Using a labelled diagram, describe how a mechanical (non-cassette) variable bypass vaporiser achieves the concentration set on the dial. Describe the mechanisms that compensate for temperature and downstream pressure changes.
The vaporiser is encased in insulating material TRUE/FALSE
The vaporiser’s heat sink has low thermal capacity TRUE/FALSE
The maximal output of the vaporiser is dependent upon the saturated vapour pressure of the anaesthetic agent TRUE/FALSE
As a liquid vaporises its temperature drops TRUE/FALSE
A large vaporising chamber will assist in compensating for pressure changes due to the pumping effect TRUE/FALSE
Time to look at the last written paper…
Q1. Describe the visceral and somatic pain of labour with particular reference to the anatomy and pain pathways.
Visceral pain predominates in the first stage of labour TRUE/FALSE
Chemoreceptors are involved in pain modulation TRUE/FALSE
Nociceptors detecting stretch are involved in the pain of second stage TRUE/FALSE
Head descent can stimulate the lumbosacral plexus TRUE/FALSE
Pain can be referred to the thighs in first stage only TRUE/FALSE
The viva component of the exam is almost upon us again. I sincerely hope that all of you sitting over the next few days, leave the exam with a sense of calm, knowing that you have done everything you can…
Last exam sitting, I posted The primary exam does not define you. The sentiments of the post hold true and I would encourage those of you sitting to read it.
Today, as the examiners finalise and double check their questions, I hope that you are able to spend some time doing something which brings you joy…
As an examiner I’m often asked how a candidate should dress for the Viva. The answer is simple. Dress in the same way as everyone else – perhaps sharper and neater if you really want to make the best impression – but not “different”.
Why should this be so? Surely the examiners should be professional enough so as to render what is on the “outside” completely irrelevant? This is true to an extent – and we do try – but examiners are only human. Impressions count. You want to make a statement with your knowledge, not through any need to express yourself as someone who rejects professional norms through a highly individualised dress sense.
So what does this actually mean? For men, dark suit and tie, neatly worn. Borrowed is generally a bad idea. Wear the tie like you don’t completely resent its very presence. Similarly for women – dark coloured professional attire is what most of your candidate and examiner colleagues will be wearing. If you front up wearing fluorescent orange (yes, it has happened) the examiners’ cortices will try and get over it – but their amygdalae won’t. And that’s just not a conflict that you want to trigger.
In a nutshell, come groomed as though you’re attending a job interview – which in a sense, is what it is.
And for those of you sitting next week – we sincerely acknowledge how you’re feeling, and wish you all the very best.
Nunn won’t be so much help today, it’s more application of some basic physics.
Turbulent flow in the upper airway is better than laminar flow for humidification TRUE/FALSE
High minute volumes will move the isothermic saturation boundary distally TRUE/FALSE
With an unchanged absolute humidity, relative humidity will decrease as temperature increases TRUE/FALSE
Gas in an oxygen cylinder has a relative humidity of 50% TRUE/FALSE
Physiological humidification of inhaled gas requires more energy than warming it TRUE/FALSE
You would normally see a study tip from me on a Friday, but not this week I am sorry.
Instead another in the series of changes that can be made to normal physiology, which help test your understanding of a topic…
And returning to one of my favourite photo topics… seen at the Monterey Bay Aquarium
IT_GS 1.9 Outline the physiological changes that occur with and the implications for anaesthetic management of the following patient positions:
- Trendelenberg and reverse trendelenberg
Trendelenburg position reduces FRC and increases the work of breathing in a spontaneously breathing patient TRUE/FALSE
Prone positioning, per se, causes minimal cardiovascular change TRUE/FALSE
The prone position improves V/Q matching in posterior lung segments, improving oxygenation TRUE/FALSE
Lithotomy position improves lung compliance by flattening the lumbar lordosis TRUE/FALSE
Lower limb compartment syndrome is a rare complication of lithotomy position due to reduced perfusion pressures TRUE/FALSE
BT_SQ 1.10 Describe the supply of medical gases (bulk supply and cylinder) and features to ensure supply safety including pressure valves and regulators and connection systems
T/F The Bodok seal shown on the right contains latex
T/F The Pin Index System can be defeated by placing two Bodok seals over the nipple
T/F The seal must not be combustible because of the high temperatures achieved when the cylinder is turned on
T/F The Pin Index for Oxygen is a single pin at the 6 o’clock position
T/F The Pin Index system is not used in the main hospital manifold
Have you ever wondered why we only use the pin index system for cylinders and not for gas hoses? The answer was in the recent A&IC History Supplement. If the connection is inserted upside-down, it is possible to fit the wrong coupling into the yoke. This is less of a problem with cylinders for obvious reasons.
A big congratulations to all of you who sat the exam today – it is quite a feat of physical and mental endurance!
Now time for a bit of a break. Give yourselves a chance to recuperate and participate in normal life – can you remember it😉 – for the next week or so. Read a novel, take your partner out for dinner or enjoy dinner with friends, permit yourself an extra hour at the gym ( only if that won’t be torture), go to the beach or the bush, binge watch your favourite TV show….
For those of you who like cooking, and who are not too health obsessed, I could recommend making this recipe, pictured above, touted by my favourite podcast.
It is quite normal to feel a bit down in the dumps after a big effort such as today’s. Here is my post from after the written exam in February. We seem to be programmed to remember and dwell on the things we have done wrong, or that upset or scare us, rather than those we have done right. Perhaps this has an evolutionary advantage to stop us getting ourselves into dangerous situations. In the coming days you are likely to mull over those things that you forgot to write down in the exam. It’s Ok. No one can possibly write all there is to know about a topic, under pressure, in 10 minutes…
I like the advice at the end of this article. We can overcome those negative thoughts by creating a bank of good ones. So have a go now, whilst the day is fresh in your mind, and think of 5 or 10 things that went well today ( making it through the exam definitely counts as one). In the coming days, if misery sets in, look back at your list and encourage yourself – well done!
Describe the pharmacology of * insulin preparations *oral hypoglycaemic *corticosteroid drugs.
Intravenous dexamethasone has a slow onset of action. TRUE/FALSE
Prednisone and dexamethasone are synthetic corticosteroids with predominantly mineralocorticoid effects. TRUE/FALSE
The anti-inflammatory response of corticosteroids is a mineralocorticoid effect. TRUE/FALSE
Mineralocorticoid effects of synthetic corticosteroids are less than the natural hormones. TRUE/FALSE
Dexamethasone lacks mineralocorticoid effects. TRUE/FALSE
Describe methods to reverse the effect of warfarin
Describe the pharmacology of warfarin and other anticoagulant drugs
The metabolic clearance of warfarin is inhibited by amiodarone. TRUE/FALSE
Third generation cephalosporins reduce the anticoagulant effect of warfarin. TRUE/FALSE
Intravenous vitamin K should return the prothrombin time to a normal range within 1 hour. TRUE/FALSE
Skin necrosis is a side effect of warfarin therapy. TRUE/FALSE
Warfarin can be reversed with recombinant factor VIIa TRUE/FALSE