Primary FRCA OSCE Questions

Primary FRCA OSCE Questions Basic sciences Clinical Measurement - Explain how cardiac output is measured using a thermodilution technique. - Describe how the partial pressure of oxygen in a blood sample is measured using a Clark electrode. - Differentiate between the terms 'heat' and 'temperature'. Explain briefly the principles of a mercury thermometer, indicating its advantages and disadvantages.How does a fall in temperature influence blood gas solubility and acid-base values? - Explain the physical principles of ultrasound imaging.Explain the principles of Doppler ultrasound when used to measure cardiac output echocardiographically. - Describe the measurement of blood pressure using an automated oscillometric non-invasive blood pressure monitor and outline the problems of using this kind of monitor. - Explain the causes of differences between measured end-tidal and arterial partial pressures of carbon dioxide. - Explain the principles of a thermistor, indicating its advantages and disadvantages. - Outline the principles of the pneumotachograph. What factors affect the accuracy of this device? - Compare two methods of measuring humidity. - Discuss the factors which influence the measurement of oxygen saturation using a pulse oximeter. Measure blood pressure (BP) on a healthy volunteer. - Discuss how BP changes with age.

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What is pulse pressure? What types of cuff would over/under read? What types of device are used to measure BP? How is mean arterial pressure calculated? What does the acronym DINAMAP stand for?

Transoesophageal Doppler probe: what investigation is this used for and what can it tell us - Discuss Fowler’s nitrogen washout method of estimating anatomical dead space. (Mention of derivation of VD/VT would be useful.) Physiology Respiratory  Talk about the effects of ventilation (IPPV) on left ventricular output.  Discuss methods of oxygen measurement  Respiratory physiology: explain dead space (anatomical and physiological)  What will be the PaO2 of a person in an aircraft with a cabin pressure of 600 mmHg? Neuro  Discuss CSF and cerebral perfusion pressure Cardiac  You are shown a diagram of an aortic pressure curve and asked to draw the cardiac cycle in detail. Draw the pressure-volume curve in detail. Mark the pressures on the y-axis and volumes on the x-axis. Show the opening and closing of the valves, the phases of the cardiac cycle and the work done Coagulation Describe the cascade. How does blood coagulate? Describe the extrinsic and intrinsic pathways. Describe the fibrinolytic pathway.

Renal Explain how the kidney handles glucose. Describe the physiological consequences of glycosuria. What mechanisms are involved in sodium handling by the kidney Pharmacology - Briefly explain non-competitive antagonism at receptor sites and give two examples. - What is the possible mechanism of action of general anaesthetics? How do drugs work? Discuss ion-gated channels, Gi and Gs subunits, NMDA receptors (ketamine) and the action of methadone. Physics  What are the principles and sources of error in the measurement of arterial blood pressure using an automated oscillometric non-invasive monitor?  Can you talk about the differences between laminar and turbulent flow?Describe the differences between laminar and turbulent flow. List the factors that increase the probability of turbulent flow.What are the factors that increase the probability of turbulent flow in a vessel?  Discuss capacitors and how they work. Understand how to interpret the graphs for build-up and discharge of current. Define Farads, Joules and Watts. Statistics - What is meant by ‘95% confidence interval’? - Describe the use of the null hypothesis and P-value in a drug trial. - How would you set up a clinical trial (phases involved)? Statistics: discuss correlation and regressio Resuscitation

A patient is bradycardic; describe how you would set up and start pacing them. - What infusion would you consider? - What pad position would you use? Discuss the management of ventricular tachycardia 3. Communication skills Explain analgesia during labour. - What are options for relief of postoperative nausea and vomiting Anatomy - Talk about the anatomy and physiology of the sympathetic and parasympathetic nervous systems. You are shown a very detailed diagram of the brachial plexus and are asked to identify the labelled nerves. - How would damage to each nerve manifest? - Describe the path and function of the vagus nerve. Skull anatomy: Describe the anatomy of the base of the skull. what goes through the orbit holes in the skull? How long is the optic nerve? Where does it stop and start? How would you perform a peribulbar block? Spinal cord Cross-section: identify the tracts which are marked. Discuss the blood supply to the cord. What happens if the spinal artery is blocked? Discuss pain and temperature pathways. You are shown a cross-section of a spinal cord and are asked to label it. - Point out the blood supply to the spinal cord, including where it starts and ends. - What volume of local anaesthetic is needed to block one segment? - What is the specific gravity of cerebrospinal fluid? Describe the cerebral circulation. What are the common

sites for aneurysms? Clinical You are shown diagrams of positional hazards. Which nerves would be injured? 6. Examination/skills You re asked to examine the respiratory system of a healthy volunteer Talk about intrapleural blocks, their indications, advantages and disadvantages

8. History taking Take a history from a patient presenting for a rhinoplasty following a road traffic accident. Take a history from a cardiac patient presenting for hernia repair Scans You are shown an ECG trace. Discuss calibration, rate, interference, CM5 electrode positioning and bifid p waves. - There is 50 Hz mains interference on the trace. Identify it and describe what you would do to eliminate it. You are shown a chest X-ray showing a pneumothorax and asked to identify it. ECG: discuss the arrhythmia shown (atrial flutter) and its management. - CXR: describe the changes shown (child aspirated peanut). You are shown a three-dimensional X ray showing the reconstruction of a supraorbital fracture and asked questions on which nerves would be damaged

