MCAI CRQ TRIAL NOV 2021

1. Zona glomerulosa, fasciculata and reticular.

a) Name a hormone produced by each layer (3m)

b) 3 factors that stimulate aldosterone release (3m)

c) Explain the physiological function of aldsterone including the cellular mechanism involved.
(5m)

Diagram of metabolism of vitamin D

d) A takes place in, what is B enzyme, C takes place in? (3m)

e) 2 other hormones in calcium metabolism. (2m)

f) Explained the term ‘adjusted calcium’ when used in clinical medicine. (4m)

2. Diagram of neuron axon (same as sample question provided in MCAI candidate

handbook)

a) State structure A-E (5m)

b) Outline mechanism of action of LA (5m)

c) How physical properties of nerve affect the speed of LA blockage onset? (1m)

d) What is levobupivacaine? (2m)

e) Max volume of levebupivacaine 0.25% if used for femoral block in a 70KG patient, Show
your calculation. (1m)

f) State influence of additive on effect of LA and describe the mechanism of action for each.
Adrenaline (3m) Sodium Bicarbonate (3m).
 MCAI OSCE TRIAL NOV 2021

1. Identify each equipment

a) Macintosh blade (1m)

b) Miller (1m)

c) Airtraq (1m)

d) Polio (1m)

e) Mccoy (1m)

f) Optical stylet (1m)

g) Fiberoptic Rigid laryngoscope (1m)

h) 4 features of macintosh blade (4m)

i) Components of fiberoptic intubating bronchoscopes. (4m)

j) Label the diagram A to C showing light travelling through a fiber optic cable and explain
the physical priciple involved. (5m) (Internal refraction, cladding and core)

2. ECG same as sample question provided in MCAI candidate handbook.

 MCAI PHARMACOLOGY CRQ NOV 2021

1.

a) Difference between summation and synergism in context of drug interaction. (2m)

b) Describe how pharmaceutical incompatibility affects drug interaction. Give 2 examples.

(4m)

c) Describe how pharmacokinetic interaction affect drug interaction. Support your

explanation eith 3 examples. (5m)

d) Define pharmacodynamic interaction and give 2 examples. (4m)

e) What is isobologram. (2m)

f) 3 factors that contribute to risk of adverse drug interaction. (3m)

2.

a) Classify NSAID according to their chemical structure. Give example of commonly used
drugs for each. (5m)

b) MOA of NSAID. (4m)

c) Role of cox 1 and cox 2. (4m)

d) Side effects of cox 1 and side effects of cox 2. (2m)

e) 3 contraindication of nsaid. (3m)

f) Drugs that increase the risk of bleeding if given with NSAID. (2m)

3.

a) Name the main endogenous glucocorticoids produced by adrenal cortex. Give 3 examples
of synthetic glucocorticoids. (4m)

b) Categories the pharmacological effect of glucocorticoids. Briefly explain the mechanisms

of any 3. (7m)

c) 3 clinical indications of glucorcorticoids. (3m)

d) 4 long term (cvs/dermatological) complications of glucocorticoids. (4m)

e) What is needed to be considered when seeing a patient peri operatively , if he is on

glucocorticoids therapy. (2m)
4.

a) MOA of sux. (4m)

b) 5 SE of sux. (5m)

c) What is sux apnea? (3m)

d) What is dibucaine? What is dibucaine number? (4m)

e) 4 characteristics of Phase 1 block. (4m)

5.

a) Describe the colour coding of medical gas cylinder for oxygen, nitrous oxide, entonox and
helium. (4m)

b) 4 ways to ensure safe storage of medical gas cylinders. (4m)

c) Describe pin index safety system. (4m)

d) What is entonox? How is it manufactured? (4m)

e) What is poynting effect and its relevance with entonox. (4m)

6.

a) What is defibrillator? Label A B C D (5m)

b) What is the function of A B C D? Is this defibrillator in charge or discharge position? (5m)

c) Formula for stored energy. (2m)

d) Two differences between monophasic and biphasic defibrillator. (4m)

e) 4 factors that affect thoracic impedance during defibrillation. (4m)

