Primary

Question 1

non-hypoxic causes
of pyruvate accumulation

Answer 1

which include; circulating catecholamines, exercise, sepsis or lack or mitochondria (RBCs)
-2020 first sitting question 8

Question 2

‘lactate sink’

Answer 2

, allowing a period of ongoing ATP production from glycolysis when cells become oxygen deplete or the Kreb’s cycle is inhibited;
-2020 first sitting question 8

Question 3

, allowing a period of ongoing ATP production from glycolysis when cells become oxygen deplete or the Kreb’s cycle is inhibited;

Answer 3

‘lactate sink’
-2020 first sitting question 8

Question 4

HO- CO - COH -CH3

Answer 4

Lactic Acid
-2020 first sitting question 8

Question 5

Lactate production
2 main categories

Answer 5

Production:
• It is produced by anaerobic metabolism of pyruvate either:
o Physiologically → in RBC (no mitochondria), renal medulla (↓ PO2), cornea/ lens (↓PO2) → hence, normal plasma [lactate] is 0.5-2 mmol/L (and NOT zero!)
o Pathologically → reduced tissue perfusion and/or O2 delivery (Eg. shock, hypoxaemia) →thus, plasma [lactate] ↑↑↑ (> 2 mmol/L)
-2020 first sitting question 8

Question 6

Lactate can be used as a fuel source from

Answer 6

Used as a fuel source by the heart and brain
-2020 first sitting question 8

Question 7

Lactate can be Transported to the liver where it is:

Answer 7

▪ Converted back to glucose via gluconeogenesis (requires 6x ATP), which is then
transported back peripherally for use → “Cori cycle”
▪ Converted to pyruvate intermediate → utilized locally in TCA cycle for ATP production via oxidative phosphorylation
-2020 first sitting question 8

Question 8

What is the Cori cycle

Answer 8

Lactate is Converted back to glucose via gluconeogenesis (requires 6x ATP), which is then
transported back peripherally
-2020 first sitting question 8

Question 9

How many ATP involve in converting lactate back to glucose

Answer 9

6
-2020 first sitting question 8

Question 10

What happens to lactate with the Resolution of hypoxia

Answer 10

Resolution of hypoxia (Ie. tissue O2 tension restored) → intracellular lactate can be oxidised
back to pyruvate for use in local tissue aerobic metabolism (Ie. fed into TCA cycle)
-2020 first sitting question 8

Question 11

what is the lactate sink

Answer 11

Lactate Sink:
• Lactate acts as a sink in heart, liver, muscle etc, allowing a period of ongoing ATP production
from glycolysis when:
o cells become oxygen deplete
o Kreb’s cycle is inhibited
o Other causes of pyruvate accumulation: circulating catecholamines, exercise, sepsis or
lack of mitochondria (RBCs
-2020 first sitting question 8

Question 12

Lactate can be Intracellular shuttle:

Answer 12

▪ mitochondrial membrane
▪ peroxisomes
-2020 first sitting question 8

Question 13

What are type 1 and type 2 muscle fibers

Answer 13

slow-twitch (red) and fast-twitch (white) respectively
-2020 first sitting question 8

Question 14

in pregnancy what happens to
Oral absorption
gastric absorption
intestinal absorption

Answer 14

↓ Oral absorption
↑ gastric absorption
↓intestinal absorption
-2020 first sitting question 9

Question 15

in pregnancy what happens to cardiac otuput

Answer 15

increases 30-40%
-2020 first sitting question 9

Question 16

What happens in pregnancy to Inhalational absorption?

Answer 16

increases
• Progesterone-mediated ↑ MV (by 50-70%)
-2020 first sitting question 9

Question 17

In pregnancy what causes a change to minute ventilation?

