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Primary Exam 2014.2 Short Answer Question Paper
Describe the washout of desflurane from a patient following six hours of general
2.
Describe the vascular anatomy of the antecubital fossa (arterial and venous).
1.
anaesthesia. You may wish to use a graph to illustrate the description.
3.
Briefly outline the acute management of malignant hyperthermia (during a relaxant general anaesthetic).
Describe the important aspects of dantrolene
pharmacology relevant to treating malignant hyperthermia.
Describe the physiology of the pain pathways and how drugs may modulate the
5.
Describe an active anaesthetic gas scavenging system.
4.
perception of pain.
6.
20mls of 0.5% bupivacaine is inadvertently administered intravenously over 15 seconds to a 60 year old, 60kg woman. Describe the potential complications and mechanisms of these.
7.
A new test called the "intubation score" has a reported 90% sensitivity and 70% specificity when used to predict difficult intubation.
Describe how this
information and other statistics related to this test can be used in predicting difficult intubation.
How will the incidence of difficult intubation affect the
performance of this test?
Page 2 of 3
8.
Primary Exam 2014.2 Short Answer Question Paper
Outline the important pharmacological considerations when stopping warfarin and commencing prophylactic (low dose) low molecular weight heparin (LMWH) in the peri-operative period.
9.
What lower limit of Sp02 would you accept in an ASAl young male under general anaesthesia?
10.
Explain your reasons for choosing this value.
How is renal blood flow regulated? What are the physiological effects of angiotensin II?
Outline the effects of intravenously administering 500 ml of 20% mannitol.
14.
Briefly explain the changes that occur in stored whole blood.
13.
Explain the Bohr and Haldane effects in trans-placental gas exchange.
12.
Describe the cardiovascular changes that occur with morbid obesity.
11.
Outline the potential problems associated with its use.
15.
Write brief notes on the physiological changes associated with sleep.
Page 3 of 3
FEBRUARY/APRIl 2014 1> What are the potential side effects of propofol and its formulations? 2. Draw and explain the characteristics of a log dose-response curve that describes the major clinical effect of rocuronium. Describe how factors encountered in clinical practice may alter this curve. 3. Outline the safety features of currently used plenum vaporisers. 4. Describe the physiological basis of methods used to prevent hypoxaemia prior to intubation in a rapid sequence induction. Include any adverse effects of these methods. 5. Explain the effects of intermittent positive pressure ventilation on cardiac output. 6. Outline the pharmacological management of bronchoconstriction in acute severe asthma. Include mechanisms of action and potential adverse effects. 7. Describe the local anatomy relevant to the performance of a lumbar epidural block. 8. Describe the princtpies of surgical diathermy. 9. Describe the washout of sevoflurane from a patient following two hours of general anaesthesia. You may wish to use a graph to illustrate the description. 10. List the pharmacodynamic differences between tramadol and morphine. 11. Compare and contrast the management of an overdose of aspirin with that of an overdose of paracetamol. 12. Describe the alterations to the physiology of the nervous system in the older patient and outline the consequent effects on pain perception, 13. Compare and contrast the pharmacology of Normal Saline and 4% Albumin. 14. Compare and contrast the physiological effects of a six hour fast of fluids and food with a twenty four hour fast in a healthy adult 15. Indicate the sequence of the physiological changes to the fetal circulation at birth and briefly describe the mechanisms that account for these changes.
Primaiy Exam 2013.2 1,
Explain the effects of intermittent positive pressure ventilation on cardiac output.
2,
Describe tiie physiological basis of methods used t o prevent hypoxaemia prior t o Intubation in a rapid sequence Induction. Include any adverse effects of these methods.
3,
Outline t h e safety features of currently used p l e n u m vaporisers,
4,
Discuss t h e physlologica} significance o f t h e h l o o d - b r a i n barrier.
5,
Outline t h e role of t h e kidneys in t h e regulation of body Vv^ater
6,
Briefly describe t h e b r e a k d o w n of haemoglobin after red cell lysis,
7,
Describe t h e phystologlcat effects of endogenous glucocorticoids,
S,
Describe the effects of resonance and damping on an invasive arterial blood pressure tracing.
9,
Using cephazoiln as an example in joint replacement surgery, outline the principles of antibiotic chemoprophytaxls for surgical site infections.
10.
List the classes of drugs t h a t may be used to manage an intra-operative hypertensive crisis and briefly outline the mechanisms of action.
11.
Describe how non steroidal anti-inflammatory drugs exert their clinical effects. Outline the advantages and disadvantages in using COX-2 selective agents.
12,
Explain how differences in the pharmacokinetics of alfentanil and fentanyl can influence the way they are administered intravenously.
13.
Draw and explain t h e characteristics of a log dose-response curve t h a t describes the major clinical effect of rocuronium. Describe how factors encountered in clinical practice may alter this curve,
14.
List the drugs t h a t affect uterine tone, and outline the adverse effects of these agents.
15.
What are the potential side effects of propofol and its formulations?
FEBRUARY /APRIL 2013 1.
What are the major classes of oral hypoglycaemic agents? Outline their mechanisms of action and possible side effects.
2.
What are the advantages and disadvantages of xenon as an anaesthetic agent?
3. Classify isomers. Briefly write an account of their significance in drugs used in anaesthesia. 4. Describe how suxamethonium and non-depolarising neuromuscular blocking agents produce their adverse cardiovascular effects. 5. Discuss the concept of volume of distribution. How may it be used in the calculation of a loading dose? What assumptions are made in this calculation? 6. Sevoflurane and fentanyl are a common anaesthetic drug combination. Discuss pharmacological reasons why it is useful to use them together. 7. Describe the pharmacology of midazolam. 8. Discuss the metabolism of morphine, codeine and pethidine. 9. Describe the cough reflex. 10. Write brief notes on innate and acquired immunity. Q11 10. Compare and contrast lung function in the neonate with that in an adult. 12. Briefly explain the cardiovascular responses to central neuraxial blockade. 13. How does a fall in temperature influence blood gas solubility and acid base values? 14. Briefly describe the structure of mitochondria. Outline the metabolic processes that occur in mitochondria. 15. Describe the peripheral and central nervous system pathways that lead to the perception of pain following a laceration to the thumb. 16. Explain how oxygen supply of organs is maintained during isovolaemic haemodilution. Q17
JULY / SEPTEMBER 2012 1. How does warfarin exert Its anti-coagulant effect? What methods can be used to reverse the effects of warfarin prior to surgery? 2. Compare and contrast propofol and sevoflurane for maintenance of anaesthesia with respect to kinetics, cardiovascular and central nervous system effects. 2. Define the terms "tolerance" and "tachyphylaxis". Discuss the different mechanisms by which tolerance can develop, giving examples where appropriate. 3. Outline the acute adverse effects of opioid receptor agonists. Describe the mechanisms of the acute adverse effects of opioid receptor agonists. 5. Discuss the pharmacology of drugs that Inhibit the activity of the renin-angiotensin system. What particular problems can occur in the anaesthetised patient taking these drugs? 6. List agents that can reduce bronchiolar tone and explain the mechanisms of action with examples. 7. Some sets of information, for example the visual analogue scale used in pain assessment, can be treated as parametric or non-parametric data. What are the advantages and disadvantages of using each method? In each case, which tests can be used to analyse the data? 8. Classify the toxic effects of local anaesthetic drugs. Detail the potential for, and mechanisms of, toxicity of prilocaine. 9. Describe the waveforms and pressures that are seen in each anatomical location during insertion of a pulmonary arterial catheter. What factors may increase these pressures? 10. Outline the mechanisms by which the kidney maintains potassium homeostasis. 11. Outline the important features of the lymphatic circulation. 12. Discuss the physiological causes of early post-operative hypoxaemia, 13. Using an example of exponential decay, define and outline the important features of an exponential function. 14. Detail the protective and regulatory roles of the liver. 15. Describe the fuel sources used during early and sustained fasting in humans. 16. Briefly outline the differences between the pulmonary circulation and the systemic circulation.
FEBRUARY /APRIL 2012 1. Outline the pharmacology of agents used in the management of pregnancy induced hypertension. 2. In relation to the pharmacokinetics of nitrous oxide, describe the significance of partition coefficients, increasing inspired concentration, the second gas effect and diffusion hypoxia. 2. Classify the drugs which are useful for reducing the volume and acidity of gastric contents, giving an outline of the mechanism of effect for each group. 4. Discuss factors influencing the recovery and reversal of neuromuscular blockade induced by rocuronium. 5. Using opioids as examples describe and illustrate with graphs what you understand by the terms "potency", "efficacy", "partial agonist", "competitive antagonist", and "therapeutic index". 6. List the side effects of non-steroidal anti-inflammatory drugs. Briefly explain the mechanisms responsible for each of these side effects. 7. Discuss the suitability of ketamine as an intravenous anaesthetic agent. 8. Discuss the statistical methods which can be used for analysis of groups of categorical data. 9. Describe the role of baroreceptors in the control of systemic arterial pressure 10. Outline the principles of a pneumotachograph. What factors affect the accuracy of this device? 11. Outline the physiology of blood groupings that allows O negative packed cells to be safely transfused to most patients. 12. Describe the main mechanisms by which chemical neurotransmitters exert their effects, using examples from the autonomic nervous system 13. Describe the factors affecting the diffusion of gas at the placenta, including the Bohr and Haldane effects 14. Outline the components of parenteral nutrition and explain the rationale for the use of each component. 15. Describe the role of the kidneys in excretion of acid. 16. Describe the factors involved in the balance between left ventricular myocardial oxygen supply and demand
1.
