FRCAQ.com, the new online testing resource for the Primary FRCA exam, includes Single Best Answer questions…

‘I love the two levels of reading you can do if you get a question wrong. And, importantly, it’s made by anaesthetists for anaesthetists…a brilliant resource.’ Alan Race, anaesthesia trainee

FRCAQ.com, the new online testing resource for the Primary FRCA exam, is the only website offering SBA (Single Best Answer) questions.

Why are SBAs important?
SBAs are included in the Primary exam from the 13th September 2011 onwards. Are you taking the Primary FRCA exam after 13th September 2011, or do you know someone who is? If so, find out more about FRCAQ.com

What does the Primary FRCA MCQ paper consist of?
We can say with some certainty what the MCQ paper will consist of in September 2011 and for a few cycles thereafter. In the exams prior to and including the June 2011 exam, the paper consisted of 90 MTF questions to be answered in three hours. This gave 450 knowledge point tests.

From September 2011, the College will replace 30 of the MTF questions with SBAs. This will provide 300 knowledge point tests from MTF and 30 from SBAs. The two styles will run in a combined paper for some time while the College gathers data comparing performance across the two paper styles. This will allow a standard to be created for the SBA question bank.

How do I answer SBAs?
Hints and Tips to help you in the exam…
This will sound like an echo from your earliest days of education, but it doesn’t hurt for us to say ‘make sure you read the question carefully‘!

A good tactic is to read the stem and lead-in, cover up the options and ask yourself what the correct answer would be. If you are 100% confident of the answer and this answer appears in the options, it is most likely to be correct.

If you are not in the lucky position of definitely knowing the answer and are trying to work it out, it is very important to not just settle on the first option you see that looks correct. Read all the options against the lead-in and ask yourself: ‘Which one fits best?’

In trials of SBAs with trainees we have noticed that they often find that two of the options can be discounted immediately, leaving two or three options to whittle down to one. If this happens to you, go back and read the stem, looking to see if there is anything within the detail that will allow you to reduce the options further. It may end up with a wild guess between two final options, but at least your odds of guessing correctly have increased from 20% to 50%.

Even if you only have the vaguest notion about the subject area, apply any knowledge you have and make an educated guess. Do not leave a blank. It is also important to state that only one mark per question should be made on the answer sheet. More than one mark and the candidate will score zero for that question.

Make sure you have the edge in your exam…
Try a free demo of FRCAQ
Subscribe to FRCAQ

New dynamic self-testing website for trainee anaesthetists from Cambridge

Cambridge Medicine has launched a dynamic new self-testing website for trainee anaesthetists – www.FRCAQ.com

What is FRCAQ.com?
It is an online revision resource of over 1,450 questions, answers and explanations in anaesthesia for trainees preparing for the Primary FRCA MCQ exam. Four different test options give you the flexibility to tailor your exam preparation to your specific needs, and detailed reports allow you to monitor your performance over time and against your peers.

Tell me more…
The site contains questions in both SBA (Single Best Answer) and MTF (Multiple True False) format. The Editors have analysed very component of the Primary FCRA syllabus and written questions on every topic you will encounter in the exam. Each question contains a short and long explanation, giving extensive background information to enhance your anaesthetic knowledge.

Which countries is the site relevant for?
Due to similarities in exam content and structure, the questions and answers on FRCAQ.com are directly applicable to the Irish Primary FCARSCI exam, the European Diploma in Anesthesia, the Australian and NZ FANZCA Part 1 exam, the Hong Kong HKCA Intermediate exam and the South African FCA(SA) Part 1 exam. Trainees preparing for these exams will find the site an invaluable revision resource.

Who are the Editors?
The FRCAQ editors, James Nickells and Ben Walton, are not only highly experienced anaesthetists and intensivists, but also expert medical educators who run the highly regarded Frenchay Final FRCA Crammer course. Members of their writing team are recent successful Primary and Final FRCA candidates or recently appointed consultants, so FCRAQ.com is written by anaesthetists for anaesthetists!

