The Last Day...

This is the final day of Final FRCA vivas, and EI hopes
many people have passed the exam. For those of you who
have yet to sit the exam this coming Autumn, all the best
of luck.

The last question we can tell you about, as intelligence
received has run thin in the last 24 hours, was a
pharmacology question which came up about the use of
NSAIDs, including the pathway and enzymes they act on and
the implications of their use and the controversy of COX-2
selective inhibitors and why increased cardiovascular
deaths occurred.

EI is going to take a (quite frankly well deserved) break
for a few days, before starting to home in on further
tips, tricks and techniques for studying, learning,
remembering and most importantly passing the Final
Examination.

Please keep visiting, as there is something new on the
horizon which is going to be developed behind the scenes,
and will initially be released in bits and pieces before
coming together in one fell swoop.

Congratulations to all those who passed, and our
comiserations for those of you that didn't. Stick with EI
and we will try to bring you information to maximise your
chances of success.

A little further Viva intelligence

EI has heard about some more exam questions that have come up in the vivas this week, so here we go:

-Describe the pathophysiology of ARDS
-Describe your management of a patient with ARDS
-How do you optimise PEEP?
-How do you optimise PEEP if you don't have fancy ventilators(!)?

-Draw a saggital section of the eye.
-Describe the anatomy.
-Mark the insertion of the conjunctiva into the sclera.
-Why is the anatomy of the eye important to anaesthetists?

A physics/measurement question on CPX and examining a CPX test result came up.

Future Sounds...
Keep an eye on this blog for some well researched answers to the questions that have come up in this last Final FRCA Exam.
Also, as the next sitting approaches, EI will bring together more resources, and simplified explanations of topics that might come up. Hopefully we can help others achieve the same success we have, by sharing some of our revision tips and tricks, and some of the cunning ploys we adopted.
We welcome any suggestions and questions, please feel free to comment or contact EI on the email link in the right-hand column.

If you have a topic you struggle with, ask us, and we will try to help.

If you are still waiting to take your viva tomorrow: GOOD LUCK!

Question some more?

Firstly, E.I. hears that the questions today included THAT
kyphoscoliotic lady for cholecystectomy, a head injured
child with fractured tib and fib, a question about
categorisation of Emergency LSCS, and a question about
heart blocks. More detailed information than that has not
really yet come this way.

Secondly, for those doing the Final FRCA in the
future....the grapevine has told us that The Clinical
Anaesthesia Viva book is going to reach us in a second
incarnation sometime soon, so keep your eyes peeled for
that one....

If you have any information you want to share, please pass
it on to examintelligence"AT"googlemail.com .

Good luck to anyone still awaiting their viva!

Practice makes perfect

Do you waffle when telling stories?
Does your partner tell you to get to the point when you're explaining about something that happened at work?
Do your family hold their heads and groan when you start off by saying "A funny thing happened the other day....", or something similar?

Then you may be a waffler, and I'm not talking about someone who bakes light crisp battercakes in a waffle iron, rather, I mean the other type of waffler, who speaks or writes in a vague and wordy manner (The Free Dictionary).

You may not even realise you are doing it, unless some particularly harsh person in your vicinity tells you about it, or you do one of the things I will come to shortly.

To realise you waffle will take some getting used to. There will have to be acceptance on your part that you are using empty "filler" words as previously discussed, which simply waste your time, as you are not scoring points. Remember back to the SAQ. The key was to transmit as much information as possible in the most succinct, legible manner possible (A remarkable achievement you got a viva then - Ed.) Yes, thanks, I know my handwriting is terrible... Anyway, BACK TO THE POINT: in the viva, you have to do the same, but in the spoken word, so to speak (ahem).

To help you on your way out of denial, try doing one of the following:
1. Pop down to your nearest Lidl and buy yourself a £15 dictaphone with 15minute blank tape, or failing that, blow all your money on one of these dinky gadgets, and practice talking about, say, "What are the changes in physiology in a runner's body from 30 minutes prior a marathon race, until some time after the race?"
2. Better yet, borrow a video camera and do the same.
3. Sit down with two really harsh consultants from your department and practice being viva'd by them on the above topic, whilst recording the whole thing with one of the above devices, or just get them to feed back to you whether you waffle or not.

If it is the case that you harp on without going anywhere, then you only have a few days in which to hone your technique to eliminate waffling. Nil desperandum, as they say. It is all perfectly feasible.

The key is in practicing with yourself, in front of a mirror, with your wife/husband/boyfriend/girlfriend, with a dictaphone or video camera, or in front of pairs of consultants (or even one will do, at a pinch) in your department.

