September 2014

  • 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.
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March 2014

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.
September 2013

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.
March 2013

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.
March 2012

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.
March 2012

a) Outline the principles of capnography using infra-red light absorption. (30%)

b) What diagnostic information can be gained from capnography in anaesthetic practice. (40%)

c) In which clinical situations and locations should continuous capnography be available for use? (30%)
Question 9: Physics and clinical measurement/capnography

60.8%pass rate
September 2011

a) How may ultrasound techniques be used in anaesthetic and critical care practice? (40%)

b) What information can echocardiography provide in a haemodynamically unstable patient? (45%)

c) What is the Doppler Effect? How may this be used in echocardiography? (15%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2011

a) List the modes of non-invasive respiratory support (NIRS). (20%)

b) In what adult clinical scenarios may NIRS be indicated? (30%)

c) What are the contraindications to NIRS? (30%)

d) Summarise the clinical advantages of NIRS compared to conventional positive pressure ventilation via a
tracheal tube. (20%)
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 principles of using an intra aortic balloon pump (IABP). (30%)

b) What are the indications (20%) and contraindications (15%) to use of an IABP?

c) List the main complications of using this device. (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
March 2010

a) List the indications for intra-operative cell salvage (ICS). (20%)

b) Which therapeutic substances should not be aspirated into the ICS system (10%)

c) What are the current controversies regarding the use of ICS in obstetrics and in patients with malignancy? (20%)

d) What additional measures can be applied to reduce the need for allogeneic blood transfusion during an operation? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2007

a) What are the important safety features incorporated into the design of a medical gas cylinder and valve? (45%)

b) How would you normally identify the content of a gas cylinder? (25%)

c) What information does the pressure gauge on a nitrous oxide cylinder provide and how would you establish the amount of nitrous oxide remaining in a cylinder? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) Why can touching a piece of faulty domestic electrical apparatus cause ventricular fibrillation? (25%)

b) What is microshock and how does this cause ventricular fibrillation? (15%)

c) List the factors which make an anaesthetised patient in the operating room at particular risk from electrical hazards. (10%)

d) What precautions are taken to reduce electrical hazards in the operating room? (40%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) How are implantable cardiac pacemakers and implantable cardioverter defibrillators classified? (25%)

b) What information should be sought relating to these devices preoperatively? (30%)

c) What precautions should you take perioperatively when anaesthetising patients with these devices, where the use of surgical diathermy / electrocautery is anticipated? (35%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) What non-invasive methods can be used to measure blood pressure? (30%)

b) How do most automated non-invasive cuff techniques measure blood pressure? (40%)

c) What are the causes of errors commonly encountered in non-invasive blood pressure
measurement systems? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) What information is available from a thermodilution pulmonary artery catheter? (35%)

b) How can this information be used in the management of a critically ill, hypotensive patient following laparotomy for faecal peritonitis? (55%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) What methods are used to measure blood pressure non-invasively? (35%)

b) How do most automated non-invasive cuff techniques measure blood pressure? (45%)

c) What are the common errors encountered in non-invasive blood pressure measurement systems? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

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

76.6% pass rate

In the main was a well-answered question
May 2004

Define capnography.
Draw and label a normal capnograph trace.
Why is capnography useful during general anaesthesia ? Give examples of abnormal traces and their causes.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

Describe how and why a vaporiser delivering desflurane is different from one delivering isoflurane.
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 limitations and risks of intra-arterial pressure monitoring in the critically ill? How may these be minimised?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2003

List the patterns of peripheral nerve stimulation that may be used to monitor non-depolarising neuro-muscular blockade during anaesthesia. How is each used in clinical practice?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

Define pressure. List the methods available for measuring systemic arterial blood pressure. Outline the principles involved in one of the methods listed.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

Describe the principles involved in pulse oximetry. What are its limitations in clinical practice?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2001

Discuss briefly the complications of placing a jugular central venous line. Where should the tip of a left internal jugular line lie and why ?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2001

Describe the features of the anaesthetic machine which are intended to prevent the delivery of a hypoxic mixture to the patient.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

How can ultrasound be useful in anaesthesia and intensive care medicine?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question