A U G U S T / S E P T E M B E R 2011 Compare a n d contrast the clinically significant cardiovascular a n d central nervous system effects of desflurane a n d sevoflurane.
2.
W h a t i s meant b y the term "two compartment model" i n pharmokinetics? U s e P R O P O F O L as a n example i n explanation.
3.
W h a t i s the m e c h a n i s m of action of p -adrenoreceptor antagonists? O u t l i n e the therapeutic uses and side effects of these drugs.
4.
Describe
the
pathogenesis
and
management
of
paracetamol
toxicity. 5.
D e s c r i b e the m e c h a n i s m of action of protamine w h e n u s e d to reverse effects of heparin. O u t l i n e the side-effects of protamine.
6.
D i s c u s s the relative advantages a n d disadvantages of u s i n g morphine a n d fentanyl for post-operative Patient Controlled A n a l g e s i a ( P C A ) .
7.
Briefly outline the acute management of malignant hyperthermia (during a relaxant general anaesthetic). D e s c r i b e the important aspects of dantrolene pharmacology relevant to treating malignant hyperthermia.
8.
D e s c r i b e the terms train-of-four stimulation a n d double burst stimulation w i t h respect to the peripheral nerve stimulator. D e s c r i b e their advantages a n d disadvantages w h e n u s e d to evaluate non-depolarising neuromuscular blockade.
9.
O u t l i n e the physiological roles of prostaglandins i n the body.
10. D e s c r i b e the effects of resonance a n d d a m p i n g o n a n i n v a s i v e arterial b l o o d pressure tracing, 11. D e s c r i b e the ionic basis of automaticity of cardiac pacemaker cells. 12. O u t l i n e the similarities a n d differences between m y o g l o b i n a n d haemoglobin, explaining the physiological relevance of the differences.
adult
13. O u t l i n e the physiological role of cerebro s p i n a l f l u i d , i n c l u d i n g a description of its production a n d fate, 14. D e s c r i b e the changes i n respiratory function tests that occur w i t h l o n g term increases i n s m a l l airways resistance, 15. O u t l i n e the physiological changes that may explain w h y a n otherwise w e l l patient m a y have a reduced urinary output intraoperatively 16. D e s c r i b e the formation, fate a n d role of lactate i n energy production.
FEBRUARY/APRIL 2011 Q l . Describe the factors which increase the risk of systemic toxicity with amide local anaesthetic agents. Q 2._Classify non-opioid drugs used for the treatment of neuropathic pain and indicate proposed mechanisms of analgesic action and potential adverse effects. Q S.Outline the effects of liver failure on drug kinetics and dynamics. Q 4..Describe the ideal properties of agents used for sedation using two examples. Q 5. List the classes of drugs that may be used to manage hypertensive crisis and briefly outline the mechanism of action. Q 6. Write a brief outline on the pharmacology of remifentanil. Q 7. Describe the advantages and disadvantages of using nitrous oxide as part of a general anaesthetic. Q 8 How may drugs potentiate the action of non-depolarizing muscle relaxants at the neuromuscular junction? Q 9. Describe the ways in which CO2 is carried in the blood Q10: Describe the factors that oppose left ventricular ejection. 11. Describe the functions of the loop of Henle, including the physiological mechanisms Involved. Q12. Compare and contrast a single twitch and a tetanic contraction in a skeletal muscle fibre. Q13. Describe the determinants of work of breathing in an adult human at rest. Q14. Describe the physiological effects of general anaesthesia on temperature regulation Q15. Describe the functions of the gastric secretions. Q 16. Explain the difference between viscosity and density. Outline the effects of changes in viscosity and density on the flow of gases and liquids.
t/J^RCHItAAY201Q QUESTION 1 Describe how the chemical structure of local anaesthetic drugs determines their efficacy and safety. QUESTION 2 Describe the methods of determining depth of neuromuscular block and list the advantages and limitations of each. QUESTION 3 Discuss the adverse effects that may occur with the administration of desflurane. QUESTION 4 Describe the time course between an intravenous injection of a general anaesthetic agent to loss of consdousness. Explain the delay using pharmacokinetic prindples. QUESTION 5 Describe how Non Steroidal Anti-Inflammatory Drugs exert their clinical effects. Outline the advantages and disadvantages in using COX-2 selective agents. QUESTION 6 List the main drug groups used in the treatment of diabetes mellitus. For each group explain the mechanism of action and give examples. QUESTION 7 Briefly describe the pharmalogical role of the nicotinic cholinergic receptor. QUESTION 8 Classify drugs used in the treatment of depression. Outline the interactions between antidepressant drugs and drugs that are commonly used during the peri-operative period. QUESTION 9 Explain the physiological factors that may lead to a decrease in mixed venous blood oxygen saturation. QUESTION 10 Describe how white blood cells defend the body against infection. QUESTION 11 Describe the changes that occur in the urine and the plasma with renal dysfunction. QUESTION 12 Briefly explain the changes that occur in stored whole blood. QUESTION 13 Describe the autonomic innervation of the heart and the effects of autonomic stimulation on cardiac function. QUESTION 14 Describe the factors that affect static respiratory system compliance. QUESTION 15
Explain how cardiac output is measured using a thermodilution technique.
QUESTION 16 Describe the processes whereby substances may cross cell membranes, giving examples.
JULY/SEPTEMBER 2010 Question 1 : Compare and contrast the pharmacokinetics of orally and intravenously administered morphine and oxycodone. Question 2 : Describe the composition of 4% albumin and Normal Saline. Compare and contrast the pharmacology of each. Question 3: Describe the mechanism of action, pharmacokinetics and major side effects of intravenously administered amiodarone. Question 4 : Briefly outline the effects of sevoflurane on skeletal, smooth and cardiac muscle tissues. Include how these effects are mediated and their clinical significance. Question 5 : Describe the pharmacodynamic effects and clinical uses of anticholinesterase drugs. Question 6 : Describe the principles of how a computer-controlled infusion device targets and maintains a constant effect site concentration of propofol. Question 7 : List the physical properties of oxygen. Discuss the potential adverse effects associated with oxygen administration. Question 8 : Discuss the statistical methods which can be used for analysis of groups of categorical data. Question 9 : Describe the factors that affect respiratory system compliance. Question 10 : Discuss the factors that influence coronary blood flow. Question 11 : Explain the physical principles of ultrasound imaging. Question 12 : Describe the function of the muscles involved in ventilation. Question 13 : Describe the cardiovascular changes in the neonate that occur at birth. Question 14 : Discuss the effects on intracranial pressure when a person is placed in a head down tilt. Question 15 : Explain the role of haemoglobin as a buffer. Question 16 : Outline the clinical laboratory assessment of liver function.
MOJSIBAY, 2 I V I A R C H 2009 QUESTION 1
Explain the concept of Minimal Alveolar Concentration (/AAC) and its clinical utility. LIST the patient factors which: a) Increase MAC fa) Decrease /AAC c) Are known to have no effect on MAC
QUESTION 2
Describe the factors which increase the risk of systemic toxicity with amide local anaesthetic agents.
QUESTION 3
Outline the factors that determine the rate of recovery from non-depolarising neuromuscular block?
QUESTION 4
Compare and contrast atropine and glycopyrrolate. Discuss the clinical implications of these differences.
QUESTION 5
Outline the effects of an opioid injected into the spinal intrathecal space.
QUESTION 6
D e s c r i b e t h e m e c h a n i s m of a c t i o n a n d p h a r m a c o k i n e t i c s of p h e n y t o i n ,
QUESTION 7
Outline the subtypes of serotonin (5-hydroxytryptamine) receptors. Discuss pharmacological agents that act at these sites.
QUESTION 8
What is meant by the term " 9 5 % confidence interval"? Explain the practical applications of confidence intervals and indicate why they may be preferred to p-values.
QUESTION 9
Discuss the physiological factors that determine intracranial pressure (ICP), and describe how changes in posture affect ICP.
QUESTION 10
D e s c r i b e t h e physiological effects of t h e glucocorticoids.
QUESTION 11
Outline t h e d e t e r m i n a n t s and regulation of e x t r a c e l l u l a r fluid v o l u m e .
QUESTION 12
Outline the factors contributing to the generation and maintenance of t h e resting membrane potential.
QUESTION 13
W h a t is t h e Frank-Starling m e c h a n i s m and d e s c r i b e its relationship to excitation contraction coupling
QUESTION 14
D e s c r i b e t h e physiological processes t h a t influence t h e rate of gastric emptying.
QUESTION 15
D e s c r i b e the formation, f a t e a n d role of lactate i n energy production,
QUESTION 16
Outline the effects of acute exposure to air at an altitude w h e r e barometric pressure is 347mmHg. What compensatory mechanisms occur with gradual exposure to increasing altitude?