What next?
Try a free demo of FRCAQ
Subscribe to FRCAQ

Which other resources will help with Primary FCRA preparation?
Check out the following bestselling books:
Fundamentals of Anaesthesia, 3rd Edition Edited by Tim Smith, Colin Pinnock, and Ted Lin
Physics, Pharmacology and Physiology for Anaesthetists: Key Concepts for the FRCA Matthew E. Cross, Emma V. E. Plunkett
Pharmacology for Anaesthesia and Intensive Care, 3rd Edition Tom E. Peck, Sue Hill
Dr Podcast Scripts for the Primary FRCA Edited by Rebecca A. Leslie, Emily K. Johnson, Alexander P. L. Goodwin
Concise Anatomy for Anaesthesia by Andreas G. Erdmann

Treating radiation injuries in US travelers returning from Japan

March 22, 2011 — In response to the crisis in Japan, the US Centers for Disease Control and Prevention (CDC) hosted a conference call for clinicians to answer questions about treating radiation injuries in US travelers returning from Japan.

During the hour-long Clinician Outreach and Communication Activity call yesterday evening, Jeffrey Nemhauser, MD, who is a captain in the US Public Health Service and a medical officer in the CDC’s Radiation Studies Branch, answered questions from healthcare providers about radiation exposure and treatment.

Dr. Nemhauser stressed that the CDC is not aware of any US travelers returning from Japan who have been “contaminated with material at a level of concern.” If a traveler is contaminated, the CDC will recommend decontamination, collect data, and follow-up with the traveler, he said.

Customs officials routinely screen travelers (and their luggage) entering the United States for radiation contamination, he said. Because of the radiation leaks in Japan, however, the CDC is creating extra screening protocols for airports. Dr. Nemhauser said that these protocols should go into effect this week.

Medical Resources Strained in Japan

 March 17, 2011 — The devastating magnitude 9.0 earthquake and tsunami that occurred in Japan’s Miyagi prefecture on March 11 have caused a cascade of health and safety problems for survivors, including possible exposure to radiation from the region’s damaged Fukushima Daiichi nuclear plant. The disaster has strained medical resources on the ground, but it is unclear how many resources will be needed in the future.

“This is a very complex disaster, and it’s an evolving, ongoing situation,” Kristi L. Koenig, MD, director of the Center for Disaster Medical Sciences at the University of California–Irvine, told Medscape Medical News.

“The recovery phase of this disaster is going to be years and years and years,” she said. “They need people over the next many months to years to help, because the whole public health infrastructure is disrupted.”

Japan’s experience has been very different from Haiti, where a magnitude 7.0 earthquake struck in January 2010 and created a vast need for medical help. “In Haiti, the existing healthcare infrastructure was basically nonexistent,” Dr. Koenig said, “and the building codes for earthquakes were not anywhere near what they are in Japan.”

Unlike Haiti, Japan has well-organized civil defense teams that helped victims immediately until outside help was available, Dr. Koenig pointed out. These factors likely mitigated the injuries and deaths from the earthquake in Japan.

“Japan has significant emergency management capacity — one of the best in the world,” Margaret Aguirre, director of global communications for the International Medical Corps, told Medscape Medical News in an email.

Future Clinical Assistance May Be Needed

Neuroanesthesia and anesthesiology

Blog Post by George A. Mashour MD, PhD, Director, Division of Neuroanesthesiology and Assistant Professor of Anesthesiology and Neurosurgery,  University of Michigan

Neuroanesthesia is a subspecialty of anesthesiology that focuses on the perioperative care of patients undergoing surgery of the brain, spine or peripheral nerves. Because the drugs routinely used for anesthesia have their therapeutic action at all of these sites, anesthesiologists and neurosurgeons must “share” the nervous system during the course of an operation. This becomes particularly important at the end of surgery, when the assessment of neurologic function is a major priority. If, for example, a patient has suffered a stroke or has brain swelling, it needs to be recognized and acted upon rapidly before permanent damage occurs.

