Examiner Humour

Solutions to the Puzzle Pages

~ cynicalanaesthetist ~ Leave a comment

How did you go?

ANSWERS

  1. A, sats99/HR60/CO240/BP100
  2. The drugs are desflurane, sevoflurane, nitrous oxide, methoxyflurane and Xenon. The rest is self-explanatory.
  3. They all start with ‘M’ and are all relaxing.
  4. All Cat A in pregnancy.
  5. All come as lipid formulations.
  6. Anagrams of drugs all missing one letter: morphine, nitrous, oxytocin, paracetamol, ether.
  7. YO2 is CO2 and its pin index is 1,6.
  8. Buprenorphine 40, oral morphine equivalents provided by 1mg of each drug.
  9. A adrenaline, B clonidine, C adenosine, D phentolamine, F propranolol
  10. Desflurane is blood. (yellow belly, purple heart, red eye, blue blood)
  11. Sevoflurane and nitrous oxide is one combination that satisfies those interactions.
  12. Sevoflurane, propofol, sodium nitroprusside, lignocaine, morphine, oxytocin.
  13. ANALGESIA; LASAGNE/LEASING/SEALING; EASING/GENIAL/LASING/LINAGE/SIGNAL/SILAGE/SINGLE; AGAIN/AGILE/ALGAE/ALIGN/ANGEL/ANGLE/GLANS/GLEAN/SINGE/SLANG/SLING; GAIN/GALA/GALE/GLEN/GLIA/SAGA/SAGE/SANG/SIGN/SING/SLAG/SNAG.
  14. G,N,U. Beginning bottom left: ‘Quote Gentlemen this is no humbug’.
  15. Why? ABC/ IVDU/ PEG/ VWF/ LMWH/ QRS/ JZ/ NOK/ XRT. Only letter not used is ‘Y’.
  16. Anaesthesia is fun but the exams are tough! Substitution cypher beginning with ANESTHIC.
  17. Ether Dome 16th October 1846; Gower Lane London 19 December 1846; Launceston 7 June 1847; Wellington 27 September 1847. Place and time first anaesthetics given in USA, UK, Australia and New Zealand.
  18. N for neostigmine. Fentanyl, propofol, rocuronium, cephazolin, dexamethasone, etc. Reversal at end.

Puzzle Pages in The ANZCA Primary Exam Companion

~ cynicalanaesthetist ~ Leave a comment

Thank you again to the many of you who have purchased my book and special thanks to those who have given feedback and identified errors/ typos. I have endeavoured to correct them all- the great thing about Amazon is that you can edit the manuscript since it is a print-on-demand product.

I have decided to add a couple of puzzle pages to the book. I have reproduced the pages below for the the many who have bought a version of the book without these pages. The questions and clues are provided. I will post the solutions to them all in a week or so. Happy puzzling.

PUZZLE PAGES

All study and no play makes Johnny/Jill a dull person. Here is a page where I have melded knowledge with fun (perhaps). They get progressively trickier. Clues and answers are on the next page.

  1. Which is correct?

A)  Y99G60W40R100   B)  Y100G40W60R99   C)  Y60G100W99R40

2. Complete the table

DRUGSVPBPMAC (%)
 66723 
   2
   104
 20104 
Xenon–-108 

3. What links these? Massage, music, mivacurium, meditation, manicure

4. What links these drugs? Thiopentone, paracetamol, suxamethonium, lignocaine, metoclopramide

5. What links these drugs? Propofol, diazepam, etomidate, morphine, bupivacaine

6. What links these? Phonier, suitor, oxyntic, metacarpal, here

7. If X2O is 3,5 and O2 is 2,5 what is YO2?

8. What is the next number in this sequence? T0.2,M1, O1.5, H5, B?

9. In the table below E is yohimbine and G is caffeine. What are the other letters? (more than one solution)

 α1α2β1β2A1
+ABAAC
–DEFFG

10. If sevoflurane is belly, isoflurane is heart and halothane is eye; then what is desflurane?

11. If X + X =2 for MAC and X + Y=2 for MAC and X + Y=1.5 for hypnosis, what are X and Y?

12. Identify the following drugs from their chemical formula:

C4H3F7O, C12H18O, Na2[Fe(CN)5(NO)], C14H22N2O, C17H19NO3, C43H66N12O12S2.

13. How many words can you make from this word cube? Words contain at least 4 letters, all must contain ‘G’, no plurals, proper nouns or verb forms ending in ‘s’. (>30 words- very good)

SIA
EGL
ANA

14. What are the top 3 letters of this word triangle?

15. A) All resuscitation algorithms begin with these three letters.

B) Most people with hepatitis C have done this.

