The Final FRCA Short Answer Questions: A Practical Study Guide

348 Pages·2018·9.46 MB·English

by  Combeer

The Final FRCA
Short Answer
Questions
A Practical Study Guide
Elizabeth Combeer
Consultant Anaesthetist
Frimley Health NHS Foundation Trust
Illustrations by Paul Hatton
CRC Press
Taylor & Francis Group
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CONTENTS
LIST OF ABBREVIATIONS v
PASSING THE FINAL SAQ ix
ACKNOWLEDGEMENTS xiii
1. Neurosurgery, neuroradiology and neurocritical care 1
2. Cardiothoracic surgery 23
3. Airway management 47
4. Critical incidents 53
5. Day surgery 73
6. General, urological and gynaecological surgery 77
7. Head, neck, maxillo-facial and dental surgery 99
8. Management of respiratory and cardiac arrest 109
9. Non-theatre 111
10. Orthopaedic surgery 117
11. Perioperative medicine 121
12. Regional anaesthesia 141
13. Sedation 153
14. Trauma and stabilisation 155
15. Intensive care medicine 165
16. Obstetrics 197
17. Paediatrics 223
18. Pain medicine 245
19. Ophthalmic 267
20. Plastics and burns 269
21. Vascular surgery 273
22. Anatomy 281
23. Applied clinical pharmacology 283
24. Applied physiology and biochemistry 293
25. Physics and clinical measurement 309
26. Statistical basis of trial management 325
Index 327
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LIST OF
ABBREVIATIONS
2,3DPG 2,3 diphosphoglycerate
A-a Alveolar-arterial
AAA Abdominal aortic aneurysm
AAGBI Association of Anaesthetists of Great Britain and Ireland
ABG Arterial blood gas
ACE Angiotensin converting enzyme
ADP Adenosine diphosphate
ALS Adult life support
ALT Alanine transaminase
APL Adjustable pressure limiting
ARDS Acute respiratory distress syndrome
ASA American Society of Anesthesiologists
ATP Adenosine triphosphate
AVPU Alert, voice, pain, unresponsive
BIS Bispectral index
BJA British Journal of Anaesthesia
BMI Body mass index
BP Blood pressure
bpm Beats per minute
cAMP Cyclic adenosine monophosphate
CBG Capillary blood glucose
CCT Certificate of Completion of Training
CEACCP Continuing Education in Anaesthesia, Critical Care & Pain
CICO Can’t intubate, can’t oxygenate
CK Creatine kinase
CKD Chronic kidney disease
CMV Cytomegalovirus
CNS Central nervous system
CO Cardiac output
COETT Cuffed oral endotracheal tube
COX Cyclic oxygenase
CPAP Continuous positive airway pressure
CRP C-reactive protein
CSF Cerebrospinal fluid
CT Computed tomography
CVC Central venous catheter
CVP Central venous pressure
CXR Chest radiograph
DAS Difficult Airway Society
DIC Disseminated intravascular coagulation
DVT Deep vein thrombosis
EBV Epstein–Barr virus
v
List of AbbreviAtions
ECG Electrocardiogram
Echo Echocardiogram
ECMO Extracorporeal membrane oxygenation
EEG Electroencephalogram
eGFR Estimated glomerular filtration rate
ENT Ear, nose and throat
ERCP Endoscopic retrograde cholangiopancreatography
ESR Erythrocyte sedimentation rate
etCO End-tidal carbon dioxide
2
ETT Endotracheal tube
EVAR Endovascular aneurysm repair
FEV Forced expiratory volume in 1 second
1
FiO Fraction of inspired oxygen
2
FRC Functional residual capacity
GA General anaesthetic
GCS Glasgow Coma Scale
GGT Gamma-glutamyl transferase
GMC General Medical Council
HIV Human immunodeficiency virus
HSV Herpes simplex virus
IASP International Association for the Study of Pain
ICP Intracranial pressure
ICU Intensive care unit
INR International normalised ratio
IQ Intelligence quotient
iv Intravenous
IVC Inferior vena cava
ivi Intravenous infusion
JVP Jugular venous pressure
LMA Laryngeal mask airway
LSCS Lower segment caesarean section
LVEDP Left ventricular end-diastolic pressure
M&M Morbidity and mortality
MAC Minimum alveolar concentration
MAP Mean arterial pressure
MDI Metered dose inhaler
MEOWS Modified Early Obstetric Warning Score
MRI Magnetic resonance imaging
NHS National Health Service
NICE National Institute for Health and Care Excellence
NMBD Neuromuscular blocking drug
NMDA N-methyl-D-aspartate
NPSA National Patient Safety Agency
NSAIDs Non-steroidal anti-inflammatory drugs
OAA Obstetric Anaesthetists’ Association
ODP Operating Department Practitioner
