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Previous TF Q from book Flashcards

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1
Q

how many stereoisomers of atracurium?

A

10

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2
Q

how many more times potent is cisatracurium than atracurium?

A

3-4 x more potent

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3
Q

how is cisatracurium metabolised?

A

hofman degradation to laudanosine and monoquartenary acrylate
then hydrolysed by non specific plasma esterases to monoquart alcohol and acrylic acid

i.e. plasma esterase metabolism IS INDIRECT

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4
Q

does cisatracurium have any active metabolites?

A

none

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5
Q

is atracurium or cis-atracurium dependant on renal function for its clearance?

A

both are INDEPENDANT

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6
Q

what is the elimination half life for propofol?

A

5 to 12 hours

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7
Q

which part of propofol undergoes glucuronidation?

A

hydroxyl group in position 1

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8
Q

how does propofol exert its antiemetic effects?

A

via D2 antagonism

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9
Q

Is potency of local anaesthetics related to lipid solubility?

A

yes

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10
Q

which is more potent ropivacaine or lidocaine?

A

ropivacaine x4

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11
Q

how much protein binding does cocaine have? what about other ester LA?

A

all ester LA are highly protein bound

cocaine = 95%

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12
Q

which block will acetylcholinesterase inhibitors potentially potentiate?

A

phase 1 block by depolarising agents

more Ach in cleft - can potentiate depolarising effects of sux.

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13
Q

does sux cause post tetanic potentiation?

A

no
feature of non-depolarising blocks
OR phase 2

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14
Q

what are the ADRs of heparin?

A

thrombocytopenia
hyperkalaemia (inhibits aldosterone)
hypersensitivity
osteoporosis

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15
Q

can heparin cross placenta?

A

No - low lipid solubilty
doesnt have any fetal side effects

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16
Q

how does 2g/kg mannitol given IV affect serum osmolarity , sodium and volume of blood

A

increases osmolarity (it is an osmole itself)

water follows - drop in cellular osmolarity

hence sodium conc drops

volume increases

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17
Q

what does acetazolamide do to urinary pH?

A

inhibits CA
hence less excretion of H+
HCO3 not absorbed
alkaline urine

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18
Q

which drug potentiates aminoglycoside ototoxicity?

A

furosemide

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19
Q

which drugs can potentiate warfarin?

A

DAPETS
Doxycycline
Aspirin . Antifungals , Amiodarone
Propanol
erythromycin
tamoxifen
SSRIs

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20
Q

how does rifampicin effect warfarin?

A

inducer
reduces effects of warfarin

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21
Q

what is ketamine a derivative of?

A

phencyclidine

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22
Q

how does ketamine have a positive iono/chronotropic effect?

A

INDIRECTLY
activation of sympathetic NS

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23
Q

what is more potent etomidate or propofol?

A

etomidate 10x more potent

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24
Q

what pH is the propofol emulsion?

A

7

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25
Q

what is the extraction ratio of thiopentone compared to propofol

A

high - propofol

low - thio

hence thio more effected by protein binding, clearance of propofol more effected by liver blood flow

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26
Q

which benzos have active metabolites?

A

midazolam
diazepam

not lorazepam

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27
Q

benzos can cause impaired motor coordination and ataxia - T or F

A

T

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28
Q

can benzos reduce Chloride plasma conc?

A

no
the opening of channels hyperpolarises cell but wont lower plasma conc

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29
Q

can midazolam be given rectally and intranasally?

A

yes

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30
Q

how does aminophylline work?

A

phosphodiesterase inhibitor

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31
Q

at pH 7.4 what level of unionised alfentanil exists?

A

90%

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32
Q

how does the clearance of alfentanil and morphine compare and the half life?

A

morphine quicker clearance

however alfentanil has a shorter half life due to its smaller Vd

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33
Q

how does Vd of alfentanil and fentanyl compare?

A

alfentanul smaller - hence short half life.

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34
Q

what is the most protein bound opioid?

A

alfentanil

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35
Q

how long do the effects of cyclizine last?

A

6 hours

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36
Q

can cyclizine have sedative effects?

A

yes

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37
Q

can cyclizine have atropine like effects?

A

yes
has anticholinergic effects

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38
Q

how much are NSAIDs protein bound

A

99%

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39
Q

why do NSAIDs have small Vd?

A

due to extensive plasma protein binding

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40
Q

what are COX2 specific inhibitors associated with?

A

IHD
thrombotic events - MI and stroke

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41
Q

what is the boiling point of sevoflurane?

A

58 degrees

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42
Q

what is the boiling point of isoflurane?

A

48 degrees

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43
Q

can sevo be a respiratory stimulant?

A

no
causes dose dependant resp depression

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44
Q

how does clonidine work and how does it effect MAC?

A

A2 agonist
decreases MAC

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45
Q

how does methyl dopa affect MAC? Mechanism of methyldopa

A

decrease by reducing NA levels

Alpha 2 agonist

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46
Q

which of the following are prolonged by renal failure?
labetolol, propofol , ranitidine

A

Only ranitidine

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47
Q

is diamorphine naturally occuring or synthetic ?

A

synthetic

(not an opiate)

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48
Q

how well does diamorphine bind receptors? what is it metabolised too?

