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1
Q

Define SPECIFICITY

A

The ability of a test to correctly identify those patients WITHOUT the disease

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2
Q

What is the mathematical equation for SPECIFICITY?

A

Specificity = True Negatives/True Negatives + False positives

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3
Q

Define SENSITIVITY

A

The ability of a test to correctly identify patients WITH the disease

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4
Q

What is the mathematical equation for SENSITIVITY?

A

Sensitivity = True Positives/True Positives + False Negatives

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5
Q

What is a meta-analysis?

A

A statistical discipline of assimilating data from multiple similar smaller studies
To measure an overall effect using all the available evidence
A quantitative form of systematic review

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6
Q

What is a Forest plot?

A

Graphical means of comparing studies included in a meta analysis

Square = each study (size represents study size) is a square; the line is the 95% confidence interval
Diamond = pooled data from all studies; width represents 95% CI
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7
Q

List the 5 levels of evidence

A

1a. Systematic review of multiple RCTs - meta-analysis; 1b. RCTs
2. Cohort study
3. Case-control study
4. Case series
5. Case report; expert opinion

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8
Q

How do you measure the osmolar gap?

A

Measured osmolality - calculated osmolality

Calculate osmolality = ((1.86 x Na+) + urea + glucose + ethanol)/0.93

Normal range = -9 - +19

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9
Q

How do you measure the anion gap?

A

(Na + K) - (HCO + Cl)

Normal range 12-16

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10
Q

Describe the 2 types of AAGA

A

Explicit awareness: conscious recollection of events either spontaneously or on direct questioning
Implicit awareness: implicit memories exist without conscious recall, but can alter behaviour after event

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11
Q

List some risk factors for having AAGA

A 
Neuromuscular blockade use
C section (highest risk - 1:670)
RSI
Thiopentone use
TIVA
Female patients
Out of hours operating
Junior anaesthetist
Previous AAGA
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12
Q

How would you manage someone with AAGA?

A 
Involve senior
See patient with nurse/midwife
Establish exact nature of AAGA - pain; implicit vs explicit
Apologise/empathise with patient
Explain nature of anaesthetic and how AAGA happens
Invite questions
Offer follow up
Document carefully
Inform GP
Incident report
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13
Q

What options are there for depth of anaesthesia monitoring?

A 
EEG based - BIS/pure EEG/M-Entropy
Clinical signs/observations
Evoked potentials - auditory/motor/sensory
Isolated forearm technique
Frontalis EMG
Lower oesophageal contractility
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14
Q

What is the EEG wave pattern consistent with: wakefulness?

A

Fine wave/beta-wave activity

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15
Q

What is the EEG wave pattern consistent with: surgical anaesthesia?

A

Spindle waves
Alpha waves
Theta waves
Delta waves

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16
Q

What is the EEG wave pattern consistent with: excessive anaesthesia?

A

Burst suppression

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17
Q

What are the levels of cleaning of medical equipment?

A

Decontamination - removal of contaminants before disinfection/sterilisation; done by washing or scrubbing
Disinfection: killing of non-sporting organisms
Pasteurisation - hot water at 77 degrees for 30 mins; intermediate level disinfection
Chemical - alcohol/aldehydes

Sterilisation: killing of all micro-organisms
Dry heat
Moist heat (autoclave)
Ethylene oxide
Gamma irradiation
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18
Q

Describe some types of bias

A

Attrition bias - failing to account for withdrawals
Publication bias - positive results
Language bias - English
Inference/reporting bias - authors place more weight on positive findings and ‘explain away’ negative findings
Selection bias - poor patient randomisation; avoided using blinded randomisation
Allocation bias - self-selecting well motivated people
Measurement/performance bias - people feel better or try more things, knowing they’re being measured
Detection bias - if researchers know which group they are checking; avoided by blinding
Commercial bias - influenced by funding body

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19
Q

What factors must be taken into account for consent to be ‘informed’?

A

Patient must have capacity
Able to receive and understand information
Free from coercion
Information is rational
Mentioning significant hazards
Can withdraw consent at any time (if still has capacity)

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20
Q

Name 2 acts of parliament which legislate for capacity to consent in the UK

A

Mental Health Act of 1985

Mental Capacity Act 2005

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21
Q

What is a Caldecott Guardian?

A

Person responsible for protecting the confidentiality of patient records
Ensures information is governed properly

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22
Q

What is the Hagen Pouiseille equation?

A

Pi x dP x r4
——————
8nl

Pi x delta P x r to the power 4

Divided by

8 x viscosity x length of tube

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23
Q

What is Reynold’s number?

A

The number at which flow changes from laminar to turbulent flow

d x v x p
—————
n

Diameter x velocity x density of liquid
n = viscosity

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24
Q

What supplies motor innervation to the larynx?

