Master of Medicine (Anaesthesiology) Part A Syllabus (Current as of 23 April 2019)

Subjects Topics within Subjects Details

Physiology (Approximately 32% of Total weightage)

Cardiovascular
Functional anatomy: Muscle; Conductive; Relation to Functional anatomy of the heart, including properties of cardiac muscle, nodal and conductive tissue, and its relationship to
Function cardiac function
Cardiac Cycle: Electrical/Mechanical/ Mechanical and electrical changes during the cardiac cycle
Electrophysiological control
Cardiac Output: Determinants Factors that influences cardiac output and its control and the application of this knowledge to clinical practice
Electrophysiological control of the heart.
Cardiac and Vascular Compliance Concept of cardiac and vascular compliance
Circulation: Overall: Control Distribution and regulation of circulation: overalll
Circulation: Regional: Specific sites: Major organs: Distribution, arrangements and regulation of Regional circulation: Coronary, muscle (skeletal), skin: other organs covered in
Control specific physiology topics
Myocardial oxygen balance Myocardial oxygen balance
Embolism Physiology of embolism, ischaemia and infarction.
Capillary/ Lympathetic Circulation/ Fluid Exchange in Capillary circulation.
Tissues Lymphatic circulation.
Fluid exchange in tissues
Blood Volume: Control Control of blood volume in normal and abnormal conditions
CVS responses to Changes Cardiovascular responses to physiological and common pathological changes; e.g.
i.Extremes of Age,
ii.Exercise,
iii.Obesity,
iv.Altitude changes
vi.Artificial ventilation,
vii.Blood loss and shock,
viii.Fluid loading and cardiac failure

Respiratory
Structure/ Function/ Humidification and heat exchange Structure and function of the respiratory system.
Humidification and heat exchange
Lung volumes and capacities/ Dead space Lung volumes and capacities and the application of this knowledge to normal and diseased respiratory states
Dead space: anatomical and physiological

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Mechanics of breathing/ Control of ventilation/ Mechanics of breathing: pressure, flow, work, compliance, muscles, etc
Respiratory reflexes Control of ventilation and changes in ventilation in abnormal physiological and common pathological conditions
Respiratory reflexes
Alveolar ventilation Alveolar ventilation
Pulmonary circulation/ Interstitial space/lymphatics Pulmonary circulation, pulmonary interstitial space and lymphatic function and their relevance in clinical practice
V/Q Matching: Determinants Normal and abnormal matching of ventilation and perfusion, the mechanisms causing ventilation-perfusion inequality including
effects of posture, respiratory and circulatory changes, and an appreciation of its clinical significance
O2/CO2; Exchange/ Transport; Principles involved in transport of oxygen and carbon dioxide in blood and their applications in clinical practice
Lungs/Capillary/Tissues; O2 casade Blood-tissue gas exchange.
Changes with Physiology/Pathophysiology/Specific Respiration responses to conditions; e.g.
Situations i.Extremes of Age,
ii.Exercise,
iii.Obesity,
iv.Altitude changes: high and low barometric pressures: short and long term adaptation
v.Changes in posture (including under anaesthesia)
vi.Common pathological conditions affecting ventilation and gaseous exchange

Causes/Effects Hypoxia/Hypo/Hyperventilation Causes and Effects of:

i.Hypoxia and asphyxia.
ii.Hypoventilation and hyperventilation.
Respiratory therapy including Artifical ventilation Respiratory inadequacy and failure; principles of therapy.
Artificial ventilation: including common modes of ventilation used in Anaesthesia
Non-respiratory functions Non-respiratory functions of lung

Renal, Cellular, Body Fluids and electrolytes, Acid Base

Renal
Functional anatomy/ Perfusion: control Functional anatomy of the kidneys including the physiology, peculiar features and regulation of renal blood flow
Glomerular filtration/Tubular function/Counter-current: Glomerular filtration and tubular function
Regulation Counter-current mechanisms in the kidney
Regulation of renal function
Assessment of function Measurement of glomerular filtration rate and renal blood flow
Physiological effects and clinical assessment of renal dysfunction
Control of acid-base, osmolality, electrolyte, glucose, Maintenance of acid-base, fluid osmolality and electrolyte balance
nitrogen products and drugs Role of the kidney in the handling of glucose, nitrogenous products and drugs
Response to Changes: Hypovolemia/ Stress/ Renal responses to hypovolaemia; hypotension; surgical stress and anaesthesia
Anaesthesia
Endocrine functions: kidney Endocrine functions of the kidney
Body fluids and Electrolytes

