I think I remember him! At least, I remember examining a candidate with an Olympic pin who used my favourite, and generally underappreciated, word (you don’t get any extra marks for using the examiner’s favourite word though you may star in a blog post years later). The word is homeostenosis, and it refers to the narrowing, or stenosing, of the physiological range over which someone can maintain homeostasis. Namely, the ‘good 90 year old’. A more irreverent definition – irreverent as only those who need to cope with constant exposure to suffering and death can manage – comes from another examiner – ‘the wheel nuts are only hand tightened’.
Anaesthetists practise quite a different type of medicine to most other doctors in that core to our role we deliberately stress our patients’ physiology, and need the tools to assess and aid their compensation. The mental tools for this are assessed in the primary examination. So it’s disappointing (and surprising even :P) that I found it in Harrison’s not an anaesthesia tome.
Almost three years ago PLOOTD was conceived by one of my colleagues (his tag is PRIMARYLOS) with a mission to assist candidates in preparing for the primary examination. By means of a daily post it was hoped to address every learning objective (LO) in the curriculum for the Primary examination. For each LO a series of TRUE/ FALSE statements was provided as an impetus for candidates to read around the topic and gain an understanding of the topic. This was thought to be a better way of acquiring and consolidating knowledge as opposed to finding the answer to a remembered MCQ on a black bank.
In addition to this there was also provided a plethora of posts on supplemental aspects of exam preparation such as study technique, exam technique and recommended resources. And if that was not enough there were also posts about historical aspects of anaesthesia as well as examiner humour. Our original contributor really upped the ante by writing a pharmacokinetic simulator program in association with some posts to help candidates understand this important topic which is poorly dealt with in the texts.
At the time of writing there are 333 LOs (half the devil’s number) that are potentially assessable in the Primary Examination. As of yesterday there has been a post written for every single one of them. For most of the LOs there are more than one post that has been written. Indeed for some of the more comprehensive LOs there are multiple posts. BT SQ 1.6 I am thinking of you in particular.*
This has been a huge effort by primarylos in terms of conceiving, building and refining the website- collating all the LOs, past SAQs and topic weightings is a monumental task in itself. I would also like to acknowledge the efforts of two of our stellar contributors: aGasgal and Vallecula. aGasgal has written so much stuff that she has a supplementary website to fit all her contributions in!
Several SAQs have been asked on this topic which is of obvious relevance to anaesthetists. It requires a sound understanding of renal sympathetic nerve activity, the mechanisms for autoregulation of renal blood flow as well as the role of the renin angiotensin system. I used Stoelting for this post as I find Vander a bit too wordy.
T/F intraoperative urine output correlates well with volume status
T/F noradrenaline preferentially constricts the afferent glomerular arteriole
T/F atrial natriuretic peptide preferentially constricts the afferent glomerular arteriole
T/F angiotensin II causes constriction of both the afferent and efferent glomerular arterioles
T/F angiotensin II activates the thirst reflex
T/F when stimulated, renal sympathetic nerves decrease blood flow more than GFR
T/F a MAP above 70 indicates that renal perfusion will be adequate
T/F renin is released from the macula densa in response to decreased renal perfusion
T/F an increase in glomerular capillary oncotic pressure will increase net filtration pressure and increase GFR
BT PO 1.65 Explain the mechanisms involved in the regulation of renal function
BT PO 1.73 Describe the mechanisms involved in the maintenance of fluid and electrolyte balance
To my mind these two LOs are about the same topic so I have taken the liberty of doing a single post for both of them. There is a lot of overlap between all the LOs that relate to the functions of the kidney.
I freely admit I exclusively used the APM: Scientific Evidence for this LO. Section 1.6.3 on page 93 of the PDF file shares the title of this LO. The best part is it is only one page long and is possibly one of the shortest references for a LO in the curriculum.
Only three statements to consider:
T/F severe pain can contribute to myocardial ischaemia, ileus and atelectasis
T/F the adverse effects of pain can be clearly distinguished from those attributable to the surgical stress response
T/F there is convincing evidence that epidural analgesia prevents these adverse outcomes
The last one is probably more Final exam fare but certainly worth thinking about.
aGasgal has previously posted on several occasions regarding BT PM 1.3 which is about the basic physiological mechanisms of pain.
The next few LOs stay on the theme of pain physiology. Fortunately they are all dealt with in the appropriate section of ANZCA’s Acute Pain Management: Scientific Evidence. An unpalatable but comprehensive tome that is on the recommended reading list.
Section 1.4 is entitled “Progression of acute to chronic pain” and is seven pages long. Consult it to find the correct answer to the statements below.
T/F chronic postsurgical pain (CPSP) is very common
T/F CPSP frequently has a neuropathic component
T/F all pain developing in the postoperative environment that is prolonged is termed as CPSP
T/F preoperative and postoperative pain are the two most potent predictors of CPSP
T/F sensitisation of the peripheral and central nervous system is the mechanism that accounts for the development of CPSP