 MCAI PHYSIOLOGY CRQ NOV 2021

1.

a) Outline production and circulation of CSF. How Increased ICP affect production and
absorption. 5m

b) Difference between biochemistry of CSF and plasma. 4m

c) What is ICP? What is the normal range? 2m

d) Describe Monro-Kellie doctrine. 3m

e) 4 physiological or anaesthetic factors causing increased CBF. 4m

f) Define cushing reflex. 3m

2.

a) Define dead space. 2m

b) Classify and define 3 types of dead space. 6m

c) 4 factors that increase anatomical dead space. 4m

d) What is FRC? 1m

e) FRC is of PHYSIOLOGICAL importance. why? Give 2 reasons. 4m

f) What causes increase in FRC? 2 causes (0.5m each) and explain each (1m each)

3.

a) Describe structure of normal adult hemoglobin HbA1. 4m

b) 3 functions of hemoglobin. 4m

c) What is anemic hypoxia? 1m What is the effect on ODC? 4m

d) What is 23 DPG and role in anemia. 3m

e) Relation between cao2 and do2. 1m

f) As an anesthetist, how you increase ca02? 3m

4.

a) Describe in detail Left coronary circulation: origin and route. Branches and supply. 5m

b) Describe in detail Right coronary circulation: origin and route. Branches and supply 5m

c) What is left coronary dominance? 2m

Picture of Cardiac cycle

d) Label ABCD (valve opening and closing) 2m

e) What is 2 (c wave) and why it happen. 2m

f) Label 1 3 4 5 (wave on right atrium pressure) 2m

g) Define isovolumetric contraction. 2m

5.

a) SI unit for temp. 1m

b) Describe how you get this SI unit. 3m

c) Boiling point of water in this unit. 1m

d) Non electrical method to measure temp. 2m

e) What is the principle of this? (picture of infrared tympanic thermometer). 3m

f) Principle of thermocouple. 3m

g) 2 advantages of thermocouple. 2m

h) Describe heat loss in OT. 5m

6.

a) What is pulse oximetry. 1m

b) 2 reading on pulse oximetry. 1m

c) what is the law used and describe. 5m

Picture of wavelength absorbance.

d) What is A and B and their value. (isosbestic point) 3m

e) The importance of this point. 2m

f) What is C and D (640 n 990) 2m and describe absorbance of Hbo2 and Hb at this point
4m

g) What is E and F (oxy and reduced hb) 2m

 MCAI OSCE PAPER 1 NOV 2021

1. 55yo male post triple A surgery, complain of chest pain and collapse in ward.

a) Describe the steps in BLS and how you provide single responder CPR. 5m

b) Describe A B C D rhythm, which is shockable and which is non shockable. 4m

c) Energy of biphasic defibrillation for adult. 1m

d) How many times can you repeat shock according to CPR algorithm? 1m

e) 2 medications to use in this scenario and dose. 4m

f) What is another medication that you would consider in this situation? 1m

g) List down 4H and 4T. 4m

2.

a) V1 - V6 lead placement. 6m

b) What are the unipolar leads other than chest leads? 2m

c) What are the bipolar leads? 2m

ECG of STEMI

d) Comment on HR and rhythm. 2m

e) State 3 abnormalities 3m and the possible diagnosis 2m

f) Other than pharmacological causes, what are the other 3 causes that can cause this? 3m

3. 60yo male plan for elective incision hernia repair. He is a heavy smoker and has chronic
respiratory disease.

a) What is the first thing you do upon seeing g this patient? 2m

b) What will you look for in tongue or finger? 1m

c) 3 signs during inspection of hands and fingers that is related to the respiratory system. 3m

d) 4 things to look for during chest inspection. 4m

e) Normal apex beat location. 1m

f) 3 things to look for during palpation of the chest. 3m

g) During percussion, where is normal dullness, and what is the pathological condition that
cause dullness? 2m

h) What area of hyperresonance means? 1m

i) Which side should you auscultate and which part of the stethoscope to use? 2m

4. 46yo female schedule for subtotal thyroidectomy.