JULY/SEPTEMBER 2009 QUESTION 1 Sevoflurane and fentanyl are a common anaesthetic drug combination. Discuss pharmacological reasons v/hy it is useful to use them together. QUESTION 2 What are the potential side effects of propofol and its formulations? QUESTION 3 Discuss classes of drugs that influence Post-Operative Nausea and Vomiting (PONV) including mechanisms where known. QUESTION 4 Describe the effect of obesity on pharmacokinetics and the potential clinical implications, providing relevant examples. QUESTION 5 Describe the factors that may decrease the clinical response to nondepolarising neuromuscular blocking agents. QUESTION 6 Discuss the pharmacodynamics of drugs that affect uterine tone. QUESTION 7 Outline the pharmacological management of ventricular fibrillation in an adult with reference to: drugs, dose, mechanisms of action, and potential adverse effects. QUESTION 8 Mean arterial blood pressure has been measured in two groups of patients one hour after the administration of either a placebo or an antihypertensive drug. Explain how these data could be analysed. QUESTION 9 Classify the causes of hypotension in the early post-operative period, giving relevant examples. QUESTION 10 Compare and contrast the neonatal respiratory system vrith the adult. QUESTION 11 Describe the role of insulin in fat metabolism QUESTION 12 Discuss the production and function of red blood cells QUESTION 13 Explain the physiological processes that cause oliguria in response to hypovolaemic shock QUESTION 14 Outline the central nervous system effects on an awake person breathing air containing carbon dioxide. QUESTION 15
Describe the complement system.
QUESTION 16 List the gastric cell types and their secretions and the functions of these secretions.
FEBRUARY/APRIL 2008 QUESTION 1
An 80 year otd woman is undergoing major emergency surgery. Describe the maintenance inhaled concentration of sevoflurane you would choose and the factors that might influence this.
QUESTION 2
List the classes of drugs that are useful in i n d u d n g diuresis clinically. Outline their mechanism of action.
QUESTION 3
Describe the ideal pharmacokinetic and pharmacodynamic properties of agents used for sedation. Outline the pharmacology of midazolam and propofol with reference to these Ideal properties.
QUESTION 4
Outline the pharmacologic management if bronchoconstriction in acute severe asthma. Include mechanisms of action and potential adverse effects.
QUESTION 5
Classify drugs that alter activity at serotonin receptors with examples. Describe their mechanisms of action and clinical indications.
QUESTION 6
A surgeon wishes to use topical anaesthetic In the nose before surgery in a 30 year old 70 kg man. He normally uses topical cocaine 5% plus lignocaine 2% with adrenaline 1:100,000 Injection. What volumes of cocaine 5% and (fgnocaine can be used safety? What are the potential toxic effects of cocaine and how do lignocaine and adrenaline affect this?
QUESTION 7
Describe the terms tratn-of-four stimulation and double burst stimulation with respect to the peripheral nerve stimulator. Describe their advantages and disadvantages when used to evaluate non-depolarising neuromuscular blockade,
QUESTION 8
Define t h e mechanisms of action and a d v e r s e effects of metoprolol, glyceryl trinitrate and dlltiazem w h e n used to manage myocardial ischaemia.
QUESTION 9
QUESTION 10
QUESTION 11
QUESTION 12
The skin, the kidneys, and the carotid bodies are examples of where specific organ blood flow is far in excess of that organ's metabolic requirements. For each example, explain what the physiological role of the high organ blood flow is, why this high flow is an advantage to the person and a brief description of the mechanisms Involved. Define "thermoneutral z o n e " . Briefly explain how the body regulates temperature when the ambient temperature exceeds the thermoneutral zone. Outline t h e physiological c o n s e q u e n c e s of d i a b e t i c keto acidosis.
Describe the physiological changes that occur In respiratory function during pregnancy.
QUESTION 13
D e s c r i b e the production of c e r e b r o s p i n a l fluid, its role and its f a t e .
QUESTION 14
D e s c r i b e t h e p a t h w a y s w h e r e b y m y o c a r d i a l i s c h a e m i a may be e x p e r i e n c e d as pain in t h e t h r o a t or a r m regions.
QUESTION 15
D e s c r i b e how the kidney e s t a b l i s h e s t h e m e d u l l a r y c o n c e n t r a t i n g gradient.
QUESTION 16
Discuss the physiological causes of early post-operative hypoxaemia.
JULY/SEPTEMBER 2008 QUESTION 1
Outline t h e potential b e n e f i c i a l a n d a d v e r s e effects of isoflurane on t h e c a r d i o v a s c u l a r system (include mechanisms of effect) in patients w i t h ischaemic heart disease.
QUESTION 2
Describe the pharmacokinetic principles of total intravenous anaesthesia using propofol.
QUESTION 3
List the anaesthetic related uses of clonidine. What are the effects of clonidine on the cardiovascular and central nervous system and how are these effects mediated?
QUESTION 4
Briefly outline the pharmacology of ketamine with r e f e r e n c e to its use as an analgesic agent in the post-operative period. O u t l i n e h o w t h e p h a r m a c o k i n e t i c s of m o r p h i n e , b u p i v a c a i n e a n d s u x a m e t h o n i u m differ in t h e n e o n a t e c o m p a r e d to t h e a d u l t . Briefly d e s c r i b e t h e c l i n i c a l implications of t h e s e d i f f e r e n c e s .
QUESTION 5
Outline the ideal properties of a colloid intravenous fluid. Give examples of colloids and briefly describe t h e features of e a c h .
QUESTION 6
QUESTION 7
List the agents used therapeutically to reduce platelet function. Outline their mechanisms of action, adverse effects, mode of elimination and duration of action.
QUESTION 8
What is meant by the term Randomised Controlled Trial (RCT)? What are the strengths and weaknesses of randomized control trial design?
QUESTION 9
What is humidity a n d h o w c a n it b e m e a s u r e d ?
QUESTION 10
D e s c r i b e sepsis a n d d e s c r i b e t h e metabolic c o n s e q u e n c e s of s e p s i s .
QUESTION
11
QUESTION 12 QUESTION
13
QUESTION 14
W r i t e b r i e f notes on t h e physiological changes a s s o c i a t e d
with
sleep.
Detail t h e p r o t e c t i v e a n d regulatory roles o f t h e l i v e r . Explain t h e c o n c e p t of t i m e c o n s t a n t s and r e l a t e t h e s e to " f a s t " and " s l o w " alveoli Explain in physiologic terms the effect of severe aortic stenosis on myocardial supply and demand.
QUESTION 15
Describe the changes that occur with ageing that can affect oxygen delivery to t h e tissues during moderate e x e r c i s e .
QUESTION 16
Outline the mechanisms by which the kidney maintains potassium homeostasis
QUESTION 1 desflurane. QUESTION 2
JULY/AUGUST 2007
Describe the adverse effects that may occur with the admim'stration of
Outline the important pharmacological considerations when stopping warfarin and commendng prophylactic (low dose) low molecular weight heparin (LMWH) in the peri-operative period.
QUESTION 3 Outline the important pharmacological considerations concerning choice of opioid and dosage when converting from intravenous morphine to oral opioid analgesia in the post-operative period. QUESTION 4
A new test called the "intubation score" has a repori:ed 90% sensitivity and 70% spedfidty when used to predict difficult intubation. Describe how this information and other statistics related to this test can be used in predicting difficult intubation. How will the inddence of difficult intubation affect the performance of this test?
QUESTION 5
Describe the factors which increase theriskof systemic toxidty with amide local anaesthetic agents.
QUESTION 6 Describe how suxamethonium produces neuromuscular blockade. What is the mechanism of recovery of neuromuscular function and what mechanisms may be involved in Phase 11 block? QUESTION 7 Outline the mechanisms of action and potential adverse effects of the oral hypoglycaemic agents. QUESTION 8 Write short notes on anti-hypertensive drugs that exert their action via blocking the effects of angiotensin. QUESTION 9
Briefly explain the cardiovascular responses to central neural blockade.
QUESTION 10 Briefly describe the factors that affect the partial pressure of carbon dioxide in mixed venous blood. QUESTION 11
Explain the physical principles of ultrasound imaging.
QUESTION 12 Outline the mechanisms by which the kidney maintains potassium homeostasis. QUESTION 13 Outline the physiology of blood groupings that allows 0 negative blood to be safely transfused to most patients. QUESTION 14
Describe the cardiovascular changes in the neonate that occur at birth.
QUESTION 15
Outline the clinical laboratory assessment of liver function.
QUESTION 16 Draw and label a lead II electrocardiogram (ECG) tradng for one cardiac cycle, indicating normal values. What is the PR interval and what factors influence it?
