What’s the point of the exam anyway? - It is an opportunity for you to get across to the examiner(s) what you have learned during your training
- As you plan and begin writing, think critically … imagine the examiner looking over your shoulder!
- You need to pass to qualify and start paying off all those debts ………….
General points - You have 3 hours overall
- 45 minutes for the essay question
- usually a choice of two questions
- 45 minutes for the short answers
- 5 out of 8 : 9 minutes each
- 90 minutes for the MCQ
- TIME MANAGEMENT IS THE KEY
General points - You have to make a choice between the two questions … this can be difficult!
- Once you have selected the question to answer … read it three times to make sure you know what the examiner is after
- Underline each significant word
- Check the wording of the question to select the right way to answer
General points - Describe the problems of prescribing for elderly patients ….
- Write an essay on the benefits and risks of using two or more drugs concurrently ….
- Discuss the mechanisms and applications of pharmacological inhibition of the actions of the renin-angiotensin-aldosterone system.
General points - There is NO DIFFERENCE in your approach to answering these questions!
- Essay does not mean one long paragraph in elegant English!
Wording which does make a difference! - Discuss, with examples, the mechanisms and applications of pharmacological inhibition of the actions of the renin-angiotensin-aldosterone system
- Compare and contrast the benefits and disadvantages of paracetamol and aspirin
- Discuss the management …….
Time management: Where to start - The clock is ticking away ….
- Two minutes to select the question to answer
- Don’t aim to write for longer than 30 - 35 minutes …. i.e. 4 to 5 sides of A4
- Thus … you have about 10 minutes to PLAN your answer .. Get it right first time!
What does the plan look like? - Draw a diagram of the system which is being considered e.g. renin-angiotensin-aldosterone system, hypertension, heart failure and so on (helicopter view)
- Headings of sections (like a table of contents)
What are the common or systemic mistakes? - Inadequate preparation: revision and practise in answering exam questions
- Not being mentally prepared for the exam on the day (and all the other exams that week!)
- Failure to read and understand the question
- TIME MANAGEMENT IS CRITICAL!
- Writing too much or ……… too little!
- Bad planning and execution … poorly set out and/or illegible or poor spelling
An actual question!! - Discuss the management of chronic heart failure in a patient with known ischaemic heart disease (write out the question!)
- Discuss the management of chronic heart failure in a patient with known ischaemic heart disease
Now it’s your turn! - Try and draw a diagram including most of the main points of this question
- Then put down a set of headings and sub-headings, arising from the diagram, to cover your answer to the question
- You have about 10 minutes!
The Question - Discuss the management of chronic heart failure in a patient with known ischaemic heart disease
How diagrams help How diagrams help Plan (1) - Definition and classification (NYHA): emphasis on CHRONIC
- Why is it important? Incidence and epidemiology
- Precipitating causes: emphasis on ischaemia
- Pathology : Effects of CCF on SNS and RAA axis on increasing problems
Plan (2) - Management … with particular emphasis on ischaemic heart disease and role of surgery
- Aims and objectives of treatment
- Diagnosis … can be difficult!
- Conservative: life style and prevention : stop smoking, lose weight, exercise, diabetes etc ….
- Drug therapies .. e.g. digoxin, diuretics, ACE inhibitors use diagram to point out their roles
- Emphasise problems with Rx for ischaemic heart disease e.g. beta blockers to ‘depress the heart’
Mistakes in this question - Inadequate definition of heart failure ..
- Inability to supply adequate oxygen and nutrients to tissues during normal activities despite an adequate filling pressure and systemic blood pressure
- Management: Aims and objectives of Rx
- conservative treatment and surgery (if necessary) as well as drugs
- Impact of IHD on the treatment
Mistakes in this question - Discussion on the use of beta blockers and ACE inhibitors
- Beta blockers now have a limited role in CCF if used judiciously
- Both ACE inhibitors and beta blockers are useful post MI (a likely prospect in this patient)
- Use of vasodilators (e.g. hydrallazine)
Another question! Acute MI: the first 24 hours - Draw a diagram of the processes involved
- Produce a plan for answering the question
- You have 10 minutes!
The question! - Discuss the management of acute myocardial infarction in the first 24 hours following diagnosis
- Atheromatous plaque
- Rupture, erosion
- Formation of thrombus
- Platelet embolisation
- Pain, sweating,
- collapse
- Nausea and vomiting
- Dysrhythmias, VF
- (ECG changes
- CPK MB, Troponin)
- Muscle
- Necrosis
- Infarction
- Beta blockers
- ACE inhibitors
The plan - Pathophysiology
- Presenting features and making the diagnosis
- Before hospital treatment: reassurance/O2/iv
- Thrombolysis
- types: streptokinase, alteplase and reteplase
- when to start, which to use, risks and contraindications
- Anti platelet therapy/beta blockers etc
- Admission to CCU (angioplasty etc.)
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