A

no affinity
metabolised to monoacetylmorphine and morphine which are both active.

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48
Q

how does the lipid solubility of diamorphine compare to morphine?

A

much more lipid soluble than morphine

rapidly absorbed after sub cut injection

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49
Q

which of the following insulins are fast/ slow acting

soluble insulin
insulin glargine
insulin lispro
protamine zinc inuslin
isophane insulin

A

soluble insulin and insulin lispro = fast acting

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50
Q

what are cells in anterior pituitary gland called?

A

chromophobe / chromophil cells

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51
Q

which part of the brain has neural connections to pineal gland?

A

hypothalamus - suprachiasmatic and paraventricular nucleus
(not pituitary)

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52
Q

how much inulin appears in glom filtrate?

A

inulin is freely filtered so same conc as in plasma

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53
Q

how does the kidney handle amino acids?

A

filtered at glom
completely reabsorbed at PCT

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54
Q

what hormones are produced in response to injury?

A

aldosterone
cortisol
adrenaline/NA
ADH
endorphins

effects - fluid retention, hyperglycaemia, catabolism, sodium retention

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55
Q

what happens to compliance of respiratory system in pregnancy?

A

lung compliance - unchanged
chest wall compliance - reduced due to diaphragm elevation

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56
Q

what happens to minute ventilation and PaCO2 and PaO2 in pregnancy?

A

increased MV
slight drop in PaCO2
no change in PaO2

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57
Q

which nerves when damaged can cause ptosis?

A

occulomotor
sympathetic chain

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58
Q

what does the supraorbital nerve do?

A

branch of frontal nerve = purely sensory

frontal is a branch of opthalmic division of trigeminal

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59
Q

why is the pH of CSF lower than blood?

A

less protein in CSF
less buffering capacity

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60
Q

how does glucose conc in CSF compare to blood?

A

glucose is lower in CSF

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61
Q

how is the blood flow to the liver divided between hepatic artery and portal vein?

A

2/3 from portal vein
1/3 from hepatic artery

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62
Q

where are the bile ducts within the lobule?

A

within triad at the corners of a lobule

(in centre of lobule is hepatic vein)

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63
Q

what is the normal pressure or the portal system in liver?

A

1-5mmHg
>5mmHg = portal HTN
>10 mmHg = significant

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64
Q

which part of the liver lobule is most at risk of hypoxic injury?

A

centre

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65
Q

what happens to urine nitrogen output and acid/base balance during starvation?

A

amino acids metabolised –> increased urinary nitrogen output

acid base - metabolic acidosis - increase in FFA and ketone bodies

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66
Q

what happens to the respiratory quotient in starvation?

A

decreases

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67
Q

how does closing capacity change from lying to standing

A

no change

HOWEVER
FRC increases so less likely that closing volume will encroach on the FRC

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68
Q

what method measures closing capacity?

A

single breath nitrogen washout
fowlers

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69
Q

can the O2 dissociation curve determine O2 content of blood?

A

no
primarily determined by Hb conc

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70
Q

what happens to O2 dissociation curve in anaemia?

A

goes to right
increase in 2,3 DPG

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71
Q

what is shape of carboxyHb curve?

A

hyperbolic
straight up and then plataeus

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72
Q

how can airway resistance be measured?

A

body plethsmography

or spirometry

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73
Q

units for airway resistance?

A

kpa.s/ L
(compare to V=IR)

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74
Q

how does airway resistance alter with forced expiration?

A

increases

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75
Q

how does airway resistance alter with flow?

A

increases from laminar to turbulent flow

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76
Q

what happens to acid base initially with altitude?

A

hyperventilation
lower CO2
alkalosis

excreted HCO3 in urine - alkaline urine

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77
Q

what parameters can be determinants of myocardial O2 consumption?

A

HR, contractility, ventricular wall tension - primarily determined by these 3

however also by these indirectly
LV EDV - corresponds to preload
pulmonary capilary wedge pressure - corresponds to preload
more pre-load = more work

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78
Q

name 2 phsyiological shunts…

A

thebesian veins
bronchial venous drainage - via pulmonary veins

(not anterior cardiac, coronary sinus)

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79
Q

what is kety schmidt method?

A

measures cerebral blood flow

NOT linked to ICP

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80
Q

how does thoracic pressure affect ICP?

A

lower thoracic pressure, more drainage, lower ICP

alternatively coughing - increases thoracic pressure and ICP

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81
Q

how does dietary protein affect osmolarity?

A

increased dietary protein increases urinary osmolarity as more nitrogen is excreted.

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82
Q

with central venous catheters how far should the tip of the catheter go?

A

should sit in SVC
depends on patient size

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83
Q

what is the normal size of a central line catheter ?

A

14-16 G
corresponds to 1.63mm and 1.3mm diameter

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84
Q

define microshock

A

current of less than 1mA
but close to the heart

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85
Q

what point is used for zeroing on the patient?

A

4th intercostal mid axillary line when supine this is as close to RA as possible

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86
Q

what is the only factor that influences the SVP of a inhalation gas?

A

temp

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87
Q

does gas mixture above the liquid affect SVP of a gas?

A

no

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88
Q

how is a watt derived in SI units?