FEBRUARY/APRIL 2007 Q U E S T I O N 1 Describe the potential adverse effects of administering neostigmine post operatively. Q U E S T I O N 2 After epidural injection i n a health term pregnant woman, discuss the factors influencing the distribution of hupivacaine to (a) the maternal C S F and spinal cord; (b) the maternal circulation; (c) the foetus. Q U E S T I O N 3 Discuss factors contributing to inter-individual variability in the therapeutic response to opioid analgesic medications. Q U E S T I O N 4 Discuss the suitability of ketamine as a total intravenous anaesthetic agent in comparison with propofol. Q U E S T I O N 5 Classify non-opioid drugs used for the treatment of neuropathic pain and indicate proposed mechanisms of analgesic action and potential adverse effects.
Q U E S T I O N 6 Briefly outline the acute management of malignant hyperthermia (during a relaxant general
anaesthetic).
Describe
the
important
aspects
of
dantrolene
pharmacology relevant to treating malignant hyperthermia. Q U E S T I O N 7 Describe the pharmacology of midazolam including its mechanism of action. Q U E S T I O N 8 L i s t the classes of drugs used clinically to treat chronic left ventricidar failure. Outlme their mechanisms of action. Q U E S T I O N 9 Define "Venous Admixture". Briefly explain how venous admixture influences arterial oxygen tension and how an increase in inspired oxygen concentration may effect this. Q U E S T I O N 10 Explain the mechanisms that prevent blood clotting in intact blood vessels (do not draw the clotting cascade). Q U E S T I O N 11
Discuss how the body handles a metabohc acidosis.
Q U E S T I O N 12 E x p l a i n the physiological principles underlyuig the use of peritoneal dialysis in a patient with chronic renal failure with this dialysate solution. Na
132mEq/L
Mg
0.5 m E q / L
K
0 mEq/L
Lactate
40 m E q / L
CI
96 m E q / L
glucose
2.5 g %
Ca
3.5 m E q / L
Q U E S T I O N 13 Describe the determinants of Venous R e t u r n and the effect general anaesthesia woxdd have on these. Q U E S T I O N 14 Explain the mechanisms whereby oxygen transfer is facilitated at the placenta.
Q U E S T I O N 15 Describe the effects of resonance and damping on an invasive arterial blood pressure tracing. Q U E S T I O N 16 Briefly outline the components of parenteral nutrition, explaining the rationale for the use of each component.
FEBRUARY/APBIL
2006
QUESTION 1 Outlme the pharmacologic management of bronchoconstriction i n acute severe asthma. Include mechanisms of action and potential adverse effects. QUESTION 2 What is an isomer? Briefly write an account of the types of isomers and their significance i n drugs used i n anaesthesia. QUESTION 3
List the non-ideal features of nitrous oxide.
QUESTION 4 Describe the pharmacodynamic properties of propofol and how this influences its clinical usage. QUESTION 5 W r i t e short notes on factors affecting the speed of onset and duration of effect of local anaesthetics when used to produce peripheral nerve block. QUESTION 6 Explain the possible mechanisms for prolonged neuromuscular blockade after a four hour procedure using a non-depolarising muscle relaxant. QUESTION 7
Briefly outline the pharmacology of naloxone.
QUESTION 8 I n a clinical trial, why is adequate power important? What factors affect the determination of an adequate sample size? QUESTION 9
Outline the systemic cardiovascular response to exercise.
QUESTION 10 List the physiological factors which increase respiratory rate and include a brief explanation of the mechanism by which each achieves this increase. QUESTION 11
Briefly outline the role of platelets i n haemostasis.
QUESTION 12 Classiiy and describe the main cellular and molecular mechanisms by which chemical neurotransmitters exert their effects. Use examples from cholinergic and adrenergic neurotransmission to illustrate the answer. QUESTION 13
Describe the factors that influence metabolic rate.
QUESTION 14 Explain the physiological processes which cause oliguria i n response to hypovolaemic shock. QUESTION 15 Briefly describe the measurement of p H i n a blood sample using a p H electrode. QUESTION 16 Describe the physiological factors that contribute to the competence and tone of the lower oesophageal sphincter.
JULY/SEPTEMBER 2006 QUESTION 1
Describe the use of different sympathomimetics to treat hypotension occurring as a result of subarachnoid block. Outline the advantages and disadvantages of these agents.
QUESTION 2 Compare and contrast the clinically significant respiratory, cardiovascular and central nervous system effects of desflurane and isoflurane. QUESTION 3
Describe the factors which contribute to the inter-individual variability in drug response seen with intravenous anaesthetic induction agents.
QUESTION 4
Describe the advantages and disadvantages of rocuronium for rapid sequence induction.
QUESTION 5 Briefly explain the mechanisms responsible for non-steroidal anti-inflammatory drug (NSAID) - induced side effects. Outline the advantages and disadvantages of selective cyclooxygenase (COX 2) inhibitors. QUESTION 6
QUESTION 7
A new clinical test called the "intubation score" has a reported 90% sensitivity and 70% specificity when used to predict difficult intubation. Describe how the accuracy, predictive value and clinical utility of this test can be evaluated. How will the incidence of difficult intubation affect the performance of this test? Outline the drug and non-drug treatment of ventricular fibrillation in an adult. Briefly describe their mechanisms of action. (Do not discuss basic life support, airway therapies and oxygen)
QUESTION 8
Describe the pathogenesis and management of paracetamol toxicity.
QUESTION 9
Describe the factors that oppose left ventricular ejection.
QUESTION 10 Describe the determinants of work of breathing in an adult human at rest. QUESTION 11 List the hormones that regulate tubular reabsorption and describe their action and site of action. QUESTION 12 Explain the difference between viscosity and density. Outline the effects of changes in viscosity and density on the flow of gases and liquids. QUESTION 13 Briefly describe the structure of a mammalian skeletal muscle fibre and explain how its structure is related to its contractile function. DO NOT describe excitationcontraction coupling. QUESTION 14 Compare and contrast the physiological effects of a six hour fast of fluids and food with a twenty four hour fast in a healthy adult. QUESTION 15 Explain how a metabolic acidosis develops in hypovolaemic shock. Describe the consequences of this metabolic acidosis for the body. QUESTION 16
Describe the physiological consequences of acute hypoglycaemia.
MARCH/APRIL
2005
QUESTION 1 Classify anti-emetic drugs. Give examples and describe side effects of each class. QUESTION 2 Outline the acute adverse effects of opioid receptor agonists. Describe the mechanisms of the acute adverse effects of opioid receptor agonists. QUESTION 3 What factors might explain the inter-individual variability in drug response seen with intravenous anaesthetic induction agents? QUESTION 4 Outline the mechanisms of action of drugs that inhibit cholinergic transmission at the neuromuscular junction giving examples. QUESTION 5 List the antiplatelet agents and outline their mechanisms of action, adverse effects, mode of elimination and duration of action. QUESTION 6 Briefly outline pharmacological methods of reducing gastric acidity. Indicate the mechanisms of action and the advantages and disadvantages of each method. QUESTION 7 Outline the main biochemical events involved i n noradrenergic transmission. Outline how these may be altered by the use of M A O (mono amine oxidase) inhibitors. QUESTION 8 Outline the pathology of acute anaphylactic reactions with reference to the mediators released and their effects. Outline the role of epinephrine and its mechanisms of action i n treating anaphylaxis. QUESTION 9
Describe the control of gastric emptying.
QUESTION 10
W r i t e brief notes on the physiological changes associated w i t h sleep.
QUESTION 11
Describe how the body detects and responds to a water deficit
QUESTION 12 Describe the physiological factors influencing the carbon dioxide tension i n arterial blood. QUESTION 13
Describe the non-respiratory functions of the lung.
QUESTION 14 Describe the compensatory mechanisms i n a fit person moving from the supine to the standing position. QUESTION 15
Discuss how the body handles a metabolic acidosis.
QUESTION 16 Briefly explain the principles of Doppler ultrasound used to measure cardiac o u t p u t
TULY/AVGVST 2005 QUESTION 1 Describe how isoflurane is metabolised. I n your answer give reasons why the overall extent of metabolism of isoflurane is so low. QUESTION 2 Using opioids as examples describe and illustrate with graphs what you understand by the terms "potency", "efficacy", "partial agonist", "competitive antagonist", and "therapeutic index". QUESTION 3 Write brief notes on the physico-chemical properties of lidocaine (lignocaine). QUESTION 4 Define die term 'context -sensitive half time'. How does i t differ from the half life typically quoted for a drug? Illustrate this concept by comparing thiopentone vs. propofol and fentanyl vs. remifentanil. QUESTION 5 Outline the advanced life support management of ventricular fibrillation i n an adult including the mechanisms of action and potential adverse effects of these therapies. (Do not discuss basic life support, airway therapies and oxygen). QUESTION 6
Describe the therapeutic and unwanted effects of dexamethasone.
QUESTION 7 Briefly outline the pharmacology of droperidol, emphasising
its mechanism
of action,
perioperative use and side effects. QUESTION 8
Describe the adverse effects of beta adrenoreceptor antagonists.
QUESTION 9 Describe the gravity dependent processes which affect pulmonary blood flow. What changes take place when the pressure increases in the pulmonary vessels? QUESTION 10 Describe the forces acting across the glomerular capillary membrane. Explain how afferent and efferent arteriolar tone affect glomerular filtration rate. QUESTION 11
Outline the principles of compatibility testing of blood for transfusion.
