Exam Intelligence

So the ex was out of my life and the hospital. I went from being in a relationship that everyone talked about to, well, just one of the ICU sisters – how dull!!

I thought working in a hospital was supposed to be exciting: trauma calls that are proper trauma calls (not just broken arms), and arrest calls that are…well, I can’t say for fear of being very very politically incorrect, but you know what I mean.

Of course to add to that would be handsome doctors. My non nursing friends STILL, after all these years, think I spend my time drooling over and lusting after sexy McDreamy types.

WRONG!!

Nursing and working in a hospital is nothing like ER or Grey’s Anatomy. I realise I’m not telling the nurses and medics reading this anything that you don’t know; but guys, it’s not even like Casualty!! Whilst we’re on the subject of what other people think it’s like to work in a hospital, my brother thinks that all ICU nurses do is sit at the end of a bed and tap on a computer that keeps the patient alive whilst eating KIT KATS! I’ve tried to tell him that we’re far more classy than that and that it’s only Godiva chocolates for us!

Here I am then just another single thirty something, so in true SATC style I did what Carrie would do and will spend my thirties buying shoes (I’m glad you mentioned Carrie, because for a moment, I thought SATC was something else… - Ed). Sadly, unlike Carrie, many of my purchases will be from Primark and not Manolo Blahnik or Jimmy Choo. I’m sure Carrie, Miranda, Charlotte and Samantha would love Primark if there was one on 5th Avenue though!

Back on the Intensive Care Unit, guess what the topic of conversation is at the moment. YEP you got it…..Vivas (Poor Primary Candidates – Ed). I can’t get away from it. I’ve broken into a sweat several times over the last few weeks over the mere mention of the white liquid. It hasn’t been in a revision type way either (Steady on! – Ed.) . It’s been in a RSI type way, but I still had to take deep breaths! So if any of you boys and girls out there are reading this on a study break please, please get to Liverpool, work hard on that course and pass the exam.

I’ve got a question for you what does lidocaine do to the ventilator reponse to carbon dioxide? If you don’t know I’m sure you’ll learn it in Liverpool or on this website. (Erm…nope. Answers in an email to help-me@examintelligence.com, please). I just cant go through it all again. I want to go back to talking about normal things like shopping, shoes, running, make up, I’ll even talk about cars and cameras with the boys if I must. Even the female doctors can’t talk about anything else other than the adverse effects of clonidine.

However what I won’t talk about with anyone is, yes you’ve guessed it, Facebook or any type of social networking site. I recently went to Tel Aviv (TA) with a friend. I’ve never been on a beach surrounded by so many good looking tanned men without having to lie or stand with my stomach sucked in. They were all gay! And all they could talk about was Facebook! The photos of our weekend will apparently be on the site. So does that mean that because I’m not on it that I won’t ever get to see any holiday photos again?! Sorry….just my monthly FB rant!

Anyway whilst in TA I got introduced to CROSSFIT. It’s fantastic! If like me you are in to exercise then you will love it.. It’s not new but I hadn’t heard about it. It seems that most of Isreal is doing it. Boy did I ache after just a half an hour session. CROSSFIT was created in the 1980s by an ex gymnast working at Golds gym in LA. It’s described as a strength and fitness methodology. It’s harsh, especially on the beach at midday in 34 degree heat. Now I’m back I’m addicted, although Crossfit in the rain in a park in Surrey isn’t quite like the beach. My advice, try it, great for beating exam stress and only takes half an hour.

Anyway, must go now, shoes to buy and general life things to sort out. Good luck boys and girls with the exams.

S xx

Image via Wikipedia

Someone asked me to produce an answer for a question that gave an idea of how much needed to be written.

I’ve shown you examples of good and bad layout, but here is an answer that could be considered as having sufficient content to gain a pass.  It must have done, because I wouldn’t have passed the April 2008 SAQ paper otherwise!

The question I am answering is about pre-oxygenation and is question 5 in the April 2008 paper which you can find by clicking here.