A

watt is rate of work

hence
joules / second

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89
Q

what is the critical temp of O2?

A

-119 degrees

boiling point at atm = -180

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90
Q

do nitrous oxide cylinders always contain liquid?

A

No

not at the end of their use

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91
Q

what is the critical temp of nitrous oxide?

A

36.5

boiling point at 1 atm -88degrees

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92
Q

define critical pressure of a gas…

A

the pressure required to liquify a gas at its critical temp

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93
Q

does boyles law take into account molecular size?

A

all ideal gas laws assume molecular size is insignificant

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94
Q

for charles law - can temperatures in kelvin and degrees be used interchangable
e.g. 10 degrees C to 20 degrees C = double temp
does this mean Kelvin doubled?

A

no

kelvin would be
283 to 293
increased by a small percentage

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95
Q

is the doppler effect true for EM radiation?

A

yes

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96
Q

does the doppler effect change the velocity of reflected sound waves?

A

NO
changes their frequency depending on the velocity of the object it hit

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97
Q

in the doppler effect how does frequency change with objects moving towards?

A

increase frequency

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98
Q

does the doppler effect depend on the piezo electric properties of the crystals?

A

no

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99
Q

what is a refractometer?

A

can measure conc of any inhalation agent
can also be called inferometer

measures how much light is bent (refracted) as it moves from air to sample.

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100
Q

out of the 2 co-axial breathing systems, which carries FGF on inner tube and outertube?

A

Bain = inner tube carries FGF

lack = outer tube carriers FGF

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101
Q

for bain coaxial system what FGF rate is required ?

A

2-4x MV

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102
Q

can bain breathing system be used in paeds

A

yes including 20kg

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103
Q

what mapelson is the Bain?

A

mapelson D

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104
Q

what is the pressure of piped gas lines?

A

4.1 bar

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105
Q

how is gas flow switched between cylinder manifolds?

A

pneumatic shuttle mechanism

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106
Q

the schrader outlet contains an internal non-return valve? T or F

A

T
prevents backwards flow if pressures in pipeline drop subatm.

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107
Q

why is o2 paramagnetic?

A

UNpaired e in outer shell

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108
Q

in a paramagnetic analyser what are the balls filled with?

A

N2

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109
Q

how does water vapour affect paramagnetic analyser?

A

can affect accuracy
also can stick and reduce functioing of the mechanism

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110
Q

how does temp affect viscosity ?

A

Increases temp , drop in viscosity for liquids . More energy to break intermolecular bonds

Increase in temp, increase in viscosity in gas . More energy for more collisions resisting the flow

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111
Q

what type of flow does viscosity affect?

A

laminar

turbulent flow is not affected by viscosity (instead density)

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112
Q

how does helium affect air flow?

A

lower DENSITY
promotes laminar flow
via reynolds
less work of breathing - as flow proportional to pressure drop rather than square root of pressure drop

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113
Q

what is the differenc between barometer and manometer?

A

manometer open to atmosphere - not closed at the top. measures gauge

barometer - closed at the top - measures absolute. has a torricellian vacuum

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114
Q

Is there variation in peak expiratory flow rate?

A

yes dip by 10% in morning and night

if more than 20% variation = asthma

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115
Q

what mechanism is a wrights peak flow meter?

A

variable orifice device

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116
Q

what is the normal peak expiratory flow rate?

A

450 to 650 L/min

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117
Q

what are active and passive trasducers?

A

active - generate electric current from other environmental stimulus e.g. piezoelectric

passive change electrical quantity e.g. thermistor and strain gauge

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118
Q

what can inulin be used to measure?

A

ECF vol and EGFR

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119
Q

how is red blood cell volume measured?

A

chromium labelled RBC

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120
Q

what are anaesthetic gas cylinders made of?

A

steel alloy
either from maganese molybdenum steel or chromium molybdenum steel or nickel chromium molybdenum steel.

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121
Q

how is the filling ratio of N20 canister calculated?

A

weight of contents / weight of water it could hold.

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122
Q

what is the filling ratio of nitrous oxide cylinders in the UK

A

0.75

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123
Q

are the confidence intervals of a good study small or large?

A

small -

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124
Q

what is the formula for standard error of mean?

A

SEM = SD / root number in sample

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125
Q

what happens to impedence if skin is wet under ecg?

A

reduced electrical impedence
increase risk of shock

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126
Q

how is the modern diathermy made safer compared to old?

A

return plate not connected directly to earth

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127
Q

why doesnt the earths magnetic field induce all ferromagnetic objects?

A

often not strong enough

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128
Q

why is coiled wire better at producing magnetic field?

A

neighbouring coils induce neighbouring reinforcing magnetic flux

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129
Q

what properties do ferromagnets have?

A

unpaired electrons spin
microscopic domains containing random magnetic fields

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130
Q

what role does the earths magnetic field have?

A

protects against solar and cosmic radiation

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131
Q

how does flux density vary with current and distance?

A

flux density is proportional to the current at a point and inversely proportional to square of distance

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132
Q

what is the formula linking Voltage to number of turns in a transformer?

A

V1/V2 = N1/N2

current would be
I1 N1 = I2 N2

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133
Q

what is the reason for propofol allergy?

