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PHYSIOLOGY FRCA > Pastest > Flashcards

Pastest Flashcards

1
Q

What is normal result of csf?
Including pH , glucose, chloride , protein and osmolality

A

pH 7.33
Glucose 3mM
Chloride 120
Osmolality 295
Protein 30mg/l

More acidotic, higher chloride, lower glucose and protein than plasma. Same osmolality

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2
Q

How does anterior spinal artery syndrome present ?

A

Bilateral
Loss of motor , pain and temp

Dorsal columns are spared - vibration and proprioception

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3
Q

How does posterior spinal artery syndrome present ?

A

Loss of dorsal columns - vibration and proprioception
Bilateral

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4
Q

How does posterior spinal artery syndrome present ?

A

Loss of dorsal columns - vibration and proprioception
Bilateral

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5
Q

Total number of reactions in glycolysis ?

A

10

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6
Q

Why can glycosuria be normal in pregnancy?

A

Increase in GFR
Due to renal vasodilation
The increase in renal blood flow also reduces the tmax for glucose reabsorption

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7
Q

What is the narrowest part of an airway in a child?

A

Level of cricoid cartilage

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8
Q

What muscles do the superior and inferior laryngeal nerve supply ?

A

Superior - external branch - only muscle is the cricothyroid - tense and lengthens vocal cords

Inferior laryngeal a.k.a recurrent - the rest of intrinsic muscle of larynx

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9
Q

What pressure and rate is C02 inflated in pneumoperitoneum?

A

Rate of 4-6L/min
To a pressure of 10-20mmHg
If higher can cause bradycardia

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10
Q

What differences are there in dependant and non dependent lung in ventilated and spontaneous ventilation patient ?

A

Dependant lung - lung on bottom
Independant lung - on the top

Perfusion favours the dependant lung in both cases

In PPV - the non dependent lung is ventilated better
In SV- the dependant lung is ventilated better

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11
Q

What is a square wave response of valsalva?

A

Normal valsalva - map increases with valsalva and as it’s released there is a drop in map and then back to baseline

Square wave - map increases and then comes back to baseline without any over/ under shoot.
Seen in

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12
Q

What are the parts of the brachial plexus ?

A

Roots c5,6,7,8,T1
Trunks - sup, middle, inferior
Division - anterior and posterior
Cords - lateral , posterior, middle
Branches

‘ Real Texans drink cold beer’

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13
Q

What are the parts of brachial plexus ?

A

Roots
Trunks - superior inferior and middle
Divisions - posterior and anterior
Cords - middle, lateral and posterior
Branches

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14
Q

How does nuclei compare in skeletal, smooth and cardiac muscle

A

Skeletal - multinucleated, peripheral
Cardiac - single central
Smooth - single central

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15
Q

What is the speed of USS in different tissues ?

A

Air - 300m/s
Soft tissue - around 1500m/s
Bone - 4000m/s

Speed of USS in tissue is influenced by density and elasticity of the tissue

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16
Q

Which vessel most likely to cause a subarachnoid haemorrhage ?

A

Anterior communicating artery

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17
Q

What do the following levels of spinal block result in … C3- C5, c8-t1, T4 , T10

A

C3 -C5- phrenic nerve - respiratory depression , will need GA and intubation
C8-T1 - weak hand grip and parasthesia
T4 - loss of sensation to nipple and sympathetic block of heart
T10 - belly button

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18
Q

What is meant by a high spinal ?

A

Above level of T4

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19
Q

If there is bradycardia with a spinal what can you say about the block ?

A

Involves sympathetic NS to the heart - T1 to T4

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20
Q

How are nerve axons classified ?

A

By diameter ..
A - largest
- further divided in a,b, g,d
B
C - smallest

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21
Q

What fibres carry -
Motor
Sharp pain
Pre ganglionic autonomic
Proprioception
Pressure
Motor to muscle spindle

A

Aa - motor and proprioception
Ab - touch and pressure
Ad - sharp pain and temp
Ag - motor to muscle spindle
B - pre ganglionic ANS
C - dull pain, pressure

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22
Q

What is the alveolar gas equation

A

PA02 = (Patm-6.3)x0.21. - pa o2/0.8

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23
Q

What pressure is recommended for cricoid in RSI?