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Body water; compartments: Fluids/ Electrolytes; Body water: distribution, movement and regulation
distribution Electrolyte composition of body fluids: distribution and regulation.
Electrolytes (Na, K, Mg, Ca, PO4) Function/ Regulation Function, regulation and physiological importance of sodium, potassium, magnesium, calcium and phosphate ions

Composition and functions of lymph Composition and functions of lymph

Determinants of fluid/electrolyte movement: osmotic Determinants and Regulation of fluid/electrolyte movement: Osmotic pressure, oncotic pressure and reflection coefficients
pressure, oncotic pressure, reflection coefficients, Measurement of osmolality and the regulation of osmolality
osmolality; Regulation
Disturbances/ Evaluation/ Therapy: pathological Disturbances of body fluids and electrolytes in pathological conditions such as dehydration, over-hydration, oedema and
conditions electrolyte changes.
Evaluation and principles of therapy of such pathological conditions
Acid Base Physiology
Acid-base balance in the body; Henderson- Chemistry and physiology of acid-base balance in the body and the application of this knowledge to clinical situations
Hasselbalch equation: Application Henderson-Hasselbalch equation and its application in clinical situation.
Regulation: Buffers/ Respiratory and renal system Chemistry of buffer mechanisms and their roles in the body
Regulation of acid-base balance by the respiratory and renal system
Changes in disordered states: evaluation/ therapy Changes in disordered acid-base states: evaluation (including interpretation of arterial blood gases and electrolyte findings) and
principles of therapy
Cellular
Components of cell/ Function Structure and Functions of a cell and cellular components: mitochondria, endoplasmic reticulum, and other organelles
Sources of energy available to cells through metabolic processes

Cell membrane: properities and transport mechanism Cell membrane and its properties
Mechanisms of transport across cell membranes; diffusion, facilitated diffusion, primary active transport and secondary active
transport
Intracellular/ Extracellular fluid and electrolytes: Pumps Composition of intracellular fluid and its regulation including the role of the sodium-potassium pump
and Regulation: Potentials; Gibbs-Donnan Effect Membrane potentials and the Gibbs-Donnan Effect

Receptors, G-proteins, secondary messengers Role of Receptors, G-proteins and secondary messengers

Nervous system, Musculoskeletal

Neurophysiology
Electrophysiology: neural tissue Electro-physiology of neural tissue including resting membrane potential, conduction of nervous impulses, action potentials,
excitatory and inhibitory post-synaptic potentials, and synaptic function
Integration CNS activity Integration of central nervous system activity via the cerebellum, hypothalamus, and limbic system
Cerebrospinal fluid Physiology of cerebrospinal fluid including formation, drainage, regulation and function

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Cerebral/Spinal cord circulation: Regulation and Cerebral blood flow, cerebral perfusion pressure and cerebral metabolism in normal patient, patients under anaesthesia (effects
cerebral metabolism of anaesthesia) and in patients with intracranial pathology
Blood brain barrier Structure, role and function of blood brain barrier
Intra-cranial/Intra ocular pressure Intra-cranial and intra ocular pressure: normal and regulation
Neurotransmitters Major neurotransmitters and their physiological role
Principles of reflex activity Principles of reflex activity
Physiology of pain i.Definition of pain,
ii.Mechanisms of nociception,
iii.Spinal cord modulation,
iv.Role of chemical mediators,
v.Central processing of the noxious impulse,
vi.Inhibitory pathways and opioid receptors

Sleep Physiology Physiology of Sleep; including stages, basis and changes of electroencephalography with sleep, sedation and anaesthesia

Muscle physiology
Physiology/Functional Anatomy Skeletal; Smooth; Physiology and functional anatomy of skeletal, smooth, and cardiac muscle
Cardiad Muscles
Microanatomy: Muscle spindle; Golgi organ; motor Muscle spindle and Golgi organ
units; Fast/Slow muscle fibres Concept of motor units
Types of skeletal muscle fibres (i.e. fast or slow)

Neuromuscular junction; receptors; excitation- The neuromuscular junction and its receptors
contraction coupling; monosynaptic stretch reflex Mechanism of excitation-contraction coupling
Monosynaptic stretch reflex
Single twitch; tetanus; Treppe effect: Physiological Single twitch, tetanus and Treppe effect, and their physiological basis
basis Relationship between muscle length and tension
Relationship: muscle length and tension

