SS_OB 1.10 Pharmacology of oxytocics

Regarding PGF2 alpha:

Q. It increases uterine tone.  TRUE/ FALSE

Q. It can cause bronchoconstriction.  TRUE/ FALSE

Q. It reliably causes systemic hypertension.  TRUE/ FALSE

Q. Can cause a low grade fever.  TRUE/ FALSE

Q. Is administered in small aliquots intravenously.  TRUE/ FALSE

The formulation currently being used in my hospital is sourced from Russia. No one in the Department can read Russian.

BT_GS 1.12 Explain and describe clinical application of concepts relating to intravenous and infusion kinetics

The joys of pharmacokinetics are relatively few but a sound understanding of PK principles is a necessary evil for the anaesthetist. The following statements relate to the ubiquitous PK parameter, keo.

Q. Is the rate constant that describes transfer of drug from the central compartment to the effect site.  TRUE/ FALSE

Q. Is the rate constant for elimination of drug from the effect site.  TRUE/ FALSE

Q. Is directly proportional to the t1/2keo.  TRUE/ FALSE

Q. Can be measured directly using frequent blood sampling.  TRUE/ FALSE

Q. Has units of inverse time.  TRUE/ FALSE

 

BT_PO 1.114 Methods for assessing coagulation, platelet function and fibrinolysis

These questions relate to ROTEM which seems to be the favourite viscoelastic assay in use at present. Even my humble little hospital has one of these things.

Q. It takes about an hour to provide clinically useful information.  TRUE/ FALSE

Q. Will reliably detect platelet dysfunction as a result of clopidogrel therapy.  TRUE/ FALSE

Q. Reliably detects the presence of heparin therapy.  TRUE/ FALSE

Q. Can detect primary and delayed fibrinolysis.  TRUE/ FALSE

Q. Will be abnormal if the patient is hypothermic.  TRUE/ FALSE

 

Patient of the week

Recently I was anaesthetising an adult with a congenital syndrome. I was quite worried about the airway—but in the end it wasn’t that which caught me out. She had no congenital heart disease, but had a pericardial effusion drained a few years previously. I was quite sparing with the induction agents as I wanted to maintain spontaneous respiration, but nonetheless…

About 5 minutes after induction, I noticed the blood pressure was 54/28.

BT_SQ 1.6

T/F At low levels of blood pressure, the NIBP tends to give spuriously low values.

T/F The most accurate component of the NIBP is the mean.

At the same time, her saturation dropped to 88, even though she was breathing 100% oxygen. The pleth had a good volume and looked normal.

BT_SQ 1.6BT_PO 1.29

T/F The fall in SpO2 was most likely to be artifactual.

I gave three doses of 1mg metaraminol, but, although the saturation improved, the blood pressure remained in the low 70s. Heart rate was in the 40s. Worried that I might see another fall in saturation I decided to run a noradrenaline infusion.

BT_PO 1.52

In such a situation, the most appropriate vasoactive agent would be:

a) Ephedrine

b) Metaraminol

c) Adrenaline

d) Noradrenaline

e) Isoprenaline

After a 20µg bolus dose of noradrenaline, the heart rate dropped to 28.

T/F The most likely cause of the fall in heart rate is alpha 1 receptor agonism in the SA node.

I found out, after the (otherwise uneventful) operation, that she normally has quite a low blood pressure. A good reminder that, when having trouble with anaesthesia, one should first look to the proximal end of the needle.

BT_GS 1.27 Describe the pharmacology of nitrous oxide

These questions actually relate to Entonox which, as I’m sure you all know, is a 50:50 mixture of oxygen and nitrous oxide.

Q. An Entonox cylinder contains a mixture of liquid and vapour.  TRUE/ FALSE

Q. An Entonox cylinder is coloured French blue and white.  TRUE/ FALSE

Q. The Poynting effect refers to how interactions between two different gases leads to a change in their physical properties.  TRUE/ FALSE

Q. Entonox provides about 0.5 MAC.  TRUE/ FALSE

Q. Can cause megaloblastic anaemia.  TRUE/ FALSE

BT_SQ 1.12 Describe the principles and safe operation of vaporizers

Q. They are heavy because they are full of liquid.  TRUE/ FALSE

Q. Must be positioned in a particular order if there are two different vaporizers on the machine.  TRUE/ FALSE

Q. All require power to operate correctly.  TRUE/ FALSE

Q. A Desflurane Tec 6 vaporizer does not require adjustment when used at altitude.  TRUE/ FALSE

Q. Should not be laid on their side.  TRUE/ FALSE

BT_PO 1.118 Pharmacology of heparin and LMWH

Excepting anaesthetic drugs and antibiotics, heparin is probably the drug that most of us have daily contact with, whether we are prescribing, administering or just managing it in the perioperative period.

Q. LMWH does not cause HITTS.  TRUE/FALSE

Q. High dose UFH is characterized by 0 order pharmacokinetics.  TRUE/ FALSE

Q. All heparins greatly increase the activity of Antithrombin.  TRUE/ FALSE

Q. Heparins are recombinant products.  TRUE/ FALSE

Q. Recent administration of 5000U heparin sc is a contraindication to neuraxial blockade. TRUE/ FALSE

Look at the ASRA guidelines for the last one, the answer may surprise you.

Study Tip: Gain knowledge and understanding, not familiarity 

Have you been I the position where someone asks you to explain something to them? You think, “Sure, that’s something I’ve read up on” – you feel familiar with the topic and happy to talk about it. But then, the wheels start falling off – as you go to explain the concept to your friend, your familiarity is not enough, everything starts to fall away, you don’t have enough knowledge or understanding of that topic to provide an explanation. It has happened to me – it’s embarrassing😉.

Talking with many registrars who have failed the exam, familiarity with the material is an enemy. They have looked at the material a number of times, but have never actually learnt the material in a way that enables them to impart knowledge to others ( specifically in answering exam questions).

How do make sure that you have learnt (know) the information?

This article from UNSW, gives some good advice on active reading and note taking as a basis for learning. Make sure that you have understood the material, before your leave it for the first time, by questioning yourself and reviewing your notes.

It is vital that you practice imparting your knowledge, and checking understanding, many times, before you get to exam. You will have read about the importance of active recall multiple times on this blog, as it is the key. 

  • Go back to your notes and practice recalling as much information as you can before looking at your notes again. Highlight any areas of difficulty 
  • Explain something to a friend, colleague, student, pet, pot plant.
  • Practice past SAQs, without your notes in front of you – be honest with yourself
  • Get people to ask you questions 

Have a look at this post from January. It shows you how important revision is. 

Make sure your learning is active. Familiarity is an enemy – you want to gain knowledge and understanding…