FINAL FRCA Viva questions from June 2012

SOE Set 1
Long case
A 65 year old man who is currently being worked up for a lobectomy for a lung malignancy
presents with an acute attack of neck pain.
PMH – diet controlled diabetes, hypertension, hiatus hernia
Medications:
Candesartan, bendrofluazide, enoxaparin, simvastatin, lansoprazole.
Examination:
Ejection systolic murmur, loudest at left sternal edge, second intercostal space.
BP 140/80, heart rate 80, saturations 95% on air.
Chest - clear.

Accompanying material
ECG – sinus rhythm rate 80, left axis deviation, incomplete RBBB
PFTs – PEFR 280; predicted 320-450
FEV1 2.80 litres; predicted 2.70-4.00
FVC 3.65 litres; predicted 3.50 – 4.6-
FEV1/FVC 0.76
Echo report – Aortic stenosis, pressure gradient 37mmHg
Aortic root 3.7cm2
No LVH. EF 70%. Otherwise unremarkable
Lateral C-spine x-ray - Subluxation of C2 on C3.

Questions
Summarize the case.
Summarize findings from each of the investigations.
How significant is his aortic stenosis? How is it classified? What is the significance of AS to
anaesthesia? How concerned am I about his stenosis?
Tell me about lung cancer. What systemic complications are there of lung cancer?
How would I initially manage him? What other history/exam/investigations would I be
interested in?
Told he has to go for a posterior neck stabilisation in the prone position.
How would I manage his airway what are the problems associated with the prone position.
How are these minimised?
Would I extubate him afterwards? How would I judge if he was safe to extubate?
How would I manage his post-operative pain?

Short Case
1) 12 year old boy coming for tympanoplasty and mastoidectomy for cholesteatoma.
What are the issues with this case?
What is a cholesteatoma? What is the significance of this? What can happen if it
isn’t treated?
How would I manage his airway? If intubated what is the problem with this. How can
this problem be overcome? What would you use?
How can hypotensive anaesthesia be achieved?
How would I manage his post-operative pain and nausea?

2) Woman with end-stage cystic fibrosis presenting following trauma to her arm needing
debridement, repair of median nerve and brachial artery.

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 FINAL FRCA Viva questions from June 2012

What is cystic fibrosis? What is the underlying disorder? How does the chloride
channel deficiency actually cause mucous to be thicker? What systems can it
involve?
How would I anaesthetise her
Can she be optimised?
How would I manage her airway

3) Shown a chest x-ray of a patient in ITU with an NG tube. Tube is below diaphragm
but obviously following the course of the left lower lobe bronchus. Would I authorise
this tube to be used for feeding?
How can tube position be confirmed?
What are normal nutritional requirements for a healthy person?
What is the definition of malnutrition?
Patient on ITU with an intracerebral haematoma, not eaten for 5 days and not
expected to eat for another 5 days. What are they at risk of?
What is refeeding syndrome. What is the underlying pathology?
If starting feeding on this patient, how would you adjust the nutritional delivery
compared to the requirements of a healthy, non-starved person?
How can you check if a person is absorbing their feed or not? What can you do if
they aren’t?

Clinical Science
1) Caudal anaesthesia. Anatomy of sacrum and sacral canal including contents.
Indications & Contra-indications, side-effects, complications.
How would you perform a caudal block? What type of needle would you use?
Volume of anaesthetic, additives.

2) Hypothermia. What are the NICE guidelines on intra-operative temperature

control?
What are the physiological effects of hypothermia? How can you keep a patient
warm.

3) Anaphylaxis. How does this present? What is the commonest presentation

what is the incidence of anaphylaxis?
How can hypersensitivity reactions be classified?

4) Osmolarity. What is this? What units?

What is the formula for calculation of estimated Osmolarity How is osmolarity
measured in the lab. Why is there a difference between the estimated and the
calculated osmolarity? What is this called? When can it be increased?
What is osmosis?
Why are patients often hyponatraemic post-op. What is the effect of
hyponatraemia on the body. Why does this happen?

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 FINAL FRCA Viva questions from June 2012

SOE Set 2
Long case

80 year Male booked for elective 8cm AAA. Previous pneumonectomy and thoracoplasty for
TB 20 years ago. CABG to LAD, RCA and circumflex 10 years ago. Asked by surgical
colleagues to see in pre-assessment clinic.

