Another exam done and dusted

Amazing porcelain starlings by Cai Guo-Qiang at the NVG

A quick post today to congratulate all of those candidates who presented for the viva exam in Melbourne over the past three days.

It was lovely to speak with many of you after the exam at the celebratory drinks. Regardless of your result, you all deserve to be proud of yourselves.

I have popped a link below to a post I wrote a couple of years ago now, but the sentiments remain unchanged. Let this exam experience shape you for the better.

Best wishes for a relaxing weekend for all of you and we will see you back here very soon…

https://primarydailylo.wordpress.com/2017/04/08/the-primary-exam-does-not-define-you/

A comedian walks into a bar

This clip from Radio National’s Ockham’s Razor https://www.abc.net.au/radionational/programs/ockhamsrazor/when-anaesthetists-cant-sleep/11187656 is well worth 11 minutes of your time if you have a viva next week. It’s also worth a listen if you intend to have, or ever have had, an ANZCA primary viva.

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.

The top five posts for PLOOTD

Having achieved the herculean task of posting for every single learning objective for the Primary exam curriculum it is time to reflect on this body of work.

I thought I might start with a post on the top five posts in terms of number of times they have been visited. I have excluded all the hits on the home page and list of LOs and subject headings etc.

The top 5 most visited posts – insert drum roll here- are:

1. A Primer for the Primary Examination    March 9, 2018
2. BT PO 1.50 Describe the cardiovascular changes that occur with morbid obesity June 19, 2017
3. The primary exam does not define you   April 8, 2017
4. Study Tip- doing effective revision   Jan 27, 2017
5. Dynamic airway closure   December 15, 2016

Unsurprisingly aGasgal wrote three of these (2,3,5) and Vallecula wrote number 4.

Mark Reeves, former Chair of the Primary Exam Subcommittee, wrote Primer for the Primary Examination. Here is another link to this great resource here.

primer for the primary

The section at the start titled “HOW TO FAIL THE PRIMARY” is essential reading.

 

 

Mission accomplished!

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!

aGasgal

To date we have clocked up over 63,000 views by over 13,000 people from over a hundred different countries.

If you look at a post for a different LO each day you can cover the entire curriculum in under a year! Okay, this might be stretching the friendship a bit.

Stay tuned to learn what PLOOTD will do in the future.

 

*This LO is the one about methods of measurement applicable to anaesthesia and by my count has no less than 16 posts devoted to it.

BT_PO 1.70 Explain the renal responses to hypovolaemia

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