Great Clarendon Street, Oxford, OX2 6DP, United Kingdom
Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries
The moral rights of the authors have been asserted
First Edition published in 2023
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above
You must not circulate this work in any other form and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2022940780
ISBN 978–0–19–886702–9
eISBN 978–0–19–289930–9
DOI: 10.1093/med/9780198867029.001.0001
Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work.
The European Diploma in Anaesthesiology and Intensive Care (EDAIC) is an internationally recognized examination run by the European Society of Anaesthesiology and Intensive Care (ESAIC). The curriculum and specific areas covered by each of the Parts and Papers is available on the ESAIC website alongside the dates and deadlines for application for each of the two Parts of the Examination: https://www.esaic.org/education/edaic.
One of the constant requests received from candidates over past years has been for a book that helps them prepare appropriately. Many of the candidates for the EDAIC work outside of Europe and are not necessarily aware of any differences between their local guidelines and treatment protocols compared with those published by ESAIC. We know that there are many Anaesthesia exam preparation books but all of them address national rather than international examinations and many use different question formats from those encountered in the EDAIC. This book is the first to address the contents of the EDAIC examination and provide examples of typical questions accompanied by answers and explanations. All the questions have been written specifically for this book but are very similar to those encountered in the examination. The contributors all have extensive experience as Examiners for the EDAIC and are best placed to provide an appropriate level of difficulty for each of the practice Papers.
When preparing for the EDAIC, it is important for candidates to use all possible resources: online tutorials, textbooks, local face-to-face or online oral practice sessions as well as exam preparation books. The educational material on the ESAIC website should be used extensively by candidates as it covers European practice. The editors hope that this book will address some of the difficulties experienced by previous EDAIC candidates and suggest ways in which to improve the likelihood of a successful attempt at both Part I and Part II of the EDAIC.
Dr Andrey Varvinskiy MD DA(UK) DEAA FRCA
Past Chairman of the ESAIC Examinations Committee
Dr Mario Zerafa MD DA(UK) DEAA FRCA FERC
Past Chairman of the EDAIC Part II Subcommittee
Dr Sue Hill MA PhD FRCA
Past Chairman of the ESAIC Examinations Committee
FOREWORD
The history of the European Diploma in Anaesthesiology and Intensive Care (EDAIC) begins in 1984 by the European Academy of Anaesthesiology (EAA), where at the time, this exam was known as the European Diploma in Anaesthesiology (EDA).
Originally created for doctors registered in Europe only, the objective of the exam was to establish a multinational, multilingual European postgraduate diploma examination, which would serve as a means of identifying well-trained anaesthesiologists from any European country. The harmonization of standards and free movement of anaesthesiologists in Europe was of great importance and this exam became the necessary key to create consistency in theoretical and clinical knowledge.
On 1 January 2005, the European Diploma in Anaesthesiology (EDA) moved under the umbrella of ESA as a consequence of the amalgamation of the European Academy of Anaesthesiology, the European Society of Anaesthesiologists, and the Confederation of European National Societies of Anaesthesiology. Diplomates are now known as DESAIC (Diplomates of the European Society of Anaesthesiology and Intensive Care, previously DEAA).
No longer just for doctors registered in Europe, in 2010, the European Diploma opened to candidates from all over the world because of the adoption of the Glasgow Declaration by the ESA. By
2013 the name was officially changed to European Diploma in Anaesthesiology and Intensive Care (EDAIC).
Today, EDAIC is recognized, worldwide, as a high-quality benchmarking tool in anaesthesia and intensive care. As an activity of the ESA, the EDAIC has an educational, non-for-profit purpose. Any profit is either invested in improvements of EDAIC or injected in other educational activities of ESA, which as of 1 October 2020, has become ESAIC (the European Society of Anaesthesiology and Intensive Care), better reflecting our full community and the theoretical skills found within the exam.