C) Feeding tube that bypasses the mouth.

D) Only clotting factor not made by liver.

E) Clexane is one.

F) This complex is normally narrow.

G) A zone where radiologists and gynaecologists intersect.

H) For a child, this is normally their parents.

I) Radiotherapy.

J) What is the remaining question?

16. What message is encoded below?

AKATQRCTQBA BQ HUK NUR RCT TXAJQ APT RLUIC!

17. What links these? What dates are associated?

42.3635N 71.0679W, 51.5224N 0.1326W, 41.4391S 147.1358E, 41.2867S 174.7730E

18. What is the next letter in this sequence? F, P, R, C, D, M, O, G, ?

CLUES

  1. Look at your anaesthetic monitor
  2. 4th one is used by ambos
  3. They share a common effect
  4. Think categories
  5. Think pharmaceutics
  6. Anagrams
  7. Cylinders
  8. OME
  9. Receptor agonists and antagonists
  10. Colours
  11. Isobolograms
  12. all used by anaesthetists
  13. don’t need any clues for this one
  14. famous quote
  15. what letter isn’t used in these acronyms
  16. substitution cypher
  17. plug in the coordinates
  18. standard anaesthetic

The alternatively worded 2019.2 SAQ exam

~ cynicalanaesthetist ~ Leave a comment

Another Primary SAQ exam has been released into the world.  I have been given another opportunity to amuse as well as help you appreciate the relevance of these questions to your clinical practice.

Enjoy:

1. Discuss the potential adverse effects of suxamethonium.

Explain how you can kill someone with sux.*

2. Describe the normal regulation of cerebral blood flow and outline physiological factors which may alter it. DO NOT discuss the effect of medications or pathology.

Demonstrate understanding of what determines how much blood is pumped to your head.

3. Draw and label a lead II electrocardiogram (ECG) tracing for one cardiac cycle, indicating normal values. What is the PR interval and what factors influence it?

Demonstrate intimate knowledge of the green waveform that you spend a considerable amount of your professional lifetime looking at.

4. Outline the theories, both current and discredited, as to how inhalational anaesthetic agents cause loss of consciousness.

Explain something that no one understands in plausible terms.

5. Outline the safety features of currently used mechanical variable bypass vaporisers.

Explain why vaporizers are heavy and account for all the projections that emanate from them.

6. Propofol and remifentanil target-controlled infusions are often given together as a total intravenous anaesthesia technique. Discuss pharmacological reasons why this is a useful combination.

Explain why we use Propofol/Remi TCI all the time.

7. Describe how morbid obesity might affect washout after inhalational anaesthesia.

Explain why an obese patient will wake from a volatile based anaesthetic as quickly as a non obese one.

8. Briefly explain the cardiovascular effects of central neuraxial blockade.

Explain why you need to needle a vein before you needle the back.

9. Using ropivacaine and lignocaine as examples, explain the pharmacokinetic principles that affect speed of onset and duration of action of local anaesthetics.

Explain why there is no difference in onset of block between different local anaesthetic agents if you inject a big enough dose.

10. Discuss the physiological responses to administration of 2 litres of Hartmann’s solution intravenously over 1 hour to a conscious, healthy, euvolaemic 70kg adult.

Demonstrate knowledge of a drug that you administer even more frequently than cephazolin.

11. Describe the respiratory and cardiovascular changes associated with a carbon dioxide pneumoperitoneum for laparoscopic surgery.

Account for why, when a pneumoperitoneum is established, the blood pressure may: a) increase b) decrease c) increase then decrease d) decrease then increase e) stay the same.**

12. Draw the oxygen-haemoglobin and carbon dioxide-haemoglobin dissociation curves on the same axes (content vs. partial pressure). Compare and contrast these two curves.

Impress the examiners by integrating some very core physiology in a novel diagram.

13. Briefly outline the roles of the hypothalamus.

Explain why the physiology of brain dead patients is so labile.

14. Discuss the role of paracetamol in multi-modal analgesia (33%). Explain paracetamol metabolism and the mechanism of toxicity (67%). DO NOT discuss management of toxicity.

Explain why paracetamol should be taken off supermarket shelves.

15. Describe the anatomy and relations of the right internal jugular vein as relevant to performing central venous cannulation.

Correlate ultrasound images with the ability to avoid important structures when you are sticking a big needle in a patient’s neck.

*what a nice question, I hope you killed it.

**astute readers will note a similar question appeared in The Cynical Anaesthetist’s SAQ exam.  https://primarydailylo.wordpress.com/2019/06/28/the-cynical-anaesthetists-saq-paper/

(I didn’t write the question.)

