Friday 5 September 2008

Make your life easy!

'A picture is worth a thousand words' (Fred R Barnard 1921)

The above quote can be applied to many parts of this exam, most specifically to anatomy. There will be an anatomy/regional technique SAQ and there will be an anatomy SOE. With that type of guarantee, one must be well prepared and learn thoroughly the anatomy syllabus. If you can produce a slick, well-labelled diagram, it looks impressive to the examiners and you will earn many more marks than trying to write a block of anatomical prose or talk through the roots of the lumbar plexus! I speak from experience, having 'come a cropper' in the anatomy section of my science viva (I will try to follow my own advice next time!).

My former exam buddy Dr B (FRCA) had a great method for anatomy and graph revision; he used a white board and continually drew and re-drew the diagrams, whilst talking to himself about what he was drawing as if explaining to the examiners. It then became second nature to reproduce what was required within seconds.

I used two textbooks for my revision: Anatomy for Anaesthetists & Concise Anatomy for Anaesthesia. I also used AnaesthesiaUK, Instant Anatomy, New York School of Regional Anesthesia, and Google Images. So what do you need to know? Well, basically all of the Primary syllabus but in a clinically-orientated manner. So, not just "Draw the brachial plexus" but "Describe with the use of a diagram which nerves are blocked with an interscalene block. Tell me how you would perform the block, and what are the contraindications/complications".

Below is a list of stuff you should know from head to toe - not definitive but should cover the majority of the syllabus:

Cerebral circulation
Cranial Nerves
The Eye: Clinical = blocks
Nerve supply to the face: Clinical = trigeminal neuralgia
Nose: it has been asked in the past!
Internal Jugular & Subclavian Vein: Clinical = cannulation
Cervical plexus and here: Clinical = superficial/deep cervical plexus blocks (+ GA vs RA for carotids)
Neck surface anatomy: Clinical = tracheostomy (+ surgical vs perc + cross-section @ C6)
Stellate ganglion: Clinical = block
Brachial plexus: Clinical = block
Axilla
Ulnar/radial/median nerves: Clinical = blocks (from BP to wrist)

Larynx and here: Clinical = LA/RA for awake fibreoptic intubation
Tracheobronchial tree: Clinical = one-lung anaesthesia/DLT
Pleural space: Clinical = intercostal N block/interpleural block/paravertebral block
Coronary circulation: Arterial & Venous
Epidural space: Clinical = epidural anaesthesia
Subarachnoid space: Clinical = spinal anaesthesia
Vertebrae: Clinical = as above/vertebral space
Spinal cord and here: Clinical = arterial blood supply

Autonomic Nervous System: so many questions!! ?Valsava manoeuvre
Coeliac plexus: Clinical = block
Lumbar plexus: Clinical = block (+ lumbar sympathetic block)
Sacral plexus
Sacrum: Clinical = Caudal anaesthesia (usually paediatric)
Femoral Triangle: Clinical = '3-in-1' blocks
Femoral Nerve: Clinical = as above
Sciatic Nerve: Clinical = blocks (different approaches)
Nerve supply to foot: Clinical = ankle block