QUESTION 12
Briefly discuss the physiological roles of plasma proteins.
QUESTION 13 Explain how cardiac output is measured using a thermodilution technique. QUESTION 14 Describe the processes of excitation and contraction within smooth muscle cells. QUESTION 15 Describe the autonomic innervation of the heart and the direct effect of autonomic stimulation on cardiac function. QUESTION 16 Explain the changes on Functional Residual Capacity (FRC) that take place with administration of anaesthesia.
FEBRUARY/MARCH
2004
QUESTION 1 Describe the effects of isoflurane on intracranial metabolism, intracranial haemodynamics, intracranial pressure and the EEG. QUESTION 2 Outline factors determining speed of onset of neuromuscular blocking agents. QUESTION 3 Briefly describe the factors that determine skin penetration by local anaesthetics. Briefly describe the formulation and pharmacology of E M L A cream. QUESTION 4
Outline the effects of an opioid injected into the spinal intrathecal space.
QUESTION 5
Outline the effects of liver failure on drug kinetics and dynamics.
QUESTION 6
Outline the circulatory effects of glyceryl trinitrate.
QUESTION 7
Describe the mechanisms of action of inotropes and provide examples.
QUESTION 8
Describe briefly the side effects and complications of heparin therapy.
QUESTION 9 Briefly outline the differences between the pulmonary circulation and the systemic circulation. QUESTION 10 Describe the vasoactive substances released by the endothelium. Explain the role they play in regulating blood flow through the peripheral circulation. QUESTION 11 What is 2,3 DPG? How is i t produced in the red blood cells and how does i t mteract with haemoglobin? What is its relevance in altitude exposure, anaemia, and stored blood? QUESTION 12 What are the physiological consequences of decreasing functional residual capacity by one litre in an adult? QUESTION 13 Describe the concept of renal clearance and its use to estimate glomerular filtration rate. QUESTION 14 Briefly describe the difference between laminar and turbulent flow. List the factors that increase the probability of turbulent flow. QUESTION 15 List the physiological factors that determine intracranial pressure. Explain briefly how intracranial pressure is regulated. QUESTION 16 Explain how the kidney handles glucose. Describe the physiological consequences of glycosuria.
JULY/AUGUST2004
QUESTION 1
Briefly describe how drugs produce their pharmacological effects. Illustrate each mechanism with examples.
QUESTION 2
Write a brief description of the pharmacology of ropivacaine.
QUESTION 3 blocking drugs.
List the effects of histamine. Write a brief outline on the pharmacology of the H j
QUESTION 4
Write short notes on tramadol.
QUESTION 5
statistics
QUESTION 6
Compare and contrast neostigmine and the organophosphorus compounds.
QUESTION 7
Outline the factors which influence the elimination half-life of propofol.
QUESTION 8 List the classes of drugs used clinically to treat chronic left ventricular failure. Outline their mechanisms of action. QUESTION 9 Describe how carbon dioxide is produced i n the body. How does i t move from the site of production to the pulmonary capUlary? QUESTION 10 List the physiological factors which affect left atrial pressure and explain their effects. QUESTION 11 Briefly explain how oximetry can be used to estimate the partial pressure of oxygen i n a blood sample. QUESTION 12
Briefly describe the secretion and functions of renin and angiotensin.
QUESTION 13
Describe the functions of the gastric secretions.
QUESTION 14 Briefly describe the difference between a single twitch and a tetanic contraction i n a skeletal muscle fibre. Include i n your answer the physiological basis for the development of a tetanic contraction. QUESTION 15
Describe the mechanism of action of G-proteins i n the cell.
QUESTION 16 Explain the physiological processes involved i n the development of interstitial oedema.
MARCH/APRIL
2003
QUESTION 1 Briefly outline the effects of isoflurane on skeletal, smooth and cardiac muscle tissues. Indicate how these effects are mediated and their clinical significance. QUESTION 2 Outline the neuropharmacology of thiopentone, covering only its site of action, EEG changes, effects on cerebral blood flow and intracranial pressure. QUESTION 3
Explain how lignocaine prevents the conduction of a nerve action potential.
QUESTION 4 Outline the potential problems associated with additives used to make medicines suitable for intravenous injection. QUESTION 5 Outline the important statistical issues in designing a study to compare the duration of analgesia of two drugs given for post-operative pain relief. QUESTION 6 Explain how differences in the pharmacokinetics of alfentanil and fentanyl can influence the way they are administered intravenously. QUESTION 7
Classify diuretics, briefly explaining their mode of action.
QUESTION 8 Describe the onset and offset of neuromuscular block at the diaphragm, larynx and adductor poUicis after administration of 2.5 x ED95 dose of vecuronium. Comment on the differences observed. What are the clinical implications of these differences? QUESTION 9
Explain the role of haemoglobin as a buffer.
QUESTION 10
Describe the factors influencing hepatic blood flow.
QUESTION 11 Define the "thermoneutral zone". Briefly explain how the body regulates temperature when the ambient temperature exceeds thermoneutral zone. QUESTION 12 Explain the mechanisms that maintain cerebral blood flow on moving from a supine to a standing position. QUESTION 13 Briefly describe the principles and sources of error i n the measurement of systemic arterial blood pressure using an automated oscillometric non-invasive monitor. QUESTION 14
Describe the factors that affect lung compliance.
QUESTION 15
Describe the physiological actions of thyroid hormones.
QUESTION 16 Describe the functions of the loop of Henle, including the physiological mechanisms involved.
JULY/SEPTEMBER
2003
QUESTION 1 Draw and label, on the same X - Y axis, F A / F I curves for the following halothane concentrations in oxygen, showing a 30 minute period from starting administration. (a) Halothane 1 % , subject breathing spontaneously. (b) Halothane 6%, subject breathing spontaneously. (c) Halothane 6%, subject paralysed and ventilated. W i t h reference to the major factors determining the shape of F A / F I curves explain the differences between A and B, and A and C. QUESTION 2 Describe the potential interactions of sevoflurane, desflurane and isoflurane w i t h carbon dioxide absorbents. QUESTION 3 Outline GABA's role as a neuro transmitter and indicate how its actions may be modified by pharmacological agents. QUESTION 4 Describe how a computer-controlled infusion device targets and maintains constant blood concentrations of propofol. QUESTION 5 Describe the pharmacological effects of paracetamol. Oufline its toxicity and management. QUESTION 6 List the potential clinical uses of an alpha-2 adrenoceptor agonist and outline the limitations of clonidine for each. QUESTION 7 Write short notes on factors affecting the speed of onset and duration of effect of local anaesthetics when used to produce peripheral nerve block. QUESTION 8 Outline the pharmacological differences between neonates and adults with reference to sevoflurane, vecuronium and morphine. QUESTION 9 Describe the effects of tachycardia on myocardial oxygen supply and demand i n a normal h e a r t QUESTION 10
Describe the role of baroreceptors i n the control of systemic arterial pressure.
QUESTION 11 Briefly describe the potential causes of a difference between measured end-tidal and arterial partial pressure of carbon dioxide. QUESTION 12 Explain the difference between perfusion limitation and diffusion limitation in the transfer of gas between alveolus and pulmonary capillary. Outline the factors that determine whether gas transfer is perfusion or diffusion limited. QUESTION 13
Describe the factors that affect airways resistance.
QUESTION 14
Oufline the role of the kidney i n the regulation of body water.
QUESTION 15 Briefly describe the N M D A (N-methyl d-aspartate) receptor and its physiological role i n the central nervous system. QUESTION 16 Outline the mechanism of secretion of hydrochloric acid by the stomach. Briefly describe how secretion of hydrochloric acid by the stomach is controlled.
MARCH/APRIL
2002
QUESTION 1 Explain how oxygen supply of organs is maintained during isovolaemic haemodilution. QUESTION 2 Draw a labelled diagram of a cardiac muscle action potential highlighting the sequence of changes in ionic conductances. Explain the terms "threshold", "excitability", and "irritabOity" with the aid of the diagram. QUESTION 3 Define "Venous Admixture". Briefly explain how venous admisture influences arterial oxygen tension and how an increase in inspired oxygen concentration may affect this. QUESTION 4 Outline the physiological factors that influence pulmonary vascular resistance. QUESTION 5 Outline the factors contributing to the generation and maintenance of the resting membrane potential. QUESTION 6 Explain the physiological processes which cause oliguria in response to hypovolaemic shock QUESTION 7 Outline the principles of a pneumotachograph. What factors affect the accuracy of this device? QUESTION 8 Describe the physiological factors that contribute to the competence and tone of the lower oesophageal sphincter. QUESTION 9
Outline the toxicity of local anaesthetics.
QUESTION 10 Outline the factors that determine recovery (offset of action) after ceasing a drug infusion. QUESTION 11 Briefly outline the effects of thiopentone and ketamine not mediated via the central nervous system. QUESTION 12 Outline the mechanism of action of non-steroidal anti-inflammatory drugs and their potential adverse effects. QUESTION 13 What are the side effects of amiodarone and what problems may develop during concurrent anaesthesia. QUESTION 14 Briefly oufline pharmacological methods of reducing gastric acidity. Indicate the mechanisms of action and the advantages and disadvantages of each method. QUESTION 15 Describe the mechanism of the anticoagulant effect of coumarin derivatives and what determines the onset and offset of effect QUESTION 16
Briefly outline the pharmacology of flumazenil.