Liver, Nutrition, Gastrointestinal

Liver Physiology
Circulation: hepatic and portal: physiology; Anatomical and physiological considerations in hepatic blood flow, and the changes that occur with anaesthesia + Portal
significance; changes circulation and its significance
Storage, synthetic, metabolic and excretory functions Storage, synthetic, metabolic and excretory functions of the liver and the physiological consequences of hepatic disease;
of liver and consequence of disease Handling of bilirubin in the body
Assessment of function Clinical laboratory assessment of liver function and hepatic failure

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Reticulo-endothelial/Protectve functions Reticulo-endothelial functions of the liver

Protective function of the liver between the gut and the body

Nutrition and Metabolism

Energy balance; Basal metabolic: Measurement and Energy balance.
factors influencing Basal metabolic rate and its measurement
Factors that influence metabolic rate
Macro/Micro nutrients Uptake, synthesis and metabolism of carbohydrates, fat and protein.
Essential nutritional requirements, including the role of vitamins and trace elements
Parenteral and enteral nutrition Principles of parenteral nutrition and enteral nutrition
Enzyme systems; disturbance; anaerobic metabolism Common enzyme systems, evaluation of disturbances.
Consequences of anaerobic metabolism
Consequence: Starvation; Sepsis; Burns; Trauma Physiological consequences of starvation
Metabolic consequences of sepsis, burns and trauma

Gastrointestinal Physiology
Functions: secretory; digestion; absorption Secretory function: salivary glands, stomach, small intestine, pancreas (external secretion) bile, volumes and composition,
regulation.
Digestion and absorption of carbohydrate, fat and protein.
Oesophageal motility: Swallowing; Vomiting; Swallowing
Preventation of relfux Vomiting
Factors preventing reflux of gastric contents into the oesophagus
Gastric motility Control of gastric motility and emptying
Splanchnic circulation Splanchnic circulation and its regulation.
GI fluid loss Gastro-intestinal fluid losses: effects and principles of treatment.

Maternal, Fetal and Neonatal

Maternal Physiology
CVS; Resp changes; effect of positioning Cardiovascular and respiratory changes during pregnancy and parturition, their causes, and their consequences
Consequences of the supine posture during pregnancy
Placenta: anatomy; physiology; function Anatomy, physiology and function of the placenta, including:
i.Placental gaseous and acid-base exchange
ii.Placental blood flow
iii.Barrier function

Gaseous transfer Transfer of gases between mother and fetus including the double Bohr and Haldane effects

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Non cardioresp changes: e.g. Endocrine and Endocrine changes that occur during pregnancy and their consequences
Haematological Haematological changes with pregnancy

Fetal Neonatal Physiology

CVS and Resp changes: At development and birth Fetal circulation during development
Circulatory and respiratory changes that occur at birth
Pulmonary function of neonate Pulmonary function; airway size, gas transfer, respiratory work, lung volume and role of surfactant
Fluid, electrolytes, kidney function and control in Body fluids and electrolyte composition
neonate Control of body fluids in the neonate and how the control and composition differ from the adult
Blood volume and haemoglobin in neonate Blood volume and haemoglobin changes,
Temperature regulation in neonate Temperature regulation in the neonate; how this differs from the adult; explain the physical and physiological reasons for these
differences
Other organ functions in neonate: e.g. liver Physiological differences in organ function, including liver, between the neonate and the adult

Endocrine and Thermoregulation

Endocrine
Secretions: pituitary, thyroid, parathyroid, adrenals, Secretions of the pituitary, thyroid, parathyroid, adrenals, pancreas, kidney and the heart.
pancreas, kidney, heart.
Formation; control; consequence of endocrine Neural control of endocrine secretions
secretions Formation and control; metabolism and excretion, over-secretion and under-secretion; evaluation of function.
Prostaglandins and other autocoids Prostaglandins and other autocoids

Temperature and Thermoregulation

Mechanisms: heat production by body; heat lost and Mechanisms for heat transfer between the body and its environment
gained; transfer of heat between body/environment Mechanisms by which heat is produced by the body
Mechanisms by which heat is lost and gained by the body
Mechanisms: managing body temperature with Processes used for conserving as well as generating heat under situations of lowered environmental temperature, and the
changes in environment and effects of anaesthesia on effects of anaesthesia on these processes
these mechanisms Processes used for losing heat as well as increasing heat loss under situations of raised environmental temperature, and the
effects of anaesthesia on these processes