A

Recurrent laryngeal nerve
-all intrinsic muscles except cricothyroid

External branch of SUPERIOR laryngeal nerve:
-cricothyroid

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25
What is the sensory intervention to the larynx?
INTERNAL branch of SUPERIOR laryngeal nerve - inferior surface of epiglottis - superior surface of larynx down to cords Recurrent laryngeal nerve -below cords
26
What are the features of LASER?
Monochromatic Non-divergent (collimated) In phase (coherent)
27
Describe ANOVA
Analysis of Variance A test that compares 3 or more normally distributed groups of interval data
28
Describe un-paired Student’s t-test
A test to compare two normally distributed independent groups
29
Describe paired Student’s t-test
A test to compare two normally distributed matched groups
30
Describe Wilcoxon rank sum test
A test that compares the mean of one sample group against a known value A test for non-normally distributed data or a one sample t-test for normally distributed data
31
Describe the chi-squared test
A test that compares greater than three sample proportions of categorical data
32
Regarding the description of a skewed dataset, the most commonly quoted measure of data spread is…?
Interquartile range
33
Define pH
-log[H+]
34
What is the Henderson Hasselbach equation?
pH = pKa + log [HCO3]/[PaCO2] Describes the derivation of pH as a measure of acidity
35
What is osmosis?
Spontaneous net movement/diffusion of water through a semi-permeable membrane from low solute to high solute concentration
36
What is osmotic pressure?
Pressure exerted within a sealed system of solution in response to presence of osmotically active particles on one side of a semi-permeable membrane Pressure needed to stop the net movement of water across a semipermeable membrane separating solvent and solute
37
Define osmolality
Number of osmotically active particles per kg of solution - independent of temperature - osm/kg - calculated by adding together the osmotically active particles in plasma (Glucose+urea+2Na)
38
Define osmolarity
Number of osmoles (osmotically active particles) per litre of solution - osm/L - influenced by temperature - measured by the depression of freezing point of a solution using an osmometer
39
What is the formula to calculate osmolarity?
2Na + Urea + Glucose (sometimes + 2K)
40
What are colligative properties?
The properties of a solution that vary according to the osmolarity of the solution - Depression of the freezing point - Reduction of the vapour pressure - Elevation of the boiling point - Increase in the osmotic pressure
41
What medical conditions affect osmolarity?
- SIADH - DI - neurogenic/nephrogenic - TURP syndrome - Water intoxication - Hyperosmolar states - DKA/HHS
42
What is oncotic pressure?
Colloid osmotic pressure - osmotic pressure exerted by plasma proteins
43
What is the Volume of Distribution?
Theoretical volume into which a drug distributes Vd = Dose/Conc at time 0
44
Define Clearance
Volume of plasma from which a drug is cleared per unit time
45
What is decontamination?
Removing, inactivating or destroying pathogens. Split into 3 parts - Cleaning Washing at low temperature to remove obvious debris - Disinfection Remove everything except spores; gluteraldehyde or pasteurisation - Sterilisation Removal of all forms of life - chemicals/high temp/radiation
46
What factors affect the type of CRRT used?
Size of the particles being removed Patient’s CVS status Availability of resources
47
Describe the 4 stages of a clinical trial
Pre-clinical: in the lab Phase I: human safety, determine safe dose - healthy volunteers Phase II: expanded safety, test effectiveness - small group patients Phase III: efficacy & safety, compare to other treatments - larger group patients Phase IV: provide more info (post approval - the drug is already available to the public)
48
Explain blood:gas partition coefficient
Partition coefficient = ratio of the amount of substance in one phase to the amount of it in another in equilibrium Blood:gas - Measure of the solubility of a substance Influences onset/offset times The less soluble an agent, the faster the onset time as it is about the partial pressure of the gas in the blood The less soluble it is, the quicker it reaches that pressure
49
Explain oil:gas partition coefficient
Measure of lipid solubility | Indicator of potency (inversely related to MAC)
50
What factors affect speed of onset of inhalational anaesthesia?
Blood:gas partition coefficient Inspired concentration Alveolar minute ventilation FRC (if large, will dilute the inspired conc) CO & pulmonary blood flow V/Q mismatch Concentration effect/second gas effect (N2O use)
51
What is interval data?
Continuous Quantitative E.g. height, weight, BP
52
What is categorical data?
``` Discrete Qualitative Can either be: —Ordinal Categories with a rank order e.g. pain score/intubation grade —Nominal Name e.g blood group, eye colour ```
53
What is parametric data?
Data described by a normal distribution
54
What are the different types of average (when referring to a dataset)?
Mean Median Mode In normally distributed data these are all the same
55
How do you measure the spread of data?
Depends whether the data is parametric or non parametric Parametric: —Standard Deviation SD —Variance —Standard error of the mean Non-parametric —Range —Interquartile range
56
How can data be presented?
Qualitative: —word cloud —time line —infographic ``` Quantitative: —scatter plot —bar chart —pie chart —line graph ```
