June 2014 Questions returned from Candidates - Thank you

Long Case 1
50yo male for elective ankle open fixation, ex-smoker, IDDM secondary to Whipple’s pancreaticoduodenectomy, lower limb
neuropathy, 2 ‘mini strokes’ 18months ago, chronic low back and lower limb pain, back operation with an implant a year ago,
poor mobility with crutches.

Drugs:
Amitriptyline Gabapentin
Fentanyl patch 300mcg PPI
Tramadol Statin
Oxycodone Clopidogrel

Haematology:
Normocytic Anaemia
WCC 10
Plts 300

Biochem:
Na, K, Ur, Cr normal
Raised calcium
Fasting Glucose 9.9, but HbA1c 7

ECG and CXR ok as far as I could see

Lumbar XR: Spinal Cord Stimulator

Questions:
• Summarise
• Blood results
• Diabetes
• Optimisation
• Anaesthesia choices given patient has SCS
• Femoral block/sciatic block
• Management of diabetic patient peri-op.
• Complications with hyperglycaemia
• Chat about the meds, would I leave Fentanyl patch on or take it off? I
• Which other meds would I continue peri-op.
• How I’d manage post-op pain
• Would I continue Gabapentin
• Conversion of Fentanyl and Oxycodone to Morphin
• Ketamine -mode of action.
• Incident was patient agitated and confused in recovery. Potential causes, investigations, treatments etc

LONG CASE 2
15 yr old girl with large superior mediastinal mass with severe compression of trachea on ct scan for cervical lymph node biopsy.
Refusing under LA. Stridor+. Large mass on CXR and CT showing tracheal compression/SVC obstruction.
Bloods showing raised lymphocytes and WBC. Lymphoma, Rx, tumour lysis syndrome. Where to go after sx.

16yrs girl, 1/12 hx cervical lymphadenopathy noisy breathing, DIB when lying flat. WCC 17, lymphocyte count 12 Hb N, plt N. CXR
mediastinal mass, CT slice tracheal compression.

Questions:
• Summarise case.
• Differentials.
• Concerns - difficult intubation
• How do you treat lymphoma
• Local and systemic effects of large goitre.
• SVC obstruction – problems of anaesthetising a patient with SVC obstruction.
• What would I ask pre-operatively?
• Further investigations.
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• How would I anaesthetise her?
• What is tumour lysis syndrome?
• On extubation what would be my concerns
• Would I extubate her? What other options are there for her?
• On ITU when would I consider extubating her.
• Her potassium rises on ITU –causes? How would I treat this?
• How does salbutamol/ calcium/ insulin/dex work.
• Critical incident – airway obstruction post-extubation. Management of this situation?

LONG CASE 3
28yr old woman, para 4 post partum. 4/7 history of generally unwell with increasing SOB. She had retained placenta removed
2/7 ago and has deteriorated since then with drowsiness and high temperatures. Gynaecologists would like to take her for a
hysterectomy. HR 135, BP 125/60, GCS 13, Temp 38.5. she is on 70% oxygen with CPAP 10.
ABG - hypoxia, compensated metabolic acidosis
Bloods – Hb 110, WCC 10.5, Plt 22, Urea 6.9, creat 70?, Bil 100, ALP increased)
ECG – Sinus tachy
CXR – CVP in situ

Questions:
• Differential diagnosis
• Pre op optimisation – fluid resus and clotting, what parameters I would expect for surgery
• Induction – awake art line, induction agents (I chose thio and got questioned intensely about this and CV instability. I stuck
to my guns and talked about fluid loading and vasopressors with small dose of thio – seemed happy with this)
• Sepsis management
• Post op ICU Management
• ARDS - Diagnosis, ventilator strategies, and other management including ECMO
• Criteria for ECMO

LONG CASE 4
2 ½ year old recent immigrant for tonsillectomy. Recurring bouts of tonsillitis.
Weight 10kg
Information given:
Overnight saturations
ECG – normal for child
Full blood count – HB 10.5 RCW 16% MCV 72 Eosinophils 1.4 (all else normal)

