Do you know any great primary teachers?

Because they could become great primary examiners.

Do you have any tutors who have been fellows of the college for at least 3 years? Who have a contagious passion for the sciences underpinning anaesthesia? Who seem to know a bit about the topic? Who might be reluctant to apply without a bit of a nudge? Or are you a tutor reading this?

We have vacancies for primary examiners. First step is to email primaryexam@anzca.edu.au to get the application documents and ask any questions. The applications are considered twice a year and and successful fellows are invited to a weekend training workshop before the following vivas. At the workshop they are allocated a mentor who helps them prepare for and at their first viva examination. If someone applied now they’d be considered in May. It’s hard work but satisfying.

We’d love you to encourage any tutors you admire.

BT_PO 1.69 Describe the physiological effects and clinical assessment of renal dysfunction

Late, AND only 4 today. They range from a simple fact (in Hemmings and Egan), through to more complex statements. Statement 4 is TRUE, more important is that you know why.

Neonates have a higher serum potassium due to poor renal excretion  TRUE/FALSE

Urea concentration is a measure of renal function independent of hepatic function  TRUE/FALSE

Creatinine is a reliable indicator of renal function in an 80 year old TRUE/FALSE

Positive pressure ventilation contributes to intra-operative oliguria  TRUE/FALSE

 

PLOOTD reading suggestions

 

I found what appears to be a little gem in the college e-book library recently – ‘SBA and MTF MCQs for the Primary FRCA’ by James Nickells et al (link to ANZCA). SBAs are single best answer and MTFs are multiple true/false, so not the ANZCA format, and the FRCA curriculum isn’t identical. With those provisos I think the multiple test papers which can be individually downloaded as PDFs would be useful revision if you’re sitting the written exam in a couple of months

On another note, PrimaryLOS recommended a review article a few weeks ago. Lots of discussion behind the scenes on that one! On the one hand we don’t want to add more to what you have to read, on the other hand we’d like to point you to useful resources so you don’t waste time looking for information on particular topics. In PLOOTD we’ll continue to suggest references if we think they’re valuable. In the exam the examiners will continue to base the factual material on the contents of the reading list, being aware that there are some LOs that are just not covered by the reading list.

 

2018.2 SAQ 11 – midazolam

I rarely use this drug as I worry about the ethical implications of amnesia in a patient who believes they were unconscious. In an anxious patient I prefer to make the experience as pleasant as possible with such activities as talking, hand holding, my ‘Lullabies for Grown-ups’ playlist and making the theatre table up as a cosy bed with the forced air warmer already running. Even so, some people are so anxious that midazolam is totally appropriate as an anxiolytic, and it has a role in my practice when performing procedures. 

The time to peak effect of midazolam is 2 minutes    TRUE/FALSE

Midazolam is water soluble in an acidic solution    TRUE/FALSE

Midazolam can be given orally    TRUE/FALSE

Midazolam can be used as an anticonvulsant    TRUE/FALSE

Upper airway reflexes are preserved with midazolam    TRUE/FALSE

 

2018.2 SAQ Q9 – Autonomic innervation of the heart

This question covers some fundamental material which is built upon in other physiology, pharmacology and anatomy topics.

A de-innervated transplanted heart has an intrinsic rate of 20 bpm TRUE/FALSE

Sympathetic innervation is responsible for sinus arrhythmia   TRUE/FALSE

A right sided sympathetic block will cause negative chronotropy   TRUE/FALSE

A right sided vagal block will cause negative chronotropy   TRUE/FALSE

At rest, parasympathetic tone predominates   TRUE/FALSE

 

 

 

 

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!