a) 3 indications for subtotal or total thyroidectomy. 3m

b) What is the clinical suspicion to suspect for hyperthyroidism? 2m

c) If patient has a significant goiter, how do you establish for airway involvement or
compromise? 3m

d) Clinical examination to establish airway involvement in significant goiter.

e) 3 things to inspect during examination.

f) 3 preoperative imaging. 3m

g) What other aspect of patient condition have to stabilize preop? 1m How to check? 1m

h) 2 options if airway is concern / compromise. 2m

i) What is the common biochemistry abnormality post total thyroidectomy and why? 2m

5. 30yo ASA 1, plan for sinus surgery. After intubation, pack nasal with co-phenyl.

HR 60 BP 110/70 etco2 4.6 etsevo 2.2% temp 36.8

a) Surgery haven't start, HR 48 BP 180/80 etco2 4.6 etsevo 2.2% temp 36.8

What is the major concern? 1m

b) What is the possible cause? 1m

c) What are the other causes? 2m

d) 4 immediate management. 2m

e) Despite adequate deepening of anaesthesia, hypertension persist, what medication and

dose to give?

f) How the drug act? 1m

g) 2 medication option for infusion. 2m

h) 4 immediate complication of hypertensive crisis / malignant hyperthermia.

i) BP is well controlled intraop, but you are unsure of the causes. 4 investigations to send
post op.

6. 71yo ASA II, underlying hypertension on bisoprolol, diuretic and aspirin 7.5mg (withheld
10 days). Hypertension is well controlled. You explain regarding SAB during pre med last
night, he is anxious but agree. Medication is not serve on the morning of op.

a) On the OT table, you noted ECG monitoring (picture of AF, no HR BP provided, no

symptoms provided). What is this rhythm? 1m

b) 4 factors that may cause this rhythm. 4m

c) 2 pathophysiology implication of this rhythm. 2m

d) 3 immediate measurements. 3m

e) 3 drugs to control the heart rate with dose. 3m

f) Will you postpone this surgery and why? 2m

g) Signs of unstable AF. 2m

h) Despite rate control, the patient is unstable, 3 things you can do that might help. 3m

7. Picture of transesophageal doppler.

a) 3 clinical indications. 3m

b) 2 advantages. 2m

c) Optimal depth of insertion. 1m

d) Contraindications.

e) What is FTc. 2m

f) Normal range for FTc. 2m

g) What is frequency shift in doppler and what measurement in TOE. 2m

h) SV 47 CO 4.7 Ftc 300 63. Interpret 1 m and treatment 1m

8. Trauma case GCS 4/15, facial fracture, blood in mouth. Vitals normal, spo2 90% under
HFM

a) How would you induce and list the steps BEFORE securing airway. 5m

b) What equipment do you want to prepare? 5m

c) 2 medications that can be used as sole induction agent and dose. 2m

d) 2 muscle relaxants to use in this situation and dose. 2m

e) After induction, direct laryngoscope CL 4 despite BURP. What is your next step according
to DAS? 4m

f) Still unsuccessful, next step? 1m

g) You are able to oxygenate and ventilate using SAD. What are your 2 options? 1m
 MCAI OSCE PAPER 2 NOV 2021

1. Picture of transverse section of 6th vertebrae.

a) Label A-F. 6m

b) 8 complications of IJC cannulation.

c) Numbness over shoulder post IJC cannulation, what nerve is damaged? 2m

d) Honer syndrome is cause by disruption to what nerve? 1m List down Honer Triad 3m

2. CXR of diaphragmatic hernia

a) What is the most obvious abnormality and what is the cause? 2m (bowel in thorax)

b) What is the second abnormality relating to airway? 1m (trachea deviated to right)

c) 2 features of symptomatology which is significant in assessing the severity of this