Bloods
Normal FBC Na K normal Ur 12 Cr 170

ECG
Sinus 80bpm Normal axis RBBB & LVH

CXR
PA L thoracoplasty/pneumonectomy Sternotomy wires R lung field – bronchiectasis

Lung function
FEV1 48% expected FVC 51% expected DLCO 30% expected

Questions
Summarise
Discussion of risk for this patient – high risk surgery and high risk patient
Benefits of EVAR vs. open, mortality rates
How is an EVAR performed
Go through investigations – restrictive picture pfts and relevance of DLCO/ KCO What other
investigations - discussed ABG, exercise tests – Bruce protocol, 6mWT, shuttle, CPET – AT
8ml/kg/min and meaning
Explanation of how I would discuss risk with patient
Despite massively high risk - asked how would anaesthetise him
Monitoring – why vascath, which side for central access
Intra op – massive bleed when clamp released and management
Massive transfusion definition and products available
Transfusion triggers for each product
Analgesia options – benefits of epidural
Went back to CPET and asked relationship between results and associated risk

Short cases
1.30 year female UC total colectomy earlier in day – epidural not working in severe pain
called to ward.
Asked how I would manage her. How to test for block.
Review, how long to monitor observations for.
Re-test block and pain score.
Documentation and clear instructions to nursing staff

2.Called to medical ward – 50yo male with cough, fever and diarrhoea, just returned from
holiday in Mediterranean. RR 30 sats 80% on FiO2 40%, HR 130, BP 90/50 temp 39
How would you manage – ABC etc.
Shown CXR – bilateral infiltration – differentials – ALI/ARDS/TRALI/LV failure
Define ALI, define
What is NIV, when would you decide to intubate
3.19y Male fractured mandible, called by max fax who want to fix it in next 24 hours
How urgent is surgery, why does max fax want to fix mandible fractures in 24-48 hours?
Airway assessment was main focus, how would you manage the airway

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 FINAL FRCA Viva questions from June 2012

Clinical Science

Anatomy
Pituitary – from college book. Focus on acromegaly and relevance to anaesthetists.
Signs of Cushings disease
Pressure effects which cranial nerves involved and signs. Visual field defects etc. Then
precise anatomy of pituitary and a bit of physiology
Hormones from ant/post and effects. ADH receptors in collecting duct
Sodium abnormalities post operatively – DI, SIADH. Result with each and treatment options

Physiology
What primary cardiomyopathies are you aware of?
Discussed pathophysiology of restrictive, dilated then focused on HOCM
Signs symptoms of HOCM
Investigation of choice in diagnosis
Anaesthetic aims of anaesthetising HOCM pt

Pharmacology
Tricyclic antidepressants
What clinical features would a pure TCA OD present with? – CNS, CVS, anticholinergic
ECG signs – wide QRS, prolonged QT
How do TCAs exert their effects? What is the absorption, VD and protein binding
metabolism?!
How do they cause arrhythmias? – fast sodium channel blockade ‘membrane stabiliser’
Management of overdose
ABC, specific treatments – activated charcoal, sodium bicarbonate and reason for giving it.
What would you expect temperature to be?
What would you expect the BP to be?
Asked about recent hormone for treatment

Clinical measurement
COPD patient requiring major surgery. How can you measure the severity of his disease?
History, examination
Focus on investigations – Resp - ABG and what results would you expect, CXR, peak flow,
pulmonary function – meaning of results, what you would expect for him. CVS – exercise
tests, CPET

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 FINAL FRCA Viva questions from June 2012

SOE Set 3
Long case
2-year old child from Africa for adeno-tonsillectomy. Supporting information included a
FBC showing a hypochromic, microcytic anaemia, a normal ECG, a sleep-study showing
multiple episodes of desaturation at night. Firstly asked to summarise case. Then asked
about the details of the FBC including red cell width % - I had never heard of this, but
guessed it was altered in sickle cell; then asked to draw a graph of red cell width % vs no of
people, so I drew a normal distribution which they seemed to like. Further discussion about
IV vs gas induction, what drugs I would use and their doses, and the pros and cons of using
an ETT for this case. Then discussion about how to manage bleeding post tonsillectomy.

Short case
1) 58-year old lady for hemi-colectomy. Showed FBC and haematinics. Hb 8.4 with low
iron level. Asked about possible causes, and whether I would transfuse this lady pre-
op, and if so, when. This led to discussion about oxygen delivery and the flux
equation.