Questions:
• Summarise case
• Discuss FBC
• Why is he anaemic? What is the significance of the raised RCW?
• How would you investigate for HbS?
• He is negative. Why might he be Fe deficient?
• How might this manifest?
• Discuss sleep studies
• Grade severity of OSA, Apnoea/Hypopnoea index
• Why might he have OSA?
• Discuss ECG? If there was RV strain how would this appear? RAD, V1 R wave large etc
• How would you assess him?
• Assuming no abnormal findings, how would you anaesthetize him?
• Obstructs after induction, but before you have paralysed him. How do you manage this?
• Size of tube (should have calculated during prep)
• Analgesia
• Post op destination
• Management of post tonsillectomy bleed
• Criteria for extubation
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LONG CASE 5
80 year old lady presenting for laproscopic hiatus hernia repair. Had a chest infection 2 weeks ago and at the time was found by
the GP to be in fast AF so was started on digoxin. She has a past medical history of diverticulitis and hypertension.
On examination
Pale frail looking lady
BP 160/90, HR 80
Chest reduced air entry with crepitations at left base

Bloods
Hb 91, Normocytic hypochromic, Platelets 480, WCC 8
Cr 62, Ur 2.9, Na 140, K 3.5, Mg 0.50, CRP 81

ECG
SR rate 80, LAD, LVH, Twave inversion through all chest leads, no ST segment changes, Poor R wave progression, Bifid P wave in
V1
CXR: Bubble with a fluid line behind the heart shadow, some upper lobe engorgement plus hilar shadowing. Left basal
consolidation

Questions:
• Summarise this case
• What are the main issues?
• Types of hiatus hernia
• Describe all the investigations: differential for fluid-gas level on CXR
• What else do you want to do pre-op?
• What are the potential causes of her anaemia?
• Would you transfuse her?
• What is the evidence for transfusion?
• What would you do about her anaemia then?
• Are you going to anaesthetise her today?
• Say she comes back in 5 weeks, how are you going to anaesthetise her? Details of RSI drugs for frail person
• Are you going to put in anything to help the surgeon? (wanted NG)
• What mode of ventilation are you going to use? Why?
• How can you minimise the peak pressure?
• What are the physiological effects of laproscopic surgery? (mainly wanted resp and cardiac)
• What are you going to do for post op pain relief?
• In recovery she becomes hypotensive and drops her sats. What are you going to do?
• She has a Tension pneumothorax how are you going to treat it?
• How long do you leave the chest drain in? what can you do to help it drain better and resolve the pneumothorax quicker?
• On HDU she goes in to fast AF again, how are you going to treat?
• The examiner wanted the details about how to give DC shock and doses of amiodarone

LONG CASE 6
71 year old man with hypertension, hiatus hernia and diet controlled diabetes scheduled for a lobectomy due to Ca lung.
Admitted with neck pain. Meds - bendroflumethiazide, omeprazole, frusemide. No other clinical information. Investigations -
ECG - SR 90, left axis deviation and RBBB. PFTs - FEV1, FVC and FEV1/FVC ratio all just within or very close to normal ranges.
FEV1 was 1.78. Lateral C-spine XR showed destruction of C2 with a discontinuity of the anterior and posterior vertebral lines.
Echo - Dilated LA with thickened AV, gradient 39mmHg, Area 1.4cm2. No bloods, no CXR

Questions
• Summary.
• Comment on all of the investigations.
• Grades of AS.
• What symptoms and signs may he have from his C2 injury. What is the likely cause of the C2 injury given there is no Hx of
trauma?
• Immediate management and assessment. What extra investigations. Why might he have abnormal U+Es
• He is going for a posterior laminectomy and fusion. What concerns you about this in this patient.
• Tell me how you would anaesthetise him.
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• How will you secure his airway
• Will you paralyse him?
• What will you use for maintainance.
• Problems with prone position.
• How will you assess him post-operatively and where.
• In recovery he complains of SOB and desaturates. What is your immediate managment? differential diagnosis? He has a
right basal collapse where is tumour is. What is your managment?
• After recovery from this operation the CT surgeons want to do his lobectomy. With his lung function can he have the
operation? Do you need any more info?

