Dr Adrian Jennings Equations for the Primary FRCA
Dr James Shorthouse
The FRCA Primary examination is a daunting prospect to both the postgraduate exam newcomer and the seasoned campaigner. The sheer breadth and depth of knowledge required over a wide range of specialties, combined with a punishing exam schedule, can make it seem an impossible task. I passed the exam at the first attempt, after fourteen months of anaesthetics, through a combination of preparation, hard work and a little bit of luck on the day (always required!). I will go through a step-by-step account of how I prepared for and passed the exam. It is important to remember that everyone works in different ways, so there may be disagreement as to my methods or suggestions. Study leave and financial circumstances certainly have an impact on preparation, as does geographical location. However, the aim of this guide is to be precisely that: a guide or a framework that can be adapted to the individual as needed. The aim is to prove that this is achievable. Exam structure, marking, & updates are continually under review by the RCOA and, as such, it is very important that the candidate keeps abreast of these updates or changes by regularly visiting the Examinations section of the RCOA website here. A further link on the RCOA site specifically for examination changes may be found here.
The two main reasons that candidates fail the Primary are through lack of preparation, and an unwillingness to take it seriously and devote adequate time/resources. The recently failed candidate is often heard loudly proclaiming how unfair his/her OSCE/viva (or Structured Oral Examination!) was because “they asked me in detail about depth of anaesthesia monitoring in my physics viva”. What they haven’t mentioned (or even realised sometimes!) is that they weren’t able to talk about propofol in a structured sensible manner, or that they weren’t able to check an anaesthetic machine confidently, or they didn’t know their resuscitation algorithms. The OSCE/SOE section of the exam is structured to be fair. It allows the prepared candidate to demonstrate as much knowledge as they can in the allotted time, giving the best possible chance of succeeding. For the old-style examination where the OSCE/SOE occurred approximately five weeks after the MCQ, the average candidate required six months to prepare for this exam, give or take. Since June 2007, the structure has changed and the MCQ section has become a stand-alone pass/fail examination. The length of time taken to prepare oneself for an MCQ examination alone will vary according to working patterns but, even though the Primary now presents itself as two separate examinations, I believe that the approach taken should be very similar if not identical to that of the old-style Primary. The syllabus has not changed and therefore the time taken to cover it will not either. If anything, the pressure that existed previously to achieve an adequate standard for the OSCE/SOE section in a relatively short period has been taken away, allowing for a structured, concentrated approach with plenty of OSCE/SOE practice! Before starting the work in earnest, a period of planning is required. Part of this is mental preparation and gearing yourself up for the fact that this will take up a significant proportion of your time and energy. It’s also extremely difficult to motivate yourself to revise for an exam in half a year’s time. The other part is the logistical preparation: planning and booking courses (see later), speaking to people who’ve already taken the exam, taking the plunge and actually booking the exam (no going back!), deciding on which books to buy and plotting your assault on the syllabus with an inevitably colourful and detailed revision timetable. a) Finance This is not a cheap exercise. As well as being an emotional/mental challenge, it can prove to be a dent in the finances. You wouldn’t spend a couple of thousand pounds on a TV and throw it away because you couldn’t understand the manual and subsequently couldn’t watch the TV. Likewise, it is pointless to spend all the money on this exam only to fail because you couldn’t be bothered to put the work in. Factors to consider include: the cost of books, courses (+ travel & accommodation), the exam fee and accommodation/travel to London for the exam. b) Study leave If you are planning on attending courses, especially day-release courses, you need to check how much study leave you have with your department prior to booking. Do not forget to factor in the exam periods as well; otherwise, you’ll end up using valuable annual leave (required for post-exam