EDAIC is organized in most European countries from Iceland and Portugal in the West to Russia and Armenia in the East, but also in other countries in South America, Northern Africa, the Middle East, and Asia. Additionally, it has been officially adopted or recognized in 17 countries in Europe and beyond.
The Society has around 3000 candidates registering for Part I every year, 1200 for Part II and 2000 for the On-Line Assessment (OLA), which was launched as a pilot in 2011 and organized on a yearly basis since 2013. It is an inexpensive but qualitative assessment.
EDAIC Part I (written exam made of 120 multiple-choice questions (MCQs)) and EDAIC Part II (oral exam made of four Structured Oral Examinations, or SOEs) are summative assessments, while the OnLine Assessment (OLA) and In-Training Assessment (ITA) are formative assessments (both made of 120 MCQs). OLA and Part I are organized in 11 languages and Part II is organized in six languages.
One of the most important elements of a successful exam is also to know and to be familiar with the format of the examination procedure. There are different ways to prepare for EDAIC: the Basic and Clinical Sciences Anaesthetic Course (BCSAC), the OLA, the ITA, the Society’s e-learning modules and webinars, and the practice of SOEs and of MCQs that are not in the actual test, but a true reflection of the types of questions to be found on the exam.
This book falls perfectly into the latter category, an area where, based on feedback from previous participants, we found a gap and a need to fill it. It was then decided to provide such a guideline with the highest quality of authors who were previously experienced examiners coming from high positions within the EDAIC structure. Finally, we are proud to say the Society’s Board of Directors fully supports this initiative and are thankful for the excellent work done by the authors. We are confident this book will be advantageous in your preparation for the EDAIC and hope you enjoy it.
Petramay Attard Cortis Anaesthetist, Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, MT
Nicolas Brogly Anaesthesiologist, Department of Anaesthesiology, Hospital Universitario La Paz, Hospital Universitario La Zarzuela, Madrid, ES
Mikhail Dziadzko Consultant, Department of Anesthesia, Intensive Care and Pain Management, Hopital de la Croix Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, FR
Vladislav Firago Head of Anesthesia Department, Consultant Anesthesiologist, Department of Anesthesia, Sheikh Khalifa General Hospital, Umm Al Quwain, AE
Svetlana Galitzine Consultant Anaesthetist, Regional and Orthopaedic Anaesthesia Training Lead, Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Duncan Lee Hamilton Consultant in Anaesthesia & Acute Pain Medicine, James Cook University Hospital, Middlesbrough, UK; Visiting Professor, School of Medicine, University of Sunderland, Sunderland, UK
Sue Hill Retired Consultant Anaesthetist, Anaesthesia and Intensive Care, Southampton General Hospital, Southampton, UK
Krisztina Madach Associate Professor, Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, HU
Else-Marie Ringvold Head of Department of Anaesthesia, Intensive care, Critical Emergency Medicine and Pain Medicine, Akershus University Hospital, Lörenskog, Norway, Assistant Professor, University of South-East Norway, Norway
Stephen Sciberras Visiting Lecturer, Department of Surgery, University of Malta, Msida, MT
Armen Varosyan Associate Professor, Department of Anaesthesiology and Intensive Care, Yerevan State Medical University, Yerevan, AM
Andrey Varvinskiy Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, Torbay and South Devon NHS Foundation Trust, Torquay, UK
Mario Zerafa Consultant Anaesthetist, Deputy Chairperson, Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Msida, MT
ABG
AC
ACB
ACE
ACOG
ACS
AD
ADH
AED