A)    Method of Pre-Oxygenation

• Ask patient to breathe normally (normal tidal volume) for 3-5 minutes,
• Via face mask tightly applied to face,
• Connected to circle-absorber system,
• With fresh gas flow of 100% oxygen of >minute volume.

B)    Physiological basis

• O₂ consumption is approximately 250ml min^-1.
• FRC is ≈ 2500ml
• Preoxygenation replaces nitrogen containing air in the lungs with oxygen and generate reservoir of ≈ 2500ml oxygen.
• Oxygen saturation therefore maintained in apnoeic patient for 5-10 minutes.
• Also, small increase in oxygen reserves within body tissues.
• Duration required for preoxygenation is dependent on washin of oxygen and washout of nitrogen and can be decreased by patient increasing per breath volume (4-breath and 8-breath techniques).

C)    Assessment of adequacy

• Measure end-tidal oxygen concentration (>85% indicates good preoxygenation)
• Measure time for SpO2 to drop below 90% from onset of apnoea
• Measure arterial oxygen tension using arterial blood gases
• Mass spectrometry of expired gas

D)    Advantages of PreO₂

• Increases time to desaturation during securing an airway

Disadvantages

• Absorption atelectasis (airway closure followed by absorption of distal gas)
• Atelectasis due to airway narrowing (gas in alveolus absorbed faster than can be replaced through narrow airway)
• Patient anxiety heightened by tight fitting face mask (”I can’t breathe”) (increases oxygen demand)
• Potential to mask oesophageal intubation by delaying desaturation (offset by EtCO₂ monitoring in modern practice).

Now that’s my answer to the question.

It isn’t perfect, but I think it’s pretty good (and I want to hear from anyone who thinks it needs modifying: help-me@examintelligence.com).

I don’t think you need to write any more than that.

On another note:

James has written a Sexy Topics list over at Passing The Final, which I highly recommend you read.  It contains a lits of topics which are prime fodder for the SAQ.  Like him, though, I urge you not to underestimate the MCQ!

Good luck!

By now you should be well into the swing of doing practice questions for the SAQ. This is a very demanding exam, and you need to practice under near exam conditions to make sure that you are able to deal with the pressure that you will feel on the day.

When you are in the exam hall, you will sit surrounded by hundreds of other people, with silence, except for the scritch, scritch, scratch of the pens of those around you…and it can feel oppressive. There will be no music to listen to, or TV on in the background. You might hear the occasional car engine, police siren or aircraft overhead, depending where you are, but other than that it’s just those pens, the shuffling of papers and occasional cough.

You will have 3 hours to answer 12 questions, and to some people that will seem like not anywhere near enough time. However, as many people who have gone before can testify, it clearly is.

In a previous post several months ago, I posted this entry, with these two images.
The first is an exmaple of a bad way to layout a question. Click on it to enlarge.

You can see the lines of writing are not separated out. Headings are poorly underlined and difficult to distinguish from the main body of the text, and in general, when looking at it, it’s not easy to mark. Don’t make this mistake. If you lay out an answer more clearly (like the image below), you stand a much better chance of getting the marks, because you are making the examiners work easier, and they will be thankful (to some slight degree, at least) for it, and this gives you a psychological advantage…

Here is an example of a better way to lay it out (again, click to enlarge):

You can see here that all the headings are more space out, and it is easier to read.
In fact in my actual exam, I left even more space, and underlined all my subheadings in the manner of the word “management” on the right hand page of the second example. I also left more spaces between lines. Try not to put too much indentation in when you are using subcategories, because you can easily end up squashing your answer to the right of the page. Again, this is completely unneccessary, because the college has caused a small forest of trees to be felled to allow us to have enough paper to write on in the exam.

So on the principle that every advantage you can gain will help, we strongly advise using clear layouts to get your point across!

If you are struggling with a concept, or need help finding an answer, or want advice for the exam, please email help-me@examintelligence.com, or use the Contact Us page to get in touch.

Apologies for the interruption in service.

Service commitments and work on something to go on here has meant we’ve not been able to keep updating the site.

Keep watching….