LONG CASE 7
65 CLL on treatment, hypertensive NOF fracture following mechanical fall requires hemiarthroplasty. Long term Smoker with
COPD X-ray and left hilar mass. EGFR 58. Hypoxic ABG. ECG ? ABG hypoxia. Pancytopaenia

Questions:
• Summarise
• Needs multi input and optimisation.
• Hb levels and platlets -
• Chemotherapy agents and effects 'bleomycin'.
• Analgesia prior to theatre - NICE and facia iliaca block / 3in1. Innervation of hip.
• Anaesthesia
• Developed acute cardio/resp depression - differentials
• BCIS pathology simplify and was to reduce it happening. Likely in which operations?
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SHORT CASES
1. 30/40 pregnant woman presenting after RTC.
• Discussed: ATLS management with consideration of pregnancy: aortocaval compression, etc
• Need to multidisciplinary team involve obstetricians early
• Physiology of pregnancy: she was tachycardic with a normal BP. Asked if I’d be worried or not. Explained difficult to
assess as would compensate.
• Where to look for blood loss: chest, pelvis, abdomen
• Would I Xray her? Would I CT her?

2. PONV
• Risks
• Management : peri-operatively
• NNT for anti-emetics, reduction with multiple agents, evidence

3. Pre op man for THR has systolic murmur

• He said it was AS-
• How will you assess?
• Notes, History, exam
• Do symptoms grade severity?
• What is prognosis when symptomatic
• Ecg what looking for? Talked about AF and coronary perfusion pressure
• investigations echo
• How do you grade with echo. How do you work out valve area?
• Principles of anaesthetising AS

4. 32 yo post partum retained placenta

• Concerns in this lady
• Causes of retained placenta. I talked about accreta, percreta
• How will you assess her for surgery
• Went through this then he said - you need to find out if she has epidural.
• What block height for spinal.
• Why is this different post partum. Why would you need to alter drug dose
• When do risks of reflux post partum return.
• How would you do epi top up. Check block working
• She has spinal and cries out. - what would you do? Bell went.

5. AF
• Shown ECG - AF
• Causes (wanted MV disease)
• Treatment options
• Talk through DC cardioversion in compromised patient- how many shocks (3) then what (Amiodarone) Doses
• CHADS2 scoring and embolic disease
• Dabigatran V Warfarin

AF
Old woman with multiple SCC for local flap surgery to her face. She has hypertension, peripheral vascular disease. I was
Shown ECG with AF (but it was broad complexed and I thought I could see p waves so I said complete heart block but
was corrected to say it was AF)
• Asked about what else I wanted to know – history (chest pain, exercise tolerance, etc)
• Asked what drugs I would expect her to be on
• Scoring system for AF and stroke (CHADS2 score)
• Would I proceed – I said I would ask cardiology review, but appreciate its surgery that is semi urgent for malignancy

Elective THR with AF and on warfarin

• 78 year old lady with 2 previous MI for THR
• Shown ECG, interpret. AF rate 80.
June 2014 Questions returned from Candidates - Thank you
• How do you preassess?
• Given medication when I mentioned this: Lisinopril, Sotalol, Warfarin, Simvastatin.
• Asked about perioperative instructions for Lisinopril. Why would you omit it? What are the problems with stopping it?
Confusing instructions esp with warfarin stopping too, may present hypertensive to anaesthetic room.
• Perioperative management of warfarin, only indication AF.
• What if it was cataract surgery?
• What is she had neurosurgery?
• What is she had a metallic valve? Discussion on bridging therapy – what regime would you use in your hospital?