A

30N -40N
10N when patient is awake

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24
Q

What can happen to partial pressure of 02 in muscle during exercise ?

A

Can drop to as low as 0.13kpa in mitochondria

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25
Q

What is the max skeletal blood flow in strenuous exercise ?

A

22L/ min

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26
Q

How is renal blood flow altered in exercise

A

Drops from 1L/min to 250ml/ min

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27
Q

What happens to pulse pressure in exercise

A

Systolic increases
A little increase in diastolic
Pulse pressure widens

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28
Q

Which block can paralyse the recurrent laryngeal nerve for planned awake fibrooptic intubation?

A

Translaryngeal nerve
Blocked at level of cricothyroid membrane

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29
Q

What is the dose of ropivacaine ?

A

3mg/kg

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30
Q

What is the dose of ropivacaine ?

A

3mg/kg

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31
Q

How does miosis affect intraocular pressure ?

A

Reduces aqueous humour production
Reduces intraocular pressure

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32
Q

How does oxygen levels in blood affect intraocular pressure ?

A

Hypoxia causes vasodilation and increases intraocular pressure

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33
Q

What is the main energy source of myocardium

A

fatty acids contribute to 60%

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34
Q

Which artery in leg should be palpated to give indication of perfusion of whole limb?

A

Dorsalis pedis - continuation of anterior tibial artery

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35
Q

How does normal saline distribute in the acute phase of IV fluid administration?

A

Only to ECF with 75% interstitial and 25% plasma

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36
Q

Which chemical can estimate plasma volume ?

A

Evans blue dye
Radioactive albumin

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37
Q

Which chemical estimates total body water

A

Deuterium oxide

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38
Q

What chemical can measure extracellular volume ?

A

Mannitol

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39
Q

What are oxygen sats in different parts of the fetal circulation ?

A

Umbilical vein - 80%
Descending aorta 55-60%
Superior vena cava - 25%

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40
Q

What are oxygen sats in different parts of the fetal circulation ?

A

Umbilical vein - 80%
Descending aorta 55-60%
Superior vena cava - 25%

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41
Q

What are the ecg changes for hypercalcaemia

A

Short QT

Other symptoms of high ca - moans, groans , stones - constipation, urine stones, depression

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42
Q

How does magnesium toxicity cause muscle weakness

A

Inhibition of VG ca release
Prevents exocytosis of Ach

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43
Q

What is the path for CSF?

A

Choroid plexus
Lateral ventricles
Foramen monro
3rd ventricle
Aqueduct of sylvius
4th ventricle
Foramen lushka and magendie
Subarachnoid space

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44
Q

What is the path for CSF?

A

Choroid plexus
Lateral ventricles
Foramen monro
3rd ventricle
Aqueduct of sylvius
4th ventricle
Foramen lushka and magendie
Subarachnoid space

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45
Q

What are the effects of ANP

A

Medullary collecting ducts to promote sodium excretion
Afferent arteriolar vasodilation - increases GFR
Promotes blood flow to vasa recta which promotes washing away of electrolytes and reduces osmotic gradient hence less reabsorbed
Inhibits renin

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46
Q

How is ards defined ? Clinical criteria ?

A

Symptoms within 1 week
Bilateral opacities
Resp failure not explained by cardiac failure
Hypoxia

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47
Q

Which glut transporter is sensitive to insulin ?

A

GLUT4 in skeletal muscle and adipose

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48
Q

How is glucose absorbed from the intestine ?

A

SGLT1 - na/glucose symporter - on luminal membrane
GLUT2 - on basolateral membrane

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49
Q

Where are GLUT1 found ?

A

Insulin independant
Red cells and brain

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50
Q

What do the waves on JVP relate to ?

A

A wave - atrial systole
C wave - ventricular systole - causes bulging of the valve towards atria

X descent - early diastole - atrial filling and so emptying of vena cava

V wave - early diastole - continued atrial filling against closed tricuspid valve

Y descent - tricuspid valve opens and atria empty

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51
Q

What do the waves of a JVP demonstrate

A

A wave - atrial systole
C wave - ventricular systole bulging of tricuspid valve upwards
X descent - atrial filling - removed from vena cava
V wave - atrial filling towards end of diastole
Y descent - tricuspid valve opens and atria drain

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52
Q

How is pregnancy in HIV managed at point of delivery ?

