a) Outline the basic principles of ultrasound signal and image generation. (6 marks)
b) How may physical factors influence the image quality of an ultrasound device? (6 marks)
c) Which two needling techniques are commonly used in ultrasound guided nerve blocks and what are the advantages and disadvantages of each? (8 marks)
Pass Rate 5.7% The very poor scores for this question were surprising given the widespread use of ultrasound imaging in current clinical practice. Eight marks were attainable for discussing two types of needling technique, hence this question was deemed to be moderately difficult and not hard. Despite this, many candidates failed to score more than five marks. A “black box” approach was evident in the written answers and examiners questioned whether the candidates had any knowledge of the factors which affect the generation of a good quality ultrasound image. Previous reports from the SAQ Group Chair have emphasised that knowledge acquired in preparation for the Primary FRCA examination can be tested in any element of the Final FRCA process. This advice seems to have been largely ignored. The question was of moderate discriminatory value as ignorance of the topic was widespread within the candidate cohort.
a) What are the indications for insertion of an implantable cardiac defibrillator (ICD)? (20%)
b) How might surgical diathermy affect the ICD? (20%)
c) A patient with an ICD is listed for elective surgery; what preparations are necessary preoperatively, intra-operatively and postoperatively? (45%)
d) How does the management differ if this patient requires emergency surgery? (15%)
Pass Rate 67.1%
Generally well answered. Indications for a pacemaker are part of core knowledge incorporating many conditions which have a bearing on the management of anaesthesia. For section (c), some candidates gave generalized answers and failed to focus on the specifics of how the risk of an ICD working inappropriately, or failing to work when necessary, would influences anaesthetic practice. In an emergency situation, deactivation of the ICD would be a reasonable “balance of risks” action.
a) What are the indications for arterial cannulation? (35%)
b) How may an invasive arterial pressure measuring system be calibrated? (20%)
c) Outline the sources of error when measuring invasive arterial pressure. (45%)
35.8% pass rate.
This question was poorly answered and therefore had a high failure rate despite a low pass mark being set. Many candidates wrongly interpreted the question as “indications for intra-aortic balloon pump”. The indications for arterial cannulation were for measurement (continuous blood pressure; cardiac output; blood gases), diagnostic (angiography) and therapeutic purposes (thrombolysis, vasodilators chemotherapy, EVAR, ECMO, stenting, renal replacement therapy). Many candidates focused on aspects of measurement only.
All transducers are calibrated in the factory but calibration is carried out in the clinical environment using static and dynamic testing methods, a short description was all that was required. Sources of error included transducer drift, the causes of damping/resonance and incorrect transducer height. There appeared to be a lack of understanding of the physical principles of transducers and confusion between damping and resonance. The ODP might well calibrate the transducer for you but this fact was not included in the model answer as it is important that anaesthetists understand the methods and principles of calibration even if they do not carry them out themselves.
a) What are the advantages (15%) and disadvantages (20%) of low flow anaesthesia?
b) Describe how a circle system should be checked before each anaesthetic? (45%)
c) What other components of the anaesthetic workstation must be checked before each anaesthetic? (20%)
35.3% pass rate.
The answers to this question were very disappointing. Candidates should have far better knowledge of a breathing system that most would use every day. There is no excuse for the apparent ignorance of a safety checking system that should be performed many times a week, particularly when the Association of Anaesthetists of Great Britain and Ireland have recently published a safety guideline on checking anaesthetic equipment (2012). These new guidelines emphasise that checks of equipment should be undertaken before each operating session and then a shorter set of checks before each case.
a) How may ultrasound be used in anaesthetic and critical care practice? (30%)
b) What information can echocardiography provide in a haemodynamically unstable patient? (50%)
c) What is the Doppler Effect? How may this be used in clinical practice? (20%)
Question 4 Physics and clinical measurement/ultrasound
66.5% pass rate ￼ In general, candidates demonstrated sound clinical knowledge but had greater difficulty in explaining the Doppler effect and how the principle is applied. This question was used in the September 2011 paper.
An adult patient requires insertion of a chest drain for management of a spontaneous pneumothorax. The patient is not in acute distress. Describe your technique for insertion of a chest drain in this patient. (50%) The diagram shows an underwater seal device. Comment on its suitability for connection to the drain you have inserted. (50%)
Question11 Critical care/management of airway problem/tracheostomy