Thermoneutral zone, inter-threshold range and energy Thermoneutral zone, and describe the energy requirements for maintaining normal body temperature
requirements
Hypothermia: effects

Haematology, Immunology
Haematology

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Blood constitutents: production; function; breakdown Production, function and breakdown of blood constituents including red blood cells, haemoglobin, and plasma proteins
Constituents and functions of plasma

Coagulation and fibrinolysis Platelets and their role in coagulation

Intrinsic and extrinsic coagulation pathways
Mechanisms of preventing thrombosis
Fibrinolysis and its regulation

Assessment of function Methods for assessing coagulation, platelet function and fibrinolysis
Anaemia: consequences Consequences of acute and chronic anaemia
Transfusion and Issues Origin and importance of blood groups of cross-matching
Constituents of blood products, their source, role and risks
Changes during blood storage and the problems of massive blood transfusion and their management
Abnormal haemoglobins Abnormal haemoglobins and their clinical significance

Immunology
Normal immune function and auto-immunity Basic immunology including non-specific resistance mechanisms and specific immunity.
Auto-immunity
Tissue typing; transplant and rejection Principles of tissue typing Principles of tissue/organ transplantation and the mechanisms of rejection of allogeneic organs

Hypersensitivity reactions; anaphylactoid/anaphylaxis; Mechanism and pathophysiological effects of hypersensitivity.

other drug reactions Significance of route of drug administration with regards to drug reactions
Principles of management strategies for anaphylactic/anaphylactoid reactions
Altered immune function due to: Anaesthesia; Surgery; Effects of anaesthesia, surgery and critical illness on immune function
Critical illness; Depression Implications of depression of immune status.
Assessment of function Assessment of immune reaction

Pharmacology + Biostatistics (33%)

General Pharmacology:
Pharmacodynamics
Basic sciences of biochemistry, cellular membranes Knowledge of the biochemistry, physical chemistry of cellular membranes and intracellular elements for understanding drug
and intracellular elements actions and metabolism
Modes of drug action Modes of drug action such as receptor theory, enzyme interactions and physico-chemical interactions
Receptor theory (in detail) Detailed knowledge of receptor theory including, ionic fluxes, second messenger, G proteins, nucleic acid synthesis, regulation
of receptor number and activity and evidence for presence of receptors.

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Dose-effect relationships: graded/quantal response, Detailed knowledge of dose-effect relationships of drugs with reference to: graded and quantal response, therapeutic index,
therapeutic index, potency/efficacy, potency and efficacy, competitive and non-competitive antagonists, partial agonists, mixed agonist-antagonists and inverse
antagonists/agonists types/ differences agonists
Law of Mass Action, Affinity, dissociation constants Law of Mass Action, Affinity and dissociation constants
Mechanism of action of GA agents Theories of mechanism of action of general anaesthetic agents

Pharmacokinetics
Single/Multiple compartment models Concept of single and multiple compartment models
half-life, half-time, clearance, zero/ first order kinetics, Concept of and the mathematics required to apply the concept of half-life, clearance, zero and first order kinetics, volume of
volume of distribution, bio-availability, area under distribution, bio-availability, area under the plasma concentration time curve, extraction ratio, loading and maintenance dosage
plasma concentration time curve, extraction ratio, regimens
loading/ maintenance dosage regimens

Absorption of drug at various sites of administration: Absorption of drug at clinically utilized sites of administration and factors that will influence it
Determinant factors
Distribution of drugs: determinants/ factors; different Factors influencing the distribution of drugs (e.g. protein binding, lipid solubility, pH, pKa) and variation in different physiological
physiological/ pathological conditions and pathological conditions
IV/infusion kinetics; context sensitive half time, effect- Concepts related to intravenous and infusion kinetics; context sensitive half time, effect-site and effect-site equilibration time
site and effect-site equilibration time: clinical and their clinical applications.
applications.
Epidural/ Subarachnoid space kinetics Pharmacokinetics of drugs administered in the epidural and subarachnoid space
Drug clearance: mechanisms and variation in different Mechanisms of drug clearance and variation in different physiological and pathological conditions
conditions
Hepatic and non-hepatic metabolism, Phase 1 & 2 Hepatic and non-hepatic metabolism of drugs, Phase 1 and Phase 2 reactions, hepatic extraction ratio and its significance, first
reactions, hepatic extraction ratio, first pass, enzyme pass effect, enzyme induction and inhibition
induction/ inhibition
Clinical drug monitoring Clinical drug monitoring

