Exam Intelligence

Might be more useful than trying to predict!

FRCA Examiners say they deliver “topical” questions… (see the SAQ report on the RCOA website)
So if it’s had guidelines and an article or two in one or more journals, it’s probably higher up the list of probable topics coming up in the exam than something else.

Anything that’s had an editorial and an article, or a CEACCP or review article, is also fair game.

If it’s headlining in the BMJ it has also occasionally shown up (apparently….), however, I’m not sure about that one.

Questions done badly the year before have a tendency to crop up again, occasionally with a twist.

Specific predictions tend to be more difficult to make.  When I did the final I guessed 8 of 12, I think.  Didn’t guess that anatomy of paravertebral space would come up, asthma, anxiety or pancreatitis (April/June 2008).  The others I guessed might come up based on the criteria outlined above.  I thought other topics might also come up, as did others, so you can’t fully narrow down what to revise, and to be honest, you’ll be better off not doing so in the long run anyway!

So we’ve been going through the last few months of journals and have a few articles that might make it into the exam.

From March 2009 BJA:

Editorial: Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia

The other editorial, whilst interesting, I don’t think contains enough substance to have a question generated from it (though I could be wrong), but it does raise some issues about the use of red blood cells, and alternatives.

Article on Regional Anaesthesia: Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.

From February 2009 BJA:

Editorial: Central neuraxial block: defining risk more clearly

This is an editorial on the recently published NAP 3 project on the complications of Central Neuraxial Blockade.  If you’re going into the exam without having read this and the results of NAP 3, then I think you are missing out on the possibility of scoring highly in a highly probable question.  The editorial is accompanied by the article Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists in the same issue.

Review Article: Antifibrinolytics in cardiac surgical patients receiving aspirin: a systematic review and meta-analysis

Another highly probable question.  This is a much discussed topic, and an important one.

Obstetric Article: Conversion of epidural labour analgesia to anaesthesia for Caesarean section: a prospective study of the incidence and determinants of failure

Another actually quite interesting article.  One I even thought of reading when I saw the title.  I can’t honestly say that’s something I do much when it comes to the blue journal…

From January 2009 BJA

Editorial Emergency Caesarean delivery: is supplementary maternal oxygen necessary?

Um…interesting question, and I never would have thought it would be one to feature in an editorial, however, they do make the point at the end, even if there is a risk to the foetus, the risk/benefit  ratio is still in favour of giving supplemental oxygen.

Review: Bone cement implantation syndrome

Funnily enough this was a topic of a presentation at a departmental meeting recently at my hospital…

Clinical Practice: Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus

Obstetric Anaesthesia: Supplementary oxygen for emergency Caesarean section under regional anaesthesia^,

From December 2008 BJA

Editorial: Can we accurately assess an individual’s perioperative risk?

The eternal question!!

Obstetrics: Intravenous oxytocin bolus of 2 units is superior to 5 units during elective Caesarean section

I’m not sure that this will make a question, but since I used 10U of oxytocin when I first did obstetrics, and I now use 5U, perhaps a further reduction is in order.

From November 2008 BJA

Clinical Practice: Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia

NICE published guidelines in April 2008 on Perioperative Hypothermia (inadvertent), and in these they mention that if a patient’s temperature is less than 36°C before an operation they should be prewarmed.  Here is a study looking into the effects of prewarming.

From October 2008 BJA

Editorial: Calcium channel blockers, beta-blockers, and perioperative cardiovascular stability

Review: Positive pressure ventilation: what is the real cost?

Clinical Practice: Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function

Clinical Practice: Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia

Critical Care: Transport with ongoing cardiopulmonary resuscitation may not be futile

Not sure that this will make a question really, but again, it’s quite interesting.

(MORE WILL FOLLOW!)

Over the last few months you will have seen that the website has been let slide a little bit….

We apologise for this, but we have been preparing some new things for you, including a lecture on anaesthesia in obese patients, which one of our Consultant colleagues kindly agreed we could put on-line, a review of some of the information you ought to be aware of which has been published over the last few months, and some new study tips and recipes from PhotoCook.

Obviously we don’t want to dump this all on the server in one fell swoop, because then we wouldn’t have anything to drag you back here for, but, keep watching this space!

The Special Article just published on the BJA website about the complications of Central Neuraxial Blockade.

You can find it here:

Major complications of central neuraxial block.

Basically it says that the risks of doing Epidurals and Spinals are much lower than expected, with a denominator of >700,000 cases to work from.

I’d say that it’s pretty solid….

Take:

• A large pot with a lid which can go in the oven (Cast Iron if you have it, Ceramic if not)
• 500g of lamb or pork for slow cooking (it normally says this on the label in the supermarket now, or if you’re posh enough to buy from a butcher, ask him/her for the best cut for making stew).
• 5 carrots
• 2 parsnips
• 1 swede (medium or large)
• 1 bouquet garni
• 4 small onions
• a small pinch of basil
• 3 large or 6 small potatoes (no place for medium sized potatoes here!)
• 2 tablespoons of oil
• 1 tablespoon of flour
• Pinch of salt
• Pinch of pepper
• Vegetable stock powder

1. Turn the oven on to 150°C
2. Peel veg, except potato and cut all veg including potato into ~ 1inch chunks (2.5cm for those of us working in the scientific metric world) - precision is not important
3. Quarter the onions
4. Heat oil in pot on hob
5. Add onions and meat (which should also be in ~1 inch chunks
6. Brown the meat - don’t let the onions burn, keep stirring.
7. Add flour to soak up fat/oil
8. Now add all vegetables and potatoes, pinch of basil, bouquet garni, salt, pepper to the pot
9. Mix up vegetable stock according to instructions, you should cover the top of the ingredients already in the pot with a few millimetres (no more than 5!) of liquid
10. Bring to the boil on the hob
11. Transfer to the oven for at least 4 hours (whilst you do some more revision!).  You should stir it at least once, preferably twice during this period, and that doesn’t mean to stirs with the spoon just before serving!
12. Serve when bored of revision, with or without salad.

Enjoy.