Primary Written and OSCE Exam Courses: Pass the ACEM Exam

01/11/2023

How did you go with the recent challenge for the Primary Course to draw the Circle of Willis? Often you find you think you know things like the Circle of Willis well until you have to draw them. What's more, being asked to draw them in the exam is a great test of people's understanding of their clinical relevance - for example, the common locations of aneurisms in the Circle of Willis. So if you ever find a structure, or graph that looks like it would make a good exam question, practice drawing it! Next week we'll look at a favourite physiology topic! Until then, happy drawing! Questions? Email us at primaryexamcourse@gmail.com

12/10/2023

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12/10/2023

What is one of the most commonly asked questions in the Written and OSCE Exam?
The Paediatric Seizure........ Get this right.
Read the summary on Status Epilepticus

Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1). We recognise it in patients where they have a depressed conscious state

13/08/2023

The Circle of Willis.

The Circle of Willis is of critical importance in providing arterial blood flow to the brain, and also in understanding the locations of Berry Aneurisms, which are the most common cause of atraumatic subarachnoid haemmorhage.
So this week…you guessed it…please draw me a diagram of the Circle of Willis and label the major arteries. In all honesty, it’s often surprising how you think you know a topic until you have to draw or explain it. So in drawing you can really test your knowledge. It helps that it’s a really important skill to have in time for the viva.
Next week I’ll give you the answer, along with a followup question…just what you were hoping for I’m sure!

https://www.primaryexamcourse.com/

20/05/2023

OKAY it's here!. You can go to www.fellowshipexam.com and do the online course. Now there is a webinar -based course with a two day live revision at www.fellowshipexamcourse.com Join the new Webinar Course now!

01/11/2022

There has been a ongoing debate over the choice of intravenous fluid in unwell patients. Here we look at the BaSICS and PLUS trials. The battle is between

16/08/2022

Primary Exam Practice Question

Which of the following lists of antibiotics ALL cover Pseudomonas?
a. Ticarcillin, Ceftriaxone, Gentamicin
b. Piperacillin, Ceftazidime, Gentamicin
c. Ticarcillin, Moxifloxacin, Meropenem
d. Gentamicin, Ciprofloxacin, Erythromycin

The answer is b. In the MCQ exam, you need to be able eliminate options based on what you do know and therefore narrow down the possible correct answers – for example, you can immediately eliminate option d here if you know that erythromycin is not active against Pseudomonas.
The choice of antibiotics is extremely important in the practice of Emergency Medicine, and therefore it is a common Primary Exam question. We need to be all over this! So, as a quick recap, here is a slide from one of the Pharmacology lectures at https://www.primaryexamcourse.com/

Good luck and make sure you work on your technique for answering questions like this where the correct answer isn’t always immediately obvious.

12/08/2022

Here's one for the Primary guys...

Which of the following do not contribute to Physiological Shunt?
a. Small pulmonary arteriovenous malformations
b. Thebesian veins
c. Veins of Artemis
d. Bronchial Veins
Answer below
Answer is c. This is a favourite exam question! Shunt should be thought of as “wasted perfusion”. It is deoxygenated blood that enters the left side of the heart and contributes to depressing the PaO2. It can be classified into phyiological (normal) shunt and pathological shunt (due to disease). Physiological shunt arises due to small pulmonary AVMs, Thebesian Veins (that drain the inner 1/3 of the myocardium into the LV) and the bronchial veins (which drain some of the venous blood from the bronchi to the pulmonary veins and hence into the LA/RA). There are no veins of Artemis. Daughter of Zeus, Artemis was the Goddess of the hunt and wilderness. This is what examiners use – it’s called a “plausible distractor” and you need to be able to w**d these out to come to the right answer.

22/07/2022

Did you get your 5 Point Fellowship Friday newsletter today. Here is one of the points on Toxicology:
The toxicology OSCE. This is a high probability question for several reasons;
· Toxicology is a core ED topic and we are expected to understand the assessment and management of common ingestions.
· The topic lends itself to the use of props like ECGs, VBGs, nomograms etc. Which are good tests of broader knowledge.
· There is a high profile media focus on certain toxidromes and overdoses which brings attention to the role of emergency physicians.
· There is the possibility of introducing a part of a question dealing with health advocacy which is a core domain.
It is a potentially high yield topic as there is a well-recognised structure to answer almost all toxicology questions.
· Resuscitation
· Risk Assessment
· Supportive care and monitoring
· Investigations
· Decontamination
· Enhanced elimination
· Antidotes
· Disposition
Which means if you follow the structure and hang your knowledge on it there is little chance of getting flustered and missing something. A well-structured answer also shows the examiners a thought process and makes the candidate comes across and confident and competent- just what we are after.
There are several variations on toxicology question themes, but all deliberate self-harm overdoses should include a toxicological and psychiatric risk assessment. Recreational drug overdoses may well present as a toxidrome rather than a named ingestant as many recreational drug users don’t know what they have taken; so know your toxidromes. The key ones are:
· Op**te
· Sympathomimetic
· Cholinergic
· Anticholinergic
· Serotonin syndrome
Know what they look like and how they are managed.