Variability in drug actions

Tolerance, tachyphylaxis, dependence, addiction, Tolerance, tachyphylaxis, dependence, addiction, and idiosyncrasy
idiosyncrasy Mechanisms of tolerance
Alterations of response: physiological/ pathological Alterations to drug response due to:
conditions a. Different physiological conditions eg: neonates, the elderly and pregnancy
b. Different pathological conditions eg: cardiac, respiratory, renal and hepatic disease
Adverse drug reaction including Anaphylaxis/ Adverse drug effects
anaphylactoid reaction Anaphylaxis and anaphylactoid reaction
Drug interactions: Mechanisms Mechanisms of drug interaction

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Drug abuse Pathophysiology of drug abuse with particular reference to the perioperative period and potential drug interactions (specific
drugs to consider include alcohol, nicotine, benzodiazepines, opioids, cannabinoids, cocaine, amphetamines and ecstasy)

Pharmacogenetics: malignant hyperpyrexia (in detail Pharmacogenetic disorders such as malignant hyperpyrexia, porphyria, atypical cholinesterase and variation of cytochrome
including Tx), porphyria, atypical cholinesterase, function
cytochrome function Management of malignant hyperthermia with reference to the pharmacology of dantrolene

Pharmaceutical aspects/drug development

Drug preparations: additives; shelf-life Shelf-life, changes drug potency during storage and methods of preserving shelf-life of drugs.
Drug additives including buffers, anti- oxidants, anti-microbial and solubilizing agents

Isomerism Isomerism
Drug evaluation and trials

Core Anaesthetic drugs: Detailed knowledge when relevant of:

Pharmaceutical characteristics: Chemical nature/ source, preparation, purity and stability, dosage, strengths of preparation, inhaled concentrations
Pharmacokinetic characteristics: routes of administration, absorption, distribution, metabolism and excretion
Pharmacodynamic characteristic: sSite/s and mechanisms of action, structure activity relationships, variation in drug effects, monitoring of drug effects, effects on other systems,
Unwanted, adverse effects and toxic effects
Clinical considerations: considerations in pregnancy and lactation, elderly, neonatal or paediatric patients; indications and contraindications for use

Inhalational agents
Intravenous agents
Local Anaesthetics
Opioids
Analgesics:Non-opioids: NSAIDs; Paracetamol
Neuromuscular blockers and reversal agents,
Antiemetics
Adjuvant medications for pain
Oxygen

Drugs for Mx of monitored Detailed knowledge when relevant of:

parameters/ Major systems Pharmaceutical characteristics: preparation, purity and stability, dosage, strengths of preparations
of Anaesthetic Interest Pharmacokinetic characteristics: routes of administration, absorption, distribution, metabolism and excretion
Pharmacodynamic characteristic: site/s and mechanisms of action, structure activity relationships, variation in drug effects, monitoring of drug effects, effects on other systems,
unwanted, adverse effects and toxic effects
Clinical considerations: considerations in pregnancy and lactation, elderly, neonatal or paediatric patients; indications and contraindications for use

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ANS: Cholingerics and Anti-Cholingerics Drugs that affects the autonomic system including the cholinergic system and anticholinesterases
CVS: Contractility; Rate; Rhythm, Vascular tone Drugs that affects the Cardiovascular system:
i.Contractility
ii.Rate and Rhythm
iii.Vascular tone

Resp: bronchial tone/ Pulmonary vasculature Drugs that affects the Respiratory system:
i.Bronchial tone
ii.Pulmonary vasculature
Renal & Volume: Diuretics; Blood products; Fluid Drugs/Fluids that affects Renal system and Volume Status:
replacement i.Diuretics
ii.Blood products
iii.Fluid replacement

Haemostasis function: prevention; facilitation Drugs that affects the coagulation pathway, platelet function and fibrinolyic pathway.