2) Shown a photo of an obese Afro-Caribbean man with a knife stuck in his neck! Also
shown an XRay, which had the knife virtually transcending the entire neck! Asked
about which structures likely to be damaged, the anaesthetic issues, and how to
manage the airway – awake fibreoptic vs tracheostomy.

3) About ECT – indications, how performed, anaesthetic issues, how I would give an
anaesthetic for it. Shown an ECG rhythm strip and asked to explain the
parasympathetic and sympathetic phases.

Clinical Science
Anatomy What symptoms would a patient have if they had a blocked left
coronary artery? Then asked to explain coronary anatomy in detail,
including venous drainage. Finally discussion about ECG changes
post MI.

Physiology Pre-eclampsia. Pathophysiology of affected systems. Details of anti-

hypertensives used in its treatment. Anaesthetic issues for C-Section.
Finally asked about role of magnesium

Pharmacology definitions hypo- and hyperglycaemia.; they wanted exact values in

mmol/l. Then asked about causes of the above. HONK, DKA, stress
response to surgery causes hyperglycaemia, and how we can
minimize its effect.
Physics LASERS

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 FINAL FRCA Viva questions from June 2012

SOE Set 4
Long case

67yo women for parotid cancer surgery and suprahyoid dissection

Limited ex tolerance

Bloods = Hb of 16, but otherwise unremarkable

ECG = NSR, RVH, no strain pattern, no axis deviation
PFTs = FEV1/FVC of 35% and FEV1 pred of 55%. Significant reversibility post
bronchodilators of >15%. DLCO was 40% pred. and no volume corrected value. Pre-
bronchodilators FEV1 was 0.8L.
CXR = typical hyperexpanded COPD, maybe a few little bullae and slight effacement of L
costophrenic angle. Didn't look infective. Normal cardiothoracic ratio.

Summarise the case. how you would evaluate the respiratory system pre-op (hx/exam/ix
etc). What specific risks does she present? Any other investigations that you would want.
How would you optimise her pre-op (nebs, physio etc.)?

Then there was discussion about intra-op Mx. Key points being that needed to be paralysis
free, so that surgeon can use facial nerve stimulator and that needed to be deep extubation,
so as to avoid coughing and bleeding from front of neck post op. Use of armoured ETT and
remifentanil infusion. When they ask about how would you extubate

Specifics about post op management. Needing nebs and physio. FEV1 <1L therefore very
poor cough and highly likely to develop LRTI. Then in post op period she develops
increasing swelling around neck and stridor. Got asked what % decrease in airway results in
stridor (50%, apparently). Asked about how you would re-anaesthetise in this situation.
Release clips, cut neck. Gas induction vs IV induction vs surgical airway.

Short cases
1.
Sickle cell.
Pre-assessment nurse calls and says they have a women with sickle cell. What do you
advise? Discussion about testing modalities, sickledex and electrophoresis. Then they
showed me a blood count with none of those tests on and asked what I thought, trait or
disease? Hb was 8.6. Anaesthetic implications (avoidance of precipitants, airway difficulty
due to bone hyperplasia in skull, spleen, tourniquets etc.). Then asked how I would
anaesthetise. Then talked about different types of crisis and their management.

2.
Runny nose in 3yo child for DSU grommets and myringotomy. What risks? Bit about
social/medical criteria for DSU in a child. How long is appropriate to delay for an URTI/LRTI?
Bit about how you'd anaesthetise. Appropriate analgesia. Criteria for discharge of child from
DSU.

3.
32/40 primip, comes in with cord hanging out between her legs
Likely diagnosis? What do you prepare before she comes round, who do you notify? CTG
shows bradycardia. Need cat 1 LSCS. How do you assess, particular attention on which
aspects . Do you think you'll have time for spinal? Probably not given prolonged bradys. RSI
for pregnant women. MAC values intra-op, post op pain relief. Where would you put her
afterwards?

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 FINAL FRCA Viva questions from June 2012

Basic Science

Anatomy
Anatomy of pain pathways from peripheral nociceptors. What receptors are where? What
neurotransmitters at different levels? How can these pathways be manipulated. TENS and
gate control theory.

