BT_PO 1.66 Outline the endocrine functions of the kidney

And it will come as a surprise to no-one reading the posts this week to find I’ve been reading Ganong again.

Vitamin D is hydroxylated to calcitriol in the proximal tubules of the kidney     T/F

Calcitriol increases calcium reabsorption in the proximal tubules of the kidney     T/F

The O2 sensor to control erythropoietin production is probably a heme protein     T/F

Increasing catecholamines will stimulate erythropoietin production     T/F

Erythropoietin is also produced in the brain     T/F


BT_PO 1.82a Outline basic cellular physiology in particular The structure of the cell membrane and trans- membrane transport mechanisms The composition and regulation of intracellular fluid The generation of the trans-membrane potential Energy production by metabolic processes in cells

AKA read most of Ganong Chapters 1 and 2

The intracellular compartment contains about 5% of body water     T/F

Colligative properties are dependent upon the types of particles in a solution    T/F

The sodium/potassium pump prevents cellular oedema AND contributes to the membrane potential     T/F

Oxidative phosphorylation occurs in red blood cells     T/F

In some cells glucose crosses the cell membrane by secondary active transport     T/F

Bonus question (the answer can be worked out from material in chapter one) – the pH electrode has a semi-permeable membrane with the selective diffusion of hydrogen ions creating an electrical gradient which is measured. What equation is used to calculate the concentration of hydrogen ions from the electrical gradient?

And remember it’s the webinar today!

BT_PO 1.96 Discuss the significance of the blood brain barrier

Devilsadvocate has made a list of LOs we haven’t addressed yet and I’ll post on some of these orphans this week. I’ve used Ganong for this one but it should be in most of the basic texts.

Glucose passively diffuses into the brain     T/F

Circumventricular organs are within the blood brain barrier     T/F

Ions cross the blood brain barrier readily     T/F

Neurotransmitters cross the blood brain barrier readily     T/F

The blood brain barrier can be disrupted by acute severe hypertension     T/F

Bombay blood group

BT_RT 1.7 Describe blood groups and the physiological basis of transfusion reactions

I first heard of Bombay blood group this year. The H antigen is an intermediary in the production of A and B antigens, and is present in the red blood cells of those with O blood also. Bombay blood group has the recessive phenotype hh and does not express H antigens. It is very rare and will test falsely as O group unless specifically looked for. The antibody response to H antigens is predominantly IgM.

I don’t think this is examinable but I do think this is a useful concept to see how well you understand blood groups and transfusion reactions. You should be able to work out the answers given the above information.

A person with Bombay blood group is a universal donor      TRUE/FALSE

A person with Bombay blood group can safely receive blood from an O- donor      TRUE/FALSE

A person with Bombay blood group can safely receive blood from an AB- donor      TRUE/FALSE

In the soap opera General Hospital Monica was group A, her husband Alan AB and her child tested O. Was Monica cheating on Alan?*      YES/NO/MAYBE

Monica’s child was at risk of haemolytic disease of the newborn.      TRUE/FALSE


*thanks to Wikipedia for this gem!

Reading your feedback in 2018 – part 3

final result feedback

My hypothetical candidate was one of the 83.5% who passed the vivas at this exam. The vivas are in some ways easier than the SAQs as the examiners can prompt and rephrase questions to help you answer them, and in some ways more difficult as they test understanding. This candidate wasn’t able to compensate for their low SAQ mark, but should be very encouraged that they passed this component which requires both a breadth of knowledge and an ability to integrate the material.

This letter will have accompanying individual feedback sheets on questions/vivas that scored <40%, often with specific comments made by the marking examiner. It should be read in conjunction with the exam report too

This may be the first examination you have been unsuccessful in. This feedback, though difficult to read, can be a stepping stone to a successful attempt


Reading your feedback in 2018 – part 2

feedback SAQ

More personal opinions and interpretations, this time on the SAQ feedback.

All the SAQs are now marked or scaled to out of 5 so in this section you are given your score for each question and your total score. In this section you need 40% to be invited to the vivas, that is a total of 30, or an average mark of 2 (borderline). I would also define a 2 as ‘the candidate has not demonstrated that they are performing at the level required in a specialty exam but rudimentary knowledge has been displayed and the examiner feels, based on that performance, that the candidate is worth inviting to the vivas to demonstrate their knowledge and understanding further’.