Drugs for Mx of conditions of Required knowledge includes:

periop concern and General idea of preparations, strength and dosages, routes of administration, absorption, distribution, metabolism and excretion
poisoning Site/s and mechanism of action, variation in drug effects, effects on other systems, adverse effects; indications and contraindications

Endocrine: Hypothalamic-pituitary-adrenal axis; Drugs that affect the endocrine system:

Steroids; Diabetes mellitus; Thyroid function i.Hypothalamic-pituitary-adrenal axis and steroids
ii.Diabetes mellitus
iii.Thyroid function

GI drugs:GI volume & composition; GI vasculature Drugs that affect the gastrointestinal system:
i.Gastric volume and composition
ii.Gastrointestinal vasculature
Genitourinary Drugs: Uterus/ Prostate Drugs that affect the uterus and prostate
Psychotherapeutic drugs. Psychotherapeutic drugs.
Anticonvulsants Anticonvulsant drugs including Mg
Antimicrobials Antimicrobials drugs
Drugs affecting immune system + Cytotoxics Drugs that affect the immune system
Cytotoxic drugs.
Poisoning: General Mx General principles of the management of poisoning
General knowledge of methods to decrease absorption and enhance drug elimination using modalities such as charcoal, emetic
agents, gastric lavage, haemodialysis and charcoal haemoperfusion etc

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Poisoning: Specific Effects/Mx: Paracetamol, aspirin, Physiological effects of and management of the overdose of agents such as paracetamol, aspirin, tricyclic anti-depressants,
TCAs, sedatives, cyanide, digoxin; organophosphates sedatives, cyanide, digoxin and organophosphates

Biostatistics/Clinical trails
Design of clinical trial Considerations of a good study design including:
a. Study design
b. Types of errors and techniques to minimize errors
c. Sampling
d. Bias and confounders
e. Optimal power of the study

Statistical Analysis a. Types of data

b. Descriptive statistics to measure central tendency and distribution of data
c. Parametric and non-parametric tests in statistical inference
d. Linear regression analysis and correlation
e. Sensitivity, specificity, positive and negative predictive value of diagnostic tests
f. Risks and estimation of Risk
g. Calculation of power of a study

Evidence Based Medicine a. Levels of evidence

b. Systemic review
c.Meta-analysis

Physics and Equipment (15%)

Physics and Measurement e.g. common gas laws,
Physics
Basic Physical and Mathematical principles A. Mathematical concepts such as exponential functions, integration, differentiation, time constants and half life
B. Electrical concepts such as current, potential difference, resistance, impedance, inductance and capacitance as they relate
to biomedical apparatus
C. SI system of units
D. Conversion between the different units: e.g. of pressure measurement

Behavior of gases, liquids and vapors Laws governing the behavior of gases, liquids and vapors in relation to temperature, pressure and volume.
Physics of flow Principles of flow and velocity of gases and liquids including relationship to viscosity and density and characteristics of laminar
and turbulent flow.
Application of Bernoulli’s principle
Diffusion; hydrostatic pressure and osmotic Laws of diffusion: O2, CO2, drugs, electrolytes etc
forces Concept of hydrostatic pressure and osmotic forces

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Heat and Humidity Physical principles of heat transfer.

Relative and Absolute Humidity
Ultrasound Basic physics of ultrasound and the Doppler principle
Principle of measurement Pressure measurement of gases, liquids
Principles of measurement employed by apparatus in clinical use, including transducers, and to describe their calibration

Clinical Monitoring Includes everything that is required for monitoring at bedside: OT or Intensive care unit: including principles, calibration, sources of errors, limitations and interpretation of readings or
Cardiovascular System results
Cardiac function: Electrical Electrocardiogram (ECG) including calibration, sources of errors and limitations
Cardiac function: Mechanical Heart tones, Echocardiography, Doppler, Cardiac Output
Vascular pressure:Non-invasive
Vascular pressure: Invasive Including invasive arterial blood pressure, central venous pressure, pulmonary arterial pressure, pulmonary artery occlusion
pressure, left atrial pressure and left ventricular end-diastolic pressure (LVEDP).
Vascular system: volume and resistance Blood volume and SVR
Organ blood flow

Respiratory System
Evaluation of respiratory function Lung volumes, gas flow, ventilation, blood flow, diffusion, compliance, resistance, gas transport, gas concentrations and
pressures in ventilating gas mixtures and body fluids.
Measurements of ventilation Measurements of ventilation, including respirometers, inspiratory force, spirometry, flow-volume loops.
Measurements of gases of clinical significance Measurements of gases of clinical significance including O2, CO2, nitrogen, anesthetic gases and vapors; using ultraviolet or
infra-red absorption, paramagnetic analysis, gas chromatography, mass spectrometry and Raman scattering

