1. How to pass the essay question Part 1

2. 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 ………….

3. 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

4. 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

5. 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.

6. General points There is NO DIFFERENCE in your approach to answering these questions! Essay does not mean one long paragraph in elegant English!

7. 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 …….

8. 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!

9. 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) –sub headings sub sections

10. 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

11. 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

12. 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!

13. The Question Discuss the management of chronic heart failure in a patient with known ischaemic heart disease

14. How diagrams help Chronic Heart failure Ischaemia Cardiomyopathy Valvular disease Smoking Obesity SNS activation TachycardiaPVR inc. Decreased Renal BF Inc. PRA Aldosterone Na retention Angiotensin Dysrhythmias

15. How diagrams help Low Q Ischaemia Cardiomyopathy Valvular disease SmokingObesity SNS activation TachycardiaPVR inc. Decreased Renal BF Inc. PRA Aldosterone Na retention Angiotensin Dysrhythmias Role of surgery?

16. 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

17. 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’

18. 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

19. 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)

20. Another question! Discuss the management of acute myocardial infarction in the first 24 hours following diagnosis

21. Acute MI: the first 24 hours Draw a diagram of the processes involved Produce a plan for answering the question You have 10 minutes!

22. The question! Discuss the management of acute myocardial infarction in the first 24 hours following diagnosis

23. Atheromatous plaque Rupture, erosion Platelet aggregation Formation of thrombus Platelet embolisation Coronary artery blockade Acute muscle ischaemia Pain, sweating, collapse Nausea and vomiting Dysrhythmias, VF (ECG changes CPK MB, Troponin) Muscle Necrosis Infarction Thrombolysis Aspirin Angioplasty Beta blockers ACE inhibitors Diamorphine Anti-emetic DEATH

24. 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.)