holiday: see later!). You may or may not have a study leave budget: use it wisely!! c) Syllabus It is often evident during Guidance Interviews for candidates who have failed the exams, that reasons for failure point towards poor study technique, particularly an ability in following the RCOA syllabus when structuring their revision. It is recommended that candidates use the syllabus for the Primary FRCA to form a road-map during their study period. I structured my revision using the FRCA primary syllabus with some adaptations. It can be downloaded here. d) Exam application The Primary FRCA Examination Calendar may be found here. Examination application forms may be found here. Examination regulations are found here. It is imperative that you read and understand the procedures involved in applying and paying for the exam. e) Courses I am extremely pro courses. I have always done as many courses as I can prior to exams. I believe that they concentrate your mind to the task at hand, and provide you with valuable teaching, practice and experience not gained just from books. They are invariably run by or taught by some of the actual examiners you may meet on the day, and, as such, will be pertinently relevant to the exam. A list of the recommended courses can be found here. There are many other courses of a similar vein, all of which have been recommended by those attending. It is a matter of talking to previous candidates and finding something that suits the individual.f) BooksThere are some books you must acquire, which are fundamental to passing this exam, and there are others that are a personal choice. I bought all of my textbooks new, so I could scribble in them, but it’s also worth checking whether anyone in your department has got old books to sell. A good place to start for recommended texts is Anaesthesia UK. The majority of these books can be ordered online via the recommended book list and the AUK Bookstores for Cambridge, Elsevier and Hodder-Arnold.Firstly, start by acquiring The RCOA Primary Guide. As well as explaining in detail the exam format, it has MCQs, OSCE stations and SOE questions taken from previous exams. I recognised at least 7-10 full MCQs word-for-word from this book in my actual exam!! Other textbooks that are seen as 'must-haves' include:- The A-Z of Anaesthesia (Yentis, Hirsch, Smith): vital for those weeks between the MCQ and oral exams- Basic Physics and Measurement in Anaesthesia (Kenny, Davis): AKA ‘Parbrook’. Many of the diagrams from this book are used in the SOE.- Essentials of Anaesthetic Equipment (Al-Shaikh, Stacey): a clear concise guide to all of the important equipment, especially good for the OSCE section. Lots of diagrams & photos, less writing – brilliant!- A general anaesthetic textbook: a great debate exists as to what is best. I used Pinnock’s Fundamentals of Anaesthesia because I liked the way it was laid out and it follows the Primary syllabus closely. The alternative is Aitkenhead’s Textbook of Anaesthesia. It is purely a matter of preference: borrow a copy of both and look through them. You’ll get a feel of what works for you.- Pharmacology for Anaesthesia and Intensive Care (Peck, Hill, Williams): great for explaining complicated pharmacokinetic/-dynamic principles clearly and concisely.- Respiratory Physiology: The Essentials (West): Needs to be read at least 3-4 times but a lot of the principles/diagrams from this text form the basis of the respiratory component of the physiology viva.- Oxford Handbook of Anaesthesia: more useful for on-calls as a junior anaesthetist, but I used it to revise all the anaesthetic emergencies. Beware the resuscitation algorithms, which are now out of date (see later). These may have been updated in the newer second edition.- **STOP PRESS: Primary FRCA in a box is a new examination aide in the ‘Question & Answer’ style from the RSM Press. Although only recently published and released, I have already heard some very positive murmurings from recent candidates!Other books that I used included:- Drugs in Anaesthesia and Intensive Care (Sasada, Smith): fits in scrubs pocket and provides a useful structure for talking about drugs in the viva situation (see later).- Anaesthesia OSCE (Arthurs and Elfituri). Very popular, with wide range of potential OSCE stations.- The Anaesthesia Viva 1(Urquhart, Blunt, Pinnock, & Dixon): Physiology and Pharmacology. Common SOE questions with model answers. Great for last minute SOE revision.- The Anaesthesia Viva 2 (Blunt, Urquhart, Pinnock, & Chong): Physics, Clinical Measurement, Safety, & Clinical Anaesthesia, as above- The Structured Oral Examination in Anaesthesia (Balasubramanian, Mendonca, & Pinnock): I found this so useful – 10 full SOEs divided by topic with model answers.