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How to Approach SBA ’s Linnet Mensuoh th Emmanuel Onyango Kate Thornhill 5 Year Student Intercalating MedEd 5 Year Student MedSoc PresidentAims • Changes to Progress Test • Active Recall + Spaced Repetition • Note-taking style • Year 3 Conditions List • How I approach revision • How to approach SBA’s • Resources • Q&APT : New Format • 125 Questions in 150 mins • Test Grade • Excellent • Satisfactory • Borderline • Unsatisfactory • Aggregate (rolling) grades Active Recall + Spaced Repetition Active Recall • Retrieving information from your brain • Questions are the best way of implanting this Spaced Repetition • Spacing out what you retrieve • Write down when you are next going to revise a topic • E.g. 1 week à 1 month à 3 months AR + SR • Make questions after your notes • Review these questions after a week and then a month Note-Taking Online vs Paper Layout • OneNote • Pathology/Pathophysiology • Notion • Evernote • Risk Factors • Apple Notes/Word Doc/Google Doc • Clinical Features • Signs + Symptoms Layout • Investigations • Question + Answer • Bedside • Table Method • Bloods • Mind maps • Imaging Organisation • Special Tests • Management • Block Based • Conservative • CD1, HFD, O&S • Medical • CD2, WCF, PNO • System Based • Surgical • Cardio, Resp, Gastro, NeuroExample Hospital Front Door Acute Aortic Aneurysm ACS/MI, arrhythmia, acute left ventricular failure, Pancreatitis Perforated peptic ulcer cardiac tamponade Pneumonia Acute Asthma Pneumothorax Acute ischaemic limb Acute liver failure Inflammatory bowel disease Ischaemic bowel Acute kidney injury Meningitis Addisonian Crisis Pneumonia Anaphylaxis Poisoning Appendicitis Biliary Obstruction Pulmonary embolism Renal Stones Cholecystitis Severe electrolyte disturbance Diabetic ketoacidosis Shock, multiorgan failure Diabetic hyperosmolar non-ketotic coma Stroke Deep vein thrombosis Subarachnoid Haemorrhage Epistaxis Testicular Torsion Gastroenteritis Trauma, fractures, acute spinal injury, head injury Gastrointestinal haemorrhage Urinary Tract Sepsis Gastrointestinal Obstruction Chronic Disease 1 Addison's and Cushing’s Disease Alcohol & drug dependency Diverticulosis Anaemia Functional Gastrointestinal disorders Gastro-oesophageal reflux Asthma HIV & AIDS Atrial fibrillation Chronic Fatigue syndrome Hyperlipidaemia Chronic liver disease alcoholic Hypertension autoimmune Inflammatory Bowel Disease Ischaemic heart disease Chronic obstructive Pulmonary Disease Obesity Chronic Pancreatitis Chronic Kidney Disease Obstructive sleep apnoea Chronic suppurative lung disorders (including Peripheral vascular disease Cystic Fibrosis) Pituitary disorders Pulmonary fibrosis Cirrhosis / portal hypertension Pyrexia of Unknown Origin Coeliac Disease Congestive cardiac failure Thyroid and parathyroid disorders Diabetes Mellitus Valvular heart disease Oncology + Surgery Anal Cancer Basal Cell Carcinoma Malignant Myeloma Melanoma Bladder Cancer Myeloproliferative Diseases Breast Tumours- Benign and Oesophageal carcinoma Malignant Renal Carcinoma Breast Abscess Pancreatic Carcinoma Carcinoma of Unknown Primary Colonic Tumours Prostate Cancer Gastric Carcinoma Rectal Carcinoma Leukaemia- Acute and Chronic Squamous Cell Carcinoma – Skin Lung Cancer and head and neck Testicular Cancer Lymphoma Common Presenting Symptoms Chest Pain Breathlessness/SOB/Dyspnoea Asymptomatic chronic disease PR bleeding Abdominal pain Change in bowel habit (Diarrhoea, Haemoptysis constipation) Breast Lump ± pain Jaundice Neck lump Intermittent Claudication/Leg Ulcer TATT, bruising and fever Night sweats, Pyrexia of Unknown OriginLo Headache Haematuria TLOC Major trauma DysphagiaKate: How I Approach Revision Start 6 weeks before each progress test PassmedPassmedPassmed!! In 3rd year: Started by creating word documents of each system (e.g. cardiology, respiratory, GI etc) containing all common conditions Use Passmed online text book (+/- BMJ best practice, NICE guidelines for important conditions where there is a lack of detail) Including symptoms, investigations, aetiology, risk factors and management of each condition Potentially include imaging where relevant • Handwriting each condition into a notebook to help convert information tolong term memory • Creating flash cards of each condition to use for each progress test Active Recall • ACTIVE RECALL by testing yourself on flash cards and highlighting conditions to go back over • Passmedquestions on conditions covered (don’t be discouraged by very obscure questions)Emmanuel: How I Approach Revision Start 6-8 weeks before an exam Determine which specialities to cover Cover 2 specialities a week (3 days on each) Do 15-20 questions a day Record percentage on each speciality to track progress How to Approach SBA’s Read the question 2 Step Process • Acute vs Chronic Wording of question • ABCDE approach •What would be next investigation vs what is the• Process of Elimination definitive/gold standard •What is the next best step? • Pattern Recognition Cover test Pharmacology •MOA, Indication, CI, SESBA 1 During a ward round you approach Sue a What is the first step in managing this patient? 