JULY/SEPTEMBER
QUESTION 1
2002
Outline the influences of pregnancy on pharmacokinetics.
QUESTION 2 Briefly describe the factors affecting the uptake of orally administered medicines. QUESTION 3 Draw a graph comparing the ratio of inspired to alveolar concentrations during the first half hour of administration for nitrous oxide, isoflurane, and halothane. Outline reasons for observed differences between the agents and indicate the effects of increases in alveolar ventilation and cardiac output QUESTION 4 Briefly outline the potential interactions between volatile agents and carbon dioxide absorbents.
QUESTION 5 Oufline the possible reasons for prolongation of paralysis induced by an intravenous dose of 1 mg.kg"^ of suxamethonium. Briefly indicate the consequences of such a prolonged block. QUESTION 6
Write brief notes on tolerance and dependence in relation to opioid analgesics.
QUESTION 7 Outline the potential pharmacological advantages and disadvantages of intra-operative betablockade. QUESTION 8
Outline the pharmacological effects of vasopressin.
QUESTION 9 Draw a pressure volume loop for the left ventricle i n a normal adult. Outline the information that can be obtained from such a loop. QUESTION 10 List the physiological factors which increase respiratory rate. Include a brief explanation of the mechanism by which each achieves this increase. QUESTION 11
Outline the factors that determine coronary vascular resistance.
QUESTION 12
Briefly explain the changes that occur in stored whole blood.
QUESTION 13
Briefly describe the functions of renin and angiotensin.
QUESTION 14
Explain the physical principles of ultrasound imaging.
QUESTION 15
Give a brief account of the mechanisms which regulate gastric secretion.
QUESTION 16
Explain the Bohr and Haldane effects in trans-placental gas exchange.
AUGUST/SEPTEMBER
2001
QUESTION 1 Explain the effects of intermittent positive pressure ventilation on left ventricular o u t p u t QUESTION 2 Describe the determinants of work of breathing in an adult human at rest QUESTION 3
Describe the fuel sources used during early and sustained fasting in man.
QUESTION 4 Describe the physiological changes that occur in respiratory function during pregnancy. QUESTION 5
Describe the structure and function of voltage gated ion channels.
QUESTION 6 Explain how the kidney handles glucose. Describe the physiological consequences of glycosuria. QUESTION 7 Explain the main difference between the intrinsic and extrinsic pathways of coagulation. QUESTION 8 Explain the physiological processes involved in the development of interstitial oedema. QUESTION 9 What do you understand by the term "clearance". Using propofol as an example, explain briefly the importance of clearance. QUESTION 10
Briefly describe the adverse effects of nitrous oxide.
QUESTION 11 Describe the required pharmacological characteristics of local anaesthetic formulations intended for topical use. QUESTION 12
Outline the effects of an opioid injected into the spinal intrathecal space.
QUESTION 13 Compare and contrast neostigmine and the organophosphorus compounds. QUESTION 14
Outline the direct effects of endogenously released histamine.
QUESTION 15 Oufline the potential benefits and disadvantages of peri-operative beta-blockade.
QUESTION 16 Briefly describe correlation and simple linear regression, and explain their differences. What assumptions are common to both?
MARCH/APRIL QUESTION 1
2001
Outlme the determinants and regulation of extracellular fluid volume.
QUESTION 2 Briefly describe the effect of resting muscle length and load conditions on the tension generated by a skeletal muscle. How do these factors affect the velocity of shortening? QUESTION 3
Briefly describe the measurement of p H in a blood sample using a p H electrode
QUESTION 4 Indicate the sequence of the physiological changes to the fetal circulation at birth and briefly describe the mechanisms which account for these changes. QUESTION 5 Explain briefly the role of the skin i n maintaining a normal body temperature. QUESTION 6 Describe the substances released by the endothelium. Explain the role they play in regulating blood flow through the peripheral circulation. QUESTION 7
Describe how the body detects and responds to water deficit.
QUESTION 8 What are the physiological consequences of decreasing functional residual capacity by one litre in an adult? QUESTION 9 Briefly describe how drugs may produce their pharmacological effects. Illustrate each mechanism with examples. QUESTION 10 Outline GABA's role as a neurotransmitter and indicate how its actions may be modified by pharmacological agents. QUESTION 11 Define the term "context -sensitive half time". How does this differ from the elimination half life? Illustrate your answer by comparing thiopentone vs. propofol and fentanyl vs. remifentanil. QUESTION 12
Briefly describe the respiratory effects of the volatile agents.
QUESTION 13 Outline the NON-ideal features as an intravenous induction agent of the current formulations of propofol. QUESTION 14 Give examples of drugs that enhance the action of the non-depolarising neuromuscular blocking agents at the neuromuscular junction. Briefly describe the mechanism of these interactions. QUESTION 15
Compare and contrast the pharmacology of esmolol and propranolol
QUESTION 16
Describe the use of the null hypothesis and the P-value in a drug trial.
JULY/AUGUST QUESTION 1
2000
Describe the role of baroreceptors in the control of arterial pressure.
QUESTION 2 Briefly describe the principles and sources of error in the measurement of arterial blood pressure using an automated oscillometric non-invasive monitor. QUESTION 3 Draw an expiratory flow volume curve for a forced expiration from total lung capacity. Describe its characteristics in people with normal lungs, as well as those with obstructive and restrictive lung disease. QUESTION 4 Outline the principles of compatibility testing of allogeneic (homologous) blood for transfusions. QUESTION 5 Briefly discuss the relationship between structure and function in skeletal muscle. QUESTION 6
Briefly oufline the physiological control of intraocular pressure.
QUESTION 7
Outline the actions of insulin that affect fat metabolism.
QUESTION 8
Describe the factors governing glomerular filtration rate.
QUESTION 9 What is an isomer? Briefly write an account of the types of isomers and significance in drugs used in anaesthesia. QUESTION 10
Qassify diuretics giving examples and briefly explaining their action.
QUESTION 11
Describe the structure and function of G proteins.
QUESTION 12 Explain how differences in the pharmacokinetics of alfentanil and fentanyl can influence the way they are administered intravenously. QUESTION 13 Write short notes on factors affecting the speed of onset and duration of local anaesthetics when used to produce peripheral nerve block. QUESTION 14 Write short notes contrasting the cardiovascular effects of propofol and ketamine seen clinically. QUESTION 15
Write brief notes on latex aUergy.
QUESTION 16 Compare and contrast the pharmacology of atracurium and cis-atracurium.
MARCH/APRIL
2000
QUESTION 1 Explain how cardiac output is measured using a thermodilution technique? QUESTION 2 Briefly describe the factors that influence the partial pressure of oxygen in mixed venous blood? QUESTION 3 What is a normal value for pulmonary vascular resistance? Oufline physiological factors that influence pulmonary resistance. QUESTION 4 Briefly describe the difference between a single twitch and tetanic contraction in a skeletal muscle fibre. Include in your answer the physiological basis for the development of a tetanic contraction. QUESTION 5 Describe the important determinants of work of breathing in an adult human at rest. Explain how to minimise work of breathing. QUESTION 6
Describe the control of gastric emptying.
QUESTION 7 List the hormones that regulate renal tubxilar reabsorption and describe their action and site of action. QUESTION 8
Briefly describe the breakdown of haemoglobin after red cell lysis.
QUESTION 9 Compare and contrast the effects of halothane and isoflurane on the heart. QUESTION 10 Briefly describe the pharmacological effects of paracetamol. Outline the mechanisms of its toxicity. QUESTION 11 Oufline the main biochemical events involved in noradrenergic transmission, and how these may be altered by the use of M A O (mono amine oxidase) inhibitors ? QUESTION 12
Outline the pharmacology of oxytocin.
QUESTION 13 Briefly describe correlation and simple linear regression, and explain their differences. What assumptions are common to both? QUESTION 14
Discuss the roles of plasma esterases on drugs used i n anaesthesia.
QUESTION 15
Describe the effects of opioids on the respiratory system.
QUESTION 16 Briefly describe the factors that determine skin penetration by local anaesthetics. What is an eutectic mixture? Briefly describe the formulation and pharmacology of EMLA® cream.
JULY/AUGUST
1999
QUESTION 1 How does a fall in temperature influence blood gas solubility and acid base values? QUESTION 2 What physiological factors contribute to the competence and tone of the lower oesophageal sphincter? QUESTION 3
Describe the factors that affect airway resistance.
QUESTION 4
Outline the role of the kidneys in the regulation of body water.
QUESTION 5
Describe the ways i n which C O 2 is carried in the blood.