- MCQs for the Primary FRCA (Bailey, Moscuzza, Pearce)- Get Through FRCA Primary: 710 MCQs (Jayaweera and Jayaweera)- QBase Anaesthesia: 1 MCQs for the Anaesthesia Primary (Hammond et al)- QBase Anaesthesia: 6 MCQ Companion to Fundamentals of Anaesthesia (Pinnock et al)As stressed before, this list of textbooks is not exhaustive, merely the ones I used. Some of my fellow candidates used additional textbooks such as Anatomy for Anaesthetists (Ellis, Feldman, & Harrop-Griffiths) and various specialist physiology texts. Obviously, there are numerous alternative MCQ/OSCE/viva texts available; these may be found by going to a bookstore with a specialist medical section (Waterstones on Gower St in London comes to mind) or searching online.g) Online revisionOne of the most important internet sites to aid in revision is AnaesthesiaUK. Register on the exam home page for free access to the online interactive examinations. There is a large bank of Primary MCQs taken from previous exams, together with explanations, and accurate negative marking! Using the exam menu on the left side of the page, you can also access the OSCE & viva resources. They have an enormous bank of OSCE stations and viva questions sent in by previous candidates. There are also large tutorial sections with many diagrams and explanations on vital topics in anaesthesia, especially relating to basic principles. Together with the text books used above, this website formed the basis for my revision and ultimate success in this exam.Keep an eye on the RCOA website, as announcements/alterations/general information about the exam are posted there.Other websites with Primary resources include:- Worldwide Anaesthetist- Update in Anaesthesia: useful articles written about basic principles/important topics.- New York School of Regional Anaesthesia: great for regional block techniques found in some OSCE stations- Virtual Anaesthesia Textbook: huge site with many anaesthetic-related resources- Anaesthesia Education Website: a portal site for other sites containing exam tutorials/MCQs & various other resources- ReviseMedicine: register for free to access a database of FRCA Primary MCQs, OSCE stations, and viva questions.Some candidates also use onexamination.com & 123doc.com as a resource for MCQs/exam preparation.h) HolidayBook a holiday for just after the exam. It will give you something to aim for and look forward to. Can you honestly say that a week of nights on the labour ward post-exam is just reward??
a) MCQ PAPER There are different schools of thought on how to revise for this section of the examination. Some candidates plough through the textbooks, and then attempt MCQs later on. Others like to base their revision around MCQs topic by topic, referring continually to textbooks. There is no correct method, but I believe the key factor to passing this section is sheer volume of MCQs completed. It gets you into the mindset of MCQ technique and there is definitely a skill to answering MCQs. There are 90 questions, each with 5 stems, to be answered in 3 hours. That equates to 24 seconds per stem! There are approximately 30 pharmacology questions, 30 physiology & biochemistry questions and 30 physics, clinical measurement, & data interpretation questions. Candidates are provided with a question booklet, some scrap paper, & an Optical Mark Reader sheet to record answers in a True/False style. The MCQ examination is a pass or fail exam. Candidates have five attempts at the examination, and a pass is valid for two subsequent years from the published start date of the exam applied for This brings us to the matter of MCQ technique itself. Most candidates will have experienced medical MCQs at some point in their careers, i.e. Finals, MRCP or other. Most candidates will also have their own methods for answering MCQs. The MCQ exam is no longer negatively marked, therefore it makes sense that all stems from the questions should be attempted. The passmark will be in the region of 80%. On the day itself, make sure you know the way to the College (type WC1R 4SG into Google Maps). Arrive early and make sure you bring ID (I took my passport). Ensure that you fill your details/candidate number in correctly on the answer sheet, and then get cracking!! Obvious things to say include: read the question, check that the relevant answer is marked in the correct box, and re-check everything at the end. It would be tragic to fail because the paper was filled in incorrectly. Once finished, go and have a drink at the Square Pig across the road and