AF
AFE
AKI
ALI
AMI
ANP
AP
APACHE
ABBREVIATIONS
Arterial blood gas
Alternating current
Adductor canal block
Angiotensin-converting enzyme
American College of Obstetricians and Gynecologists
Acute coronary syndrome
Autonomic dysreflexia
Anti-diuretic hormone
Automated external defibrillator
Atrial fibrillation
Amniotic fluid embolism
Acute kidney injury
Acute lung injury
Acute myocardial infarction
Atrial natriuretic peptide
Anterior-posterior
Acute Physiology and Chronic Health Evaluation
Acute pulmonary embolism
Adjustable pressure limiting
Acute respiratory distress syndrome
Acute renal failure
American Society of Anesthesiologists
Aspartate transaminase
Brainstem auditory evoked potentials
BBB
Blood-brain barrier
BCSAC
BIS
BMI
BMR
BNP
BP
BSAC
CBF
CC
CEMACH
CENSA
CF CI
CICO
CIED
CM
CMR
CNB
CNS
CO
COMT
COPD
COSHH
CPB
CPG
CPP
CRP
CRRT
CSF
CT
CTEPH
CVP
DAS
DBS
DCT
Basic and Clinical Sciences Anaesthesia Course
Bispectral Index
Body mass index
Basal metabolic rate
B-type natriuretic peptide
Blood pressure
Basic Sciences Anaesthesia Course
Cerebral blood flow
Closing capacity
Confidential enquiry into Maternal and Child Health
Confederation of European National Societies of
Anaesthesiologists
Cystic fibrosis
Confidence interval
Can’t intubate can’t oxygenate
Cardiovascular implantable electronic devices
Chiari malformations
Cerebral metabolic rate
Central neuraxial blockade
Central nervous system
Cardiac output
Catechol O-methyl transferase
Chronic obstructive pulmonary disease
Control of Substances Hazardous to Health
Cervical plexus block
Central pattern generator
Cerebral perfusion pressure
C-reactive protein
Continuous renal replacement therapy
Cerebrospinal fluid
Computed tomography
Chronic thromboembolism pulmonary hypertension
Central venous pressure
Difficult Airway Society
Double burst stimulation
Distal convoluted tubule
DESA
DIC
DK
DLT
EAA
EC
ECG
EDAIC
EEC
EJA
ER
ERC
ERS
ESA
ESAIC
ESC
ESICM
ETC
ExC
FAST
FONA
FRC
FRCA
FVC
GA
GABA
GBS
GCS
GFR
GIT
GOLD
GPCR
HELLP
HFA
Diplomate of the European Society of Anaesthesiology
Disseminated intravascular coagulopathy
Don’t Know
Double-lumen tube
European Academy of Anaesthesiology
European Community
Electrocardiogram
European Diploma in Anaesthesiology and Intensive Care
European Economic Community
European Journal of Anaesthesiology
Emergency room
European Resuscitation Council
European Respiratory Society
European Society of Anaesthesiology
European Society of Anaesthesiology and Intensive Care
European Society of Cardiology
European Society of Intensive Care Medicine
European Trauma Course
Examination Committee
Focused assessment with sonography in trauma
Front of neck access
Functional residual capacity
Fellowship of the Royal College of Anaesthetists
Forced vital capacity
General anaesthesia
Gamma amino butyric acid
Guillain–Barré syndrome
Glasgow Coma Scale
Glomerular filtration rate
Gastro-intestinal tract
Global Initiative for Obstructive Lung Disease
G-protein-coupled receptors
Haemolysis elevated liver enzymes and low platelets
Heart Failure Association
HFV
HME
HPV
HSCT
IABP
ICAROS
ICD
ICF
ICP
ICU
INR
ITU
LBBB
LCCA
LDCT LED
LIA
LMA
LMWH
LV
MCQ
MEP
MI
MIDCAB
MILA
MILS
MRI
MTF
NA
NDMR
High-frequency ventilation
Heat-moisture exchanger
Hypoxic pulmonary vasoconstriction
Haematopoietic stem cell transplantation
Intra-aortic balloon pump
International Consensus on Anaesthesia-Related
Outcomes after Surgery
Implantable cardioverter-defibrillator
Intracellular fluid
Intracranial pressure
Intensive care unit
International normalized ratio
Intensive therapy unit
Local anaesthetic
Left anterior descending
Left bundle branch block
Left circumflex coronary artery
Low dose computerized tomography
Light emitting diodes
Local infiltration analgesia
Laryngeal mask airway
Low molecular weight heparin
Left ventricle
Left ventricular ejection fraction