A

Viral load needs to be <1000 copies within 4 weeks of delivery for vaginal

Otherwise c section

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53
Q

What is the rarest blood type ?

A

AB negative
1 % prevalence

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54
Q

Do thyroid receptors have greater affinity for T3 or T4?

A

T3

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55
Q

How many isoforms of thyroid receptor are there ?

A

3

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56
Q

How is the standard error of mean calculated ?

A

SD / root no. Of values

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57
Q

What is the gold standard measurement of cardiac output measurement ?

A

Thermo dilution
Uses a pulmonary artery catheter with a thermister at the tip
Inject cold inject
Plot temp overtime on semi log scale
Use Stewart Hamilton equations to measure

58
Q

What is the gold standard measurement of cardiac output measurement ?

A

Thermo dilution
Uses a pulmonary artery catheter with a thermister at the tip
Inject cold inject
Plot temp overtime on semi log scale
Use Stewart Hamilton equations to measure

59
Q

Which of the catecholamines is metabolised in lungs?

A

NA

(Adrenaline and dopamine aren’t )

60
Q

List the metabolic actions of the lung ?

A

Metabolism of serotonin, NA

Production of ATII
Arachidonic acid metabolism to prostaglandins and leukotrienes

Production of NO, endothelin and histamine

61
Q

Which cells are the pacemaker of the GIT?

A

Interstitial cells of cajal

62
Q

Which symptoms do anterior and middle cerebral artery strokes present in ?

A

Anterior - leg weakness predominant and sensation loss
Middle - arm weakness predominant and slurred speach

63
Q

What is the most common site for subarachnoid haemorrhages caused by aneurysm ?

A

Anterior communicating artery

64
Q

What is the most common site for subarachnoid haemorrhages caused by aneurysm ?

A

Anterior communicating artery

65
Q

What part of the brain sets the temperature set point ?

A

Posterior hypothalamus

66
Q

What neurotransmitters are involved in temperature regulation?

A

Serotonin , NA , dopamine, PGE- anterior hypothalmus
Ach - in posterior hypothalamus

67
Q

Which receptors in skin act as cold and warm receptors?

A

Bulbs of Ruffini - hot
Bulbs of krause- cold

68
Q

Which part of hypothalamus responds to hot vs cold ?

A

Hot - anterior
Cold - posterior

69
Q

how is bradycardia treated in transplanted heart?

A

transplanted heart lacks innervation so cant block ACh receptors i.e. blocking parasympathetic response as there is none.
instead need to act directly on heart - give adrenaline to act on B1 receptors

70
Q

Which muscle relaxant should be avoided in acute amphetamine toxicity ?

A

Succinylcholine

71
Q

what does grip strength correlate with?

A

total body protein

fist grip is a validated measure of nutritional status

72
Q

what is the cormic index?

A

ratio of sitting height to standing height

73
Q

can cormic index affect BMI?

A

yes -
cormic index varies between populations
cormic index can be used as a correction factor to make BMI as an assessment of nutritional status more valid

74
Q

how accurate is a DEXA scan in determining body fat %?

A

overestimates body fat % in those with high fat

underestimates body fat % in those with low fat

75
Q

which level of albumin is associated with malnutrition?

A

less than 10mg/dl

76
Q

what are the initial steps in managing an airway fire?

A

remove ET tube
turn of O2
wash with normal saline

77
Q

which vasopressin receptors are in the kidney?

A

V2

78
Q

where are vasopressin V1 receptors found?

A

vascular smooth muscle in
sphlanchnic
renal
coronary
and systemic vessels

Gq - vasoconstriction

79
Q

where are vasopressin V3 receptors found?

A

pituitary - involved in regulating release of other hormones.
Also know as V1b
Also found in pancreas involved in hormones release

80
Q

what type of receptors are vasopressin receptors?

A

GPCR
V1 - Gq
V2- Gs
V3 - Gq

81
Q

which antibody is most abundant in human serum?

A

IgG

82
Q

which Ab crosses the placenta?

A

IgG

83
Q

which Ab is mostly present at mucosal surfaces?

A

IgA

84
Q

which is the least abundant serum Ab?