ignore everyone else dissecting the exam in intimate detail!! b) OSCE Again, turn up early and register with ID. Dress smartly, i.e. suit (neutral shirt/tie) mandatory for men and interview clothes for the ladies. Bring a stethoscope. It is a long stressful day; some people even bring a change of shirt/underwear for the afternoon!! The OSCE section of the examination is held in one room, divided by many little cubicles. There are up to 18 stations over approximately 1 hour & 50 minutes, of which only 16 will count towards the final mark; there may be a rest station or a trial station. Make sure that you write your candidate number at the top of all answer sheets! Some cubicles have one or two examiners in them, some will have a live patient in them as well. Others, e.g. X-ray, just have a question/answer sheet. Each station is five minutes long, with a one-minute break in between, to gather your thoughts and read the instructions for the next station. The format for the history-taking station changed recently. It is now a double station: firstly, five minutes with the patient alone to take the history; secondly, five minutes with an examiner to present the history and answer questions. Hint: there may be an operating list to read before taking the history – memorise the name, age, operation and often the side of the operation. By understanding the format and marking of the OSCE, you give yourself the best chance of passing it. Each station has a specified mark sheet with tick boxes; if you say/do the right thing, you get a tick - i.e. there is no examiner discrepancy. Each station is marked out of 20, the pass marks for all 16 stations are added together to determine a final result for the OSCE. At the first attempt, the OSCE & SOE are taken together (both as Pass/Fail exams); if one section is failed then only that section must be repeated, if both failed, then both repeated. There is a maximum of four attempts allowed and the OSCE/SOE pass is valid for 2 years. i) OSCE stations - Anatomy/nerve blocks/technical skills - Communication skills - Scan Interpretation: CXR/angio/CT - Anaesthetic monitoring & measuring equipment/hazards - Examination skills - History taking - Resuscitation - Clinical anaesthesia - Anaesthetic machine check NB/ one or more stations may include the use of a medium fidelity simulator (see below) Examples of OSCE stations in each section can be found on the Anaesthesia UK website. There are some important points to remember: - If you have a bad station, as hard as it may seem, forget about it and move onto the next station. You will not do yourself justice if an under par performance in one station affects subsequent ones. My first three OSCE station were, in my opinion, disastrous and I felt like leaving right there and then. My next one was a respiratory exam which I could do, and it got me back on track. - There will always be an anaesthetic machine check. This may include the old Boyle’s machine. Practice until you can do it blindfolded – if you fail this station, it looks very bad if you’re borderline elsewhere! The Association of Anaesthetists publish the guidelines for checking the machine here and here. There may also be checking of various circuits, e.g. Bain. - There will always be a resuscitation station. You are expected to know the updated algorithms for both ALS & PALS, including emergency paediatric drug doses. They can all be downloaded from the Resuscitation Council UK website. Resuscitation of a pregnant woman has been included in the past. Don’t forget left tilt, and request obstetric/paediatric assistance. Again, there is no excuse to fail this station – it should be a gift! - Similarly, there may be a trauma scenario, so ATLS knowledge is required. Try to book an ATLS course if not done; more resources found here. - In my exam, there was a SimMan®, a mannequin with a heartbeat (+ arrhythmias etc), breath sounds (including one-sided!) and pulses etc. It is connected to a computer and an anaesthetic monitor with changing parameters. If possible, it is worth trying to practice scenarios on one locally, as some departments do own them. - Re-learn how to examine body systems (the ‘Finals’ way - i.e. like a medical student!). You are likely to get one of CVS, respiratory, cranial nerves, upper & lower limb peripheral nervous system. This may also include measuring and describing pulse, BP and CVP. You need to look slick and gain yourself an easy pass at this station. - In communication stations, you get a mark for introducing yourself and also for checking who you are speaking to sometimes. There are also further points for empathy etc, so