthesia (TIVA)? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) List the potential clinical advantages for the use of nitrous oxide as part of a general anaesthetic. (25%)

b) List the potential clinical disadvantages of the use of nitrous oxide. (50%)

c) State the currently accepted safe occupational exposure limit for nitrous oxide. What measures are taken
to achieve this within the operating theatre when nitrous oxide is used? (15%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

a) Name 4 drugs that may be used to treat thyrotoxicosis and briefly outline their mechanism of action (40%)

b) What are the main anaesthetic priorities in assessing a patient with treated thyrotoxicosis who is presenting for thyroid surgery? (20%)

c) List the procedure-specific complications that may present in the post-operative thyroidectomy patient. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

a) In which clinical situations would you consider total intravenous anaesthesia (TIVA) advantageous? Explain the benefits in each situation. (50%)

b) List the disadvantages of TIVA and explain how these may be minimised. (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2008

a) What are the most important risk factors for postoperative nausea and vomiting in adults? (40%)

Some anti-emetics are associated with an acute dystonic reaction:

b) What is an acute dystonic reaction? (10%)

c) How may it present? (10%)

d) Give one class of anti-emetic that may precipitate an acute dystonic reaction. (5%)

e) What other conditions should be considered in the differential diagnosis? (10%)

f) Describe your specific treatment of an acute dystonic reaction. (10%)

g) What are the most frequent adverse effects of ondansetron? (5%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) If neuromuscular block has been achieved during general anaesthesia using rocuronium explain the mechanism of spontaneous recovery from neuromuscular blockade. (15%)

b) What classes of drugs could be used to accelerate the recovery from rocuronium? (10%)

c) How do the classes of drugs in part (b) work? (15%)

d) What are the advantages and disadvantages of the classes of drugs identified in part (b)? (50%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) List the different mechanisms for transport of drugs across a cell membrane. (20%)
b) What factors influence the rate of transfer of drugs across the placenta? (40%)
c) How do these factors affect the transfer of pethidine (meperidine), muscle relaxants and local anaesthetics across the placenta? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2005

What are the pharmacokinetic (45%), pharmacodynamic (45%) and physical (10%) properties required of a drug intended for use in total intravenous anaesthesia?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2004

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%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2004

Outline the pharmacology and clinical use of low molecular weight heparins for prophylaxis
against deep vein thrombosis.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

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?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

Relate the clinical use of thiopentone and propofol to their pharmacological properties.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2003

What is the mode of action of epidural opioids? Discuss the relative merits of epidural fentanyl and morphine.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

Discuss the reasons for and against the use of nitrous oxide in anaesthetic practice.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

What are the therapeutic uses of magnesium and how does it work?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question