Capnography Principles of capnography including calibration, sources of errors and limitations

Measurement of flow Measurements of gas flow including flowmeters and rotameter
Oxygenation Measurements of oxygenation such as pulse oximetry including principles, calibration, sources of errors and limitations

Blood gases Measurements of Blood Gases: Electrodes for pH, PO2, PCO2, Calibration, Temperature Corrections, Errors

Nervous system
Consciousness Electroencephalogram (EEG) (raw and processed), Principles and available anesthesia monitors; (including Bispectral, others),
Evoked potentials

Brain Spinal cord Other neurological functions Motor (MEP) and sensory (SSEP)
Intracranial pressure
Blood flow and oxygenation Measurement of brain tissue oxygen saturation (including near infrared spectroscopy (cerebral oximetry)
Measurement of regional flow such as transcranial doppler, jugular venous oxygen saturation.

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Depth of paralysis
Neuromuscular function
Localisation for regional anaesthesia

Temperature and Humidity

Principles of temperature sensing devices
Measurement: Temperature and Humidity Various sites of measurement; calibration; interpretation; sources of error
Miscellaneous monitoring
devices
Minimum monitoring standards

Equipment and safety Equipment and safety e.g. anaesthesia machine, airway equipment, safety in the OT
Equipment
Supply of medical gases The supply of medical gases (bulk supply and cylinder)
Oxygen therapy Oxygen supplementation and oxygen therapy
Airway devices for positive ventilation Devices to facilitate manual and mechanical ventilation: masks, airways, supraglottic devices, endotracheal tubes etc
Devices to facilitate placement of airway Devices to facilitate endotracheal intubation and tube change adjuncts: bougies, jet stylets, soft and rigid tube change devices

Suction Set-up and operation of medical suction

Breathing circuits and components Circle breathing circuits and Ayre's T-piece and components: advantages and hazards of use
Removal of carbon dioxide in a circle system and associated hazards.
Ventilators Commonly used modes of ventilation available in Anaesthetic practice
Scavenging
Vaporisers
Anaesthesia machine Components and operation of the anaesthetic machine
Anaesthesia machine check
Temperature and humidity Methods of maintaining and regulating temperature and humidity: including active warming of patients: safety and hazards

Safety
Electrical safety Microshock and macroshock, and the mechanisms for preventing these.
Safety features of the operating room and equipment used in the operating environment; including surgical diathermy, its safe
use and the potential hazards
Fire, explosions, LASERs Fire and explosions hazards: causes, prevention and management
Surgical lasers, their safe use and the potential hazards

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Biozards Anaesthetic gas pollution,

Infectious diseases: airborne and contact; Universal precaution, Needlestick injuries
Radiological investigations Principles of radiological investigations (X-rays, CT scan and MRIs), their safe use and the potential hazards

Patient safety considerations

Positioning and Pressure effects Understands safe positioning of patient on the operating table and is aware of the potential hazards e.g. nerve injury, pressure
points, ophthalmic injuries,
Risks of tourniquet usage
Drug error Considerations for prevention of drug errors: selection, checks, preparation, labelling and administration
Blood product administration Consideration for preventing error; management of reactions

Anatomy (10%)
Head and Neck (including airway)
Face; Eye; External ear In particular Eye: Contents of the orbit
Determinates of ocular perfusion and intra-ocular pressure
Innervation and eye reflexes (including: oculo-cardiac, oculo-respiratory, oculo-emetic)
Innervation of the face

Nose; Oral Cavity; Pharynx Nose: Innervation and blood supply

Oral cavity: structures (floor of mouth, tongue, teeth, hard and soft palate), innervation.
Pharynx: Subdivisions; Innervation
Larynx Innervation; muscles; blood supply; cartilages
Vocal cords, positions with paralysis
Differences between infant and adult
Trachea Structure, innervation and relationships in neck and chest
Neck Surface Anatomy, musculoskeletal structure, Innervation
Major vessels, nerves and nerve plexuses
Structural relationships: normal anatomy and current imaging techniques including roentgenograms, ultrasound, CT and MRI.