be nice!! Some of the patients (actors/actresses) may get quite aggressive, e.g. the ‘tooth-knocking-out scenario’. This has been known to upset candidates in the past. Do not be put off by this, remain calm and try to diffuse the situation professionally, as you would do at work. - Have a structure for examining/presenting CXRs and ECGs. ii) Anatomy There will be anatomy OSCE stations in the exam. The majority of candidates find anatomy tedious to learn and will often skimp on this revision section. This is not advisable, for reasons already mentioned. Although not exhaustive, the following list can be used as a guideline (full list found in the RCOA syllabus): Regional blocks These must include: landmarks, indications, contraindications, technique, LA dose and complications. - Epidural - Spinal - Brachial plexus (interscalene/supraclavicular/axillary) - Upper and lower limb (especially femoral and ankle blocks) N.B. occasionally lumbar/celiac plexus blocks have turned up Other - Respiratory tract - Cardiac + coronary arterial/venous supply - Vertebrae (cervical, thoracic, lumbar, sacrum) - Upper limb (brachial plexus, antecubital fossa) - Head and neck (Base of skull, including ‘holes’ and CN pathways, neck/laryngeal/pharyngeal anatomy, the orbit, Circle of Willis) - ANS - Ascending/descending motor/sensory tracts - Dermatomes c) Structured Oral Examination The Structured Oral Examination (SOE) is a game, and to succeed or win at the game, one needs to learn how to play it. It is the section of the exam which the majority of candidates are most apprehensive about, as the onus is on them to do the talking. In fact it is much more structured than the candidate realises. The Structured Oral Examination has been merged into a single SOE examination which is taken as two sub-sections, each with two examiners (one asks questions and the other one marks, and then they swap after 15 minutes), & the number and contents of questions are unchanged. The two SOE sub-sections, each lasting 30 minutes, are divided as follows: - 30 minutes consisting of three questions in Pharmacology, and three questions in Physiology & Biochemistry - 30 minutes consisting of three questions of Physics/Clinical Measurement/Equipment and three questions on Clinical Topics (which will always contain a Critical Incident). There are 12 questions, 2 marks for a pass, 1 mark for a borderline performance, and 0 marks for a fail, giving a maximum total score of 48 marks and a pass mark of 37. The examiners are not allowed to ask any question they like, avoiding the problem of ‘pet topics’ in times gone by. They have a list of questions/topics upon which they have to guide the candidate through; obviously, the better the candidate, the more material covered and potential marks picked up. The examiners will also move the candidate on to a different topic if they appear to be struggling or have stalled; again, the idea being to find out what the candidate does know. Contrary to popular belief/scare-mongering, the examiners are very friendly and do their best to put you at ease. The hardest part of viva preparation is starting the viva practice itself. You may have all the knowledge in the world, but the trick is to be able to impart this knowledge in a concise, relevant, structured and confident manner. Practice is the key; bully your consultant/SpR/SHO colleagues to give you regular viva practice. At first, it will be an awkward experience but do not be concerned about humiliating yourself in front of them – they have all been through the same ordeal. The more you practice, the more refined and polished your technique will become, and the more tips you will pick up from various colleagues. If you are lucky enough to have a Consultant who is a Primary examiner, make full use of this valuable resource. They will know exactly what is required to be successful in the viva section. There is a bank of viva questions asked in previous Primary exams on the Anaesthesia UK website. The big secret to passing the viva is to look at it from the examiners' viewpoint. Examining multiple candidates on the same questions for several hours can be BORING!! Your job is to make it easy for the examiners to pass you. They will generally be able to tell whether they want to pass you in the first couple of minutes; from the moment you sit down to your opening statement. Your appearance matters, so dress appropriately (see earlier), smile and look confident, even when you feel like a spot of reverse peristalsis!! Maintain good eye contact, especially with the person asking the questions, and avoid wild gesticulations and nervous tics/habits (hopefully these will have been spotted during previous practice). Hands clasped in lap, unless drawing a diagram/graph is usually recommended. Once completed, to avoid playing with the pencil, I would put it back on the table and clasp my hands again! Do not mention subjects about which you know very little; the examiner may ask you to elaborate! You must have a confident opening statement. Do not say the first thing that comes into your head! Take a few seconds to think about the question - i.e. what the examiner requires - take a deep breath and then proceed. I used the ‘DEFINE & CLASSIFY’ approach which was recommended on a course, e.g. ‘Tell me about Thiopentone’…….. ‘Thiopentone is a thiobarbiturate used for the intravenous induction of anaesthesia and in the management of status epilepticus’ etc etc. At this point, the examiner will start to relax: here is a candidate who knows his essential basics well, and so on. i) Drugs On the subject of drugs, it is vital to have a framework which can be used to talk about any drug. I used a combination of structures obtained from textbooks & courses: - Chemical/Classification - Presentation/Manufacture/Physicochemical properties - Uses - Action & mechanism/Duration of action - Onset/Offset of action - Doses/Routes of administration - Effects – CVS, Respiratory, CNS, Other - Side effects/ Toxicity/Contraindications/Interactions - Kinetics – Absorption, Distribution, Metabolism, Excretion ii) Drug you should be able to talk about Anaesthetics: Intravenous/Inhalational agents / Muscle relaxants (non-depol/depol) / Anticholinesterases / Local Anaesthetics / Anticholinergics Intravenous fluids: Colloids / Crystalloids Analgesics: Opioid / Simple CVS: Antiarrhythmics/Antihypertensives/Beta-blockers/Inotropes CNS: Stimulants/Anti-epileptics GI: Antiemetics / prokinetics Other: Antidiabetics (Insulin/PO hypoglycaemics) / Diuretics / Anticoagulants / Antibiotics iii) Drugs you should be able to draw It is quite feasible to be asked to draw the structure of a drug, and then describe the structure-activity relationship. Propofol Thiopentone Inhalational anaesthetic agents Local anaesthetics basic structure Acetylcholine + suxamethonium Anticholinesterases basic structure Catecholamine synthesis pathway iv) Clinical Candidates are given a clinical scenario, including blood results/ABGs/ECG etc to read and think about approximately ten minutes before starting the viva. The viva usually begins with: ‘How would you anaesthetise this patient?’ I used the following approximate approach: ‘I would divide my approach to anaesthetising this patient into preoperative, perioperative, and postoperative: - ‘In my preoperative assessment, I would go the ward to introduce myself to the patient, explain my role, and establish a rapport. I would perform a full history and examination, review of observations and investigations, e.g. blood results, ECG (+ further cardiac investigations) and CXR. I would also read the case notes, particularly paying attention to previous anaesthetic charts and any documented perioperative complications. I would explain the nature of the anaesthetic to the patient, documenting any potential complications of procedures discussed’. - The next section would involve perioperative management. It is wise to mention that you recognise that this patient has numerous comorbidities and you would request the advice and help of a senior anaesthetist, i.e. Consultant, to be present for the anaesthetic (at which point you are usually told that there are none available!!). Plan your anaesthetic sensibly. Rapid sequence induction is not: ‘RSI with thio, sux and tube’; rather, ‘I would ensure that I had checked the anaesthetic machine and all equipment according to the Association of Anaesthetist’s guidelines. I would have a trained assistant with m,e and all drugs, including emergency drugs (be prepared to explain which ones), pre-drawn up before patient arrival. I would apply monitoring according to the Association minimum monitoring guidelines. I would check that I could tip the trolley, and that adequate suction is to hand. I would preoxygenate the patient for at least three minutes, and, with cricoid pressure maintained, I would administer intubating doses of thiopentone and suxamethonium via a fast-running wide-bore cannula. Upon cessation of fasciculations, I would pass the endotracheal tube through the vocal cords into the trachea and inflate the cuff. I would check the position of the endotracheal tube by auscultation bilaterally, visible chest movement, and by looking for the presence of a capnography trace. Upon confirmation of tube