6. Emergency AAA 80 years old, hypotensive, low GCS, cold peripheries

• Management in A and E. Who I needed to contact: haematologist, blood bank, surgeons, senior help etc
• Large bore access, x-match,
• Induction, where? How to induce, monitoring
• Art line pre induction? CVP line pre induction?
• Patient went to ITU
• Developed severe lactic acidosis the day after. Wanted to know possible reason for this. Where happy with gut
ischemia but wanted DDx
• What was I going to tell the family and wanted to know if we should have done nothing to begin with for this patient.
They wanted to talk about Hardman study and how that gave an idea of mortality

7. Child with a runny nose/ URTI for an ENT procedure

• What are the potential problems
• how would you assess the patient
• would you provide anaesthesia
• then told that the consultant is happy that it is just a URTI and to proceed with the case.
• how would you anaesthetise the child (discussed EMLA, parental presence, gaseous induction vs Iv induction)
• Post op analgesia - specifically interested in why not to give NSAIDS
• Child the develops laryngospasm, how do you manage it.

8. Phrenic Nerve Palsy. Elderly woman having had right humerus operation, post-operative difficulty in breathing
• shown CXR of patient with raised right hemidiaphragm and associated right lower lobe collapse
• Differentials of postop difficulty in breathing
• How do you approach this patient - management plan and investigations and why
• Differentials of raised right hemidiaphragm
• Causes of phrenic nerve palsy
• Other ways to distinguish this as phrenic nerve palsy
• CXR signs of phrenic nerve palsy
• Incidence of phrenic nerve palsy following interscalene block
• How long does it last
• What else would you see following interscalane block e.g. Horner's syndrome

9. HOCM Phoned by pre-assessment nurse as has found an ejection systolic murmur on 36 year old male.
• What would you do now?
• What else do you want to know from the history e.g. family history of sudden death, symptoms
• What other investigations do you need (including bedside - found to have equal pulse and BP on each side)
• Shown ECG - asked to interpret - LAD and LVH
• Causes of LVH
• Differential diagnosis for this patient
• Pathophysiology behind LVH in general
• Pathophysiology of HOCM i.e. LVOT leading to function aortic stenosis
• What are the main issues anticipated
• How would you manage the patient under GA i.e. keep sinus rhythm etc

10. Fess Procedure (in an otherwise fit and healthy 28 year old)
• Definition of hypotensive anaesthesia
June 2014 Questions returned from Candidates - Thank you
• Indications for hypotensive anaesthesia
• What BP/MAP would I be happy with in this case
• What do the surgeons do to improve their surgical field
• How can anaesthetis induce hypotensive anaesthesia
• How would I anaesthetise for this case
• Would I consider using a throat pack
• What are the safety aspects involved in ensuring safe use of a throat pack

11. Autonomic Dysreflexia (in a patient with T2 injury requiring bladder stone removal
• What are the anaesthetic complications associated with this cas
• What is autonomic dysrelexia and how does it occu
• Discuss the use of suxamehtonium and spinal cord injur
• How would I anaesthetise for this cas
• Why do they need an anaesthetic if they are unable to feel below the level of the injur
• Why could they suddenly become bradycardi
• How would I treat a sudden bradycardi
• What treatment could be used for hypertension

12. LBBB in preop

• elective pt for arthroscopy. LBBB. Would you anaethetise? What is LBBB, causes, dangers (HOCM), any other
investigations (ECHO CXR, hx). All was normal in the end and LBBB 2 years old so I went ahead and anaesthetised
• ECG of LBBB for man I’ve been asked to anaesthetise in half an hour
• Causes
• Symptoms
• Investigations
• Review previous notes again!
• Would I anaesthetise..bell rung...I said No