Physiology
of ageing

Pharmacology
Tocolytics and . uterotonic

Clinical measurement
Awareness and monitoring depth of anaesthesia

SOE Set 5

Long Case
75 Male patient. Lung malignancy is been worked up for lobectomy. HTN, hiatus hernia, DM
diet controlled. Bendroflumethiazide, clexane, ranitidine, simvastatin, candesartan. Attended
A&E with acute onset neck pain.
Examination: BP, pulse normal. rhonchi right lower base. Systolic ejection murmur left
sternal edge. ECG: left axis deviation. PFT: PEFR slightly low, the rest normal. ECHO:
slightly dilated LA. Other chambers normal. EF good. Aortic valve is abnormal. Trans
valvular gradient pressure 37 mmhg. ABG: Po2 9.5 on air the rest normal. Lateral neck xray:
C2 fracture.

Questions: Summary, my preop assessment, What investigation I would like to do. What
surgeons would like to have before surgery (CT MRI). how I would anaesthetise for posterior
stabilisation, Why awake fibreoptic. Why not asleep. How do I do awake fibreoptic. How is
the positioning. Problems with positioning.

Short Cases
1. Anaphylaxis
2. Caudal block
3. Cholesteatoma child

Basic Science
1. Severe cystic fibrosis girl age 35 coming for wound debridement of the
elbow. Questions: what is CF. Problem with it. What anaesthetic technique.
complications with brachial plexus block
2. Osmolarity
3. NICE guideline for hypothermia
4. Diaphragm

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 FINAL FRCA Viva questions from June 2012

SOE Set 6
Long Case
67 years old gentleman with adenocarcinoma of rectum posted for Laparoscopically
assisted anterior resection. Smoker - 20 cigarettes a day
PMH - COPD, Hypertension
Drugs - Bendroflumethiazide, Enalapril, Salbutamol & Beclomethazone inhalers
O/E - conscious, oriented, bilateral pedal edema
ECG - Sinus Tachy, Right atrial enlargement, RAD, Poor progression of R wave.
FBC - HB - 17.1, PCV - 51, WBC - 13.2, others normal
U&E - Na - 135, K - 3.3, Creat - 95(Normal upto 88)
CPEX - AT-10.3, VO2max - 12.3, Max HR - 136, NO overt Ischaemic changes
ABG - PH-7.31, PO2 - 8.2, PCO2- 7.4
PFT - Pre & post bronchodilator therapy
- FEV1 - 55% & 56%(of predicted)
- FVC - 62% & 71% of predicted
- FEV1/FVC ratio - 55%
- DLCO - not given
NO CXR available!!!!
Questions-
Summarise
concerns
Go through FBC - why polycythaemia - respiratory cause, how will it occur -hypoxia
Induced. Other causes of polycythaemia
Read through CPEX, PFT & ECG - Difference between Restrictive & obstructive.
How will you optimise this patient?
How will you anaesthetise -
What additional monitoring will you use apart from AAGBI guideline
Problems with Laparoscopy? Pneumoperitonium, CO2, Positioning related. Lot in detail
will you extubate? where will the patient go?
Post op management - pain, o2, fluid, ERAS, Physio
How will you manage if he desaturates in post op after 2 hours of extubation?

Short cases
1. Awareness
2. transection of spinal cord at T2 level and problems
3. AV Block ECG

Basic Science
1 Anatomy of IJV and CVP trace
2 House fire and CO poisoning
3 ICU Sedation and drugs
4 Noninvasive blood pressure monitoring
. what are the ways of measuring BP noninvasively
Asked about manual - Mercury / aneroid. How aneroid work
Korotkoff sounds
How Von recklingausen works and it’s trace
DINAMAP &FINAPRESS

SOE Set 7

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 FINAL FRCA Viva questions from June 2012

Long Case

80 year old.
AAA- 8cm infra renal
Triple CABG 10 years ago
Left pneumonectomy due to TB
Bp- 140/90
ECG- LVH
Cxr- left pneumonectomy with midline sternotomy wires and right side diffuse infiltration.
Pfts- restrictive lung defect with dlco of 30%
?pulmonary fibrosis.
u&es showed renal impairment
Summary

Review of ix
mx- EVAR vs open
Massive haemorrhage intra- op
Extubation criteria

Short cases-

1. Assessment of epidural that's not working. What to do if it is definitely had it?

Assessment and mx of back pain 4/7 post epidural .

