I believe my "Big Blue" book, "Essentials for the Anesthesiology Written Board Examination" is currently the best single source for the Written Board examination. This book is a companion for, an adjunct to, my Big Blue book. After extensively studying the exam, I believe there are recurrent concepts and facts that are tested. These need to be anticipated and then understood and memorized. This companion will help you achieve this.

This book does not contain all of the information you need to pass. Its purpose is to bring together common facts and concepts in a format (a small compact companion) that is easy to use.

It has been said that the will to win to less important than the will to prepare to win. Most anesthesiologists don't lack either of these. Rather, they lack the time to win. Time is often the critical lacking ingredient to a successful strategy for written board preparation. After 12-16 hour work-days and with the demands of a family a strategy to achieve victory breaks down not because of lack of desire or will but because of a lack of time and focus.

One must be working consistently hard and in a focused manner during the best part of the day--not just late at night while exhausted and frustrated. Effective focus upon this exam is not only possible in the operating room and between cases it is highly desirable. Knowledge and interest promote vigilance and by reviewing essential information as time and circumstances permit we become more knowledgeable professionals, more interested in what we do, and better servants to our patients--our ultimate goal as physicians. The science of anesthesia is fascinating! By learning it better, we become better doctors. That is what the Board process should be all about.

This little companion will help you prepare for this difficult test. In collecting the information and preparing the tables and mnemonics I have often utilized several sources, separating chaff from substance. I've also tried to format the information in a manner that is easy to remember and to put it under a roof that is convenient to use.

This little book will not alone win the war just as air power was not alone enough to defeat Nazi Germany. A ground war, at times hand to hand combat, will be required. While not alone enough, this little book, by helping you to master facts and concepts that are repetitive, may prove vital to your overall strategy for success.

I have taught written Board review for almost four years. In writing this book, I have chosen only the top lists, mnemonics, concepts relevant to this exam. These lists, this little O.R. companion, will help you to ultimate Victory.

Please don't give this little book away. Be a friend and appreciate the work I have done. The truth is, I need your help and support. Let's be friends.

I can be reached at 235 Lexington Avenue, Iowa City, Iowa 52246. My home telephone number is 319-337-3700. Call any time. I would be happy to discuss any aspect of your preparation with you. This may or may not include a tutorial. I do this as a hobby. I'll give you an honest assessment.

Have fun! There aren't enough challenges as meaningful and interesting as designing an effective, successful ground campaign to defeat this challenging test. These are the very kind of challenges you have always loved. Let's do it! Remember the words of Theodore Roosevelt:

Far greater it is to seek glorious triumphs,
even though checkered by failure,
than it is to seek refuge
with those poor souls
who live in the twilight zone,
knowing neither victory nor defeat.

Best wishes.
Onward to Sweet Victory!

Niels F. Jensen, M.D.
Iowa City, Iowa

A SAMPLE CARD FROM OR COMPANION:

MAC, Blood Gas Partition Co-efficients, Vapor Pressure

Niels F. Jensen, MD
Copyright 1995: Written Board PREP Cards
The Best Medicine for Your Written Boards
Phone: 319-337-3700

 
   1.  What do we need to command?
 
                     MAC        B/G           Vapor Pressure
                                solubility    (Volatility)
 
   Halothane         0.75       2.3           240
 
   Enflurane         1.68       1.8           175
 
   Isoflurane        1.15       1.4           238
 
   Methoxyflurane    0.15      12.0           22
 
   Ether             2.0       12.0           450
 
   Nitrous Oxide     105        0.47          --
 
   Desflurane        5.70       0.42          665
 
 
   2.  MAC (see above):
       a.  It is a measure of anesthetic potency.  The lower the MAC, the
       greater the potency.
       b.  MAC is the alveolar concentration at which 50% of patients will
       not respond to a surgical stimulus.
       c.  Methoxyflurane is the most potent agent (It is also the least
       volatile).
 
   3.  B/G partition coefficient
       a.  The lower the blood gas partition coefficient, the less soluble
       the agent and the faster the rate of rise of alveolar anesthetic
       concentration.  The patient goes to sleep and wakes up faster.
 
   4.  Vapor pressure:
       a.  The percent of an anesthetic delivered increases with increasing
       vapor pressure.
       b.  If halothane is used in an enflurane vaporizer, the delivered
       concentration will be higher.  Therefore, one of the worst situations
       would be to have a very volatile agent, for example, Ether (450) in a
       methoxyflurane vaporizer Methoxy (22).  The delivered concentration
       would be 450/22= 20.5 times as great as expected.  (Memorize the
       common VPs)
       c.  If the machine is calibrated at sea level and we take it to a
       higher elevation, what happens to the VP/BP ratio?  Since the VP
       remains the same and the barometric pressure decreases, the ration
       increases.  Therefore, the delivered concentration is higher than
       indicated on the dial.
 
"No matter how far a stream flows it never forgets its source."
 

-Proverb