QUESTION 6 Explain the mechanisms that maintain cerebral blood flow on moving from a supine to a standing position. QUESTION 7 Describe how the partial pressure of oxygen in a blood sample is measured using a Clark electrode. QUESTION 8 Draw both aortic root and a radial artery pressure wave forms on the same axes. Explain the differences between them. QUESTION 9 What is meant by " 9 5 % confidence interval"? Explain the practical applications of confidence intervals and indicate why they may be preferred to P-values? QUESTION 10 Outline factors determining speed of onset of neuromuscular blocking agents. QUESTION 11
Outline the toxicity of local anaesthetics.
QUESTION 12 Briefly describe the mechanism and treatment of the toxicity of sodium nitroprusside. QUESTION 13 Using opioids as an example describe and illustrate with graphs what you understand by the terms "potency", "efficacy", "partial agonist", "competitive antagonist", and "therapeutic index". QUESTION 14 Briefly outline the effects of intravenous induction agents not mediated via the central nervous system. QUESTION 15 Briefly describe the preparation of oxygen for medical use. List the physical properties of oxygen. Outline the potential adverse effects associated with its medical use. QUESTION 16 Outline the factors that determine recovery (offset of action) after ceasing a drug infusion.
MARCH/APBIL1999
QUESTION 1
Explain the Bohr and Haldane effects i n trans-placental gas exchange.
QUESTION 2 Explain the mechanisms that prevent blood clotting in intact blood vessels (do not draw the clotting cascade). QUESTION 3 Describe the factors that affect the transport of oxygen and carbon dioxide from the alveolus to blood. QUESTION 4 Explain how the kidney handles glucose. Describe the physiological consequences of glycosuria. QUESTION 5 Differentiate between the terms "heat" and "temperature". Explain briefly the principles of a mercury thermometer, indicating its advantages and disadvantages. QUESTION 6
Describe the factors influencing hepatic blood flow.
QUESTION 7 Describe the autonomic innervation of the heart, and the direct effect of autonomic stimulation on cardiac function. QUESTION 8 Explain the significance of plasma oncotic pressure i n capillary fluid dynamics. QUESTION 9 I n a clinical trial, why is adequate power important? What factors affect the determination of an adequate sample size? QUESTION 10
Write a brief oufline on the pharmacology of remifentanil.
QUESTION 11 Briefly compare and contrast the clinical pharmacology of atropine, hyoscine (scopolamine) and glycopyrrolate.
QUESTION 12 Explain the phenomena known as fade and post tetanic facilitation associated with the use of neuromuscular blocking agents.
QUESTION 13 Describe the neuropharmacology of thiopentone covering its site of action, E E G changes, effects on cerebral blood flow and intracranial pressure.
QUESTION 14 Briefly oufline the pharmacological effects of the volatile anaesthetic agents on the kidneys.
QUESTION 15 List the drugs used clinically as anticoagulants and antithrombotics. Write short notes on their mechanisms of actions.
QUESTION 16 Describe the effects of the alpha-2 adrenoceptor agonists relevant to anaesthesia.
MAKCH/APML1998 QUESTION 1
E x p l a i n the effects of intermittent positiA'e pressure ventilation on left ventricular o u t p u t
QUESTION 2
QUESTIONS
QUESTION 4
QUESTION 5
QUESTION 6
QUESTION 7
QUESTION 8
D r a w a flow/volume curve for a maximally forced expiration in a person with healthy lungs from a) Total lung capacity b) Function Residual capacity Ex-plaiu your curves Briefly describe the structure of a mammalian skeletal muscle fibre and explain how its structure is related to its contractile function. D O N O T describe excitation-contraction coupling.
Briefly explain the principles of Doppler ultrasound used to measure cardiac output using echocardiography.
D e s c r i b e the factors g o v e r n i n g g l o m e r u l a r filtration r a t e .
HoAV does a fall i n temperature Influence blood gas solubilit>^ and acid base values?
O u t l i n e the actions of i n s u l i n t h a t affect fat metabolism.
B r i e f l y describe the N M D A ( n - m e t h y l d-aspartate) receptor a n d its physiological role i n the central nervous system
QUESTION 9
L i s t the effects of histamine. Write a brief outline on the pharmacology of the H i blocking drugs.
Q U E S T I O N 10
Outline the NON-ideal features as an intravenous induction agent of the current preparation of propofol.
Q U E S T I O N 11
Briefly describe the pharmacological implications of the administration of a single dose of gentamycin during anaesthesia.
Q U E S T I O N 12
Classify' the drugs "which are useful for reducing the volume and acidity' of gastric contents, giving an outline of the mechanism of effect for each group.
Q U E S T I O N 13
OutUne the factors that determine r e c o v e r y (offset o f action) after ceasing a d r u g infusion.
Q U E S T I O N 14
D i s c u s s the use of different vasoconstrictors to t r e a t hypotension o c c u r r i n g as a result o f subarachjnoid block.
Q U E S T I O N 15 Q U E S T I O N 16
C o m p a r e the m e t a b o l i s m of sttxamethontum to t h a t of a t r a c u r i u m . Outline the potential for methox)'flurane and sevoflurane to produce toxic effects on the kidney.
AUGUST/SEPTEMBER
1998
QUESTION 1
Describe the concept of renal clearance and its use to estimate glomerular filtration rate.
QUESTION 2
Describe the compensator^' mechanisms in a fit person moving from the supine to the erect position.
QUESTION 3
QUESTION 4 QUESTION 5
QUESTION 6 QUESTION 7
QUESTION 8 QUESTION 9
Q U E S T I O N 10
Describe the process of tubuloglomendar
feedback.
Explain the physical principles of ultrasound imaging Explain how a metabolic acidosis develops in hypovolaemic shock. Describe the consequences of this metabolic acidosis to the body. Briefly discuss the physiological roles of plasma proteins. Briefly describe the structure of mitochondria. Outline the metabolic processes that occur in mitochondria. Briefly describe the factors that affect airway resistance.
Write short notes contrasting the cardiovascular effects of propofol and ketamine seen clinically. Describe the sites of action of antiemetic agents used for postoperative nausea and vomidng.
Q U E S T I O N l l D e s c r i b e briefly the acute unwanted effects of the opioid agonist drugs.
Q U E S T I O N 12
Q U E S T I O N 13
Q U E S T I O N 14
Q U E S T I O N 15
Briefly describe the correlation and simple linear regression, and explain their differences. What assumptions are common to both? Draw and explain the characteristics of a log dose - response cun'e that describes tlie major clinical effect of vecuronium. List factors encountered in clinical practice that may alter this cun'e. Outline the cheraistrj' of heparin. Describe its mechanism of action and list its toxic effects.
Describe the pbarmacologj' of ropi^'acaine and explain why it may be considered a safer agent than bupivacaine.
Q U E S T I O N 16Write brief notes on latex allergy.
AUGVST/SEPTEMBEIl, QUESTION 1
QUESTION 2
1997 E x p l a i n the local effects of a decrease in plasma colloid osmotic pressure in a skeletal muscle capillary bed.
D e s c r i b e the m e c h a n i s n i o f action o f G - p r o t e i n s i n the cell.
QUESTION 3
L i s t the physiological factors which determine intracraniai pressure and explain briefly how it is regulated.
QUESTION 4
Briefly describe the influence of general anaesthesia on intraoperative temperature regulation.
QUESTION 5
QUESTION 6
B r i e f l y describe the c o m p l e m e n t system.
Briefly describe the difference bet^veen laminar and turbulent flow. L i s t the factors that increase the probability of turbulent flow.
QUESTION?
E x p l a i n the factors influencing the distribution of ventilation during the inhalation of 500 ml of air from Functional Residual Capacity in the erect posture.
QUESTION 8
Indicate the sequence of the physiological changes to the fetal circulation at birth and briefly describe the mechanisms which account for these changes.
QUESTION 9
L i s t the properties of an ideal intravenous anaesthetic T o what extent does methohexifone conform to this ideal?
Q U E S T I O N 10
Describe the ideal phai-macological characteristics of local anaesthetic agents a n d formulation intended for topical use, including their clinical applications.
Q U E S T I O N 11
G i v e examples of drugs that enhance the action of the non-depolarising neuromuscular blocking agents at the neuromuscular junction. Briefly describe the mechanisms of their action.
Q U E S T I O N 12
Q U E S T I O N 13 Q U E S T I O N 14
Outline the mechanism of action of non-steroidal anti-inflammatorj' drugs a n d (heir potential adverse effects. I n a clinical trial, why is adequate power important? WTiat factors affect the determination of a n adequate sample size? C o m p a r e a n d c o n t r a s t the effects on the heajrt of h a l o t h a n e a n d
isoflurane Q U E S T I O N 15 Q U E S T I O N 16
B r i e f l y outline the p h a r m a c o l o g y of naloxone Describe the location a n d function of dopamine receptors. G i v e some examples of agonist and antagonist drugs.
MARCH/APmi,
1997
QUESTION 1
Describe the structure and function of voltage sensitive ion channels.
QUESTION 2
Describe the gravit}'^ dependent processes which affect pulmonarj' blood flow. W h a t changes take place when the pressure increases in the pulmonary vessels?
QUESTION 3
Describe the role of haemoglobin in the carriage of carbon dio.xide in die blood.
QUESTION 4
QUESTION 5
QUESTION 6
QUESTION 7
QUESTION 8
QUESTION 9
Wix^t factors oppose gastro oesophageal reflux?