A

preservatives - more likely in asthmatics
metabisulphite and benzylalcohol

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134
Q

why does propofol sting on injection?

A

bradykinin

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135
Q

what can propofol do to skin, hair and urine?

A

antiprureitc effects
green hair and urine- secondary to quinol metabolites

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136
Q

what age is propofol not liscened?

A

3yrs and below

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137
Q

where are glycine receptors found?

A

spinal cord

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138
Q

which induction agent can cause hiccups?

A

propofol

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139
Q

which NMBA is propofol physically incompatible with?

A

atracurium

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140
Q

why should propofol syringe be changed after 6 hrs?

A

egg lecithin derivative can fascilitate bacterial growth

141
Q

why may thio be prefered to propofol in difficult airway?

A

patients breath quicker after thio

142
Q

how do NSAIDs react with thio?

A

reduce protein binding, increase free proportion

143
Q

why is thio solution bacteriostatic?

A

high pH

144
Q

how many optical isomers does methohexital have?

A

4 optical
2 are used in racemix

145
Q

how does ketamine effect heart?

A

directly cardio depressant however indirectly stimulates via sympathetic. however if depletion of catecholamines/ weak response in elderly, the depressive effects may become more apparent

146
Q

what other receptors does ketamine act on , other than NMDA?

A

nACHR, L type Ca, HCN channel
opioids

147
Q

how do barbiturates and etomidate effect haeme synthesis?

A

increase ALA production by liver
ALA is a precursor for heme production.

(hence risk of porphyria)

148
Q

what neurotransmitter does paracetamol effect?

A

5HT3
- responsible for part of its analgesic effects.
hence partly inhibited by ondansetron

cannabinoids too

149
Q

when is naltrexone contraindicated?

A

liver disease

150
Q

where are cannabinoid receptors found?

A

dorsal horn
brain

151
Q

which lead is best for detecting arrhythmias?

A

lead 2

152
Q

who should have an ecg pre op

A

> 60 yts
or >50yrs + smoker
or any CVS disease

153
Q

how long to post pone surgery post MI?

A

3 months

154
Q

most common abnormality on ecg?

A

t inversion.
t wave is most sensitive

155
Q

how is sinus tachy distinguished from SVT?

A

deep breath will slow a sinus tachy only

156
Q

what is the normal velocity of aortic blood flow from doppler?

A

1.7m/s

157
Q

how is different levels of aortic stenosis defined?

A

mild = valve area >1.5 cm2, gradient <20mmHg, velocity <3m/s

moderate = area 1 to 1.5
20-40mmHg, velocity 3-4m/s

severe
<1.0cm valve area
>40mmHg gradient
velocity >4 m/s

critical if <0.7
>50 mmHg
>5m/s

158
Q

MAP is measured by 1/3 systolic and 2/3 diastolic why is this not accurate always?i

A

if HR increased ratio becomes closer to 50:50

159
Q

which part of the cardiac cycle does the R wave on ecg correspond to?

A

isovolumetric contraction

160
Q

what % of ventricle filling occurs at atrial systole?

A

30%

161
Q

what causes cannon a waves?

A

heart block where dissociation between ventricle and atria contraction
- atrial contract
- at same time as ventricles contract

162
Q

what does tricuspid regurg do to JVP?

A

increase v waves

163
Q

area inside a pressure volume loop for left ventricle means what?

A

stroke work

164
Q

how does the pressure volume loop change with increased preload?

A

up and to the right

165
Q

what happens to gradient of Ees of pressure volume loop when catecholamines given?

A

increased gradient

166
Q

which coronary blood flow can continue in systole?

A

right coronary (lower presures)

167
Q

how is coronary blood flow related to heart rate?

A

inversely

168
Q

which is the main determinant of coronary blood flow

A

aortic DIASTOLIC pressure
flow occurs in diastole

also equivalent to LV end diastolic pressure

169
Q

what determines the resting membrane potential?

A

Na/K ATPase

Donnan effect - negative proteins and phosphates in the cell

equilbrium potential for K / relative permeabilities of different ions

170
Q

how long does the cardiac action potential last?

A

200-300ms

171
Q

state mechanisms for Ca entry in cardiac cell AP and Ca removal./

A

entry
L type Ca
ryanodine - calcium induced calcium release

uptake
- inactivation of L type (time inactivation)
- SERCA pump
- Na/Ca pump (on plasma membrae)

172
Q

how does B adrenergic stimulation increase ionotrophy?

A

increase Ca via L type channels

173
Q

what does dp/dt represent in cardiac cycle?

A

contractility
the higher , the better CO

174
Q

when is aortic pressure the highest?

A

mid systole

175
Q

when is aortic blood flow lowest?

A

early diastole

176
Q

how much does pulmonary vascular resistance change at birth of fetus?

A

80% drop

177
Q

when does foramen ovale and ductus arteriosus close?

A

foramen ovale closes immediately but fuses within 48 hrs

ductus arteriosus within 48hr

178
Q

which organ has biggest AV difference?

A

cardiac

179
Q

valsalva increases intensity of what murmur?

A

mitral regurg

all others are decreased

180
Q

what is the preffered route from right atria to left atria electical signals?

