Exams

Malaysia Anesthesia Parallel Pathway Post FCAI Assessment, Part 4 of 6, Clinical Review /  by Muhammad Amir Ayub

Station 1:
Elective AAA preop assessment
Scoring
Relationship with smoking
Physics relationship as regards to rupture
Indications for op
Access and monitoring
Physiology of cross-clamping and release
Management of the above
Renal protection
Spinal cord ischemia, monitoring/prevention
Lumbar drain physiology
Anterior cord syndrome & anatomical basis

Station 2:
Assessment of patient with TBI, possible maxillofacial injury
Ideal preparation for airway management
Emergency intubation management
MILS
Interpretation of CT: EDH, gross cerebral edema. Cervical X-ray: cervical retrolisthesis
Anticipated neurological deficit
Anesthetic management for neurosurgery
BTF targets - Gases, hemodynamics
Mannitol
DI and management

Station 3:
Classification of CDH, embryology
Pathophysiology
Timing of surgery
Assessment and optimization
iNO in respiratory failure
Decision on proceeding with surgery
Ventilatory management (protective ventilation strategy)
Fluid management
Airway management for child not already intubated
Prevention of hypothermia
Concerns post reduction (atelectasis, abdominal compartment syndrome)
Tension pneumothorax

Station 4:
Perforated gastric ulcer with septic shock
Surviving sepsis campaign (SSC) definition of septic shock
Hemodynamic recommendations (fluids, vasopressors)
Physiologic basis for MAP vs SBP
Recommendations on vasopressor, inotropic choice
CO monitoring
PiCCO
Interpretation of values (supranormal CO, normal GEDVI, low SVRI, normal EVLW)
Choice of induction agent choices (etomidate, ketamine)
Choice of volatile mixture (air, nitrous) - hemodynamic, surgical implications
Refractory hypotension
Fluid challenge
Steroids - recommendations, physiology

Yeah, I passed, but I’m burned out preparing for repeated assessments while the COVID epidemic rages on. While living away from the wife and kids (and currently an inability to travel) for almost 5 years now. I felt I prepared better the last time around (despite less than ideal circumstances). This time around the “study week” (thank you roster makers) was spent more recuperating and weaning from stimulant, ehem caffeine, abuse and trying to slow down my personal struggle versus frailty (with the closure, and lack of time when it was open anyways, of the gym) as compared to studying. This is proven by the relative lack of notes written for this exam season.

Going to the exam 2 days after my second COVID vaccine jab probably didn’t help, but I don’t think it affected my handling of the exam at the end of the day.

But then again, every healthcare worker is burned out. There is no solution. Just survive it before it kills you, then medicine becomes more of a venous ooze versus arterial cut. I wonder how was the suicide rate among Western healthcare workers the past 1 year… The fuck (while looking this up):

“...residents are used “as cheap labor,” making on average $61,000 a year for working 80+ hours a week.”

I’d rather not talk about how much we earn here in comparison. But enough sad shit. Have you heard of Crossy Road Castle?

Malaysia Anesthesia Parallel Pathway Post FCAI Assessment, Part 3 of 6, Clinical Review /  by Muhammad Amir Ayub

What a lengthy title….

Anyways, I passed this with distinction despite the odds: Broken computer a few months back, lack of any time in another month, and lastly my son is down with bronchiolitis, currently being taken care by my non-doctor wife at home. He’s improving, but I barely studied anything 3 days prior to the exam and drove to KL from Melaka only when “happy enough” the morning of the exam with little sleep. But that’s beside the point. I want to share the topics discussed that you, the reader, can reference for your own study topics.

Examiner 1:
Preggy elective breech ppm sick sinus syndrome
All about obs preoperative review, ppm classification n management
ECG review; pacemaker (ventricular pacing) dependence
Anesthetic technique (decided for CSE), needs during LSCS
Blood on aspirating epidural
Tachyarrhythmia post buzzing

Examiner 2:
Cardiac assessment non cardiac surgery
RCRI
Non invasive tests
Elective BKA for patient on warfarin
Bridging & Chads2vasc
Fast AF intraop; stable tachyarrhythmia algorithm
Guillain barre syndrome coming for tracheostomy
What is GBS and anesthetic concerns
Airway emergency post tracheostomy
Concerns with new tracheostomy

Examiner 3:
Neonatal vs preterm definitions
CVS changes of infants vs adults
Common surgical procedures in the age groups
Preparation for neonate/preterm surgery
2 week post 35 weeks premmie for herniotomy; concerns
Anesthetic technique in full
Postop considerations

Examiner 4:
SAH presentation
CT scan interpretation
SAH classification and implications
Myocardial injury post sah
Differentiation with MI?
Deferral of op?
Anesthetic aims, technique, TIVA vs inhalational
Monitoring (considerations for neuromonitoring/CO monitoring)
Temporary clipping n complications
Transmural pressure and implications
Management of rupture (burst suppression, flow arrest)

Many of the topics here were not specifically covered during my preparations. Probably around 30%-50% of the topics have been made into notes the past, but I only reread a minimal amount of them. Personally I wasn’t happy with my performance during the 2nd and 4th sessions. Will probably have to go deeper into these topics next time. If you followed this blog, you’d know that none of my new notes actually made it into this particular exam.

Based on my own personal review, I don’t think I need to drastically change my approach to studying yet. Don’t fix what is not broken.