Minimum alveolar concentration
Mean arterial pressure
Multiple-choice question
Motor evoked potentials
Myocardial infarction
Minimally invasive direct coronary artery bypass
Metformin-induced lactic acidosis
Manual in line stabilization
Magnetic resonance imaging
Multiple true-false
Neuraxial anaesthesia
Non-depolarizing muscle relaxants
NIV
NMDA
NSAID
NSTEMI
NYHA
ODC
OHSA
OLA
OPCAB
ORIF
PA
PAC
PACU
PAH
PAOP
PAP
PASMC
PCI
PDA
PDPH
PE
PEA
PEEP
PESI
PG
PH
PPI
PRES
PTC
PVR RA RAAS
RASS
RBF
RCA
RCT
Non-invasive ventilation
N-methyl-D-aspartate
Non-steroidal anti-inflammatory drug
Non-ST-elevation myocardial infarction
New York Heart Association
Oxygen dissociation curve
Occupational Health and Safety Act
On-Line Assessment
Off-pump coronary artery bypass
Open reduction and internal fixation
Postero-anterior
Pulmonary artery catheter
Post-anaesthesia care unit
Pulmonary arterial hypertension
Pulmonary artery occlusion pressure
Pulmonary arterial pressure
Pulmonary artery smooth muscle cells
Percutaneous coronary intervention
Posterior descending coronary artery
Post-dural puncture headache
Pulmonary embolism
Pulseless electrical activity
Positive end-expiratory pressure
Pulmonary Embolism Severity Index
Pressure gradient
Pulmonary hypertension
Proton pump inhibitor
Posterior reversible leukoencephalopathy syndrome
Post-tetanic count
Pulmonary vascular resistance
Regional anaesthesia
Renin-angiotensin-aldosterone system
Richmond Agitation-Sedation Scale
Renal blood flow
Right coronary artery
Randomized controlled trials
RF
RHC
ROSC
RSI
RV
RVLM
RVOT
SBA
SEM
SIADH
SID
SIG
SIMV
SIRS
SMFM
SOE
SOFA
SSRI
STEMI
SVC
SVP
SVR
TAP
TAPSE
TARN
TBG
TBI
TIPSS
TIVA
TOF
TPR
TSH
VAE
VC
VEGF
VF
Radio frequency
Right heart catheterization
Return of spontaneous circulation
Rapid sequence induction
Residual volume (alsoRight ventricular)
Rostral ventrolateral medulla
Right ventricle outflow tract
Single best answer
Standard error of the mean
Syndrome of inappropriate antidiuretic hormone
Strong ion difference
Strong ion gap
Synchronized intermittent mandatory ventilation
Systemic inflammatory response syndrome
Society of Maternal-Fetal Medicine
Structured oral examination
Sequential Organ Failure Assessment
Selective serotonin reuptake inhibitors
ST-elevation myocardial infarction
Superior vena cava
Saturated vapour pressure
Systemic vascular resistance
Transversus abdominis plane
Tricuspid annular plane systolic excursion
Trauma Audit and Research Network
Thyroxine-binding globulin
Traumatic brain injury
Transjugular intrahepatic portosystemic shunt
Total intravenous anaesthesia
Train of four
Total peripheral resistance
Thyroid-stimulating hormone
Venous air embolism
Vital capacity
Vascular endothelial growth factor
Ventricular fibrillation
VILI
VSD
VT
WFNS
WPW
Ventilator induced lung injury
Ventricular-septal defect
Ventricular tachycardia
World Federation of Neurological Surgeons
Wolff-Parkinson-White
section 1 INTRODUCTION
AND ADVICE
Introduction AndreyVarvinskiy
Structure of the EDAIC (Parts I and II) AndreyVarvinskiy
How to answer multiple choice questions (MCQs) SueHill
How to pass the Part II examination MarioZerafaandSueHill
chapter 1
INTRODUCTION
This book is the first attempt to put together some training material to help candidates prepare for Part I and Part II of the European Diploma in Anaesthesiology and Intensive Care (EDAIC). We, as authors, also act as trainers and advisers to many candidates in our own institutions and beyond and have known for a long time that no dedicated text existed for this purpose. This is why we decided to offer you this book that will provide a few useful tips and strategies about how to approach written and oral examinations together with examples of Multiple True-False (MTF) questions with explanations and full narratives of the oral examinations with model answers.