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14/07/2022

OSCE VIVA begins July 18th 1830 (Melbourne time)
You will receive a zoom invitation today to join us on Monday for our first session.

WRITTEN FELLOWSHIP WEBINAR
To all the written members there will be a webinar introducing 'strategic studying for the exam' as well as 'ECG's for the Fellowship Exam'. This is a 'Bread and Butter' Topic as ECGs come up in every exam! Date Saturday 30th July 1400-1500 Melbourne time.
Go to the website 'Course Directory' and click on 'GO TO THE WEBINARS PAGE'. When on that page click on 'UPCOMING WEBINAR' for all the details on the link.

08/07/2022

Back by popular demand The 5 Point Fellowship Friday Newsletter. It's free and will always be free and it's one of the most important ways we communicate with you. You don't have to be part of the courses to enjoy it.
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22/12/2021

Congratulations to everyone who passed their Written Fellowship Exam! Thankyou to all of our graduates for letting us know.
If you didn't get the exam, here's some quick advice....
Get back on the horse as quickly as you can. There is always the initial concern of "What will people say?" Although most of the people you know will ask and be disappointed for you, they quickly forget. The illusion that people will not think you're good enough because you didnt get the exam, is just that...an illusion. The reality is that although for a day or two people will remember, they quickly forget, as everyone has their own 'stuff' to deal with and in a time of COVID, even more so.
The key is to sit the very next sitting of the exam.
It is important to read your commentary from the examiners and understand what happened and be truthful to yourself about it.
For the people that didn't get it. Don't worry. Sometimes it's just bad luck! However read the examiners response to make sure that it isn't a knowledge issue.
If you are not part of the course, but want to know where you went wrong, I am happy to look at the examiners' commentary, confidentially and discuss with you how you should approach preparing for the next sitting. There is no obligation and no need to be part of the course for this, I just want to see you get this thing! If you need to start a conversation with me, do so at drpeterkas@gmail.com and we can go over everything. I've gone over this will delegates in the past and it has changed their whole approach to the exam and they got it!
Whatever you decide to do, stay strong, good luck, approach it with strategy and see you on the other side.

Peter Kas

14/12/2021

A 40 yo is brought to the emergency department with the following vitals:
GCS 4
SBP 70mmHg
HR 140
RR 50
T 39C
There are no signs of injury. Heart sounds are dual and no extra sounds. There are reduced breath sounds and crepitations in the left base. The abdomen is soft and the patient appears to have peripheral cyanosis.
The patient has a known history of IVDU and has been found in a chair, not rousable.
She has fluids and inotropes and antibiotics and she has the ECG shown.
What are your differential diagnoses for this patient? What is the most likely diagnosis?
The computer says acute AMI. Could it be?
Let’s look at the ECG
https://www.cardiacbootcamp.org/ecg-of-the-week/40-yo-with-a-depressed-conscious-state

​The Case ​A 40 yo is brought to the emergency department with the following vitals: GCS 4 SBP 70mmHg HR 140 RR 50 T 39C There are no signs of injury. Heart sounds are dual and no extra sounds....

08/12/2021

https://www.resus.com.au/the-right-ventricular-spiral-of-death/

The right ventricular spiral of death in PE is very real and very scary. We sometimes miss it, because we treat all resuscitations the same way and we

07/12/2021

Pulmonary Embolism is a big area in Emergency Medicine and in the exam. Take the poll. Read the ECG. Would you do a CTPA on a 31 yo woman who is 19 weeks into her pregnancy and now has left sided pleuritic chest pain?
https://www.cardiacbootcamp.org/ecg-of-the-week/31-yo-female-g1p0-with-pleuritic-chest-pain

A 31 yo female presents to the emergency department with pleuritic chest pain. The patient is 19/40 gestation and no medical conditions. The history of the event is that the patient was sitting on...

02/12/2021

The ECG and the ABG/VBG are the two bread and butter Fellowship Exam Questions. Are you an expert at reading the ECG? Try this free quiz from www. cardiacbootcamp.org this week. https://www.cardiacbootcamp.org/ecg-of-the-week/its-time-for-a-quick-ecg-quiz

This week I have 4 questions for you. 3 are ECGs you must know and the fourth is a simple question on what you should look for in the QRS complex, when reading the ECG. Enjoy. Hope to see you at the...