Answer 17

• Progesterone-mediated ↑ MV (by 50-70%)
-2020 first sitting question 9

Question 18

What happens in pregnancy to minute ventilation

Answer 18

increases
• Progesterone-mediated ↑ MV (by 50-70%)
-2020 first sitting question 9

Question 19

what happens to VD in pregnancy

Answer 19

• ↑ VD
• ↑ TBW/ECF (by 50%) (important for polar/ionized drugs)
-2020 first sitting question 9

Question 20

what happens to body fat in pregnancy

Answer 20

• ↑ body fat % (important for lipid soluble drugs)
-2020 first sitting question 9

Question 21

what happens to plasma protein in pregnancy

Answer 21

• ↓ plasma protein 2° to dilutional effect
-2020 first sitting question 9

Question 22

what happens to albumin in prengnacy

Answer 22

• ↓ albumin →
• ↑ free % of acidic drugs (Eg. STP, propofol)
• ↓ dose required
• ↑ transplacental transfer of drug.
-2020 first sitting question 9

Question 23

what happens to A1AGP in pregnancy

Answer 23

• ↓ A1AGP (by 30%) →
• ↑ free % of basic drugs (Eg. LA, β blockers)
• ↓ dose required
• ↑ transplacental transfer of drug
-2020 first sitting question 9

Question 24

in pregnancy do you get a
metabolic vs respiratory
acidosis vs alkalosis

Answer 24

• Ionisation (mild ↑pH alters ionisation based on pKa)
• ↑ MV = mild respiratory alkalosis
↑ transplacental transfer of basic drugs as they will have ↑ % in
unionized form
• (Base in base is less ionised)
• ↑ ion trapping in more acidotic foetal circulation
-2020 first sitting question 9

Question 25

in pregnancy what happens to the Progesterone:oestrogen ratio

Answer 25

• Progesterone:oestrogen ratio
-2020 first sitting question 9

Question 26

Effect of Progesterone and Oestrogen on hepatic hepatic enzymes

Answer 26

• Progesterone → induces hepatic enzymes
• Oestrogen → inhibits hepatic enzymes
-2020 first sitting question 9

Question 27

what happens to plasma cholinesterase in preganancy

Answer 27

• ↓ plasma cholinesterase (30%)
-2020 first sitting question 9

Question 28

can the Placenta metabolise drugs?

Answer 28

• Placenta metabolises some drugs
-2020 first sitting question 9

Question 29

does the Foetal liver have a functioning CYP450?

Answer 29

• Foetal liver has functioning CYP450
• Can metabolise drugs
• But requires transfer back to maternal circ for conjugation
-2020 first sitting question 9

Question 30

what happens to RBF/GFR in pregnancy

Answer 30

• ↑ RBF/GFR (50%)
• ↑ clearance/↓ elimination t1⁄2 of water-soluble drugs

-2020 first sitting question 9

Question 31

what happens to MV/FRC in pregnancy

Answer 31

• ↑ MV/↓FRC
• ↑ washout of volatile agents

-2020 first sitting question 9

Question 32

what happens to MAC in pregnancy

Answer 32

• Decreased MAC – Increased sensitivity to volatile anaesthetics

-2020 first sitting question 9

Question 33

what happens to LA sensitivity in prengancy

Answer 33

• Increased LA sensitivity due to decreased α1-glycoprotein

-2020 first sitting question 9

Question 34

what hapepns to sensitivity to IV anaesthetics in pregnancy

Answer 34

• Increased sensitivity to IV anaesthetics

-2020 first sitting question 9

Question 35

Cardiac output measurement can be performed:

Answer 35

INVASIVELY
o Pulmonary Artery Catheter
▪ Thermodilution
▪ Fick Principle
o Indicator Dilution Technique
o TOE
o Arterial waveform analysis
▪ PiCCO
▪ Vigileo

Non-invasively
o TTE
o MRI
o Thoracic impedance

cicm wrecks 2017-2-10

Question 36

Cardiac output Definition

Answer 36

Cardiac output is defined as the volume of blood ejected by the heart per unit time.
It is usually presented as [stroke volume × heart rate], in L/min

Deranged 2014 march

Question 37

The equation for thermodilution measurement

Answer 37

• This uses the equation, V̇ = m/Ct, where:
o V̇ = flow, or cardiac output
o m = dose of the indicator,
o C = concentration, and
o t = time

Deranged 2014 march