13. Trifascular block in preop

trifascicular block on ecg in a patient from preop clinic

14. Mandible fracture

15. Dural tap on labour ward

16. CAP/Empyema
20 year old student with 2/52 history of rigors and increasing SOB
Cxr – showed large right side pneumonia with fluid level
• Asked about assessment – CURB 65 and other clinical markers.
• What antibiotic choice?
• Common organisms for pneumonia?
• Then showed CT scan of chest – loculated abscess formation in lung
• Whats my management now – VATS procedure
• Then went on to what choice of airway I would use DLT, What and what size?
• OLV and hypoxia management

17. Epidural problems

• Woman post colectomy on ward with epidural but now she is complaining of pain
• Talked about assessment, reviewing old notes, assessing motor and cold sensation, epidural site.
• What would I do now? – top up, change to PCA

18. Child with stridor

• 2 year old come in with stridor – how would you assess - Asked about the 3 E’s of APLS – effort, efficacy, effect – i.e.
clinical features of upper airway obstruction
• What is stridor?
• What does inspiratory or expiratory stridor tell you about the location of the problem in the airway?
• What are the causes of stridor?
• How would you assess this child? Immediate Management
June 2014 Questions returned from Candidates - Thank you
• How would you treat it?
• Say the child is toxic and ENT think the child has epiglottitis, how would you manage the airway?
• What is the main cause of epiglottitis?
• How do you know when the child is deep enough asleep to intubate?
• The child is toxic and has bacterial tracheitis
• How would you secure airway? Gas induction no IV access

19. Nutrition on ITU

• Patient admitted to ITU age 54, weight 44kg (no height given)
• What do I think of this man’s nutritional status?
• How do we assess nutritional status?
• What are the daily requirements of protein, fat, carbohydrates, electrolytes?
• What other things need to be taken into account?
• What are the disadvantages of enteral (not parenteral) feeding?
• What is refeeding syndrome?
• CXR with NGT in the lung - how to check NG tubes, NPSA guidance.

20. Lady with TB with ruptured ectopic

• 19yrs ectopic pregnancy, from Indian subcontinent, septic, cough, febrile
• CXR : showed R upper zone consolidation
• Differential diagnosis
• How to diagnose TB
• How would you obtain sputum sample
Isolation and precautions when bringing to theatre

21. Man for gastrectomy

• 64 male Gastrectomy - pre / intra / post op.
• Chemo effects
• aspiration risk.
• Risk assessment - malnourished and drinks - liver impairment with regional technique - functions of liver.
• Discussed feeding and refeeding syndrome.
• Intra op analgesia without epidural.
• DLT and the usual questions.

22. Conscious sedation for colonoscopy

• 35,MALE with h/o Crohns. Posted for Colonoscopy as day case
• Definition of Crohns - common treatments.
• Explain to this man why sedation not a GA for endoscopy. Concept of conscious sedation.
• How I would do it?
Define sedation - any classifications AAGBI and American Society for conscious sedation.
• Problems with sedation. Methods of it including why I thought propofol (which I did not choose) would be good. I said
the usual pharmacodynamic things about day case and added PONV with bowel distension for endoscopy.

23. SAH
• 50F with headache, neck stiffness, photophobia and GCS 7
• How would you manage?
• Differentials
• Cerebral vasospasm management
• Investigations and other investigations if that fails
June 2014 Questions returned from Candidates - Thank you
ANATOMY

Lumbar plexus
• Asked to regional block in ED for fracture NOF. What will I do? Nerve supply of hip joint
• How will I perform? Nerve stim/USS?
• Anatomy of femoral nerve – from lumbar plexus to foot. – branches and what do they innervate.
• Anatomy of fascia iliac block – what volume to use?
• Does USS reduce the risk of b=nerve injury? Does it improve efficacy of block?
• Diagram of ant and post lower limb with areas of innervations – name which nerve innervates which area.