condition. 2m

d) What is the anaesthetic risk? 1m

e) 3 respiratory complications if this happens. 3m

f) 2 factors determining the morbidity of such event. 2m

g) Fasting guideline for elective surgery. 1m

h) 2 objectives in premedication to avoid complication. 2m

i) 4 drugs to prescribe, dose and MOA. 4m

j) How will you manage induction? 1m

k) What to make sure during emergence and extubation? 1m

3. pH 7.20 pco2 60 p02 60 Bicarb 25 BE +1

a) State 3 abnormalities 1m and what is this condition called? 2m

b) Is there any metabolic compensation? 1m

c) 2 conditions that cause this. 2m

d) 3 management that may be beneficial. 3m

e) is sodium Bicarbonate indicated? 1m

f) What is this? 2m (battery symbol in electrical circuit)

g) What is this? 2m (earth symbol in electrical circuit)

h) What is this? 2m (transformer symbol in electrical circuit)

i) What is this? 2m (switch symbol in electrical circuit)

j) Function of capacitor in defibrilator. 2m

4.

a) What is the innervation of anterolateral abdominal wall? 4m

b) Label 1-5 (ultrasound image of layer of abdomen). 5m

c) Where you aim to deposit the LA? 2m

d) Where is the best place to put ultrasound probe? 2m

e) 3 surgical procedures where TAP is useful. 3m

f) 3 complications. 3m

g) 2 contraindications. 1m

5.

a) What is this? (Picture of VIE) 1m

b) It's function. 1m

c) It's temp and pressure. 2m

Picture of E size cylinder

d) What material it is made of? 1m

e) Pressure at 15 degree Celsius if full? 1m

f) Pressure at 150 degree Celsius if half full? 1m

g) What volume of nitrous oxide will be delivered if full? 1m

Picture of flowmeter

h) At position A (high), what is the flow and depends on what physical properties of the gas?
1m

i) At position B (low), what is the flow and depends on what physical properties of the gas?
1m

Picture of head of gas cylinder with engravement.

j) What is A? (Serial number) 1m

k) What is B? (TP 220 bar) 1m

l) What is plastic ring C and function? 2m

m) 4 ways to ensure safe storage of medical gas cylinder. 4m

6. 6 years old child planned for elective orchiopexy for retractile testis. Mother and child are
anxious. You are seeing the mother for premedication.

a) First thing you do when you meet the mother. 2m

b) What history do you want to elicit? 4m

c) 2 premedications that you can give. 2m

d) Mother claims child is scared of needle, she is concerned how the child will be asleep.
What options will you give? 2m

e) Mother claims the child's elder brother has had previous surgery, and when he wakes up
for anaesthesia, he wake up like a demon, anxious. She wants to know why this happened,
will this happen again this time, and how it may be prevented. What do you tell her. 3m

f) What will you tell her about common and serious side effects for general anesthesia in
children? 3m

g) What regional technique is suitable in this case? 1m What other types of analgesia you
will give? 1m

h) 2 complication of this technique that you will tell her. 2m

i) She is asking if the child’s dad or she can accompany to OT. What will you say? 1m

7. 30yo female ASA I planned for emergency op for knee surgery under general
anaesthesia. She said her relative has some serious reaction from anaesthesia previously.

a) What questions do you want to ask about the relative regarding her previous anesthesia?
4m

b) According to the relative, she had high temperature and was admitted to the ICU for 3
days. What is the most likely diagnosis? How to explain this to a non medical personnel? 4m

c) She wants to know if she can knows if she is susceptible to this condition preop. What do
you tell her? 3m

d) If unable to know pre-op regarding susceptibility, she wants to know if she still can
proceed for op, is it safe. 4m

e) She wants to know after discharge, what she needs to do in case she needs another
operation. 3m
f) She wants to know if there is any drug for this condition. 2m

*** based on this exam, according to the style, topics prediction for next exam

Isomer

Kinetics

LA

Antiarrhythmatic/ Anti emetic

OHA

Antihypertenive

Bronchodilator (Drugs for asthma)

Renal system

Gastric system

Oxygen or CO2 transport

Cerebral blood flow

Lung compliance

Control of ventilation

Spirometry

Muscle physiology

OSCE

IABP/BP

Ultrasound

Capno

ICB/CT brain

Gas law

Laser

Vaporiser

Spinal / CSE / high spinal / PDPH

LAST
Bronchospasm management intraop

MH / sux apnea / reversal

Embolism