A

bachman bundle

181
Q

fetal circulation at birth - what happens to flow in IVC?

A

falls

182
Q

at birth what pressure does the first breath generate?

A
  • 50 cmH20
183
Q

what can LV end diastolic pressure say in terms of O2?

A

Raised LVEDP increases myocardial work and therefore oxygen requirement.

hence determines myocardial o2 consumption

184
Q

when do type A and B atrial receptors discharge?

A

Atria have Type A stretch receptors that discharge predominantly during atrial systole and
Type B receptors that discharge predominantly during atrial diastole.

185
Q

what is bainbridge reflex?

A

stretch of RA causes increased HR

186
Q

what is Lusitropy?

A

Lusitropy is a term that decribes myocardial relaxation.

Catecholamines have a positive lusitropic action (allowing rapid relaxation) whilst hypercalcaemia inhibits relaxation due to incomplete calcium reuptake (an essential process in diastole).

187
Q

how does the timing of contraction of chambers compare?

A

RA contration preceeds LA contraction, however LV contaction precedes RV contraction.

188
Q

what happens to urinary nitrates in trauma?

A

increase
due to catabolism

189
Q

how does mitral regurg effect afterload?

A

reduces it
low resistance pathway back into atria so less tension needed by LV

190
Q

what is afterload likely to be in HF?

A

lower

191
Q

what is the anrep effect?

A

If afterload increases, SV initially falls. SV is then (partially) restored by an increase in LVEDV.

192
Q

what is afterload?

A

Afterload is the tension developed in the LV wall during systole.
SVR is the commonest index of afterload but is not equivalent to it

193
Q

how much blood comes from hepatic artery?

A

The hepatic artery is a branch of the coeliac axis.
1/3 of hepatic blood comes from the hepatic artery.
2/3 portal vein

194
Q

during exercise, what is the main factor increasing CO?

A

HR

195
Q

does CVP change in exercise?

A

no

196
Q

what happens to haematocrit and blood volume in exercise?

A

fluid loss
haematocrit increases
blood volume drops

197
Q

what does hyperkalaemia do to automaticity?

A

increases it

198
Q

what acts as a marker for preload and afterload?

A

preload - CVP (right side), pulmonary cap wedge pressure (left ventricle preload)

afterload - MAP / SVR

199
Q

both left and right sympathetic chain innervate heart - what is their relative purpose?

A

left - force of contraction
right - rate

200
Q

which vagus nerve innervates SAN vs AVN?

A

SAN - right vagus
AVN - left vagus

201
Q

what changes are quicker - parasympathetic changes to heart or sympathetic?

A

para

202
Q

what ratio of adrenaline / NA released by adrenal medulla?

A

adrenaline 4: 1 NA

203
Q

what is normal aortic diameter?

A

2.5cm

204
Q

what type of capillaries present in OVLT?

A

fenestrated

205
Q

what do mesangial cells do? what do pericytes do?

A

contract to reduce S.A for Glomerular filtration. similar to pericytes

pericytes are found outside of the capillary - contract to regulate flow

will regulate capillary permeability by altering pore size

206
Q

what type of capillary present in GIT? where else has this type of capillary?

A

fenestrated

endocrine glands , hypothyroid, pituitary, pineal gland
choroid plexus

207
Q

how much does lymphatics drain?

A

2-4 L / day

208
Q

when is the glycolayx disrupted?

A

sepsis , surgery - causes leaky capilaries.
oncotic pressure less significant

209
Q

which tissues dont have lymphatics?

A

cartilage, CNS, eyes

210
Q

where does the cisterna chyli lie?

A

L1/ L2
5-7cm long

211
Q

what nodes do following organs drain into?..
adrenals
gonads
liver
abdo wall

A

adrenals and gonad = para aortic

liver = mediastinal nodes

abdo - mediastinal, superficial groin, axillary

212
Q

where do T and B cells mature

A

T thymus
B bone marrow

213
Q

how does CO of left side of heart compare to right?

A

left > right
recieves additional drainage from bronchial veins

214
Q

how much is PVR compared to SVR?

A

1/10th

215
Q

what is the blood flow and O2 consumption of the brain?

A

750ml/min
45ml/min

216
Q

what is the blood flow and O2 consumption of the heart?

A

250ml/min
30ml/min

217
Q

what is the blood flow and O2 consumption of the skeletal at rest?

A

1L/min
50ml/min

218
Q

what is the blood flow to liver and kidneys?

A

kidneys - 1.25L/min (25%)
liver - 1.5L/min (30%)

219
Q

what capillaries are found in spleen?

A

sinusoidal

220
Q

what % of blood volume is in the veins?

A

around 50%

221
Q

what is the main driver of lymph flow?

A

positive hydrostatic pressure in tissues.

222
Q

the length of the cardiac cycle shortens with HR, is this linear?

A

no

223
Q

which Ca channels are present in phase 4 and 0 of pacemaker AP?

A

phase 4 - T type
phase 0 - slow L type - hence slower upstroke that fast VG Na

224
Q

what level do sympathetic fibres innervating heart come from?

A

T1 to T5

225
Q

why is VOO pace mode safe in surgery?

A

ventricles are being paced
but nothing is being sensed hence no interference

226
Q

what parameters are surrogates for contractility measure?

