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Final FRCA Exam Viva Qs (Dec 2018)
#1 · December 7, 2018, 11:59 am
As per Sara Ko, Thanks!
Clinical with Science:
21 year old student with cough and swinging fever.
Pneumonia organisms after interpreting a CXR with right sided consolidation.
Then showed CT chest - empyema and how u would manage (they didn’t ask about how to insert chest drain)
Antibiotics prophylaxis in surgery - why and recommendations
What antibiotics you would choose for what surgery. What organisms in orthopaedics
86 years old for diagnostic procedure for hoarseness - what lesions would it be
Shared airway - which technique
Laser - science
Laser safety and airway fire
Tracheostomy indications and anatomy of the larynx. Nerve supply
How you would manage obstructed tracheostomy
Placental blood supply (I have no idea) - meant to be physiology but sounded more like anatomy
28yo at term with placental abruption for c section. How to manage
Massive haemorrhage and transfusion parameters
How you would resuscitate/anaesthetise
SOE 2
38 years old with known cardiomyopathy with PPM/ICM 18months ago. Presented with severe abdo pain and irreducible paraumbilical hernia with necrosis overlying
ET 100m but able to swim up to half an hour a month ago.
Ascites and ankle oedema on examination
Drugs:
Ramipril
Metalozone
Spironolactone
Frusemide
Digoxin
Bisoprolol
NKDA
FBC:
HB 128
Everything else normal
Normal Na and K
Raised Ur (27) Cr (280)
CXR with right pleural effusion with upper lobe diversion and ICD/PPM in situ
ECG 60bpm paced
They didn’t even ask for summary and talked about drugs and their significance in terms of cardiac failure
CXR and what it shows
ECG and pacemaker/ICD management
How you would anaesthetise
Short cases:
21 years old with complete spinal cord injury 2 years ago
Needs cystoscopy for bladder stones
Recurrent UTIs
Discussion about probs of anaesthesia- basically about autonomous dysreflexia
Woman at term needing emergency section so you topped up 20ml 0.5% levobupivacaine. She becomes drowsy.
Talked about differential diagnosis
Then talked about what would point to LA toxicity
Management but didn’t really go into intralipid
#2 · December 7, 2018, 3:22 pm
More Courtesy of Liana Zucco, with thanks!
SOE1:
Clinical case with anatomy
Patient attending for elective lap chole
- Concerns, management, implications of laparoscopic surgery & pneumoperitoneum
- Anatomy of T10 and the diaphragm
- Shown a CT scan of T10 (with air under the diaphragm —> pneumoperitoneum)
- Differentials
- Management of laparotomy
- Management of pain relief for laparotomy: describe in detail how you perform a TAP block … how is it different from a rectus sheath block, what are the nerves you are blocking
- What measures have been shown to improve outcomes emergency laparotomy: discussed all NELA recommendations
- Why do we risk stratify
Clinical case with physiology
Patient with sickle cell disease for elective lap chole
- What are the peri-op concerns
- What targets do we have for Hb, how do we optimise this?
- What investigations do you want
- What types of crisis do they get: explain them and explain the acute chest syndrome
- Physiology of Hb
- Describe structure (alpha, beta subunits, etc)
- Questions then progressed to what HbSS, HbSA, HbA, HbC is …. and thalassaemia, etc
Clinical case with pharmacology
Obs, labouring woman, 36/40 gestation, HTN (159/110), oedema
- What are your concerns?
- Discussion of pre eclampsia, diagnosis, severity
- What are the symptoms that concern you?
- What are the treatment options for pre-eclampsia?
- Now need to go for emergency C-section, what are your options: pros and cons of GA v regional
- Forgot to mention careful fluids (due to risk of pulmonary oedema)
- Pharm - Mg: indications, doses, signs of toxicity, treatment
Clinical case linked with Physics/Equipment
Mgmt of cyclist/head trauma in A&E resuscitation
- ATLS,
- What are the indications for intubation in a head injured patient (GCS, resp compromise, PaO2, etc)
- What drugs would you use for intubation and why
- General head injury mgmt
- CT head image shown - dx - extradural, needs referral to neurosurgical centre for evacuation
- What are your needs for a safe transfer needs: what kit do you want (airway, lines, drugs, pumps), what monitors and what equipment (ventilators)
- How much oxygen, which cylinders of o2, how many L in size CD/E cylinder
- What do you want to know for an inter hospital transfer: location of destination (theatre, resus, ICU, etc), named consultant, contact number,
SOE2
Long case (EVAR 7.1cm AAA, elective, in pre-assessment)
- HTN, T2DM, CKD, otherwise fit
- CXR and FBC/U&E/Coag provided - all relatively normal except Plts 148 and Cr 120
- ECG: 1st degree block …
- What do I estimate (with an aneurysm size of 7.1cm) is this lady’s risk of rupture?
- What is the general risk of rupture for AAAs?
- What are your periop concerns
- What the options for anaesthesia (for EVAR): GA, sedation, regional (spinal, epidural, CSE)
- What are the pros and cons of GA v RA
- What are the pros and cons of EVAR v Open
- How do we risk stratify AAA patients (Glasgow index, Hardman’s index, SORT, V-Possum tools)
- Why do we risk stratify patients?
- Do I have concerns about the use of intra-operative heparin with the use of an epidural/spinal
Short case 1 - cholesteatoma & mastoidectomy
- Anaesthetic implications of mastoidectomy
- How to provide a bloodless surgical field
- What are your anaesthetic options: GA with ETT, GA with reinforced LMA
- Need for neurological monitoring, what nerve (facial), does this impact your anaesthetic choices (e.g.: atracurium v rocuronium)
- Options for pain relief
Short case 2 - myotonic dystrophy and dental extraction
- What is MD, what are the problems associated with it
- How will you perform an anaesthetic for this case
- Differences between MD, DMD and Becker’s