My hypothetical candidate will be invited to the vivas based on their SAQ score but they have a lot of ground to make up in the viva examination. This will be difficult but it is doable. Study is often more dynamic, interactive and effective leading up to the vivas.

I suggest you classify each SAQ based on

  • topic
  • whether it asks for factual material only, or integration
  • whether it is clinically based

For example, question 7 in this exam asked to justify the dose of propofol used in different scenarios and requires integration of knowledge in a clinical setting, while question 8 in this exam just requires you to set down what you know about IV metoprolol.

Is there a pattern in your performance?

Question 15 scored 0 which suggests poor time management.


2018.1 SAQ 6

BT_GS 1.24 (Inhalational agents – pharmacokinetics)

Describe the washout of sevoflurane from a patient following two hours of general anaesthesia. You may wish to use a graph to illustrate the description.

Anaesthesia is unique in medicine for many reasons, one is our need to control offset of action of drugs as closely as onset. Desired effects become adverse effects once the patient is wheeled out of the operating theatre.

The scale on the abscissa (y axis) of this graph is logarithmic  T/F

This graph is modeled with a single exponential function T/F

High solubility drugs will wash out more quickly than relatively insoluble ones T/F

This graph takes into consideration metabolism of drugs in the liver  T/F

The initial rapid decline is due to washout from well perfused organs such as the heart  T/F


2018.1 SAQ 5

BT_PM 1.12 (Opioid receptors)

List the desired and adverse effects of opioids and the corresponding anatomical location of the receptors being activated

Opioids have multiple sites of action and many of their effects are undesirable. These should be considered in your patients, and other analgesic techniques used if harms potentially outweigh benefits.

Opioids can mediate analgesia through presynaptic primary sensory afferents T/F

Opioids can mediate analgesia in the dorsal horn of the spinal cord T/F

Opioids have no supra-spinal mediation of analgesia  T/F

Immunosuppression is an adverse effect of opioids T/F

Biliary spasm is an adverse effect of opioids T/F

Bonus question, definitely not core material in answering this question but interesting. First paragraph of the pethidine entry on wikipedia leads you to the answer but it’s worth considering why the Germans were trying to develop drugs of this class in 1939.

Pethidine can cause mydriasis T/F

Reading your feedback in 2018 part 1

mcq feedbackBy now those who weren’t successful in meeting the requirements of the primary examination will have received their feedback letters. A difficult read which I’d like to try and make easier by helping you approach logically. This isn’t official advice, just what I would recommend to any SOT or candidate who approached me for help. I’ll talk about looking at the MCQ marks today.

I’ll be including photos of a feedback letter I’ve created for an imaginary candidate. Here are their MCQ marks. The candidate passed the MCQ and I would like to take this opportunity to say well done to everyone who passed the MCQ. You’ve demonstrated a great breadth of knowledge covering over 300 LOs. This requires significant organisation and diligence. Even if you didn’t go on to be successful in the overall exam this is a great achievement.

This candidate has only just passed the component though, and I’d recommend people in the 75-84 range realise they have a good base but they should try to improve this component to safely pass in their next attempt. More ruthless organisation and diligence is the key here. Aids I would recommend would be The Primer for the Primary which I’ve recently recommended, and a new resource which will be released soon at I’ve spoken with registrars who have used a beta version of this and they have given glowing reviews.

Low scores in this component mean you haven’t demonstrated a foundation in the basic sciences in anaesthesia, and it may well be very difficult to build this over just a few months. If training requirements allow it might be best to build up to sit in 2019.

Mind games : recovering from a cycle crash

I was reading this article – Mind games: Getting your head back in the game after a crash  and found a box at the end of the article full of fantastic advice both for getting back on the bike and getting back to study after an unsuccessful attempt at the primary exam. Elite sport and specialist medical training have quite a lot in common.


Take your time

Identify what you enjoy about anaesthesia and use that to motivate you

Identify what’s within your control. And what’s not within your control.

Set successive challenges for yourself to get back into it under control

Recognise unhelpful thoughts.

Connect with other trainees and your family and friends outside anaesthesia.