A

Stroke work
stroke volume
end systolic pressure

227
Q

what type of hormone is angiotensin?

A

peptide
AT1 = 10aa
AT2 = 8aa

228
Q

what is normal value for PVR in health?

A

160 dyn/sec / cm5

229
Q

what is max stroke vol in normal adult?

A

100-120ml

in athletes may go higher - up to 180 ml

230
Q

what is triamterene?

A

a diuretic
acts on DCT
stops Na reuptake

231
Q

in plasma protein binding - are the unbound and bound drug related?

A

The bound and unbound portions of a drug are in equilibrium and therefore closely related.

the unionised proportion is what binds plasma protiens

232
Q

define clearance..

A

Clearance is that volume of a body compartment (often blood or plasma) from which a drug is completely removed per unit time, usually expressed in ml min-1.

233
Q

what is edrophonium?

A

Edrophonium has a quaternary nitrogen, which binds to the anionic site of acetylcholinesterase,

it is not an ester, so cannot bind to or be metabolised by the enzyme.

used in diagnosis of myasthenia gravis

234
Q

how does MAC alter with temp?

A

increases with hyperthermia

235
Q

how is MAC affected by CO2 tension, anaeamia, Mg?

A

AC is not affected by haemoglobin concentrations, arterial CO2 tensions or plasma magnesium concentrations.

236
Q

what are microsomal liver enzymes?

A

group of enzymes of ER of hepatocytes

include CYP450

237
Q

what induces cYP2E1?

A

Chronic intake of barbiturates, alcohol or cigarettes

238
Q

how does lithium affect NMBA?

A

can prolong
(acts like a sodium ion)

239
Q

what can prolong competitive NMBA?

A

hypothermia, hypokalaemia, hypocalcaemia and metabolic acidosis.

Mg
gentamicin

240
Q

how does carbamazepine effect NMBA?

A

inducer
shortens effect

241
Q

methods of measuring anaesthetic gases…

A

infra red
mass spec
ultrasonic
refractormeter
raman spec
photoacoustic spec

(NOT PARAMAGNETIC)
(not chromatography - too slow)

242
Q

how does peak inspiratory flow compare to expiratory?

A

peak expiratory flow is much higher.

(flow in inspiration is highest at begining and then decreases. same for expiration).

243
Q

how should frequency of a system compare to fundametal frequency?

A

The frequency response should ideally be above the first 8-10 harmonics of the fundamental frequency (heart rate), i.e. ten times the heart rate.

244
Q

how long is the oesophageal doppler probe inserted to?

A

40cm

245
Q

does ambient pressure affect rate of diffusion?

A

no

246
Q

how many quarternary ammonias in
- acetylcholine
- succinylcholine?

A

acetylcholine = 1
sux = 2

247
Q

how is aspirin metabolised?

A

Aspirin is rapidly metabolised by esterases in the intestinal mucosa and liver to acetic acid and salicylate;

248
Q

what does aspirin do to urate excretion?

A

In normal doses (lesser than 2g per day), aspirin inhibits renal tubular secretion of urate
(not urea)

249
Q

how much protein binding of aspirin?

A

80-90%

250
Q

what are the causes of hypotension with morphine?

A

vagal stimulation
arteriole dilation (directly and sympathetic)
histamine release
decreased sympathetic activity

( myocardial contractility maintained)

251
Q

what additional affects does pethidine have?

A

acts like atropine - anticholinergic
local anaesthetic effect
NA reuptake inhibition

252
Q

what molecule is pethidine structurally related to?

A

atropine - anti Ach effects

253
Q

what is the half life of pethidine compared to morphine?

A

pethidine

254
Q

can ephedrine inhibit MAO?

A

yes

although not its main role / not clinically that significant

255
Q

name 3 acetylcholinesterase inhibitors and state their duration of action

A

Edrophonium - shortest duration of neostigmine
pyridostigmine - longer than above

256
Q

what type of amine does neostigmine have? what does this mean?

A

quarternary
doesnt cross BBB
poor oral absorption

257
Q

what is Disopyramide

A

Disopyramide is a Class 1a antiarrhythmic

258
Q

what does hydralazine do?

A

dilates arteries (not veins) via smooth muscle

259
Q

how does GTN affect CVP?

A

falls
dilation of vessels

260
Q

why is headache a side effect of GTN?

A

mengingeal dilation

261
Q

why does GTN have low oral bioavailabity?

A

metabolised in both gut wall and liver
high first pass

262
Q

what is diazoxide?

A

slows release of insulin from pancreas
increases glucose
for those with hypoglycaemia

263
Q

which penicillin is active against penicillinase producing staphlococci

A

flucloxacillin is effective against penicillinase-producing staphylococci

264
Q

which adreno receptors are present on uterus?

A

B2
hence salbutamol causes uterine relaxation

(NA has no effect on uterine tone as no A1)

265
Q

what drug is flumazenil structurally similar to?

A

benzos

266
Q

what is plasma protein binding of ropivacaine?

A

Plasma protein binding of ropivacaine is similar to that of bupivacaine; it is about 94% protein bound.

267
Q

what is the pKA of lidocaine and ropivacaine?