Carotid Endartarectomy
• Indications for carotid endarterectomy
• Which part of the carotid artery is being operated on
• The course of the cervical plexus (in detail)
• What is the sensory supply to the face
• Analgesic techniques for carotid endarterectomy
• How would I perform a superficial cervical plexus block
• How would I perform a deep cervical plexus block
What are the complications associated with each technique

Internal jugular vein anatomy

• Indications of central line, they would like a lot
• Course of jugular vein from brain, where does it start and end?
• borders of ijv, in details, relation of ijv and carotid within the carotid shealth, then ask about medial, lateral, anterior
and posterior borders
• why choose right side rather than the left side
• How do you do a rij line?
• how can you confirm the line is in the right place?

Considerations of heart transplant

• Anatomy of sympathetic and parasympathetic
• Neurotransmitters in autonomic nervous syste
• Physiological dennervated
• Action of drugs
• Anti rejection drugs
• Accelerated atherosclerosis
• Horners-what is it, how does present, how can anaesthetists cause i
• CN 3 role in autonomic nervous system
• Patients that get autonomic neuropathy
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PHYSIOLOGY
Head/Neck Surg with Flap
• Different types of flap. Free versus pedicle. Any research findings for one over another?
• Spoke about Hagen-Poeuseille and factors to improve oxygenation. Asked about which vasodilators/vasoconstrictors
would be effective
• We then weirdly went off into what we do or give that would make the tumour spread
• Anaesthetic issues with flap surgery. Access to patient etc.

Decompensated ALD
• What are the different reasons someone with liver failure presents to the HDU/ ICU
Tests of liver function - synthetic vs enzymatic. Which goes off first?
• Why do they get volume overloaded. Effects of aldosterone
• How would you manage a 35 year old with decompensated ALD?
• What are the causes of decompensation?
• What complications can occur following chronic ALD?
• What is the pathophysiology behind portal hypertension?
• How would you treat portal hypertension?
• Reasons for renal impairment in liver failure. Would you filter this patient if he develops renal failure?
What are the effects on the other organ systems of ALD?
How can you assess it severity?

Prone position
• Prone - reasons for its use
• Physiological changes mostly CVS and Resp.
• Also how to prone and number of people to have.
• Nerve or inadvertent injury
• Name of mattress

Aortic Stenosis
This was a man in his 60s I think with moderate aortic stenosis coming for elective inguinal hernia repair and I was seeing him in
pre op assessment.
• Causes of aortic stenosis
• Pathophysiology.
• How you would diagnose the grades of as
• The most useful bedside test i could request
• She asked what the echo would show.
• We then talked about anaesthetising this patient.
• Neuroaxial
• Incidence of sudden death in people with asymptomatic as.

Brain stem death

• What would make a patient who is brain stem dead appropriate for transplantation (ended up mentioning contra-
indications instead!)
• Patient is eligible. How do you proceed?
• What are the effects of brain stem death on body systems?
• What hormones need replacing?
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PHARMACOLOGY
Day case
• Day case surgery. Pt wants to go home.
• Criteria for going home.
• What we can do to facilitate early discharge. (preop pathway, patient info, anaesthetic agents, analgesics, anti-emetics,
LA techniques).
• Goverment targets.
• Fasting times.
• Regional over GA
• What does the hospital need to do (general set up of Day ward, high turnover, close to theatre, staffing

Antiobiotics:

NICE antibiotic guidelines

Suxamethonium
• What are complications of using suxamethonium
• What is the structure of suxamethoniium (they wanted me to draw the molecule, I said I couldn't)
• Why do you get a raise potassium with using suxamethonium (exact mechanism behind this)
• Why do you get a bradycardia with using suxamethonium (exact mechanism behind this)
• When do you get a phase II block
• What are the features of a phase II block
• What problems does suxamethonium apnoea cause and the mechanisms behind this
• How would you anaesthetise a patient differently who has known suxamethonium apnoea
• What duration of block would you expect with Es:Es genotype
• How would you manage a patient who is discovered to have suxamethonium apnoea

Myasthenia Gravis
• What is it?
• How does it present?
• How do you diagnose it?
• Tell me about edrophonium.
• Tell me how other anticholinesterases work. Can you classify them (they accepted me saying how they modified AChE
enzyme)

