Exam Intelligence

1. The following are associated with a decrease in muscle strength/power:
A. Eaton-Lambert syndrome - TRUE
Myasthaenic syndrome is associated with a decreased release of Acetylcholine from the nerve terminal, and therefore patients will have decreased strength.

B. Fallot’s Tetralogy - FALSE
Sorry, we just made that up. You can find out all about the Tetralogy of Fallot by looking at this link (http://www.emedicine.com/med/topic3579.htm)

C. Treacher-Collins syndrome - FALSE
This one too. Treacher-Collins is a syndrome known by several other names. As a hater of eponyms (and I would hate to inflict my name on future students of medicine for some little known group of signs or symptoms), I would rather people just called it mandibulofacial dysostosis. Read about, and see photos of patients with it, here (http://www.treachercollins.net/syndrome.html). Once you have seen the gallery of photos, you will not forget it. It is important to anaesthetists because of the associated airway problems that may arise.

D. Guillain-Barrè syndrome - TRUE
Need we say more?

E. Kawasaki disease - FALSE
Nope. This is an acute febrile vasculitic syndrome of early childhood. There is increasing evidence for an infective cause. The vasculitis is most can occur in veins, capillaries, small arterioles, and arteries. characterized by fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, and erythema and edema of the hands and feet.

2. Tetanus
A. is caused by the Gram-positive bacillus Tetanus botulinum - FALSE
Um, no. It’s a Gram-positive rod-shaped anaerobic bacterium called Clostridium tetani.

B. has an incubation period from 1 to 36 days - FALSE
The incubation period is 3-21 days.

C. is fatal >50% of the time - FALSE
Mortality in untreated patients is apparently up to 45% (66% in neonates), with treatment <10%, the rate in those who have received 1-2 doses of vaccine previously being approximately half that of the unvaccinated. (http://www.patient.co.uk/showdoc/40000432/)

D. is associated with myocardial infarction - FALSE
Nope.

E. can be prevented by vaccination with inactivated tetanus toxoid which should be boosted every 3 years. - FALSE
Vaccination is a core tenet of the childhood vaccination program. Its normally given as part of “triple vaccine”, followed by boosters at school entry and leaving. It is thought that 5 doses likely to confer lifelong immunity. Additional boosters may be given to travellers to areas where medical attention may be unavailable,(and likely to sustain at-risk injury) if last dose >10yrs ago, even if completed 5 dose schedule.

As a part of a drive to bring you better intelligence we are developing a new website. This will be up and running very very shortly. We’re just learning how to operate the more sophisticated parts of our webhost, which is a stunning machine based in the US, with ridiculous amounts of bandwidth, power and storage, so keep checking back.

In the meantime, for a little fun, we thought you might like to see some MCQs, which are definitely different from the ones you’ll have seen elsewhere:

Some of them will be at the same level, some will be harder, some will be easier, and some of them will be plain ridiculous (and therefore tagged as work distraction).

So:

1. The following are associated with a decrease in muscle strength/power:
A. Eaton-Lambert syndrome
B. Fallot’s Tetralogy
C. Treacher-Collins syndrome
D. Guillain-Barrè syndrome
E. Kawasaki disease

2. Tetanus
A. is caused by the Gram-positive bacillus Tetanus botulinum
B. has an incubation period from 1 to 36 days
C. is fatal >50% of the time
D. is associated with myocardial infarction
E. can be prevented by vaccination with inactivated tetanus toxoid which should be boosted every 3 years.

Image via Wikipedia Critical Temperature is the temperature above which, no matter how much pressure you apply, you cannot force a gas to become a liquid. Interestingly enough, though, if you apply sufficiently high pressures, you can form a solid. Essentially, distinct liquid and solid phases of a substance no longer exist.

If you measure the vapour pressure of a substance at the critical temperature, that pressure is called the critical pressure. Alternatively it could be defined as the pressure which is required to liquefy a vapour at its critical temperature.

