Monday, April 28, 2008


I've deliberately not written anything for about a week to try and forget about the written exam last week.
It was an exhausting day, but I'm really glad it's done for now. I thought that with a couple of exceptions, the SAQ paper was reasonable - it could have been a lot worse. The MCQ paper was an absolute nightmare - more about that later.

1) Thoracic paravertebral space: either you know it or you don't. Despite having performed a couple of these blocks in early SHO-days, I couldn't recall the anatomy as I hadn't revised it - simple as that. I tried to make it up as best I could. The indications and complications were fairly generic answers for all nerve blocks.

2) CEMACH - one of my predicted questions came up, so the risk factors and causes of death were hopefully recalled verbatim. The next bit about Early Warning Scoring Systems was the usual lists of stuff making up PAR scoring/APACHE or whichever system is used.

3) Air Embolism - standard question seen before in similar guise in Bricker. I think there was a review article in Anaesthesiology about this subject.

4) 4yo appendicitis, dehydrated - fluid management. This question was about paediatric fluid management with specific reference, I think, to NPSA guidelines on avoiding hyponatraemia in children post-operatively. I thought that the NPSA website was a bit of a nightmare to navigate around, and had not found these guidelines pre-written paper. So, consequently had not read them, so probably missed out some quite important points - typical the only bloody guideline I do miss comes up!!

5) Pre-oxygenation. The lucky people who went on the Booker Course and did this question almost verbatim up there will be happy with this one

6) Complex Regional Pain Syndrome. As for 5) I'm afraid - congrats to Dr Booker!

7) Rocuronium - the 'topical' question. Fortunately I used to have a boss who was fascinated with Sugammadex, so was at least able to give a basic description of this. Unfortunately, I had a complete blank about neostigmine and was only able to write some pretty basic stuff about it - c'est la vie.

8) Asthma/Acute Bronchospasm - waffling plus some standard clinical emergency management.

9) Elective paeds - child not cooperating. The first part of the question about decreasing pre-op anxiety was a chance to be very touchy-feely etc. The second part was much less structured, and perhaps was touching upon consent in paediatric patients ?Gillick competency. I don't think I answered the second bit very well, but hopefully did enough on the first bit.

10) AAA - emergency. So much to write, too little time. A recent CEACCP article on exactly this topic.

11) Needlestick injuries. Very unusually for the College they have repeated a question from just six months ago - I assume it was done fairly badly last time out.

12) Acute Pancreatitis - again repeated from six months ago. So much to write, too little time.

I honestly don't know what to say about the MCQ section. I normally go through the paper fairly quickly to start with, just answering the stems that I definitely know. By the time I got to Q.45 and a lot of stems were unanswered, I started to get that feeling of desperation. You know, six months of hard work, thousands of practice MCQs - utterly pointless in trying to do this exam!!
I recognised a few questions from the college book. There were also a few questions from Elfituri & Arthurs MCQs (which incidentally I would have tried to do more questions from had there not been so many dreadful errors in it). But the rest of them......

There were obviously quite a few new questions, as the exam had to be halted numerous times to make corrections for the paper.

The only consolation was the fact that everyone else found it exactly the same!

So, onto viva practice - A senior registrar has grilled me today on the exam he got. Subjects include: phaeochromocytoma, pacemakers, N2O cylinders, tetanus, foetal circulation, and adverse drug reactions.


ketamine said...

would echo ur thoughts,
the ftnoon seesion was a real nightmare...
i hp if all had a similar experience thn probably the pass mark would be driven down, so may be more would pass... hopefully...
fingers crossed...

Anonymous said...

record breaking number of candidates this time!! for some unknown reason.

MCQs were tough, lots of thought process required, felt pretty numb later on.

any courses booked, james ?

Dr James Shorthouse said...

I am booked on the Mersey Viva weekend in June - it will be well worthwhile as all Mersey courses are but there will be no examiners, just candidates viva'ing other candidates. I may not go as my hospital has arranged an extensive viva programme from mid-May every night for 90 minutes after work for free !!