Examination format

You need to be aware of the format of the vivas.

The day consists of two viva sessions:

1. The clinical viva

1. This lasts 50 minutes and consists of a long case and three short cases or scenarios. During the first 10 minutes, you will have the opportunity to view clinical information related to the long case consisting of history, examination findings and investigations, e.g. ECG, chest X-ray, pulmonary function tests and blood results. This is followed by 20 minutes of questioning related to this case. During the final 20 minutes, the examiners will question you on three further unrelated topics.

1. 2. The clinical science viva

1. This is a 30-minute viva consisting of 4 questions on applied pharmacology, anatomy, physiology and physics. This viva is not within the scope of this book.

An approach to revision for the clinical vivas

The period between the written paper and viva examination is a stressful time. For the first 2 weeks you do not even know if you have a viva. This makes it difficult to find the motivation to carry on working until the results are posted. The last thing you want to do is continue the cold, factual learning that has made your life such a misery over the last few weeks. You want to go to the pub instead! However, if you are ‘invited’ to attend for the vivas, you will find yourself wishing you had worked solidly for the 2 weeks since the written paper! What is needed is a change of tack in order to sustain the flagging momentum.

Welcome to the second edition of The Clinical Anaesthesia Viva Book. We are extremely grateful for all the positive feedback that we received for the first edition, both from candidates for the FRCA and from examiners and consultant colleagues. We actually set about writing a ‘Book 2’ several months ago and two things became apparent. Firstly, was the fact that the first book needed some updating, especially with regard to some aspects of peri-operative care; examples of this are investigation of high-risk patients for non-cardiac surgery and the recommendations for peri-operative beta-blockade. Secondly, after questioning the current batch of trainees about what they had been asked in their clinical vivas, it became clear that while there were some new questions, they weren't in abundance. This is good news if you are about to take the exam and reaffirms a point we made in the first edition – there aren't many ‘new’ diseases, just patients still suffering from bad hearts, bad chests and difficult airways that need anaesthesia! The clinical problems remain very much the same, and this explains why it can't be an easy job to write new questions for the exam! For these reasons we decided to add to, and update, the first book.

Having been consultants for 5 years or so now, the three of us felt a bit more distanced from the exam than we did when we wrote the first edition.

When faced with a chest X-ray in the heat of the examination, it is vital to have a system of interpretation and presentation, particularly if the diagnosis does not jump out at you.

It is always difficult to know whether to present an X-ray starting with the diagnosis and following up with the supporting findings, or whether to use your system to present the findings and then reach a diagnosis.

For example: ‘This chest X-ray shows the features of mitral stenosis which are…’ or ‘There is a double heart border and calcification… These features suggest a diagnosis of mitral stenosis.’

In the Long Case you will have had a chance to view the chest X-ray and can therefore be more confident mentioning a diagnosis first. If the abnormality or diagnosis is ‘barn-door’ (e.g. large, cavitating lesion), then the examiners may not be impressed if you take 5 minutes to mention it! In the Short Cases you may be given chest X-rays that are more of a ‘spot diagnosis’ (such as pneumothorax) and you should try to mention the gross abnormality first. You should then use your system to make sure you do not miss other abnormalities (such as a bilateral pneumothorax!). Other chest X-rays may be more subtle (such as features of cardiac failure) and these may be better dealt with by using the systematic approach.

Introduction

Tremendous therapeutic advances in the management of childhood malignancies mean that the majority of children can realistically hope for long-term survival. Cancer in childhood is rare, with about 1400 new cases per year in the UK and a cumulative risk of 1 in 650 by the age of 15 years (Stiller, 1997; Wallace, 1997). With survival rates in excess of 70%, it is estimated that by the year 2010, 1 in 250 of the young adult population will be a long-term survivor of childhood cancer (Fig. 32.1) (Bleyer, 1990). However, the successful treatment of cancer in childhood with chemotherapy and or radiotherapy is associated with a number of unwanted side effects in later life (Wallace et al., 2001). Therefore, the major challenge faced by paediatric oncologists today is to sustain the excellent survival rates while striving to improve the quality of life of the survivors.

One of the most important issues for the survivors of childhood cancer is the impact of their disease and its treatment on reproductive function and the implications for the health of their offspring. In the female, chemotherapy and radiotherapy may damage the ovary and hasten oocyte depletion, resulting in loss of hormone production, truncated fecundity and a premature menopause (Meirow, 2000; Thomson et al., 2002). Infertility is one of the most commonly encountered and psychologically traumatic late complications of treatment for childhood cancer, and consequently, strategies to preserve fertile potential are being pursued.