A substance is a vapour when it is in equilibrium with the substance in another phase, and a gas when there is no liquid or solid present. Therefore, by definition, except at the extremely high pressures mentioned above, any substance above its critical temperature, is a gas. A liquid does not have to boil, nor a solid to sublime (change state directly from solid to vapour/gas-Ed.) to form a vapour. You can draw a serious of lines, plotted on a graph where the x-axis shows volume, and the y-axis shows pressure, which correspond to different temperatures and called isotherms, which demonstrate what will happen to a substance as you increase temperature with a given volume (or pressure). The one with most relevance of course is nitrous oxide…(see here).

Pseudo-critical temperature is the critical temperature of a mixture of gases. In anaesthesia it is commonly used to describe the temperature at which a 50:50 mixture of oxygen and nitrous oxide separates (laminates) forming liquid nitrous oxide and gaseous oxygen, which occurs at (depending on the pressure) temperatures in the range -7 to -5.5 degrees Celsius in cylinders, and lower temperatures in a pipeline (due to lower pressures) at around -20 degrees Celsius.

Image via Wikipedia Critical Temperature is the temperature above which, no matter how much pressure you apply, you cannot force a gas to become a liquid. Interestingly enough, though, if you apply sufficiently high pressures, you can form a solid. Essentially, distinct liquid and solid phases of a substance no longer exist.

If you measure the vapour pressure of a substance at the critical temperature, that pressure is called the critical pressure. Alternatively it could be defined as the pressure which is required to liquefy a vapour at its critical temperature.

A substance is a vapour when it is in equilibrium with the substance in another phase, and a gas when there is no liquid or solid present. Therefore, by definition, except at the extremely high pressures mentioned above, any substance above its critical temperature, is a gas. A liquid does not have to boil, nor a solid to sublime (change state directly from solid to vapour/gas-Ed.) to form a vapour. You can draw a serious of lines, plotted on a graph where the x-axis shows volume, and the y-axis shows pressure, which correspond to different temperatures and called isotherms, which demonstrate what will happen to a substance as you increase temperature with a given volume (or pressure). The one with most relevance of course is nitrous oxide…(see here).

Pseudo-critical temperature is the critical temperature of a mixture of gases. In anaesthesia it is commonly used to describe the temperature at which a 50:50 mixture of oxygen and nitrous oxide separates (laminates) forming liquid nitrous oxide and gaseous oxygen, which occurs at (depending on the pressure) temperatures in the range -7 to -5.5 degrees Celsius in cylinders, and lower temperatures in a pipeline (due to lower pressures) at around -20 degrees Celsius.

FINAL FRCA Short answer questions by James Nickells, Maan Hasan, Vino Ramachandra and Neville Robinson (ISBN: 0-7279-1289-5; Publisher: BMJ Books)

Published way back in 1998, this book is looking a bit dated now, and that’s not just in terms of it’s cover, but also it’s typeface (better known as font, nowadays). The layout is in the form of nine exam papers which are the same format as the current paper, and include some old favourites, such as writing notes on statistical tests, describing the anatomy of the trachea, stress ulcers in ICU and anaesthetising in an MRI. From this point of view it gives you the opportunity to set a timer, and sit down and do “a practice paper under exam conditions”.

The model answers are simply laid out with bullet points and subheadings given to show a suggested framework, and the explanations are generally short and sweet. The questions chosen for inclusion were quite cleverly chosen for the principles of management and principles of answering, and answers are still applicable today. However, because the book is from 1998 some of the answers can be out of date and/or dated. For example magnets are no longer recommended for routine use (Anaesthesia 2006) with pacemakers. After a prolonged re-read, however, no massive glaring problems were discovered, and any issues there are with answers are fairly obvious, on the whole, and should only cause a minor irritation to the reader.

Less wordy than some other SAQ books in its answers, this proved a useful revision aid for it’s simle layout and simple answers. There are no “for extra bonus points” points, instead the authors stuck to the KISS principle. (Keep it simple, silly - Ed.)

Would we recommend it? Difficult one. Questions in this book are covered in other books which also cover more topics. I preferred the style and layout of the answers in this to some of the other books, but not everyone will do. Overall, it wouldn’t be top of the list, because other books have slightly more to offer, but it’s a useful adjunct to revision.