September 2015

  • a)  Outline the production and circulation of cerebrospinal fluid (CSF) and how intracranial pressure affects
    production and absorption. (5 marks)
  • b)  How does the biochemistry of CSF differ from plasma? (4 marks)
  • c)  List the indications for lumbar puncture. (6 marks)
  • d)  Which factors predispose to the development of a post-dural puncture headache after lumbar
    puncture? (5 marks)
CSF Physiology and lumbar puncture Pass rate 50.9% This was one of the easy questions in the paper so we would have expected the pass rate to have been a little higher. As mentioned above, some candidates did not answer the question asked in part (d) so lost marks.
March 2016

  • a)  What physiological factors determine the rate of fall in arterial oxygen saturation in an apnoeic patient (3 marks), and which patient groups are most likely to show a rapid fall? (4 marks)
  • b)  How may oxygenation, prior to intubation, be optimised during a rapid sequence induction (8 marks), and how can its progress be measured? (1 mark)
  • c)  What are the possible respiratory complications of prolonged delivery of 100% oxygen? (4 marks)
Preoxygenation Pass rate 44.4% Again the pass rate for this question was low. The physiology surrounding oxygenation and the practice of preoxygenation should be well understood by candidates as this subject is very relevant to every day clinical practice. As mentioned above applied physiology is part of the syllabus, yet many candidates had no knowledge of the physiology in part (a). Part (b) was also poorly answered, with candidates failing to give sufficient detail about how to effectively preoxygenate a patient.
September 2012

a) Outline the major changes in the cardiovascular system of elderly patients. (35%)

b) What are the perioperative implications of each change? (65%)
Question 7: Outline the major changes in the cardiovascular system of the elderly and anaesthetic implications.

46.9% pass rate.

This question was set to explore the knowledge of both the physiological and pathological changes that occur as a result of ageing. Many of the answers were insufficiently detailed and not systematic. It is acceptable to structure your answers in tabulated form if the sections of a question are linked. In this case the answers to a) and b) were associated.

For example:

a) Cardiovascular change
Increased systemic vascular resistance Hypertension
Left ventricular hypertrophy
Beta receptor down-regulation
b) Anaesthetic implication
Reduced responsiveness to catecholamines and sympathomimetic agents
Cardiovascular instability
May need to obtund pressor responses Antihypertensive medication

Other cardiovascular changes include reduced autonomic responsiveness, reduced cardiac output secondary to reduced stroke volume, degeneration of SA/AV nodes and conducting system, increased incidence of valvular heart disease and ischaemic heart disease. Similar questions in future might feature changes of the respiratory or central nervous systems of the elderly.
March 2012

a) What factors determine how long oxygen saturation is maintained in an apnoeic patient? (30%)

b) How may pre-oxygenation be performed and its progress assessed? (30%)

c) What are the clinical advantages and disadvantages of pre-oxygenating a fit adult? (40%)
Question 10: Physiology of apnoea and preoxygenation

50.5% pass rate

This question has featured in the past and was poorly answered. In section a) focused on the physiology. Key words such as FRC, oxygen consumption, carbon dioxide production alveolar ventilation, alveolar gas equation and wash-in all too often were missing. Section b) concentrated on the techniques of effective preoxygenation and again was poorly answered.
March 2011

a) List the complications associated with the delivery of high partial pressures of oxygen? (60%)

b) What are the oxygen saturation targets of oxygen therapy in: (i) previously healthy adult patients and (ii) patients with chronic obstructive pulmonary disease (COPD)? (10%)

c) What are the postulated cellular mechanisms of oxygen toxicity? (10%)

d) Which common themes associated with oxygen therapy were identified by the National Patient Safety
Agency (NPSA) in 2009 as having contributed to patient deaths? (20%)
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 possible causes of a progressive rise in end-tidal carbon dioxide concentration during anaesthesia. (50%)

b) What are the physiological effects of acute hypercapnia? (30%)

c) Why may permissive hypercapnia be of benefit in a patient ventilated for acute lung injury? (10%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2009

a) What physiological changes during the maintenance phase of general anaesthesia may require an increase in the FiO2? (40%)

b) Following an open cholecystectomy with an opioid-based postoperative analgesic regimen, why might supplemental oxygen be required in the recovery room (20%) and on the ward (up to 72 hours) postoperatively? (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 a method of preoxygenation prior to induction of general anaesthesia. (20%)

b) What is the physiological basis of preoxygenation prior to anaesthesia? (30%)

c) How could the adequacy of preoxygenation be assessed? (10%)

d) What are the advantages and disadvantages of preoxygenating a fit adult? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2006

a) Briefly state the basic neurological principle of the apnoea test component of Brain Stem Death (BSD) testing. (30%)

b) What value must be achieved and what factors determine the time of achievement of the threshold PaCO2? (40%)

c) Describe the physiology of maintenance of oxygenation during the apnoea test. (30%) (You may assume criteria for testing for BSD have been fulfilled.)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

What is the physiological basis of preoxygenation for anaesthesia? (40%)
Describe a method of preoxygenation and how you would assess its adequacy. (35%)
What are the advantages and disadvantages of preoxygenating a fit adult? (25%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2004

Compare the electrolyte content and osmolality of 0.9% sodium chloride (Normal Saline) and compound sodium lactate solution (Hartmann’s). (40%)
Why might compound sodium lactate solution be a better crystalloid replacement fluid than 0.9% sodium chloride? (40%)
Explain the effects of a large infusion of 0.9% sodium chloride on acid base balance and electrolytes. (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2003

Draw the following diagrams (with values): A spirometer trace showing normal lung volumes, FEV1/FVC graphs and flow volume loops. How are these altered by the following diseases:
asthma, emphysema, pulmonary fibrosis, chest wall restriction and respiratory muscle disease?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

What is pulmonary surfactant? Discuss its production in the lung, mechanism of action and function. What would be the effect of insufficient pulmonary surfactant?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

Define contractility. Outline the methods available to the clinician to assess myocardial contractility in the peri-operative period.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2002

Outline the nerve pathways involved in the transmission and perception of a painful stimulus from the foot.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2001

What tests may be done to evaluate the adequacy of pulmonary oxygen transfer? Briefly describe how you would interpret the results.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2001

Draw a nephron with its blood supply. Where and how do the following exert their effects: loop diuretics, thiazide diuretics and aldosterone antagonists?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2001

Outline the methods of estimation of arterial pCO2 and their limitations.
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question