The Cynical Anaesthetist’s SAQ Paper

~ cynicalanaesthetist ~ 1 Comment

I quite enjoyed doing the alternatively worded SAQ paper last week so I have come up with another paper for your reading pleasure. Again it is an attempt to link SAQs with real world practical relevance.

Although you will never sit a paper with questions like these, the content they ask for are all straight from the curriculum.

The Cynical Anaesthetist’s Primary SAQ paper

 

  1. Explain why the capnograph is the most useful monitor on an anaesthetic machine.
  2. Explain why delivering 0.8 MAC of sevoflurane makes the chances of the patient being aware close to negligible.
  3. Explain why putting 5 of PEEP on your ventilator settings makes not a lick of difference to anything.
  4. Explain why your anaesthetic supervisors will be reluctant to lose thiopentone from their pharmacological arsenal when it happens.
  5. Describe the cardiovascular response to a pneumoperitoneum. Account for why the blood pressure may: a) increase b) decrease c) increase then decrease d) decrease then increase e) stay the same.
  6. Explain why there is a considerable degree of annoyance when there is a shortage of 2% lignocaine with adrenaline and you work in a hospital that does obstetrics.
  7. Explain why no one understands how haemostasis actually works.
  8. Describe the contents of a bag of saline, Hartmann’s solution and P148. Explain why it makes no difference which one you use in practice.
  9. Justify the common practice of giving every patient dexamethasone and a 5HT3 antagonist.
  10. Explain why it would be so awesome to use Xenon.
  11. Define renal protective strategies and then explain the complete lack of pharmacological options apart from saline.
  12. Explain why the number displayed by the BIS is the least useful aspect of this monitor.
  13. Explain why contemporary anaesthetists have no clinical experience with: nitrous oxide, isoflurane and neostigmine. Do not discuss thiopentone (see Q4).
  14. Describe the clinical features evident when a patient is induced with ketamine.
  15. Explain in simple terms that an obstetrician could understand why the cardiovascular changes that occur during pregnancy mean that blood transfusion of a parturient is very rarely clinically indicated.

BONUS QUESTION

Explain using statistical principles why the pass rate for the Primary Examination hasn’t changed significantly for the last two decades despite alterations in its content and format.

 

Coats of Arms and Mottoes

~ vallecula ~ Leave a comment

Now that the written exam is over, you might welcome a fun distraction in the form of Coats of Arms and mottoes. These are full of symbolism and history, and it is always fascinating to learn about the many layers of meaning that they each have.

Below are 5 examples related to anaesthesia. Can you guess them (and have a guess at the English translation of the motto)?

(1)  Corpus Curare Spiritumque

ANZCA-Crest

(2)  Fax Mentis Incendium Gloriae

RACS coat of arms

(3)  Divinum Sedare Dolorem

RCA coat of arms

(4)  Salus Dum Vigilamus

College-of-Anaesthetists Ireland coat of arms

(5)  Mente Perspicua Manuque Apta

RCPS Canada coat of arms

 

ANSWERS

(1) Hopefully you all spotted this one straight away as the Australian and New Zealand College of Anaesthetists! The motto translates as “to care for the body and its breath of life”. To read more about our College crest, click here.

(2) This one is the Royal Australasian College of Surgeons. Why, you may ask, is that included here? Many trainees don’t realise that ANZCA has only existed since 1992. Before that, we existed as the Faculty of Anaesthetists in the Royal Australasian College of Surgeons. So the FFARACS diploma had the surgeons’ crest on top! The RACS motto translates as “the torch of the mind is the flame of glory”. Hmmm…

(3) This one is the Royal College of Anaesthetists in the UK. The motto translates as “it is divine to alleviate pain”.

(4)  This is the College of Anaesthetists of Ireland. The motto translates as “safety while we watch”.

(5) This one is the Royal College of Physicians and Surgeons of Canada. All medical specialties in Canada come under the single Royal College. Fellows use either FRCPC or FRCSC depending on the specialty. Anesthesiologists use FRCPC. The motto translates as “with a keen mind and skillful hand”.

Which of the mottoes appeals to you the most? Perhaps you have an alternate favourite – maybe your school or university motto? 

Medical Latin

~ vallecula ~ 1 Comment

We use Latin abbreviations all the time….. do you know the meanings of any of these terms?

 

T / F    PRN is the abbreviation for pro re nata which means “never actually given”

T / F    “stat” is short for statim which means “melodramatic”

T / F    “Q” (as in Q4H) is short for quaque, which means “every”

T / F    “PO” is the abbreviation for per os, meaning “through the mouth” – NOT “go away”

T / F    “TDS” (ter die sumendum) and “TID” (ter in die) are equally acceptable for “three times a day”

 

For those sitting the written exam on Tuesday – all the very best!!!