1. Q9 COPD VBG utility BIPAP & Intubation

2. Overall – Q 9 Pass mark ~ 27

3. Length 2015.1 – 14 marks for 6 minutes – 9 min ~ 21 marks 2016.1- similar My question = 36 marks

4. Your exam “ The number of responses required for the whole exam has been reduced substantially from the 2015.1 paper. It is expected that well prepared candidates will not be time pressured”

5. What do words mean? the words “describe, outline, and discuss” are now absent from the paper – these words suggest a paragraph or short essay answer the word “list”, if used, suggests the answer items will each be 1-3 word answers. the word “state”, if used, suggests the answer items will each be a short statement, phrase, or clause. if the word “list” or “state” is used, the precise number of answer items requested will also be known, with each item attracting one mark e.g. “state 3 items, list 4 items”.

6. Standard setting – answers Actual exam SAQ Q writer  SAQ group of 7  SAQ group of 20  Fellowship exam committee  Standard setting process  Examiners marking the Q  RV SAQ chair  Final Q MMC SAQ Q writer  RV by MMC  RV by 1 member of SAQ committee

7. MMC trial exam Is: Opportunity: – Practice close to exam conditions – Identify areas of weakness – Improve knowledge in examinable areas ALOT of work for Rachel & others

8. MMC trial exam Is: Opportunity: – Practice close to exam conditions – Identify areas of weakness – Improve knowledge in examinable areas ALOT of work for Rachel & others Is not: An isolated tool to decide whether to sit An opportunity to hate/fight the exam format An opportunity to fight over model answers/ pass standard

9. Overall Core Consultant knowledge i) utility of VBG ii) indications for BiPAP iii) settings for BiPAP iv) indications for intubation v) intubation ETT size and drugs vi) ventilator settings

10. Q1 22/39 received 0 / 8 0 - blank8 0 - attempt14 12 21 38 41 51 61 70 80

11. A 52 year old woman presents to your emergency department with breathlessness for the last 24 hours. She is known to have Chronic Obstructive Airways disease in association with alpha-1 antitrypsin deficiency. Complete this table, describing (state) the utility of venous blood gas variables for this patient.

13. Several described ABG utility vs ABG utility

15. ii) List four (4) indications for Bi-level Positive Airway Pressure for this patient. “acidaemia” or “acidosis” or pH < 7.30

16. ii) List four (4) indications for Bi-level Positive Airway Pressure for this patient. “acidaemia” or “acidosis” or pH < 7.30 Moderate to severe acidosis - pH 7.25- 7.35 (venous 7.20- 7.30)

17. ii) List four (4) indications for Bi-level Positive Airway Pressure for this patient. Indications ≠ conditions that must be met An alert patient Lack of contraindications

18. iii) Complete the table demonstrating your regime for Bi-level Positive Airway Pressure for this patient. Problems: Lack of knowledge Mixing IPAP with EPAP

19. iv) List five (5) indications for intubation in this patient. Many full marks v) You decide to progress to intubation soon after arrival to the emergency department. The patient has received 10mg Ventolin via nebuliser only. She weighs 70 kg. Her observations prior to arrival are: BP 100/60 mmHg PR 130/min RR 30/min Temp 37°C GCS 15 -Complete the table provided with regard to intubating this patient. – Wide range of possibilities – Many unacceptable doses suggested

21. Summary Writing

22. Summary Writing Must do exam condition practice WITH feedback

23. Summary Writing Must do exam condition practice WITH feedback Don’t fight the system…..yet

24. Good luck, hang in there – still 2 ½ months to go!!!!!!!!