2. Ward patient- hypoxic, d & v, foreign travel. CXR shows ARDS. Discussion of ARDS
and it's causes.

3. 19 year old- been knocked out 8 hours ago. # mandible. Smells of ETOH. Mx. CT
head guidelines

Basic Science

Pituitary tumours.
Their physical effects.
Their endocrine effects.
Postoperative hypo/ hypernatraemia and it's investigation and management.

Hypertrophic cardiomyopathy.
Presenting symptoms/ signs.
Underlying physiology.
Principles underlying anaesthetic management.

Tricyclics antidepressant.
History.
Signs and symptoms in overdose.
Management.
Why are they hypotensive.
What management could you instigate if they are hypotensive?

COPD.

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 FINAL FRCA Viva questions from June 2012

Diagnostic tests.
Spirometry- what the values show- interpretation and reversibility.
ABG.
Carbon monoxide transfer factor.
FBC- polycythaemia
CPEX testing and how it's applicable in COPD.

SOE Set 8
Long case

28 yr old female - NVD 4 days ago. Unwell with Group A Strep in BC

Theatre for retained products 8 hours ago. Now SOB and unwell.
Bloods - essentially DIC
CXR - Left lower zone consolidation. ?something else
ECG - sinus tachy
ABG - compensated metabolic acidosis. PaO2 12 on 70% O2

Questions...
Summarise...
What are the problems?
What’s the diagnosis?
What would you do next?
What other monitoring?
How would you anaesthetise?
Where would she go afterwards?
ITU management principles

Short Cases
1) Post tonsillectomy bleed (standard)
2) Head Injury for Transfer (again as before and in barker)
3) Arthroscopy - guy with LBBB - random questions on investigation

Basic Science

Anatomy
Tell me about awake fibreoptic
And then anatomy of trachea. Relations?
How to anaesthetise for AFOI

Physiology
Aortic X-clamping - effects. Similar to RCOA book.

Pharmacology
Tolerance?
Mechanisms?
Examples?
How to avoid? Conversion to which routes?

Physics
Venturi - examples in anaesthesia?
Then all about Sanders Jet ventilator?

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 FINAL FRCA Viva questions from June 2012

SOE Set 9
Long case:
63 year old female admitted following a fall, sustained a NOF # requiring hemiarthroplasty

PMH: rheumatic heart disease, requiring aortic and mitral valve replacements 20 years ago.
Poor exercise tolerance of 100 yards
Drug Hx: ramipril, spironolactone, bumetanide, warfarin, digoxin

Examination revealed raised JVP, reduced AE bilaterally

BMI 38

Electrolytes:
Na 130
K 4.8
Cr 150
Urea 12.0

Hb 10.1
MCV normal
WCC 3.0
Low lymphocytes
INR 3.6
ECG: nodal rhythm
CXR: 2 metallic valves, cardiomegaly, raised right hemidiaphragm

Questions asked:
Can you summarise the case
What are the pertinent features? I said need to investigate fall, warfarin and bridging therapy,
physiological and anatomical considerations of obesity
What further investigations would you request before theatre?
What will an echo show?
Why has she got a raised right hemidiaphragm?
Which is the aortic and mitral valve on the CXR?
What should her normal INR be?
How will you correct it?
How effective is FFP?
What about PTC?
I talked about cardiology and haematology reviews
How would you anaesthetise her?
What lines would you insert?
How else would you monitor her? Would you give Abx? We talked about clean surgery.
What Abx?
Do you know about the NICE guidelines on Abx?

Short cases:
1. Management of a dural tap

2. You are called by the pre-operative assessment nurse who is assessing a 38 year old
male for an elective polypectomy. On examination he had a heart murmur. He knew about
this murmur but has never been investigated.
What would you do?
Shown ECG-LV hypertrophy.

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 FINAL FRCA Viva questions from June 2012

What are the cause of LVH?

Tell me about HOCM-inheritance, presentation, pathophysiology
What the pathophysiology was and how to anaesthetise

3. Stridor in a child
What is stridor? Does it only happen upon inspiration?
How would you approach
Your anaesthetic plan if it was epiglottis
Differential diagnosis

Basic sciences:
1. If you saw a patient involved in a trauma, how could the brachial plexus be injured? How
does damage present?
What types of nerve injuries do you know?
Then they showed a diagram and I had to explain the roots, divisions etc
I was asked how to perform a supraclavicular block

2. Young female having a laparoscopic cholecystectomy

What are the causes of increasing ETCO2?
What are the physiological effects of the pneumoperitoneum?
How do you ventilate your patients for laparoscopic surgery?