The EDAIC has a long history that goes as far back as the days of the European Academy of Anaesthesiology (EAA), an organization that was established on 5 September 1978 and held its first General Assembly in Paris after two years of preparatory work1. This preparatory work began in 1976 after a group of anaesthesiologists met during the World Congress in Mexico City to discuss the consequences of Medical Directives of the European Economic Community (EEC) that were adopted by the Council of Ministers in June 19752. Medical Directive 75/362/EEC governed mutual recognition of basic medical qualifications throughout the EEC. This mutual recognition became the basis for the free movement of medical practitioners within the EEC. The minimum requirements for specialist training were described in Article 2 of Medical Directive 75/363/EEC. This Directive also laid down, in Article 4, a minimum
length of training for all specialties, which for anaesthesiology was set at three years3 .
The newly formed EAA set itself the following objectives:
Raise the standards of practice of anaesthesiology
Improve the training of anaesthesiologists
Encourage scientific meetings
Encourage research in anaesthesiology
Promote exchanges between anaesthesiologists in different countries
Advise relevant European organizations4
The first President of the EAA was Professor J. Lassner (France), who was elected by the initial 42 delegates. The delegates also elected 11 Senators and formed six Committees. In 1984, the EAA started its own journal, TheEuropeanJournalofAnaesthesiology, which over the years has become a very well-respected journal with a recent impact factor of 4.14. Also, in the same year, the EAA introduced the EDAIC consisting of two parts and established the Examinations Committee, led by John Zorab (UK).
The first two EDAIC Part I examinations (written) took place in Oslo and Strasbourg in 1984 followed by the EDAIC Part II examination (oral) in 1985 in the same European cities. The main purpose of the EDAIC was to establish a multinational, multilingual European postgraduate diploma examination that would serve as a means of identifying well-trained anaesthesiologists from any European country. In its original format, this examination could be taken in four languages. At that time, it was known as the European Diploma in Anaesthesiology and Intensive Care but abbreviated simply as EDA. The successful candidates were given the right to use the title of Diplomate of the European Academy of Anaesthesiology (DEAA).
In 2005 the EAA merged with the former European Society of Anaesthesiology (ESA), which was originally established in 1992, and the Confederation of European National Societies of Anaesthesiologists (CENSA), established in 1998, and adopted the common name of the ESA. As a result of this merger, the abbreviated name of the examination was then changed to EDAIC
and the title of the successful candidates to Diplomate of the European Society of Anaesthesiology (DESA), and more recently DESAIC.
In 1984 only 101 candidates took Part I followed by 25 candidates who took Part II in 1985. In comparison in 2019 (35 years later) as many as 2720 candidates attempted Part I in 11 languages, in 76 centres across 42 countries and 1175 candidates registered for Part II across 15 exam centres. EDAIC Part II can now be taken in six languages.
Today the objectives of the EDAIC are:
To assess knowledge
To improve and harmonize training programmes
To assist in career progression
To help in the evaluation of non-European medical graduates
To provide evidence when there is competition for permanent posts
Mutual recognition of other diploma examinations
In recent years the EDAIC was opened to the rest of the world and quickly became a truly global phenomenon. In order to sit Part I, a candidate must simply be a medical school graduate and to be eligible for Part II should be either a certified anaesthesiologist in any country or a trainee in the final year of their training in anaesthesiology in one or more of the European member states according to the World Health Organization5 .
