Exam Intelligence

Well, the great fluid debate continues to rage as ever, including the colloid/crystalloid argument, but more importantly there has just recently been an explosion of interest in balanced fluid solutions.

According to a review article in the August edition of the BJA (2008) there are probably several reasons for this:

• Renewed interest in Stewart’s hypothesis in assessing acid-base balance.
• Recognition of the fact that “normal” saline causes hyperchloraemic acidosis,
• And the arrival of new balanced salt solutions.

Braun AND Fresenius Kabi have recently had hydroxy-ethyl-starch solutions in balanced solutions (i.e. things similar to Hartmann’s) approved in the EU.

Acidosis has long been known to cause all kinds of problems, although there are examples of physiological acidosis (such as in exercise) which confer advantage.

We believe that there is a possibility that in light of an NPSA publication about paediatric fluid administration and the fact that these fluids have been licensed, followed by a review article in the BJA, a question on fluid use and possibly on how it can affect acidosis is a possibility.

There are several resources on the internet about acidosis and the Stewart hypothesis:

• Physicochemical approach to acid-base balance
• Anaesthesia UK Explanation
• Acid-Base Websites Reviewed

One of the recipes I cooked up during exam time.
Very simple, very straight forward, and fairly healthy as well!

LAZY CHOPS RECIPE

1 tbsp dried thyme
1 tbsp “Lazy Garlic”
Juice of 1 half lemon
1 tsp salt
1 tsp coarse ground black pepper
Dash of water
1 tbsp olive oil
2 pork chops
4 carrots
1 courgette
125g bulgar wheat
1 tsp chicken stock powder
3 tbsp pesto (red or green)
sharp knife

Mix up thyme, pepper, salt, garlic, lemon juice, water and olive oil in a bowl. Pierce pork chops with knife multiple times. Soak chops in mixture for 10-15 minutes.

Prepare carrots and courgette and slice in slices about 1/2 cm thick.

Add chicken stock powder to pan of boiling water, add bulgar wheat, carrots and boil for 8 minutes whilst putting chops under grill.

Grill chops on side 1 for 4-5 minutes, then turn. Add courgettes to bulgar wheat pan.

Grill chops for further 4-5 minutes.

Serve with pesto (green or red) smeared on chops.

How lazy was that?

James continues to maintain his blog at PassingTheFinal.BlogSpot.com and has posted up a pointer about the last report into SAQs from the RCOA. They always report back on what the problem questions were in previous papers. As he points out, questions which have been badly answered before have a habit of sneaking up on you again (and usually for good reason!).

We would like to thank him for his kind words….

PS:Watch out for the “Ex-Girlfriends Guide to Coping with His Exam Stresses…” series, coming soon….

As a working man/woman you will spend most of your week, like me, giving anaesthetics. Some days you will be on call long-days, some days you will be on call nights. Depending on your rota this may or may not be called on-call anymore. You could technically be working a partial or full shift, but for the purposes of this blog, I’m going to refer to on-call when you work outside the hours of 8am to 5pm.

Unfortunately you still have to read, mark, learn and inwardly digest a whole host of information, in preparation for what one of the Consultants I have worked with insisted on referring to as

“a little test”.

Slap.

One of the things that will make your life easier in setting out to study is setting aside regular time to read. Now personally I’m not much of a revision planner, and I don’t go in for those large wall charts people at college used to have in the run up to the exam. (They used to be elaborately coloured and precisely drawn, and took up more time to plan than it took to revise, I believe).

In any case, the point I’m trying to make is that you need to set aside time.
I had the luxury of 1/2 hour in the morning on the train and 1/2 hour in the evening on the train, in which to read a book or journal article, do some MCQs or listen to a podcast, which meant that of my 2-3 hours a day, 1 hour was conveniently scheduled for me, as there was not much else I could do!

If you don’t have a commute, or you drive, however, this makes things a bit more tricky. You need to sit down with your rota and significant other and decide when you are going to work. Plan out what evenings you are going to cook (use our recipes!) and which you are not. Perhaps get together with friends to both learn together and share the cooking. (Choose friends who have a large dining table and a dishwasher, for maximum efficiency here!)

The important thing is to make a schedule about when you are going to study, not necessarily what it is exactly you are going to study, at least, not until the point where you are about to sit down. (Although having said that, of course, you do need to make sure you cover the knowledge…)

And then stick to it.

Bored? Frustrated? Restless? Irritable?
Are you hungry, by any chance?
Try this…

Ingredients:
Lamb Mince or even lamb pieces with a bit of fat but no bones.
Half an Onion
2 cloves Garlic
2 cm of fresh Ginger
Handful of Coriander
teaspoon of Cumin
One Fresh green Chili

If you have a food processor:
Put the lamb pieces and all of the other ingredients into it and blitz. Add salt and pepper to taste.
Remove and shape in to small flat burger shapes - or whatever shape you want really!

If you don’t have a food processor:
Use the lamb mince instead. Chop the onion finely and crush the garlic and ginger. Finely chop the coriander and chili. Mix it all together with the mince. Add salt and pepper to taste. Shape as above

Cook the burgers on a griddle pan or in a hot frying pan with a small amount of oil to stop them sticking.

Serving suggestions:
With some salad and pita bread and a yoghurt dip.
In a burger bun with salsa and a slice of cheese.
With chips!!