How to pass the essay question

Part 1

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 ………….

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

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

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.

General points• There is NO DIFFERENCE in

your approach to answering these questions!

• Essay does not mean one long paragraph in elegant English!

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 …….

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!

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

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

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

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!

The Question

Discuss the management of chronic heart failure in a patient with known ischaemic heart disease

How diagrams help

Chronic

Heart failure

Ischaemia

CardiomyopathyValvular

disease

Smoking Obesity

SNS activation

Tachycardia PVR inc.

Decreased Renal BF

Inc. PRA

Aldosterone

Na retention

Angiotensin

Dysrhythmias

How diagrams help

Low Q

Ischaemia

CardiomyopathyValvular

disease

Smoking Obesity

SNS activation

Tachycardia PVR inc.

Decreased Renal BF

Inc. PRA

Aldosterone

Na retention

Angiotensin

Dysrhythmias

Role of surgery?

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

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’

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

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)

Another question!

Discuss the management of acute myocardial infarction in the first 24

hours following diagnosis

Acute MI: the first 24 hours

• Draw a diagram of the processes involved

• Produce a plan for answering the question

• You have 10 minutes!

The question!

Discuss the management of acute myocardial infarction in the first 24

hours following diagnosis

Atheromatous plaqueRupture, erosion

Platelet aggregation

Formation of thrombusPlatelet embolisation

Coronary artery blockade

Acute muscle ischaemia

Pain, sweating,collapse

Nausea and vomiting

Dysrhythmias, VF(ECG changes

CPK MB, Troponin)

MuscleNecrosis

Infarction

Thrombolysis

Aspirin

Angioplasty

Beta blockersACE inhibitorsDiamorphine

Anti-emetic

DEATH

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.)