Part 1 Lounge

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Part 1 Candidates Sitting

Please add your name to the list (use ~~~) and indicate when you're sitting, which exams, and if you've passed any exams already and when.

Pharm SAQ 2007

Phys SAQ 2007

  • Beardoc (passed Physiology August 2005)
  • Lexoi (sitting Physiology and Pharmacology July 2007)
  • John (passed Physiology August 2005)
  • Coggo (sitting Physiology and Pharmacology July 2007)
  • Timmeh1234 (sitting Physiology and Pharmacology July 2007)
  • Essaynode 23:44, 26 Feb 2007 (EST) (Both parts Feb 2007)
  • Panacaea (passed Physiology April 2007 sitting Pharmacology July 2007)

The Day of the Exam

I've started a page on the ANZCA Primary Exam which can answer all those questions that people have about the exam on the day. I will be adding to it over time. If you have any helpful hints, please do add them!

Difficult Questions for Discussion

If you have any questions that you want to discuss, please add them here.

OP26

Fentanyl given at dose of 50-150 mcg/kg:
  • A. Causes potent cardiac depression
  • B. Does not cause muscle rigidity
  • C. Has an elimination half-time of more than 3 hours
  • D. Not enough to relieve the stress response to surgery
  • E. Preserve cardiac output
I looked up Stoelting 3rd Ed p94 (under Fentanyl: Clinical Uses), and got: "Large doses of fentanyl, 50 to 150 mcg/kg IV, have been used alone to produce surgical anesthesia. Large doses of fentanyl as the sole anesthetic have the advantage of stable hemodynamics due principally to the
  • (a) lack of direct myocardial depressant effects,
  • (b) absence of histamine release, and
  • (c) suppression of the stress responses to surgery.
Disadvantages of using fentanyl as the sole anesthetic include
  • (a) failure to prevent sympathetic nervous system responses to painful surgical
stimulation at any dose, especially in patients with good left ventricular function,
  • (b) possible patient awareness, and
  • (c) postoperative depression of ventilation"
It just seems strange to me, but do (c) from the first list and (a) from the second list contradictory? Aren't the stress responses sympathetically mediated? the answer is D. when you do anaesthesia for cardiac surgery use have to use a volitile or propofol because even massive doses of fentanyl will not abolish the response to sternotomy or laryngoscopy and will not produce amnesia.
  • In my clinical experience I have seen cardiac surgery with predominantly fentanyl anaesthesia, provided long term amnestics have been given pre-op, viz lorazepam 2mg night before and morning of surgery. Sometimes this is supplemented with volatile (isoflurane or sevoflurane -depending on anaesthetic preference - at my institution) for some parts of the surgery but not always, and certainly not for the whole case. We do return patients to Cardiac ICU ventilated for approx 18-24h post op. see also British Journal of Anaesthesia, 1994, Vol. 73, No. 2 162-166. (anon)
  • that's a very old paper your quoting there dude! Since 1994 there has been a realisation that fentanyl doen't stop recall or PTSD. I always thought E was the answer Erich 01:46, 26 Feb 2007 (EST)
  • The answer is D
Not sure if I have understood the subject of the saturation of tissues by high dose/prolonged infusion of fentanyl, but doesn't a very high dose (eg 100mcg/kg) have the same effect as a several hour infusion? The Stoelting Handbook 2nd ed p.91 gives the elimination half time of fentanyl as 3-6+ hours, and Peck Hill and Williams 2nd ed p.132 says that with high doses (50-100 mcg/kg), fentanyl's "...duration of action is extended to about 6 hours." Doesn't this make 'C' correct also? Incidentally option D is poorly worded as "surgery" covers a multitude of sins (!)

Useful Links

The American Heart Association Resuscitation Guidelines, which could be examinable as part of the Pharmacology syllabus, are now on the Wiki.


Got a link that you think is good for Part 1? List it here!

[1] Drug class comparison worksheets. Tables that compare and contrast drugs in the major anaesthetic categories (info mainly from stoelting): Volatile Agents, Intravenous Agents, Opioids, Muscle Relaxants, Anticholinesterases, Anticholinergics, Local Anaesthetics, Sympathomimetics.

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