The Examination Committee (ExC) of the ESA introduced the OnLine Assessment (OLA) in 2011. This new modality serves as a preparatory knowledge test helping candidates to understand what the EDAIC Part I consists of, using exactly the same layout and format, but a separate bank of MTF questions. Several countries now use OLA to assess the level of knowledge of their trainees year by year. Another initiative of the ExC was the introduction of a Basic and Clinical Sciences Anaesthesia Course (BCSAC) that is run annually during the Euroanaesthesia Annual Congress.
References
1. Spence, A. Editorial, European Academy of Anaesthesiology. Br JAnaesth, 1978;50(12):1172.
2. European Economic Community. Council directives. OfficialJournalofthe European Communities, 1975;18:No. L167.
3. Zorab, J.S.M., and Vickers, M.D. The European Academy of Anaesthesiology 1992 and beyond. JRSoc Med, 1991;84:704–708.
4. Zorab, J.S.M. The European Diploma in Anaesthesiology and Intensive Care. Acta AnaesthesiolScand, 1988;32:597–601.
5. European Diploma in Anaesthesiology and Intensive Care. How to prepare. Available at: https://www.esaic.org/uploads/2022/04/how-to-prepare-for-theedaic-2022english.pdf
chapter 2
STRUCTURE OF THE EDAIC (PARTS I AND II)
The European Diploma in Anaesthesiology and Intensive Care examination (EDAIC) is a multilingual, two-part examination covering the relevant basic sciences and clinical sciences topics appropriate for a specialist anaesthesiologist.
Part I
The examination is held annually in September simultaneously in several centres and different languages as listed in the annual examination calendar. Part I languages are English, French, German, Italian, Polish, Portuguese, Romanian, Russian, Scandinavian, Spanish, and Turkish.
The Part I examination comprises two multiple-choice question (MCQ) papers. Each paper has 60 questions and is of two hours duration (or 90 minutes if the examination is taken online). The MCQ format adopted is that of a stem with five responses, where each may be either true or false. This format is also known as multiple true-false (MTF).
PaperAconcentratesonthebasicsciences
Physiology and biochemistry (normal and pathological): respiratory, cardiovascular, and neurophysiology. Renal physiology and endocrinology. Physiological measurement: measurement of
physiological variables such as blood pressure, cardiac output, lung function, renal function, hepatic function, etc.
Pharmacology: basic principles of drug action. Principles of pharmacokinetics and pharmacodynamics, drug–receptor interaction, physicochemical properties of drugs and their formulations, drug actions, and drug toxicity. Pharmacology of drugs used, especially in anaesthesia and in internal medicine.
Anatomy: the anatomy of the head, neck, thorax, spine, and spinal canal. The anatomy of peripheral nervous and vascular systems. Surface markings of relevant structures.
Physics and principles of measurement: SI system of units.
Properties of liquids, gases, and vapours. Physical laws governing gases and liquids as applied to anaesthetic equipment such as pressure gauges, pressure regulators, flowmeters, vaporisers, and breathing systems. Relevant electricity, optics, spectrophotometry, and temperature measurement together with an understanding of the principles of commonly used anaesthetic and monitoring equipment. Electrical, fire, and explosion hazards in the operating room.
Statistics: Basic principles of data handling, probability theory, population distributions, and the application of both parametric and non-parametric tests of significance.
Clinical anaesthesiology (including obstetric anaesthesia and analgesia):
Preoperative assessment of the patient, their presenting condition, and any concomitant diseases. Interpretation of relevant X-rays, electrocardiogram (ECG), lung function tests, cardiac catheterization data, and biochemical results. Use of scoring systems, e.g. American Society of Anesthesiology (ASA).
Techniques of both general and regional anaesthesia, including agents, anaesthetic equipment, monitoring and monitoring
