tutorials – week of 22 April 2013


tutorials this week are as follows


MONDAY!  – Dr T Kleyenstuber – Cardiac anatomy and coronary perfusion (HJH) 17h00

Wednesday  – Dr O smith – Pulse oximetry and capnography (these topics are traditionally very poorly answered in exams – it would be well worth your while attending)



Have a good week.




Humidity Notes

Hi guys

following a request at my tut on Thursday, herewith the notes I was using. They are by no means exhaustive, but should provide some spots to hang some information on.

They can be accessed here


Let me know if there are any issues.



Date change – tomorrow’s tutorial

Hi guys. Could I please move my tutorial to Thursday 17:00 instead of tomorrow?
17:00 at CMJAH.

Tutorials, week of 15 April 2013


Only one tutorial next week. It will be on humidification and filters/HMEs and will be done by yours truly on Wednesday. I presume it is a combined meeting so we’ll follow the meeting with the tut at 18 Eton.


The supplemental pharm tuts by Prof Milner will continue next week – 06:30 at CMJAH on Tuesday – Local Anaesthetics.

Please note that these tutorials are supplemental to the established program and are not designed to be exclusionary. However, they can only be given in the mornings and obviously this will limit who can attend.

From the week after next Prof Oosthuizen will be giving extra physiology tuts on Thursday mornings at 06:30 at CMJAH. Soon we hope to add supplemental physics tuts too.


Have a good week.



Supplemental pharmacology tutorials


Professor Analee Milner has kindly offered to give an extra pharmacology tutorial tomorrow (9 April) at the great and wonderful good charlotte hospital.
The tutorial will be at zero six fifteen. Yes, 06:15 and will finish before the morning meeting at 07:00.

Whether or not these continue will depend on the support expressed.


Mock Questions – 24 Sept 2012

We’ve been a little remiss in the mock question department of late. Have a look at these. Initially I’d suggest that you merely try to plan an answer rather than writing a whole essay.



– List various methods of determining cardiac output. Give advantages and disadvantages of each. (20)



– Write notes on the structure-activity relationship of Non-depolarising Muscle relaxants (15)



– Describe in detail the counter-current concentration mechanism used in the production of urine. (20)


Have fun…

Well this is embarrassing

I must apologise for the post last night. This happens occasionally because I set up the roster for teaching a year in advance, and occasionally the college swaps the exams around. So as you all know the FCA I exams are next week and not this week. I am in the process of trying to swap next weeks tuts to this week.
Dr Marsden will do on Thursday temp regulation at 17:00 at CMJAH.
I am waiting to hear back from Dr Morgan as t whether she can do the cerebral blood flow tut tomorrow or Wednesday.

Apologies for any confusion

Good Luck

Hi guys.

Just a quick note to wish those of you writing this week all the very best.

This is going to be a very tough week. Please remember to sleep! You will gain nothing by staying up cramming until ungodly hours. You have done the work already. Give yourselves the best chance of regurgitating what is needed.


Please write as neatly as you can, write as MUCH as you can think of (but not junk 🙂 ). Think about what is being asked.

Most of all, GOOD LUCK. You shouldn’t need it. But a little bit of luck never hurt anyone.



Neuromuscular Junction review article


I found this article to be quite useful and I feel it is of sufficient standard for the FCA I exam.

It is from the BJA

Fagerlund et al, Current Concepts in Neuromuscular Transmission BJA 103(1):108-114

Here is the link. [Clickety Click]

Have a nice day.



Neuromuscular Junction – Phase II block

I wanted to clarify the phase II block that we discussed today at the tutorial (ok, the one that the 8 people who were at the tut discussed)

Some facts about Phase II block

  • It occurs exclusively with exposure to depolarising muscle relaxants
  • Prolonged exposure of the neuromuscular junction to scoline causes one of two events to occur – desensitisation block or phase II block
  • What I described to you today was desensitisation block – remember that the receptors fluctuate constantly between open, closed and desensitised states. Agonists (scoline) predispose to desensitisation as they have a higher affinity for the desensitised receptors and they promote transition to the desensitised state. It follows that prolonged exposure will result in an increase in the average number of receptors which are desensitised. Normally ACh is so rapidly inactivated that desensitisation does not occur. This may be a safety mechanism.
  • Phase II block differs from desensitisation block. It is characterised by fade, tetanic fade and post-tetanic facilitation. After initial depolarisation, the membrane potential gradually returns to normal even though the nAChRs are still exposed to drug and neurotransmission is blocked.
    • There is still debate about the actual process
    • It may be a presynaptic phenomenon (at another AchR where scoline can bind (not the alpha3Beta2))
    • It may result from some postjunctional receptor desensitisation
    • It may be due to activation of the NA/K ATPase pump by initial depolarisation of the postsynaptic membrane which repolarises it.


This probably doesn’t clarify this much, but to be honest, i’ve done a (very brief) literature review and most papers are pretty vague as to what causes phase II block.

What they are clear about is that treatment is controversial. If the pt is known to have NORMAL AChE then the recommendation is to give neostigmine. If the patient has ABNORMAL AChE then neostigmine will at best have no effect and at worst worsen the block.

I hope this helps somewhat.