PaCO Partial pressure of carbon dioxide in arterial blood
2
PACU Post-anaesthetic care unit
PaO Partial pressure of oxygen in arterial blood
2
PCA Patient controlled analgesia
PCR Polymerase chain reaction
PEA Pulseless electrical activity
vvii
List of AbbreviAtions
PEEP Positive end-expiratory pressure
PEG Percutaneous endoscopic gastrostomy
PEJ Percutaneous endoscopic jejunostomy
PONV Postoperative nausea and vomiting
RSI Rapid sequence induction
S1Q3T3 S wave in lead 1, Q wave and inverted T wave in lead 3
SAD Supraglottic airway device
SIRS Systemic inflammatory response syndrome
SVR Systemic vascular resistance
SVRI Systemic vascular resistance index
TCI Target controlled infusion
TENS Transcutaneous electrical nerve stimulation
TIVA Total intravenous anaesthesia
TNF Tumour necrosis factor
VATER Syndrome of vertebral, cardiac, renal and limb anomalies, tracheo-oesophageal
fistula, and anal atresia
vCJD Variant Creutzfeldt–Jakob disease
VF Ventricular fibrillation
VRIII Variable rate intravenous insulin infusion
VT Ventricular tachycardia
V/Q Ventilation:perfusion
WHO World Health Organisation
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PASSING THE
FINAL SAQ
These are my top tips for approaching the Final SAQ. They are based on what I find myself
saying repeatedly at weekly teaching with the trainees at Frimley.
Print Off a Copy of the Syllabus
Both basic and intermediate-level syllabi are tested in the Final. I know these are dauntingly
large documents, but it really is important that you understand the breadth of what you
need to learn, and looking at these helps you direct your reading. Revision for subspecialties
such as burns, cardiothoracics, neuro, paediatrics and obstetrics can largely be covered
by searching for CEACCP/BJA Education articles that relate to the specified learning
objectives. In this way, you will be learning the College-approved facts on the subject. There
is also a very strong link between topics addressed in the exam and topics that have been
featured in these articles within the preceding two years. Every time you do some revision
that relates to something in the syllabus, cross it off. Remember that a broad understanding
is more important than learning a few topics in great detail.
Three Types of Questions
There are three main types of questions in the Final SAQ. Firstly, there are those that relate
to new guidance or reports (such as National Audit Projects or National Institute for Health
and Care Excellence guidance). Secondly, there are the questions that test knowledge of
the manner of anaesthesia provision for specific operations or in particular situations. The
third group assesses knowledge of how particular patient conditions impact on anaesthesia
management. Make sure you decide what group each question you encounter falls into as it
will impact on your approach to answering it.
Questions Relating to New Guidance or Reports
Questions based on these topics tend to appear within two years of their publication.
Search the likely websites (Royal College of Anaesthetists, Difficult Airway Society, Obstetric
Anaesthetists’ Association, NICE, Association of Anaesthetists of Great Britain and Ireland)
and be aware of new national guidelines that are implemented in your place of work. Also,
be aware of topical causes of medical error, such as new additions to the list of never events
that are relevant to anaesthesia, and statements and alerts from the Safe Anaesthesia
Liaison Group. Think about the impact of these guidelines at the organisational level, not just
at the point of delivery of anaesthesia.
Questions Relating to Anaesthetic Management of a Specific Operation
or Situation
This includes questions about nerve blocks as well. Nerve blocks have peaks of popularity,
and the timing of inclusion of questions about them in the SAQ reflects this. Remember to
learn the specific complications of such blocks, not just ‘bleeding, infection, nerve damage.’
It is by listing the specific complications that you demonstrate that you actually know the
relevant anatomy.
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