Non-invasive ventilation for acute cardiogenic pulmonary oedema

Blog Post by Mr Tim Case MPhil MA (Cantab) Medical Student, Hughes Hall, University of Cambridge, Cambridge, CB1 2EW, UK, and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Acute cardiogenic pulmonary oedema (ACPO) is a life-threatening consequence of acute heart failure that affects more than 17000 patients in the UK per year[i].  As the left ventricle fails, increased hydrostatic pressure causes fluid to leave the pulmonary capillaries and fill the alveoli.  Clinical features of ACPO include dyspnoea, tachypnoea, wheeze, pulmonary crepitations and hypoxaemia. 

‘So you want to be… an intensivist’

Blog Post by Dr Darcy M Pearson FRCA, Specialty Trainee in Anaesthesia & Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK, and Dr Kamen Valchanov MD FRCA, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

DMP: How long have you worked as an Intensive Care Consultant?

STW: 2 years

DMP: When did you decide that you wanted to pursue a career in Intensive Care Medicine?

STW: During my training in anaesthesia I realised I enjoyed managing sick patients in intensive care as well as anaesthetising high-risk patients in theatre. Both interests led my down the road of a career in ICM and cardiothoracic anaesthesia.

DMP: Did you have an opportunity to experience Intensive Care Medicine as a medical student?

The Ongoing Challenges with the Peri-operative Care of the Morbidly Obese Patient

Blog Post by Jay B. Brodsky, MD and Harry J.M. Lemmens, MD, PhD, and Stanford University School of Medicine, Stanford, CA, 94305

We are all aware that the world is experiencing an obesity epidemic. Given the great numbers of morbidly obese patients currently undergoing surgery and the predicted increases in those numbers for the future, every health care professional must be familiar with the unique management concerns of these potentially complex patients.          

The morbidly obese patient can be especially challenging for their anesthesiologist and surgeon.  There are physiologic changes to almost every organ system, numerous associated medical co-morbidities, altered uptake and distribution of anesthetic agents and other drugs, potentially difficult airways, as well as technical difficulties related to the large size of these patients.

Intensity of renal replacement therapy in critically ill patients with acute kidney injury

Blog Post by Dr Kaushik Bhowmick FRCA, Specialty Trainee in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK and

Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK

Acute kidney injury (AKI) is common in critically ill patients in the intensive care unit (ICU). Renal replacement therapy (RRT) is required in approximately 5% of patients in intensive care with severe AKI and is associated with substantial mortality.

There are two broad methods of RRT, continuous and intermittent RRT. Although no significant mortality difference has been demonstrated between the two methods, continuous RRT is preferred method in intensive care units in many countries including UK, Australia and New Zealand. Continuous renal replacement therapy provides continuous fluid removal, steady acid-base and electrolyte correction and relative haemodynamic stability. In spite of much development, the optimal intensity, timing and mode of RRT remain uncertain. One of the many complications of AKI is uraemia. RRT aims not only to reduce the clinical complications of uraemia but also the adverse subclinical pathophysiological effects of uraemia.

Severe local anaesthetic toxicity

Blog Post by Dr Natasha Elworthy FRCA, Specialty Trainee in Anaesthesia, Papworth Hospital NHS Foundation Trust, Cambridge and Dr Stephen T Webb MB BCh BAO FRCA EDIC, Consultant in Anaesthesia & Intensive Care Medicine, Papworth Hospital NHS Foundation Trust, Cambridge

The use of local anaesthetic in hospitals is commonplace and thus management of local anaesthetic toxicity is of paramount importance. Recent cohort studies have established the incidence of severe systemic local anaesthetic toxicity, defined as seizures with or without cardiac arrest, as 1:10,000 following epidural local anaesthesia and 1:1000 following peripheral nerve blockade ₍₁₎.

Until as recently as 2005 there was no widely agreed approach to the management of local anaesthetic toxicity ₍₂₎, local anaesthetic toxicity seeming to be largely resistant to standard Advanced Life Support (ALS) resuscitation efforts. By 2007 there was however an increasing case database of successful cardiac resuscitation from severe local anaesthetic toxicity following the use of intravenous Intralipid 20%, a sterile fat emulsion. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published the first set of standardised guidelines for severe local anaesthetic toxicity in 2007 _(1,3).