SAQ 2.17 Question 2

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

SAQ 2.17 Question 1

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

Remember the Primary Exam does not define you

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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…

 

Dress for Success

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.

BT_PO 1.38 : Define humidity and outline the importance of humidification

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

 

 

IT_GS 1.9 Effect of patient position

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

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IT_GS 1.9 Outline the physiological changes that occur with and the implications for anaesthetic management of the following patient positions:

  • Supine
  • Trendelenberg and reverse trendelenberg
  • Lateral
  • Lithotomy
  • Prone

 

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

Pin Index System

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

Pin Index.png

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.

Phew – well done!

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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!

Mineraloglucoaldosticosteroids

BT_PO 1.90

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

 

 

Bleedy McBleedster

BT_PO 1.121

Describe methods to reverse the effect of warfarin

BT_PO 1.120

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