Exam Intelligence

Eaton Lambert is a funny guy. He’s got plenty of mates to play with, but he just can’t throw the ball fast enough.
Why’s that? When he was young his dad (Igor) stopped him from drinking his milk like every good little boy should. Now he doesn’t have the strength. His skinny upper arms mean he can’t whip the ball far enough to reach his mates.
He does get noticeably better the more he practices though, and if he drinks his special “power up” (Guanidine) he’s much better at it. He’s tried his sister’s Regonol*, but that just didn’t do it for him.
He’s still a sensitive boy though, and whenever Tracria (his latest crush) comes near him, he goes very weak at the knees (too much of a good thing, apparently).

His sister, Myasthenia is a troublesome young minx, who goes around causing all sorts of problems. She seems to get on well with the little old men in the retirement home (they like her cakes), and spends lots of time in the company of other young troublemakers for example with weight problems, depression and dry hair and skin. She hates Igor too, who hangs around 90% of the time at home, and 10% in the pub. (He says he’s 3/4 Thymic). Unlike Eaton, whenever she starts to try and play with her friends she ends up tiring herself out, gets blurry vision, slurs her words and can’t drink her Regonol*. If she gets a cold (or Igor is nearby) things just get worse. (God forbid if she ever got pregnant!) The first time she got ill she got really weak, and they gave her some disgusting stuff they called “Deltacortil*”, but it made her much worse before she got better. The second time they hooked her up to a machine with lots of tubes and spinning pumps, which made her feel better in no time. Now she just drinks the Regonol instead. Sometimes she overdoes it though, and starts drooling like Homer Simpson, and has real problems seeing if someone turns out the lights. When that happens she needs to make sure she stays in the vicinity of the nearest ladies.
Like Eaton she goes weak at the knees whenever Tracria is around…for similar reasons (hey, it’s the 21st Century, you know!). One of the boys in her class, a guy called Scoline Anectine (nickname Sux, poor guy), has a real crush on her, but hasn’t got the message that he doesn’t have any effect on her, even though after every approach she blanks him.
Most of time she wishes that Igor would disappear back to Thymus, but since it disappeared (after a vicious, but surgically executed coup during which many people were gassed; and following which there were more than a few breathless moments), he can’t.

Their second cousin Dystrophia (a very unusual name, only 1 in 20,000! Her parents thought she was going to be a boy…it was a 50:50 chance I suppose) goes to a school just around the corner, because the teachers there can spend more time with her. She’s quite weak, and has problems controlling her movements. Sometimes when she shakes hands with people she can’t let go, a situation that always seems worse in winter. She has a poor constitution, and has been told she’s got a weak heart. She certainly gets a few chesty coughs.
She’s been told that her eyesight will almost certainly deteriorate as she gets older, and she’s not going to be able to eat much apart from soup. Her father has started going bald at a young age, and her mother is worried that she will too (D, that is, not mum!) She hates Tracria and Sux equally because they always seem to be hanging around, and she just can’t seem to catch her breath when they’re nearby.

*Regonol is a trade name for pyridostigmine, and deltacortil is a trade name for prednisolone tablets.

Hopefully this will serve me as an aide memoir for the Final FRCA Viva….

I finally found a way of remembering which area of auscultation is which. Normally I spend ages working it out from first principles…

Only at exam time….

Neuroanaesthesia is not by way of being my forte, having
not done any lengthy period of it.

I did, however, find this, which seems to be a fairly straightforward, as long as you
recognise that a “tuberculin syringe” (or TB syringe) is
very very similar to what we might call an “insulin
syringe” (see here), that “anode tubes” are reinforced ET tubes, and
remember that Pentothal is the trade name for Sodium
Thiopental.

Another little resource is the SNACC website (Society for
Neurosurgical Anesthesia (sic) and Critical Care), which
has this little guide on it.

In all honesty I think, however, that the questions are
more likely to be asked on principles, such as ICP (and
management) and Cerebral Blood Flow (and that nice graph
with the three lines for MAP, PaCO2 and PaO2 on it plus
effects of anaesthetic drugs). There might be a mention
of air embolism and management in a sitting neuro case…

For a little light revision regarding ElectroCardioGraphy (or EKGs if you’re from the USA) this link to the University of Utah’s ECG image library may be useful.

Another link is this one to the ECG Library, created by the authors of ECG by Example.

Just to prove a point, new BTS Asthma Guidelines were published this May.
And here they are. (Well, the quick reference, anyway).

And, if like me, you had a really hard time understanding Flow-Volume loops, see this article (which has a nice downloadable PDF of loops part way down) at Merck.