70 year old woman, who was admitted 1 week ago for suspected pneumonia. She A. Intramuscular (IM) insulin appears drowsy and isn’t responding to your questions. A full assessment reveals B. Intravenous (IV) glucagon a Glasgow coma scale (GCS) of 12 and a C. Intravenous (IV) glucose blood glucose concentration of D. Orange juice 2.5mmol/L. She has a viable cannula on E. Oral glucose 40% gel her left hand.SBA 1 During a ward round you approach Sue a What is the first step in managing this patient? 70 year old woman, who was admitted 1 week ago for suspected pneumonia. She A. Intramuscular (IM) insulin appears drowsy and isn’t responding to your questions. A full assessment reveals B. Intravenous (IV) glucagon a Glasgow coma scale (GCS) of 12 and a C. Intravenous (IV) glucose blood glucose concentration of D. Orange juice 2.5mmol/L. She has a viable cannula on E. Oral glucose 40% gel her left hand.SBA 2 A 68-year-old woman presents with a What drug should be given? severe right sided headache. On examination, there is tenderness on palpation of her right temporal region. A. azathioprine B. methotrexate Investigations: C. naproxen ESR: 114mm/hr (1-36) D. prednisolone C-reactive protein: 356mg/L (<10) E. sumatriptanSBA 2 A 68-year-old woman presents with a What drug should be given? severe right sided headache. On examination, there is tenderness on palpation of her right temporal region. A. azathioprine B. methotrexate Investigations: C. naproxen ESR: 114mm/hr (1-36) D. prednisolone C-reactive protein: 356mg/L (<10) E. sumatriptanSBA 3 A 45-year-old man presents to his GP with Which organism is most likely responsible? dyspnoea, a productive cough and malaise. His symptoms started 5 days ago and have been getting progressively worse. On examination, his A. Haemophilus influenza respiratory rate is 30, he has a temperature of 38.5oC, his sputum is purulent and rust-coloured B. Klebsiella pneumoniae and on auscultation crackles are heard on the left hemi-thorax. Chest x-ray shows shadowing C. Mycoplasma pneumoniae containing air bronchograms in the left-mid D. Staphylococcus aureus zone. E. Streptococcus pneumoniaeSBA 3 A 45-year-old man presents to his GP with Which organism is most likely responsible? dyspnoea, a productive cough and malaise. His symptoms started 5 days ago and have been getting progressively worse. On examination, his A. Haemophilus influenza respiratory rate is 30, he has a temperature of 38.5oC, his sputum is purulent and rust-coloured B. Klebsiella pneumoniae and on auscultation crackles are heard on the left hemi-thorax. Chest x-ray shows shadowing C. Mycoplasma pneumoniae containing air bronchograms in the left-mid D. Staphylococcus aureus zone. E. Streptococcus pneumoniaeBonus SBA 4 A family asks about the implications of a Which organism is most likely responsible? genetic test that their child has a large copy number variant 22q11.2 deletion syndrome. A. Dysthymia They ask about links with psychiatric conditions B. Major depressive disorder C. Panic disorder For what psychiatric disorder is the child most D. Phobia at risk in the future? E. SchizophreniaBonus SBA 4 A family asks about the implications of a Which organism is most likely responsible? genetic test that their child has a large copy number variant 22q11.2 deletion syndrome. A. Dysthymia They ask about links with psychiatric conditions B. Major depressive disorder C. Panic disorder For what psychiatric disorder is the child most D. Phobia at risk in the future? E. SchizophreniaResources Question Bank • Passmed • PastTest • Quesmed – YouTube videos Notes • NICE CKS • BiteMedicine – also have questions • ZerotoFInals Revision Societies Tips • Utilise feedback from previous PT’s PRACTICE, PRACTICE, PRACTICE • Exam vs Reality • Study Timetable Know the content • Resources Overload Reflect and Review Studying Style • It’s okay not to know/remember everything Pomodoro Technique Common is CommonQ&A