Out of the blocks...True or False?

Since adding a counter to the website approximately two weeks ago, over 1000 people have had a look - many thanks. Feel free to leave (constructive) comments, and if there are any suggestions please either comment or email me: jrs970@yahoo.co.uk

I started work again yesterday with great difficulty and attempted upsurges in motivation. Actually quite an encouraging start: I began with the MCQs from the new edition college book, some of which I recognised from previously, and some which were new. It's a different ball game with MCQs from now on without the negative marking, as this takes the dilemma about leaving questions unanswered out of the game. All questions should be answered as there is nothing to lose, and the college is recommending 80% as a passmark (which is probably the equivalent of approx. 60% for the negatively marked paper). I got 77% on the first 90 questions - don't be too alarmed as I have done the damn exam before so hopefully would have retained some knowledge. The last time I started MCQs, I was getting dreadfully embarassing marks e.g. 20-30%!! My advice would be: do not underestimate this part of the exam - it is where I came unstuck at my peril. Practice practice practice.

It is also worth (if not already done so) thinking about courses. Not for everyone, granted, but they do focus the mind somewhat (and it's a weekend/week off work too!). My experience is entirely with the Mersey courses. I can't recommend the Booker Course highly enough for the experience, practice, timing, and lectures on SAQs -it really whips you into shape! There are also various weekends/weeks for SAQs/MCQs, and SOEs once you hopefully get there.
Other courses available can be found at Anaesthesia UK.

Read the press.....

Guidelines and national publications for two years previously are much beloved of this exam. Common places to look include:

The Association of Anaesthetists (2007-8)

-LA toxicity +/- Intralipid use
-Malignant Hyperthermia treatment
-Perioperative Management of the Morbidly Obese Patient - THIS IS FAIR GAME FOR THIS YEAR!!
-Standards of monitoring during anaesthesia & recovery
-Blood Transfusion & the Anaesthetist (recent publication: I will summarise very soon)

NICE (2007-8)

-Venous Thromboembolism: April 2007
-Acutely Ill patients in hospital: July 2007
-Head Injury: September 2007
-Intrapartum Care: September 2007
-Ultrasound Guidance in locating the Epidural Space: January 2008
-Prophylaxis against Infective Endocarditis: March 2008
-Perioperative hypothermia: April 2008
-Technical solutions for VAP in adults: August 2008

NPSA

Reducing the risk of hyponatraemia when administering intravenous infusions to children

-Since 2000, there have been four child deaths following neurological injury from hospital-acquired hyponatraemia reported in the UK.

Recommendations
-Remove 0.18% NaCl with glucose 4% from stocks & general use in areas treating children.
-Produce local clinical guidelines for the fluid management of paediatric patients.
-Provide adequate supervision and training for all staff involced in the prescribing, monitoring, and administering of IV fluids for children.
-Review & improve design of existing drug prescription/fluid balance charts.
-Promote reporting of hospital-acquired hyponatraemia incidents

Resuscitation: intravascular volume depletion should be managed with 0.9% NaCl boluses
Deficit: estimate fluid deficit & replace as 0.9% NaCl with 5% dextrose or 0.9% NaCl over a minimum of 24hrs
Maintenance: do not use 0.18% NaCl with glucose 4%

The majority of children may be managed with 0.45% NaCl with 5% glucose (or 2.5% glucose)

CEMACH (report summarised in previous blog posting)

Journals

Thanks to everyone who is visiting the site - I now have a little counter to the left to get an idea of readership. It first went up about two weeks ago, and I've had nearly 800 views (thanks to Mum for all of them!).

As I have mentioned previously, the review articles in our journals (BJA & Anaesthesia) provide some ideal SAQ/SOE hot topics for the exam. It is important to recognise that there are some subjects much more likely to appear in an exam setting than others e.g. remifentanil as apposed to mitochondrial disorders! I estimate that approximately a year and a half's worth of articles are covered, so everything from April 2007 - September 2008. I have made what I consider to be exam topics in bold type:

BJA: here & here

2007
April: Blood flow & ventilation in the lung / percussion pacing
May: CA stents in non-cardiac surgery
June: Diastolic heart failure
July: Neuro ++! The whole post-grad issue is neuroanaesthesia/NICU reviews
August: Carotid endarterectomy
September: Perioperative platelet Rx
October: Sciatica & epidural injections / contrast-induced nephropathy
November: Cardioprotection with remote ischaemic preconditioning
December: Gabapentin

2008
January: Sedation & Regional anaesthesia
February: Prone position / epidural analgesia vs periph NB for knee surgery
March: Statins & Sepsis / VAP
April: Mitochondrial disorders
May: Perioperative anaemia management
June: Opioids & respiratory control
July: Its all about Pain! A whole postgraduate educational issue! Read the reviews.
August: Physiological effects of hyperchloraemia and acidosis + Acupuncture for post-operative pain
September: Perioperative management of pts with renal failure


Anaesthesia here and here

2007
April: Temp. epicardial pacing part 2
May: Systemic complications post-head injury
July: Propofol-infusion syndrome
October: Interpleural block part 1
November: Interpleural block part 2 / new thrombotic agents & neuraxial anaesthesia for major orthopaedic surgery
December: Remifentanil

2008
January: Oesophageal Doppler in abdominal surgery / Statins for non-cardiac surgery part1
February: Statins for non-cardiac surgery part 2 / cardiac output monitoring
March: Helium & Xenon / Metabolic acidosis in the critically ill Part 1
April: Metabolic Acidosis in the critically ill Part 2
June: IV contrast
July: Intubation aids