3. Patient is not recovering from your anaesthetic. No twitches on the TOF. What would you
do? I talked about PTC.
What nerves do you use to test?
What nerves are more sensitive?
What patient factors may affect the recovery of NMSK agents?
Tell me what dose of vecuronium you use?
What is ED95?
Detailed pharmacokinetics of vecuronium

4. What are the signs of ICP?

What are the causes of ICP?
Why do children get raised ICP?
Monroe Kellie theory
What is the Cushing’s response? Why do you get hypertension?
How do you manage patients with raised ICP?
Where are the baroreceptors?
How do you measure ICP?
What are the waveforms?

SOE Set 10
Long Case
63 year old lady with #NOF.
Rheumatic fever as a child. Mitral and aortic valve surgery 25 years ago.
2 CVAs. Walks with a frame. Breathless after about 100m.

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Drugs: ACE-i, bumetanide, spironolactone, warfarin

Investigations Normochromic normocytic anaemia.
WCC 3
Platelets normal
Na 130 K 4.9 Ur 16, Cr 160
INR 3.6
ECG showed LBBB rate 120 with LVH
CXR showed massive heart with ill defined borders, very raised right
hemidiaphragm.
Asked about pre op investigations and optimisation. What about the INR? What would be
your plan for anticoagulation?
Patient has advanced directive with DNAR status. Does this affect your management?
Anaesthetic plan. I went for a spinal.

Short Cases
1. Dural tap with epidural for labour. What would you do? What are advantages /
disadvantages of the 2 options? If you put an intrathecal catheter in, what dose
would you put down it? 6 hours later she asks to see you with a characteristic
headache – what do you do?
2. 25 year old fit active patient in preop clinic found to have systolic murmur loudest at
left sternal edge. Had a murmur as a teenager which was never investigated. What
could this be? What do you do? Asked for ECG and was shown one with 1st degree
heart block, LVH, T wave inversion in v5 and v6. What is HCM and how do you
manage it? Why do they get outflow tract obstruction?
3. 2 year old with stridor. Focussed on assessment of airway. Causes of inspiratory
stridor, expiratory stridor and biphasic stridor. How do you manage suspected
epiglotitis?

Basic Science
1. Brachial plexus

Mechanisms of injury in a RTA victim.

2. Laparoscopic surgery

What are causes of raised PaCO2 introperatively? What are the complications of
laparoscopic surgery? Talked about positioning, CO2 and systems problems.

3. Vecuronium

At the end of surgery a patient has zero response to TOF stimulation. What are the
potential causes?

4. ICP monitoring
Why might ICP be raised? What is CPP? How can you measure ICP? What are the
Lundberg waves? Who should have ICP monitoring?

SOE Set 11
Long Case
Lady in 60’s came for hip hemi following NOF #. History of rheumatic fever with aortic valve
and mitral valve repair 24 years ago. On bumetanide, spironolactone, warfarin, ACE inhibitor

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O/E, BMI 31. BP and heart rate stable, breathless on oxygen.

Bloods showing normocytic anaemia, INR 3.6
CXR – cardiomegaly, bat wing shadowing for pulmonary oedema, shadowing right lower
zone ? collapse, consolidation. Raised right hemi-diaphragm.

QUESTIONS
Opened the case by asking what the issues are.
+ve findings on CXR.
‘Cause of normocytic
‘Cause of hyponatremia’
‘How to manage’ . - new AAGBI hip # guidelines.
‘Technique’

SHORT CASES:
1. 2 year old child with stridor..
2. PDPH.

3. 36 year old man for simple surgery. Preop nurse tells u that he has systolic murmur
and completely asymptomatic person. ‘How to proceed’ He then said that patient had
ECHO which shows HOCM. ‘What is HOCM’. ‘Clinical features and anaesthetic
aims’.

Basic Science

ANATOMY:
Brachial plexus. Picture shown. Mechanism of brachial plexus injury intraop

PHYSIOLOGY:
Effects of laparoscopy on different body systems.

PHARMACOLOGY:
vecuronium in detail.
.
PHYSICS:
ICP

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