Cardiovascular/ Respiratory anatomy

Cardiovascular System Heart Normal Anatomy of Heart and Major Vessels correlating to current imaging: Radiographic: Roentgenograms, CT, MRI
Coronary Circulation
Heart conduction system; innervation and control systems
Vessels of Anaesthetic interest Anatomy, anatomical relations and ultrasonic anatomy of the vessels in the following regions (relevant to vascular cannulation):
Neck; Subclavian and axillary region; Femoral region; Cubital fossa; Wrist; Foot

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Major organ systems Blood supply of other major organs: kidneys, central nervous system including spinal cord, liver, gastrointestinal system
Respiratory System Thorax Thorax: surface anatomy, intra-thoracic structures and relations
Innervation of the intra-thoracic structures.
Muscles of Respiration, Accessory Muscles
Lung Tracheobronchial tree: Divisions
Lung lobes and segments
Bronchial and pulmonary circulations
Microscopic anatomy

Neuroanatomy (Central nervous system and peripheral nervous system): Anatomy and (where relevant) radiological feature
Central nervous system
Skull and Brain Skull
Brain: Cerebral cortex, Cerebellum, basal ganglia, major nuclei and motor and sensory pathways, Brain stem: nuclei and cranial
nerves, Ventricular system, Cerebral circulation; circle of Willis, venous sinuses and drainage
Meninges: Epidural, Subdural and Subarachnoid Spaces
Radiological features of common acute neurosurgical conditions

Spine and Spinal Cord Variations in vertebral configurations

Spinal and sacral nerves: dermatomal and myotomal innervation
Ascending and descending tracts
Epidural (cervical, thoracic, lumbar, caudal), subdural and subarachnoid space
Blood supply

Autonomic Nervous system Parasympathetic Nervous System

Sympathetic Nervous System
Role in controlling body function
Peripheral nervous system Anatomy and (where relevant) radiological features (including ultrasound imaging). Note that head and neck covered in head and neck sesion

Truncal Paravertebral space, intercostal space, neurovascular plane in the thorax and abdominal wall, e.g. transversus abdominis
plane, rectus sheath, ilioinguinal etc.
Perineum including penile innervation etc
Brachial Plexus Brachial plexus: formation, branches, relations and distributions
Lumbosacral plexus Lumbosacral plexus: formation, branches, relations and distributions

Clinical Medicine (10%)

Acute Medicine Presentation, Investigation and immediate management of common crisis encountered in the OT

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 Master of Medicine (Anaesthesiology) Part A Syllabus (Current as of 23 April 2019)

Cardiovascular conditions Abnormal rhythms such as tachyarrythmias, bradyarrythmias, narrow or board complex, asystole, associated with or without
haemodynamic changes according to recognised guidelines including ACLS
Hypotension or Hypertension
Acute myocardial ischaemia

Respiratory issues Difficult airway algorithm

Dyspnoea or Hypoxia
Hypocapnoea or hypocarbia
Hypercapnoea or hypercarbia
Laryngospasm or Bronchospasm
High airway pressures during positive pressure

Neurological issues Perioperative confusion, delirium, cognitive dysfunction or failure to awaken

Specific conditions of interest Local anaesthetic toxicity
Malignant hyperthermia
Anaphylaxis
Blood Transfusion Reaction
Electrolyte abnormalities: e.g. Hyperkalemia and hypokalemia

Perioperative Medicine Common issues in Perioperative Medicine e.g. URTI, airway assessment, management of chronic disease, acute pain management
Generic preoperative issues Common perioperative issues e.g. Airway assessment, Premedication, URTI
Specific common conditions Pathophysiology, assessment and perioperative management of commonly encountered disease conditions; such as
a. CVS conditions: e.g. Ischaemic heart disease, Valvular heart disease, Hypertension
b. Respiratory conditions: e.g. Asthma, Chronic obstructive lung disease, chronic smoking, Obstructive sleep apnoea
c. Endocrine conditions: e.g. Diabetes, Hyper and Hypothyroidism
d. Metabolic conditions: e.g. Morbid obesity,
e. End stage renal failure
f. Haematological conditions: e.g. Anaemia; use of anti-coagulants or antiplatelet medication management

Abnormal findings Identification and appropriate management of abnormal findings in the perioperative period:
a. History and Physical examinations (e.g. Heart murmur, thyroid nodule etc)
b. Investigations and Management e.g. (Abnormal ECG, CXR, blood investigations etc)
Postoperative Management a.Criteria for safe extubation
b.Management in recovery
c.Acute Pain Management e.g. management of patient on PCA, Epidural

Prepared by
Dr Tay Kwang Hui
Master of Medicine (Anaesthesiology) Chief Examiner, 2019
In consultation with Master of Medicine (Anaesthesiology) Examination Committee

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