• Try using the Five Word Viva Game to cut out absolutely everything extraneous, then flesh out your answers a little bit to build up to a sensible answer.
• Don't repeat yourself: "The main concerns are residual nerve block, excess opioid and residual narcotisation, incomplete recovery of neuromuscular function, hypoxia and metabolic/endocrine derangement, are the main concerns."
• Try to cut out saying "Er, um, ar, ah, aer" etc. Try a pause instead.
• Elongate vowels in starts of sentences slightly "Weeelll", "Theeeere aaaarre" and "Iiiiii wooouuullld" for example (you get the idea, I hope?).
• Be confident about your knowledge when you are sure about it, and make the examiners feel you are confident. Remember that you are not about to become a consultant (this isn't an exit exam, as one of my consultants put it), but they are looking for someone who is a good Registrar (Specialist, Specialty or otherwise) to whom they could entrust a case in the middle of the night whilst they cosy up back to sleep, and not worry about it (unless worrying is really necessary, in which case they'll probably come in anyway).

Keep at it: one way or another it'll all be over bar the drinking in a 10 days time...

Final Vivas of the Past

Unfortunately, my ISP has managed to cut me off from my web-server, meaning I can't upload anything at the moment. However, some readers have expressed interest in some Past Viva papers I discovered in my filing cabinet at home, as mentioned in a previous post. If you are interested in seeing them, please email me. Eventually I will be able to upload them, but I don't hold high hopes of that happening before the middle of next week!

Congratulations!

Congratulations to all those who passed the Primary MCQ, results of which came out on Thursday!

As anyone who has done this exam will be aware, it is a bugger, but only the first step on the way to becoming FRCA.

Next up is the OSCE and viva, which are also a bugger in a different way. If you want a useful book for this (it has many little tidbits and lots of diagrams you could be expected to reproduce in the exam) consider this one The Anaesthesia Viva: Volume 1, Physiology and Pharmacology and this one: The Anaesthesia Viva: Volume 2, Physics, Clinical Measurement, Safety and Clinical Anaesthesia. Although not perfect, they have helped many people in their preparation for the exam, and I've even looked back at it in revising for the Final (though there are better books for this).

For the OSCE examinations, the most popular book is probably this one: Anaesthesia OSCE. I am not sure that there is actually anything else out there at the moment.

Other books I bought and used to revise for the Primary Structured Orals, and useful for the Finals as well were The Clinical Anaesthesia Viva Book and The Anaesthesia Science Viva Book. The latter is probably more use going into Primary, to be honest, and contains a reasonable amount of detail. I didn't come to these until very late in the day, but I reckon that if you can reproduce some of the stuff in the Science Viva book in the Primary, you'll be well away.

Anyhow, best of luck!

How To Arrange Your Thoughts (or Classify or Die Part 2)

Time is running away fast now, with 12 days until viva week, so I need some help brushing up my skills as well as my knowledge.

When giving an oral presentation or answering a viva voce question, it's important to appear organised with your thoughts. (See Classify Or Die part 1)
To that end, here are some suggestions as to how one should organise these thoughts:

• At medical school we are taught: History of Presenting Complaint, Past Medical History, Drug History, Social History, Examination, Investigations. It still applies that we do them in that order (well, obviously we know that's not always true, but you should do First Things First).

• Pre-/peri-/post-operative management (includes history taking and examination)

• "The problems of anaesthetising/associated with disease x can be divided into patient factors, surgical factors and anaesthetic factors (order these by which ones you want to talk about first, or which ones are the most important)

• "Complications of performing procedure y can be divided into immediate, early and late"

• When presenting an answer to "How would you anaesthetise this 63y old obese patient with a BMI of 44 and a history of aortic stenosis for a total knee replacement?", talk about the underlying principles (maintain SVR, maintain preload, avoid rhythm disturbances etc... ). The same is true for any of the other questions which could come up. It is important that they know what you are worried about. It's important that you know what you are worried about too...

• Be concise and try to be precise. If you mean a vasopressor, don't say "inotrope".

• Remember:

• Blood Pressure = Cardiac Output x SVR
  
• Cardiac Output = Stroke Volume x Heart Rate
• Therefore Blood Pressure = SV x HR x SVR
• Stroke Volume is dependent on contractility, preload and afterload
• Heart rate is a function of rhythm.

James has some other tips.

Long Case Tip

My friend Tash showed me a neat little trick. Some of you probably do this anyway...

Take a sheet of A4, and divide it up into sections for History and Examination, Investigations, Bloods, Drugs, Main Problems and Implications, and if you have time add information about your possible anaesthetic technique.

Use this when going through any practice long case viva, so that you get used to the layout, and it becomes a bit like the Mersey technique for SAQs, where you do it the same way often enough you don't get frightened of it.

When Tash showed me this I remarked that it seemed to be remarkably similar to the front side of the anaesthetic charts where I work...

For an example (obviously created in Paint):



Why do this? Well, it keeps everything neat and organised, and means you can easily refer back to your information "at a glance".