A

IgE

85
Q

which ab is primarily found in blood and lymphatics?

A

IgM

86
Q

what cells make up the reticuloendothelial system?

A

kupffer cells
microglial
osteoclasts
pulmonary alveolar macrophages

87
Q

what is first step in managing acute severe asthma?

A

salbutamol nebs / ipratropium nebs

IV MgSO4
IV hydrocortisone

if refractory IV aminophylline

last resort intubation

88
Q

which B blockers are selective to B1? hence ok in asthma?

A

BEAM
bisoprolol
esmolol
atenolol
metoprolol

89
Q

which B blockers should be avoided in asthmatics?

A

propanolol
timolol
sotolol

with caution
labetolol
Carvedilol

90
Q

what is the mechanism of action of fluoexetine?

A

SSRI - serotonin selective reuptake inhibitor

91
Q

what is the mechanism of entacapone ?

A

COMT inhibitor
used to reduce breakdown of dopamine in parkinsons

92
Q

which drugs should be avoided with ephedrine?

A

highest risk irreversible MAO - A inhibitors e.g. phenelzine

direct acting sympathomimetics - metaraminol

TCA

(MAO- B are not responsible for catecholamine breakdown so can be used, COMT enzymes are not main mechanism of NA breakdown so COMT inhibitors can be used)

93
Q

what ecg changes are associated with hyperkalaemia?

A

peaked T
wide QRS
flat P waves

94
Q

which nervous system and receptors innervate sweat glands?

A

Sympathetic
cholinergic
M2

95
Q

what is the mechanism of action of neostigmine?

A

carbamylation of cholinesterase

it is broken down by cholinesterase but takes longer than ACh

96
Q

which drug helps to maintain patent ductus arteriosus?

A

Prostaglandin E2

97
Q

what closes patent ductus arteriosus with birth?

A

lack of prostaglandins from placenta
higher O2 conc

98
Q

what drug closes patent ductus arteriosis?

A

indomethacin - reduces prostaglandins

99
Q

what is needed in context of a bleed and high INR on someone on warfarin?

A

prothombin complex concentrate - factors 10,9,7,2 (1972), protein C and S

100
Q

which antibiotics are bacteriocidal vs bacteriostatic?

A

bacteriocidal
B lactams - penicillins
glycopeptides
fluroquinolones
metronidazole

bacteriostatic:
macrolides
tetracyclines
trimethroprim

101
Q

why is meperidine/ pethidine not good in renal failure?

A

meperidine metabolite = normeperidine = seizures and 50% activity which can accumulate in renal failure

102
Q

which is more degraded by hoffman elimination and hence better in renal failure of the neuromuscular blockers?

A

CISATRACURIUM

103
Q

what is LD 50 in pharmacology? how does this relate to therapeutic index?

A

lethal dose for 50%

if LD50 and ED95 are close - narrow therapeutic index

104
Q

which nerve is damaged to result in vocal cord being partly held in adduction/ abduction? what muscles does this supply?

A

recurrent laryngeal

all intrinsic muscles except cricothyroid

105
Q

which nerve innervates cricothyroid muscle?

A

superior laryngeal

106
Q

which TCI model is used for paeds ?

A

paedfusor

107
Q

which cranial nerve is most likely compressed with tumours at cerebellopontine angle?

A

CN VII

leads to ipsilateral motor loss - drooping of face and loss of ipsilateral taste.

also parasympathetics - reduced tear and salivation

108
Q

what is the equation for Cerebral perfusion pressure?

A

CPP = MAP - CVP OR
CPP = MAP - ICP

(whichever is higher out of CVP and ICP is used).

109
Q

what physiological factors increase cerebral blood flow?

A

hypoxia
hypercapnia
reduced viscosity
increased MAP
reduced CVP
reduced ICP
ketamine (other agents reduce it)

110
Q

how much can skeletal blood flow increase at rest to exercise?

A

1L/min to 22L/min
highest increase of all organs during exercise.

111
Q

how much can coronary blood flow increase at rest to exercise?

A

250ml/min to 1000ml/min

112
Q

how does renal, skin and GI blood flow alter in exercise?

A

drop in renal and GI
increase in skin to dissipitate heat.

113
Q

what are ECG changes with hyperMG and hyperCa?