Equipment Discuss laryngeal masks: sizes, types, insertion, indications for use, sizes for children. Thermometers: You are shown various graphs of temperature and asked to identify what type of measuring device may be used. - What is its mechanism of action? - What type of material is used in a thermistor? What is a hot water bath humidifier? - How does it work? - What are its disadvantages? - You are asked some questions about humidification. Demonstrate on a simulator mannequin how you would manage head injury in a patient who was intubated and ventilated. You are asked questions on management in this case Lasers: discuss how they work and safety features. List the characteristics of different types of laser and the appropriate ET tubes. - Demonstrate on a dummy the correct use of a defibrillator. - Monauricular stethoscope: discuss clinical diagnosis and management of gas embolism. - Bourdon gauge on N20 cylinder: discuss pressure, critical temperature and physical properties of nitrous oxide. - Circle system: check the equipment (note the sticking expiratory valve and that the soda lime is only half full). Discuss circle systems and soda lime.

Final FRCA Basic Sciences Viva A 5-year-old child has collapsed. Basic life support is performed for 2 minutes, after which an ECG trace is presented. You are told that there is no cardiac output. Give five reversible causes for this scenario and their treatment. - A 50-year-old woman presents for a gynaecological procedure with a mask phobia. Explain, reassure and explore alternative methods of anaesthetising her. -Assess the Glasgow Coma Scale score of an actor with a possible head injury. How would you manage him now? (C-spine management mainly)

- A 65-year-old male presents for carotid endarterectomy. He is on aspirin for previous CVAs, but is otherwise fit. Take an anaesthetic history. - A 50-year-old male presents for nasal septum surgery with sleep apnoea and severe reflux. He also has a ‘smokers’ cough’ and gives a possible history of aspiration leading to subsequent respiratory problems. Take an anaesthetic history. -A 43-year-old male with Down’s syndrome, known to have an ASD, underwent an operation 3 months ago for cataract surgery to the right eye. This surgery failed. The patient has returned for a cataract operation in the left eye. He lives in sheltered accommodation and is needle-phobic. On examination, he is plethoric and has a respiratory rate of 18/min, with a loud systolic murmur, best heard in the left sternum, second rib space. On air, his PO2 is 10 mmHg, pH 7.4, PCO2 4.5 mmHg, [HCO3]22.9 mEq/L and base excess -1. Haemoglobin is 18 mg/dL. White cell count, platelets, urea and electrolytes and liver function tests are all normal. - You are asked to interpret the ECG. (It shows sinus rhythm at a rate of 80/min with right bundle branch block and left axis deviation.) - You are also shown a CXR and asked to correctly identify the following three features: i) upper lobe diversion of blood ii) very prominent pulmonary hila iii) rotated vertebral spines indicating a scoliosis. - Bearing in mind that patients with Down’s syndrome may have endocardial cushion defects (ostium primum and ostium secundum), would you be concerned about shunting in this case? What about pulmonary hypertension? A 26-year-old male attended A&E with a compound fracture of the left tibia. The orthopaedic team want to take him to the operating theatre. His girlfriend says that he is hepatitis B positive.

- Would you take him for surgery? - What is the need for an urgent operation (compound fracture)? - What is the significance of saying he is hepatitis B positive? - What types of hepatitis do you know of? - What other non-hepatitis group viruses could cause jaundice? - How is hepatitis transmitted? - What risks are involved when anaesthetising a patient with hepatitis B? - What risks would he pose to staff? - How can you avoid risks - what precautions would you take? - What are universal precautions? - How do you resuscitate? Would blood loss have occurred? - What investigations would you ask for? - What anaesthetic technique would you use? - What monitors would you use? Critical incident: postoperatively, the nurse says that he has breathing difficulty and he is cyanosed. - What would you do? (If you cannot correct the cyanosis immediately, call for help.) - What are the various causes of cyanosis? - How would you diagnose cyanosis? - How would you diagnose and differentiate between opiate overdose and non-reversal? - What would you look for on the nerve stimulator in this patient? - How would you treat the various causes of cyanosis? An 8-year-old boy presents with a head injury and compound fracture of the leg. - Discuss head injuries and assess ABCD. - You are told that he has a Glasgow Coma Scale score of 3: outline how you would manage him (would have to be intubated). - Talk about intrapleural blocks, their indications, advantages and disadvantages. - You are asked to anaesthetise a primigravida who is to have an emergency caesarean section for foetal distress. - What anaesthetic would you use? (A rapid sequence induction should be carried out using thiopentone not propofol. Note the importance of left tilt (Cardiff wedge) and oxygen preinduction.)

A 4-year-old child presents with an inhaled foreign body and grunting. - What would be your management? - What was the likely cause of the child’s grunting (probably an effort to increase PEEP) and how significant was this finding? - A 70-year-old male presents with a fracture of the neck of the femur. He had had an MI 8 weeks previously. - What are the risk factors when anaesthetising this man?