A

he pKa of lidocaine is 7.9 and that of ropivacaine is 8.1

268
Q

which flow measurements rely on variable orifice vs variable pressure?

A

variable pressure, fixed orifice = pneumatochograph

variable orifice, fixed pressure
= rotameters, writght peak flowmeter

269
Q

how does wrights respirometer work?

A

measures a volume and then flow can be worked out from this.

wet spirometer also measures a volume

270
Q

what is a lusitrope?

A

A drug that increases relaxation - e.g. B blockers

271
Q

what is the minimum setting for expiratory valve to open?

A

50 Pa

272
Q

what is the intracellular mechanism for ionotropy? which drugs act

A

B1 = PKA –> phosphotylates L type Ca Channels. dopamine, dobutamine, NA

Phosphodiesterase inhibitors - milronone

levosimendan - increases sensitivity to contractile units to calcium without increasing

273
Q

what waves does doppler effect use

A

both sound and electromagnetic

274
Q

with the doppler effect how does the frequency shift when blood is moving away?

A

shifts to lower frequency

275
Q

can metaraminol show tachyphylaxis?

A

yes after days - not as quick as ephedrine

276
Q

what is the strength of magnetic field in MRI

A

2-3 tesla

277
Q

what does an osmolarity of 700mOsm/kg correspond to?

A

An osmolality of 700 corresponds with a specific gravity of 1020

278
Q

what is the specific complication of vasopressin?

A

intra abdominal complications
from sphlanic vasoconstriction

279
Q

what blood gas abnormality is seen with adrenaline infusion?

A

lactate acidosis

280
Q

how does enoxamone work?

A

phosphodiesterase inhibitor
ionodilator

similar to milronone

281
Q

how is Confidence interval calculated?

A

mean +/- 1.96 SEM

282
Q

how many half lives and time constants to complete exponential process?

A

5 half-lives but just 3 time constants for an exponential process to be almost complete.

283
Q

why is a capacitor used in lead of diathermy plate to earth?

A

The capacitor provides a high impedance to mains frequency current and prevents patient injury by preventing current flow to earth.
only allows high freq AC

284
Q

how is ecg leads design to reduce current leak

A

a resistance is incorporated in each lead from the patient to an ECG machine

285
Q

what happens to soda lime when left unused

A

hen left unused, the carbonate on the surface of the granules will move to the inside of the granule and the hydroxide moves to the surface

will regenerate

286
Q

what is the advantage of jackson rees?

A

no valves - low resistance to flow
can add PEEP

287
Q

what is pressure of N20 in pipeline?

A

4.1bar

288
Q

what valve does the schrader system work with?

A

one way non return

289
Q

name drugs metabolised by esterases

A

esmolol
aspirin
diamorphine
etomidate
local ester anaesthetics
remifentanil

290
Q

how does diamorphine relate to morphine?

A

Diamorphine is 3,6 diacetylmorphine, a di-ester of one molecule of morphine and two molecules of acetic acid.

291
Q

what can salicytates do to prothrombin?

A

hypoprothrombinaemia

292
Q

how much protein binding is paracetamol

A

10%

293
Q

which induction agent is the only one not to cause sleep in one arm brain circulation?

A

ketamine

294
Q

does ketamine have active metabolites?

A

yes - norketamine

295
Q

what is terminal elimination half life of propofol

A

5-12 hours

296
Q

name the macrolides and mechanism

A

50S inhibition
erythromycin
clindamycin
Azithromycin
Clarithromycin

297
Q

which abx inhibit 30s

A

tetracyclines
aminoglycosides

298
Q

how is SVT treated?

A

vagal manouevres
6mg adenosine
12mg adenosine
18mg adenosine

if shock, Chest pain, HF signs = DC cardioversion

299
Q

describe how a pH electrode works?

A

measuring electrode
- pH sensitive glass
- silver/AgCl electrode
- buffer solution

reference electrode
- permeable membrane
- solution of Kcl
- mercury/ calomel electrode (or silver/ agcl)

blood in contact with both electrodes
- H+ ions accumulate on pH sensitive glass (do not cross) but create a charge diference (i.e. attract negative ions) - this is called ion exchange
- buffer keeps pH constant

potential difference is measured in mV
60mV = 1 unit pH

the reference electrode and ionic solutions complete the circuit.

300
Q

how does an osmometer work?

A

uses colligative properties of solution to measure osmotic pressure.

Colligative properties are physical properties that are dependent on number of dissolved particles rather than the identity of the solute.

These include elevation of boiling point, reduction of freezing point, reduction in vapour pressure and change in osmotic pressure.

usually depression of freezing point is used

301
Q

what does aspirin have a higher affinity for COX 1 or 2

A

COX 1

302
Q

what does heparin do?

A

binds ATIII and increases breakdown/inhibition of factor 2, 10 and 12,11,9 (intrinsic pathway)

LMWH only 2 and 10
fondaparinux only 10

303
Q

protamine sulphate allergy can overlap with which other allergies?

A

allergies to protamine - in some insulins, fish and in sperm (vasectomized men)

304
Q

what can be used to treat von willebrand disease?

A

desmopressin - stimulates release of vWF

305
Q

what is the new reversal agent for apixaban and rivaroxaban ?