W h a t is saltatory conduction and what are the advantages of this type of conducdon? Briefly outline the role of platelets i n haemostasis
Compare the effect on arterial blood carbon dioxide and oxygen levels of ventilation/perfusion inequalities.
L i s t the determinants of coronai-j^ arterj' blood flow. Briefly compare phasic coronary blood flow in the left and right coronarj' arteries.
Briefly describe the phannacological role of the nicotinic cholinerginic receptor.
Q U E S T I O N 10
W h a t do you understand by the term "clearance"? Using propofol as an example, explain briefly th& importance of clearance.
Q U E S T I O N 11
Outline the main biochemical event involved in noradrenergic transmission, and how these may be altered by the use of JVIAQ (mono amine oxidase) inhibitors.
Q U E S T I O N 12
Briefly describe the pharmacological actions of the anti-cholinesterases with reference to edrophonium, neostigmine and the organophosphorus compounds. Indicate the similarities and differences with the 3 drugs.
Q U E S T I O N 13
L i s t the physico-chemical characteristics of bupivac^aine. Explain how they influence its pharmaco-dynamic effects at the site of administration.
Q U E S T I O N 14
What is meant by ^'95% confidence interval"? Explain the practical applications of confidence inten'als and indicate why they may be preferred to p-values.
Q U E S T I O N 15
Briefly write an account of the d r u g factors that m a y predispose to thrombophlebitis.
Q U E S T I O N 16
Discuss the possible effect of volatile inhalational anaesthetic agents on the liver.
MARCH/APRIL,
1996 PHYSIOLOGY
QUESTION 1
QUESTION 2
L i s t the n o r m a l values ix»r mixed venous blood gases and explain briefly the factors d e t e r m i n i n g m i x e d venous oxygen tension. Briefly describe the measurement of blood pressure using an automated oscfliometric non-invasive blood pressure monitor. Briefly oufline the problems of this tj'pe of monitor.
QUESTION 3
Draw a pressure-volume loop for a left ventricle in a healthy adult and state the normal pressures and volumes. Outline the information which can be obtiiined f r o m a pressure-volume loop and how such a loop can be constructed.
QUESTION 4
Outline the factors contributing to the generation and maintenance of the resting membrane potential.
QUESnON 5
Compare the effects of a six hour fast from fluids and food w i t h those of a twenty four hour fast in a healthy adult-
QUESTION 6
Define thermoneutral zone. Briefly explain how the body regulates temperature when the ambient temperature exceeds the thermoneutral zone.
QUESTION 7
I n the diagram below indicate how the solvent and solute move across the semipermeable membrane and give a brief explanation of the principles involved. BLOOD Potassium (6.5 mwol-L"')
Urea (40 mmol-L"')
Osmolalit}' (320 mosmoLL"^)
Pressure (100 mmHg)
SEMIPERMEABLE MEMBRANE DIALYSATE Potassium (3.5 mmol.L"^) QUESTION 8
Urea (0 mmol.L'')
Osmolalitj' (346 mosmoLL"^)
Pressure (10 mm'Hg)
List the physiological factors which determine intracranial pressure and explain briefly how i t is controlled.
PHARMACOLOGY QUESTION 9 Q U E S T I O N 10 Q U E S T I O N 11 QUESTION 12 Q U E S T I O N 13
D e s c r i b e b r i e f l y t h e c e n t r a l n e r v o u s system effects o f i s o f l u r a n e . Describe briefly the mechanism of action of dantrolene. List its adverse effects and oufline its uses in anaesthesia. Describe briefly the pharmacokinetics of pethidine. Define M A C and outline the factors which influence i t Briefly e.xplain MAC-hoar, MAC-awake, and M A C - b a r and the application of these terms. Describe briefly the factors determining transdermal uptake o f drugs and give some examples of drugs which can be administered by the transdermal route. Briefly' outline the advantages and disadvantages of transdermal adnunistradon of drugs.
Question 14 statistics Q U E S T I O N 15 QUESTION 16
Describe b r i e f l y the p h a r m a c o l o g ) ' of adenosine and its p o t e n t i a l uses i n anaesthesia Define therapeutic index and briefly outline its significance. Describe briefly also the therapeutic ratio and the use of the cardiac/ens toxicity' ratio (ens = central nervous system).
AUGUST/SEPTEMBER, QUESTION 1
QUESTION!
1996
E x p l a i n briefly the physiological mechanisms whereby an action potential arriving at a synapse might not be conducted. E x p l a i n briefly the role o f the s k i n in m a i n t a i n i n g a n o r m a l body temperature.
QUESTIONS
Explain briefly the effects of intermittent positive pressure ventilation on left ventricular output.
QUESTION 4
Explain briefly the mecham'sms that maintain cerebral blood flow on moving from a supine to a standing position.
QUESTION 5
E x p l a i n briefly how oxygenation of organs c a n be maintained d u r i n g isoA'olaemic haemodilution.
QUESTION 6
QUESTION 7 QUESTION 8
Draw a respiratory Clow/volume loop and outline how it is obtained. Briefly explain the physiological mechanisms involved in the concept of flow limitation. E x p l a i n briefly the causes of differences between measured end-tidal and arterial partial pressures of carbon dioxide. Briefly explain how an "oxj'gen debt" arises and how the body deals with it.
Question 10 statistics QUESTION 9
B r i e f l y explain the factors w h i c h determine the d u r a t i o n of effect of intravenously administered bolus doses of fentanyl.
Q U E S T I O N 11 Q U E S T I O N 12
Briefly outline the effects of the volatile Inhalational agents on muscle tissues, indicating postulated mechanisms and clinical significance Briefly describe how drugs may produce their pharmacological effects. Illustrate each mechanism "vvith examples.
Q U E S T I O N 13 Q U E S T I O N 14
Outline briefly the pharmacokinetics and pharmacodynamics of lignocaine. O u t l i n e briefly the p b a r m a c o l o g j ' of o.xj'tocin.
Q U E S T I O N 15
Briefly give an account of the pharmacological methods of reducing gastric acidity. Indicate the mechanisms and their advantages and disadvantages.
Q U E S T I O N 16
Outline briefly the possible reasons for prolongation of paralysis induced by an intravenous dose of 1 mg.kg"^ of suxamethonium. Briefly indicate the consequences of such a prolonged block.
AUGUST/SEPTEMBER
1995
PHYSIOLOGY Q U E S T I O N 1: Define "Venous A d m i x t u r e " . Briefly explain how venous admixture influences arterial oxygen tension, and how an increase in inspired oxygen concentration may affect this. Q U E S T I O N 2: E x p l a i n the physiological processes which cause oliguria in response to hypovnlaemic shock. QUESTIONS: Briefly outline the differences between the pulmonar)' circulation and flie systemic circulation Q U E S T I O N 4: Draw a labelled diagram of a cardiac muscle action potential highlighting the sequence of changes in ionic conductances. Explain the terms "threshold", "excitabUitj'", and "irritability" >Yith the aid of the diagram. Q U E S T I O N 5; Outline the effects of intravenously administering 500 ml of 20% mannitol, and the potential problems associated with its use. Q U E S T I O N 6: L i s t the physiological factors which deternune intracraiual pressure and explain briefly how it is controlled. QUESTION?; Briefly differentiate betsveen the terms "heat" and "temperature", explain briefly the prmciples of a thermistor indicating its advantages and disadvantages.
QUESTIONS: Outline the physiological consequences of hj'perosmolar diabetic keto acidosis Q U E S T I O N 9: List the physiological factors which increase respirator}' rate and include a brief explanation of the mechanism by which each achieves this increase.
Q U E S T I O N 10: Briefly explain the changes that occur in stored whole blood.
AUGUST/SEPTEmER
1995
PHARMACOLOGY
Q U E S T I O N 1; Describe the clearance of drugs by the kidney.
Q U E S T I O N 2: Briefly describe the pharimacological effects of paracetamol. List its clinical indications and outline the mechanisms for its toxicity.
Q U E S T I O N 3: Give a brief account of drug protein binding and outline its significance. Q U E S T I O N 4; Outline the chemistry of heparin. Describe its mechanism of action and Ust its toxic effects. QUESTIONS: Briefly outline the effects of the volatile agents on muscle tissues. Include a description of how these effects are mediated and their cUnical significance. Q U E S T I O N 6: Outline the influence of pregnancy on pharmacokinetics. Question 7 Statistics Q U E S T I O N 8: Oufline the factors that determine recover}' (offset of effect) after ceasing a drug Infusion. Explain the relevance of a drug's elimination half time. Q U E S T I O N 9: Using opioids as examples, describe and illustrate vs'ith graphs what you understand by the terms "potency", "efficacy", "partial agonis", "competitive antagonist", and "therapeutic index". Q U E S T I O N 10: Draw a graph comparing the ratio of inspired to alveolar concentrations during thefii-sthalf hour of administration for nitrous oxide, isoflurane, and halothane. Outline the reasons for the obsen'ed differences between the agents and indicate the effects of non concurrent increases in alveolar ventilation and cardiac output.
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