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.

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 Fowlers 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 Downs 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 Downs 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 childs 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?