position, the cricoid pressure will be released and the endotracheal tube fastened securely in position. - ‘Postoperatively, I would ensure that the patient is maintaining their own airway with spontaneous respirations, has supplemental oxygen, stable observations, good fluid balance, and is ideally pain-free or with a pain management plan. There must also be a clear plan for discharge from the Recovery suite, i.e. ward/HDU/ITU’. v) Critical incident At some point, inevitably, there will be a critical incident either perioperatively or postoperatively. It is your job to anticipate it and recognise its onset. It can be quite subtle sometimes, so be alert. The Oxford Handbook of Anaesthesia has a well-organized and concise section on anaesthetic emergencies. It is imperative that you know how to deal with a range of critical incidents; poor performance in this area is not favourable!! The following list is not exhaustive but provides a guide for revision: - Difficult/failed intubation - Difficult ventilation - Displaced ETT during operation - Pneumothorax - Bronchospasm - Postoperative hypoxia/hypercarbia - Intraoperative hypoxia/hypercarbia - Postoperative airway obstruction - Postoperative apnoea - Failure to wake postoperatively - Hypothermia - Anaphylaxis - Aspiration of gastric contents - Malignant hyperthermia - Suxamethonium apnoea - Cardiac arrest/peri-arrest - Arrhythmias/Heart block - Hypertension/Hypotension - Massive haemorrhage - Pulmonary/Air/Cement embolism - Complete/high spinal block - LA toxicity - Blood transfusion complications - TURP syndrome d) FORMULAE, DEFINITIONS & DIAGRAMS Candidates may be asked to produce formulae, definitions and diagrams/graphs to form the basis of an answer to a particular question. These should be at the tip of your tongue, so before the examiner has finished the question, the pencil is in your hand, ready to reproduce what is required. Blank paper is provided with a pencil – make sure your ‘sketchings’ are large, well-labelled and clear. When drawing graphs, label the axis first (correctly), and then proceed with the rest of the graph. The following list contains examples of formulae & diagrams. i) Formulae CVS - CO/SV/MAP - PVR/SVR - Fick Principle Respiratory - Dead space: physiological/anatomical - Bohr’s equation - Shunt equation (+diagram) - Alveolar gas Equation - Oxygen content/Flux Physics - Gas Laws + Universal Gas Equation - Hagen-Poiseuille equation Pharmacokinetics/Pharmacodynamics - Henderson-Hasselbalch equation - Bioavailability - Drug-receptor kinetics - Michaelis-Menten equation - Clearance/half-life/time constant - Context-sensitive half-time Other - Renal: GFR/clearance/RPF/RBF - Coagulation cascade (including updated theory) - Fibrinolytic System ii) Diagrams CVS - Iso-shunt graphs - Valsava manoeuvre - Action Potential: Cardiac Muscle fast-response & Pacemaker slow-response cell - Cardiac cycle - Starling’s law - Jugular venous pressure waveform - Pulmonary artery catheterisation waveforms Respiratory - Fowler’s Method for anatomical dead space - Compliance curves - Oxygen cascade - Alveolar wall-cross section - West zones - Oxyhaemoglobin dissociation curve - Lung volumes CNS - Action potential - Spinal cord: Transverse section - Pain pathway + gate control theory - Cerebral blood flow/Cerebral perfusion pressure Physics - Nitric oxide isotherms - Vacuum insulated evaporator - Vaporisers including desflurane - Defibrillator circuit - Electrical symbols - Wheatstone Bridge circuit - OxyHb/DeoxyHb wavelength absorptions - Mapleson breathing circuits Pharmacokinetics/Pharmacodynamics - Bioavailability - Agonists/partial agonists/antagonists Other - Renal: Nephron/Juxtaglomerular apparatus - Starling’s forces - Body water distribution - Meyer-Overton hypothesis iii) Definitions - Potency/efficacy/affinity - Volume of dstribution - Mass/force/momentum - Pressure + units - Electrical units e.g. Ampere/Joule/Coulomb etc - Resonance/damping - Humidity/SVP - Osmolarity/osmolality - pH/H+/mole - Critical/pseudocritical temperature - Critical pressure - Filling Ratio
Disclaimer
A lot of material used in this guide has been obtained from the textbooks, courses and online resources described above. I make no claim that any of it is my own work, merely that this guide is a collaboration of these sources, in addition to an account of my experience of passing the FRCA Primary examination. There is no personal financial gain to be made from this guide; it is freely available to all online, and will in no way act as a substitute for textbooks, online revision and courses.
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