Drugs used post MI

• ACEi
• How do they work
• Want to know that Ramipril is a pro-drug
• which is more active ramipril or ramiprilat
• PHARMACOKINETICS of Ramiprilat
o protein binding
o peak plasma conc occurs when
o half life
o metabolism and excretion

VTE
• Are you aware of any guideline for VTE?
• What is it in details?
• Risk factors of VTE
• Ask about risk assessment of the risk factor and what would you do
• Compare LMWH to UFH
• How do you classify anticoagulant
• Examiner was nice, said choose your favorite one to talk about, I chose Antiplatlet
• Then ask about how does Warfarin work
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Tolerance
• What are the problems with anaesthetising a heroin addict
• Brief discussion regarding infection and ppe, malnutrition, dentition
• Discussion about opiate tolerance
• What is the mechanism of tolerance
• Discussion about synaptic plasticity
• Pain management in those who have developed opiate tolerance
• Discussion regarding regional alternatives, clonidine, ketamine, nsaids etc.
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PHYSICS
Osmolality
• How to calculate serum osmolarity
• Why glucose and urea in the calculation and not magnesium and calcium for example
• When it’s useful to calculate
• Hyponatraemia and causes peri-op
• Why a healthy patient post-op would struggle with 1l 5% dex whereas a normal healthy patient would be ok?
• definition of osmotic pressure
• What crystalloids, are they isotonic, what's the danger with too much N. Saline.

Capnography
• Shown normal capnogram. Asked to identify stages and label axis (CO2 could be % as well as kPa).
• Shown abnormal traces: partial NMB, obstruction, reduced cardiac output/oesophageal intubation,
• Rebreathing (why does this happen on a circle system? Exhausted soda lime, low FGF, broken unidirectional valves).
• How do you measure CO2? Infrared, explain technique (drew diagram). Interference from other agents, N2O water
collision broadening.
• Mainstream vs sidestream

Flow

• Types of flow Draw diagrams of turbulent and laminar flow? What is the differece? How does velocity
change in laminar flow as you move from edge to centre?
• Hagen-Poiselle
• When does laminar become turbulent?Reynolds number
• characteristics of flow in anaesthetic circuits
• How do we measure flow?
• Design of flowmeters,
• Hot wire pneumotachograph
• Wrights respirometer

MRI
• How does the MRI work
• Problems of GA in MRI
• Standards for safety. Screening questionnaires
• Equipment – what is safe to use?
• What is the 50 Gauss line?
• Problems with infusion pumps.
• Monitoring problems especially ETCO2
• Gadolinium how does it work? Side effects.
• Helium for supercooling

Temperature
Definition, measurement, NICE guidance on control perioperatively, methods of control - deep hypothermic arrest etc.
Graph of time vs temperature under anaesthesia and physiological effects of temperature changes.

C-Pex testing
• What is it
• vO2 max and anaerobic threshold- how are they useful
• how does C-Pex testing work
• What equipment do you need
• tight fitting mask
• Bike
• pneumotacograph
• how do you measure the 02
• they prompted me !! It uses a fuel cell
June 2014 Questions returned from Candidates - Thank you
• how does a fuel cell work

Theatre pollution
• Give me causes of theatre pollution.
• Scavenging discussion.
• COSSH regulations
• Effects of volatiles on staff/ harmful effects
• How to reduce pollution? e.g. regional/ tiva/ circle/ low flow

Oxygen toxicity
• Absorption atalectasis (brief), Hypoxic drive (brief)
• Free radical damage (extensive discussion including formation of hydroxyl radicals and superoxide dismutase)
• Detailed discussion on changes on the neonate with given oxygen concentrations
• CNS involvement (signs symptoms) vs Pulmonary problems (discussed tracheobronchitis, ARDs and pulmonary fibrosis)
• British Thoracic Society Guidelines on oxygen prescribing
• Discussion on Bleomycin
• Clark electode
• Fuel Cell
• Paramagnetic analyser
• Calorific Testing