57
How do you choose a statistical test?
Whether the data is parametric or non-parametric Parametric: —Paired or unpaired —How many groups of data there are Non-parametric: —Paired or unpaired —How many groups of data there are
58
# Define volume of distribution What factors affect it?
Theoretical volume into which a drug must disperse in order to produce the measured plasma concentration Cannot be measured but derived from: Vd = Dose/C0 Affected by: —lipid solubility of drug —protein binding —blood flow to tissues
59
Define clearance
The volume of plasma completely cleared of a substance per unit time
60
What is Type 1 error? What is Type 2 error?
Type 1 error = the null hypothesis falsely rejected. False positive. Alpha error - the probability of a positive finding from a study being wrong Type 2 error = the null hypothesis falsely accepted Beta error - not picking up a difference where one exists Both caused by small sample size
61
What is probability?
The chance of an outcome happening | The p-value is used to give reassurance that the outcomes did not happen by chance
62
What is the power of a study?
The probability that it will detect a statistically significant difference Related to Type 2 error/beta error Power = 1-Beta
63
What is meta-analysis?
Assimilating data from multiple similar studies to measure an overall effect Plotted on a Forest plot
64
What is tonicity?
The ability of a solution to cause a cell to gain or lose water Based on the concentration of solutes in the solution
65
What is the normal osmolarity?
265 - 285 mOsm
66
Which ion has the greatest effect on resting membrane potential of nervous tissue?
Potassium / K+
67
How do you calculate the Positive Predictive Value of a test?
True positives ——————— TP +FP If a test has a high PPV, it usually has a low NPV Only valid for the population in which they are tested - population demographics affect the likelihood of different outcomes
68
How do you calculate the Positive Predictive Value of a test?
True positives ——————— TP +FP If a test has a high PPV, it usually has a low NPV Only valid for the population in which they are tested - population demographics affect the likelihood of different outcomes
69
How do you calculate Number needed to treat?
1/Absolute Risk Reduction
70
How do you calculate absolute risk reduction?
Usually expressed as a percentage Risk difference between 2 groups
71
What is the commonest never event?
Retain foreign object post-procedure Wrong site surgery Wrong implant/prosthesis Inappropriate administration of methotrexate Misplaced NG tube
72
Which test would you use for QUALITATIVE data?
<10 in sample = Fisher’s exact test >10 in sample = Chi-squared test
73
Which test would you use for QUANTITATIVE data?
Parametric = Student’s t test Non-parametric = Mann-Whitney U test
74
What test would you use for multiple groups of quantitative data?
Parametric = ANOVA Non-parametric = Kruskal-Wallis
75
What test would you use for paired quantitative data?
Parametric = Paired t test or ANOVA Non-parametric - Wilcoxon signed rank or Friedman
76
What would be the ideal scoring system?
Once which: - had scores using easily recordable values - well calibrated and validated - high level of discrimination - applicable to all patient populations - applicable across all countries/health systems - can predict mortality, morbidity and QoL after discharge - considers comorbidities - considers organisational aspects
77
What is an error? What is a critical incident? What is a patient safety incident?
1. An act that can lead to undesirable outcome -latent (drug labels) (system) vs active (incorrect drug dose) (human) -intended (mistake, violation) vs unintended (slip, lapse) 2. Active error with significant consequences 3. Potential or actual harm due to any healthcare event
78
What is a never event?
-results in moderate/severe harm/death -known source of risk -existing national guidelines -preventable if above guidelines are followed -easy to identify and measure
79
How can we reduce errors?
1. Active errors: —checklists, briefings, guidelines, double checks 2. Latent errors: —automated systems, standardisation, optimal equipment design preventing cross-use
80
What are the principles underlying confidentiality?
1. Use minimum necessary personal info 2. Manage and protect information 3. Be aware of responsibilities 4. Comply with the law 5. Share relevant information for direct care in appropriate manner 6. Ask for consent to disclose 7. Tell patients when you disclose 8. Support patients to access their information
81
What are the main principles of the Caldicott report?
1. Justify the purpose of holding patient information 2. Information should only be held if absolutely necessary 3. Use only minimum of information that is required 4. Information access should be on a strict need to know basis 5. Everyone in the organisation should be aware of their responsibilities 6. The organisation should understand and comply with the law 7. The duty to share information can be as important as the duty to protect confidentiality 8. Inform patients and service users about how their confidential information is used
82
What is a hormone?
A hormone is a substance released by a cell in one part of the body that exerts its effects on tissues elsewhere in the body

FRCA & FICM (9 decks)

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