Every year, I give my predictions of the top questions for the Fellowship Exam. Usually, my hit rate is good. One of my students recently said, “I should have just studied your top 30 list”. I don’t recommend this, but here is another year’s predictions.

The predictions are based on:

  1. Questions that have been asked since the new exam began
  2. An understanding of how the examiners think, in terms of how soon an area can be asked again and
  3. The very structure of the new exam making some questions not suitable for SAQs.

Without an understanding of the above, the probability of picking all 30 questions is fruitless, about  1 in 10000000000000000000000000000000000000000………. and few more zeros. Happy to discuss this with the mathematicians.

When you understand the above behaviours, the chances drop significantly.

Although I do give all my guys in the Fellowship Course the top 30, the list I’ll give here is:

“You’re Crazy If You Don’t Know these Seven” 

1. ECG: MOBITZ BLOCKS

The Mobitz block is one of the most popular questions in the exam and a sure bet. In fact two ECG’s are a sure bet. Any person with syncope and an ECG, remember the ‘ECG’s of Syncope‘. 
Beware the hidden p waves.
Understand the significance of clumping of QRS’s
Know the importance of the p-p interval. 
Try some examples 

2. FLUID MANAGEMENT IN CHILDREN

Understanding fluid resuscitation in children has become very popular recently. Nowhere moreso than in the area of DKA in children. The fear ( regardless of some saying it is irrational) of cerebral oedema in children has resulted in some states producing specific Emergency Department Guidelines for the management of DKA. For a quick review complete the module DKA in Children.

3. SEIZURES IN CHILDREN

This is always a good area. The progression down the seizure algorithm, the knowledge of the various drugs and the ability to know when and how to secure the airway make this an area that is ‘choc full of goodness’ for the examiners. Certainly some areas, such as airway are more suited to the OSCE, however this kind of question suits both.

4. TRAUMA

Trauma is one of the major areas in the Emergency syllabus. Although the big topics such as chest trauma and management of the unstable pelvic fracture are great exam questions, I think its also important to look at the slightly smaller stuff. Burns have been asked before, however electrical burns are a great topic. An understanding of the difference in AC versus DC current, the different types of burns including, flash, arc and thermal burns, as well as the futility of the Parkland Formula for fluid resuscitation, in these presentations, makes this a great area to draw questions from.

5. ANYTHING TO DO WITH EYES

The examiners have a long standing love affair with the eye and repeat the questions often. I suppose that this is because they make great pictures. This about all the different conditions they can ask:

  1. Abrasions around the eye
  2. Hyphaema(ultimo favourite)
  3. Glaucoma
  4. Orbital/peri-orbital cellulitis
  5. Retinal vein/artery occlusion

and so many others, including all the causes of red-eye, painful/ painless visual loss.

6. ANYTHING TO DO WITH THE NECK

Just when we think, we’ve done the neck and we won’t get that any more, we get the neck again. Why? It can represent a true emergency and it make a great picture. This can be abrasions, penetrating injury or lacerations.

7. THE BLOOD GAS

This has been, is and will always be a favourite. If you’ve done the Fellowship Course or The ABG MODULE here on Resus if you’ve read Luke Lawton’s great book ‘Own The ABG‘, with example after example to practice on, you know just how simple interpreting the ABG/VBG can be.
Get ready for the triple abnormality; look for it. Know the cause of more than RAGMA. Know the NAGMA. If they give an osmolality, its almost alway going to be an alcohol issue.

Ok there you go. There are no surprises there I hope. This is ‘bread and butter’ stuff. Good luck in the exam. See you at the Course and see you as FACEMs soon.

Peter Kas