A

andexanet alfa

306
Q

what is the role of citrate in blood products?

A

prevents coagulation
binds calcium

although since clotting factors have been removed, this is not so much of an issue hence SAG - M (the most common prep) doesnt contain citrate

307
Q

what is the rarest and most common blood type?

A

AB negative = rarest
O most common

308
Q

what type of inheritance is the ABO?

A

mendelian

309
Q

what ab are present in ABO system and rhesus?

A

ABO = IgM - cant cross placenta
rhesus = IgG = can

310
Q

which chromosome is rhesus antigen on?

A

chrom 1

311
Q

what does sickle cell do to Hb dissociation curve?

A

shifts to the right
hence the anaemia seen isnt as severe as the same anaemic value in HbA because HbS can give up O2 to tissues more easily.

312
Q

what happens in sickle cells - mutation and aa change?

A

adenine –> thymine
glutamate –> valine

on B chain of Hb

313
Q

what does adenine do to packed red cells?

A

increases ATP for use and prolongs shelf life

however does also decrease 2,3 DPG

314
Q

how are ABO antigens identified?

A

terminal sugar on the H antigen

315
Q

where is ABO antigen found?

A

many different tissues not just RBC

316
Q

what is the leading cause of mortality and death following transfusions?

A

TRALI

317
Q

is donor blood tested for malaria?

A

no not routinely

318
Q

which Ab is involved in acute haemolytic reaction and delayed haemolytic reaction

A

acute = ABO = IgM
delayed = others = IgG

319
Q

what is the difference between intra and extravascular haemolysis ?

A

intra - occurs within vasculature, RBC rupture in blood stream
extra - in liver/ spleen - RBC ingested by macrophages

haptoglobin binds free Hb so this is lowered in intravascular but not in extra vascular

acute haemolytic reaction = intravascular
delayed = extravascular

320
Q

what type of endothelium is present in kidney tubules

A

in proximal tubules - tight junctions

in bowens capsule fenestrated capillaries

321
Q

in the kidney what is the difference between transcellular and paracellular transport?

A

transcellular - through cell

Paracellular transport occurs through both tight junctions and intercellular spaces via diffusion/ osmosis (not active)

322
Q

what is FICKs law?

A

rate of diffusion proportional to…

SA (Con difference) / Distance

323
Q

what FGF does a mapelson A / magil require?

A

minimum 70% of MV in spontaenous
2-3x MV in controlled

324
Q

what is the capacity of a reservoir bag?

A

2L

325
Q

what is the function of a reservoir bag in a breathing system?

A

prevents wastage of FGF during expiratory pause
visual aid
can meet peak inspiratory flow - otheriwse would need very high FGF rates to do this and would be wasteful at other points in vent cycle

326
Q

which breathing systems are T pieces

A

D, E, F

327
Q

why is magils inefficient in controlled ventilation?

A

The Magill system is inefficient during controlled ventilation because much of the gases are vented via pop-off valve

328
Q

what gas is used in a quantiflex mixer

A

N20 can be safely delivered via a Quantiflex mixer which allows a full range oxygen/nitrous oxide mixtures to be administered from 21-100% oxygen so avoiding accidental hypoxic mixtures.

329
Q

does the cardiff aldasorber increase work of breathing?

A

no low resistance device

330
Q

how packed is a soda lime cannisters?

A

50%

331
Q

does the concentration of inspired vapour exceed that on the setting in low flow anaesthesia at steady state?

A

During maintenance (i.e. at steady-state), the inspired volatile agent will eventually reach but never surpass the set concentration on the vapouriser.

332
Q

what type of isomer is enflurane and isoflurane?

A

structural

333
Q

what does isoflurane do to CVS system?

A

SVR drop
reflex tachy
minimal change to myocardial function
coronary steel

334
Q

which inhalation agent doesnt have a chiral centre?

A

sevo

335
Q

what does sevo produce when stored in glas?

A

hydrofluric acids

336
Q

what molecule is sevo flurane

A

polyfluorinated methyl isopropyl ether.

337
Q

which inhalation agent has largest molecular weight and what is this?

A

sevo, 200

338
Q

molecular weight of desflurane

A

168

339
Q

what inhalation agent should you be careful with when using adrenaline and why?

A

halothane
sensitiser heart to catecholamines

340
Q

which bonds are most stable in inhalation agents?

A

C-F

341
Q

the liver produces tri-fluroacetyl chloride under what conditions?

A

oxidative conditions

342
Q

boiling point of desflurane

A

23.5

343
Q

what can desflurane do to heart if mac >1

A

tachycardia and HTN

344
Q

how does N20 cause sub acute degen of the cord?

A

oxidises B12 in colbalt ion
means methionine synthase is no longer able to function
inhibits DNA synthesis
needed for myelin

345
Q

in descending order which inhalation agents affect cerebral blood flow?

A

halothane
enflurane
N20
isoflurane

346
Q

why is halathane prepared with 0.01% thymol?

A

prevent decomposition by light.

347
Q

what does halothane do to ANS?

A

bagal stimulation
can cause bradycardia

348
Q

how much N20 is metabolised?

A

less than 0.01%

349
Q

critical pressure of O2

A

50 bar

royal college questions (4 decks)

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