A

hyper Mg = prolonged PR and wide QRS

hyper Ca = short QT, PR prolonged, potential J waves.

114
Q

when should hartmans be avoided?

A

when lactate is high in presence of liver failure.

115
Q

what nerves should be blocked in inguinal hernia repair if performing regional anaesthesia?

which nerve root does this come from?

A

ilioinguinal and iliohypogastric

both come from L1

116
Q

what is the ductus arteriosus?

A

remnant of patent ductus arteriosus
connects aorta and pulmonary artery

117
Q

which fluid compartment does evans blue dye measure?

A

plasma

118
Q

how is the blood volume of a neonate estimated?

A

80-90 ml/kg - neonate at term

119
Q

name the paired cartilages in the larynx..

A

arytenoid
corniculate
cuneiforms

120
Q

is the cricoid cartilage paired/ unpaired and a complete or incomplete ring?

A

unpaired
complete ring

121
Q

how does ANP act? (Receptor)

A

increases gaunyl cyclase activity
increases cGMP

122
Q

what is the armitage rule for local anaesthetic in children for caudal anaesthesia?

A

0.25% bupivacaine

0.5ml/kg - lumbrosacral block
0.75ml/kg - inguinal hernia
1ml/kg - lower thoracic block
1.25ml/kg - mid thoracic block

123
Q

what is the blood:gas coefficient of sevoflurane ?

A

0.65

124
Q

what makes sevoflurane suitable for day case?

A

low blood gas partition coefficient - quick offset

125
Q

which inhalation agent has the lowest blood gas partition coefficient? and hightest?

A

desflurane = 0.45

halothane = 2.3

126
Q

what are the nerve roots of the long thoracic nerve?

A

C5, C6, C7

127
Q

how does 5% glucose distribute?

A

equally amongst all compartments

2/3 = intracellular
1/3 = extracellular (of this 3/4 = interstitial and 1/4 = blood)

128
Q

what are the guidelines for evacuating patients in a fire?

A
  1. those nearest the fire
  2. the most well
  3. the most unwell
  4. those in side rooms
129
Q

how much current reaches the heart in a monophasic defib? and a biphasic defib?

A

30 A - 40 A in monophasic

15-20 A in biphasic

130
Q

when is adenosine contraindicated?

A

symptomatic bradycardia
sick sinus
2nd / 3rd degree HB - unless they have a pacemaker

Asthma

131
Q

what is a type 1 error?

A

shows a difference when not actually one

more likely in small study

132
Q

what wavelengths of light are used by pulse oximeter and which Hb absorbs what?

A

660nm = deoxy
940nm = oxy

133
Q

what is a strain gauge?

A

a device whose electrical resistance varies with strain and this can be used to measure pressure or force applied
e.g. used in invasive BP

134
Q

what is the best location for thoracocentesis?

A

8th - 10th intercostal space
mid axillary line

risk of lung injury is reduced here as lung ends up to 8th rib

135
Q

how much of the following are equivalent to IV morphine…
oral morphine
diamorphine
oxycodone
tramadol

A

oral morphine –> IV factor of 3
oral oxycodone –> IV morphine factor of 2
tramadol oral 100mg –> IV morphine 5mg
codeine 60mg oral –> IV morphine 2mg
transdermal fentanyl 50mcg/hr = 60mg IV morphine in 24 hours

136
Q

What level is cricothyroid membrane?

A

C6

137
Q

Name 2 direct thrombin inhibitors? Which can be reversed

A

Dabagatrin - can be reversed
Bivalirubin - can’t

138
Q

Name 2 direct thrombin inhibitors? Which can be reversed

A

Dabagatrin - can be reversed
Bivalirubin - can’t

139
Q

What does metabolic acidosis do to MAC?

A

Decreases
(Alkalosis has no effect )

140
Q

In manual mode what can the manley MP3 ventilator be used as ?

A

Mapleson D

141
Q

Pneumonic for post intubation hypoxia

A

Dopes
Displacement
Obstruction
Pneumothorax
Equipment
Stomach distension

142
Q

What is the pneumonic for causes of traumatic arrest ?

A

Hott
Hypovolaemia
Oxygen (Hypoxaemia )
Tension pneumonia
Tamponafe

PHYSIOLOGY FRCA (10 decks)

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