Primary Exam SAQ Flashcards
<p>Discuss the pharmacology of ketamine in acute pain management. Include in your answer the advantages and disadvantages of different routes of administration.</p>
<p>A</p>
<p>List the components of soda lime, used for the absorption of carbon dioxide. Outline the hazards associated with the use of soda lime within a circle circuit and how the risks can be minimised.</p>
<p>A</p>
<p>What affect does placing a patient in the right lateral position have on lung ventilation and perfusion?</p>
<p>A</p>
<p>Discuss the concepts of half life and context sensitive half-time with examples from anaesthetic pharmacology.</p>
<p>A</p>
<p>Describe how morbid obesity affects time to awakening after inhalation anaesthesia.</p>
<p>A</p>
<p>Describe the sites of action of antiemetic agents used for post operative nausea and vomiting.</p>
<p>A</p>
<p>Discuss the potential adverse effects of NON depolarising muscle relaxants.</p>
<p>A</p>
<p>Outline the physiological changes that may explain why an otherwise well patient may have a reduced urinary output intra-operatively.</p>
<p>A</p>
<p>Briefly outline the differences between the pulmonary circulation and the systemic circulation.</p>
<p>A</p>
<p>Outline how hyperventilation may reduce intracranial pressure.</p>
<p>A</p>
<p>Explain the mechanisms whereby oxygen transfer is facilitated at the placenta.</p>
<p>A</p>
<p>Describe the physiological factors that contribute to the competence and tone of the lower oesophageal sphincter.</p>
<p>A</p>
<p>Describe the fuel cell and the paramagnetic oxygen analyser. Discuss their use in anaesthetic practice.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of neostigmine and sugammadex.</p>
<p>A</p>
<p>Discuss the prevention of electrical shock in the operating theatre.</p>
<p>A</p>
<p>Discuss the physical principles and equipment used for measurement of exhaled carbon dioxide by infrared analysis using side stream sampling. Outline the potential sources of error.</p>
<p>A</p>
<p>Draw and label a circle breathing system. Explain its advantages and disadvantages.</p>
<p>A</p>
<p>Describe the anatomy of the neonatal airway, and what implications this has for airway management.</p>
<p>A</p>
<p>Discuss the potential adverse effects of NON depolarising muscle relaxants.</p>
<p>A</p>
<p>Discuss the relative advantages and disadvantages of using morphine and fentanyl for post-operative Patient Controlled Analgesia (PCA).</p>
<p>A</p>
<p>Discuss the factors influencing the speed of onset of blockade, of a major peripheral nerve, with local anaesthetic.</p>
<p>A</p>
<p>Describe the pharmacodynamic properties of propofol EXCLUDING its effects on the central nervous system. Describe how these influence clinical use.</p>
<p>A</p>
<p>Outline the pharmacology of agents used in the acute management of hypertension in pregnancy.</p>
<p>A</p>
<p>Describe the mechanism of action, pharmacokinetics and major side effects of amiodarone.</p>
<p>A</p>
<p>Describe the cardiovascular changes that occur with ageing.</p>
<p>A</p>
<p>Describe the respiratory effects of adding positive end expiratory pressure (PEEP) to intermittent positive pressure ventilation (PPV).</p>
<p>A</p>
<p>Describe the autonomic innervation of the heart and the effects of autonomic stimulation on cardiac function.</p>
<p>A</p>
<p>Outline the physiological mechanisms of progression from acute to chronic pain and how drugs may alter this progression.</p>
<p>A</p>
<p>Describe the physiological role of prostaglandins on smooth muscle throughout the body.</p>
<p>A</p>
<p>Describe the physiological effects of sleep on the brain and the respiratory system.</p>
<p>A</p>
<p>Compare and contrast oxygen delivery via nasal cannulae (nasal prongs/specs), simple face mask (eg Hudson or CIG mask) and Venturi mask.</p>
<p>A</p>
<p>Propofol and remifentanil TCI are often given together as a total intravenous anaesthesia technique. Discuss pharmacological reasons why this is a useful combination</p>
<p>A</p>
<p>Outline the genetic variations on the cytochrome P450 2D6 enzyme and discuss the clinical relevance for drugs used in the perioperative period</p>
<p>A</p>
<p>Describe the advantages and disadvantages of using nitrous oxide as part of a general anaesthetic</p>
<p>A</p>
<p>Discuss the potential adverse effects of suxamethonium</p>
<p>A</p>
<p>Discuss the factors affecting the duration of action of a local anaesthetic block to a major peripheral nerve</p>
<p>A</p>
<p>Compare and contrast LMWH and unfractionated heparin</p>
<p>A</p>
<p>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?</p>
<p>A</p>
<p>Draw both aortic root and a radial artery pressure wave forms on the same axes. Explain the differences between them</p>
<p>A</p>
<p>Draw an expiratory flow-volume curve obtained from a maximal expiratory effort after a vital capacity breath, for a person with:
<br></br>normal lungs
<br></br>restrictive lung disease
<br></br>obstructive lung disease
<br></br>(10 marks)
<br></br>Explain how and why these curves (and the derived parameters) are different in each disease state (15 marks)</p>
<p>A</p>
<p>Discuss the physiological consequences of total spinal anaesthesia caused by intrathecal administration of 20 ml of 2% lignocaine at the L3/4 level. (Do not include management)</p>
<p>A</p>
<p>Describe how the large daily volume of glomerular filtrate is altered by the kidney to form a relatively low volume of concentrated urine</p>
<p>A</p>
<p>Outline the physiological effects of the adrenal hormones aldosterone and cortisol. (Do NOT describe synthesis or metabolism)</p>
<p>A</p>
<p>Outline the clinical laboratory assessment of liver function</p>
<p>A</p>
<p>Describe the respiratory effects of adding positive end expiratory pressure (PEEP) to intermittent positive pressure ventilation (IPPV).</p>
<p>A</p>
<p>Compare and contrast the action potentials from the sino-atrial node and a ventricular myocyte.</p>
<p>A</p>
<p>Explain the physiological processes that cause oliguria in response to hypovolaemic shock.</p>
<p>A</p>
<p>Outline the physiology of blood groupings that allows O negative packed cells to be safely transfused to most patients.</p>
<p>A</p>
<p>Describe the cardiovascular changes that occur with morbid obesity.</p>
<p>A</p>
<p>Discuss the determinants and control of spinal cord perfusion.</p>
<p>A</p>
<p>Explain the reasons why a pulse oximeter may give incorrect readings.</p>
<p>A</p>
<p>Describe how the oxygen Vacuum Insulated Evaporator works.</p>
<p>A</p>
<p>Describe the anatomy and relations of the right internal jugular vein relevant to performing central venous cannulation.</p>
<p>A</p>
<p>Describe the effects of giving an unopposed dose of neostigmine.</p>
<p>A</p>
<p>a) Briefly describe the bactericidal activity of gentamicin. Explain why it is usually administered as a single daily dose.
<br></br>b) Describe the potential toxic effects of gentamicin.</p>
<p>A</p>
<p>Explain the mechanisms by which intravenous morphine produces analgesia. Your answer should focus on the location and function of mu opioid receptors.</p>
<p>A</p>
<p>Describe the effect of a pregnancy, at term, on wash-in of volatile anaesthetic agents.</p>
<p>A</p>
<p>Describe the principles of how a computer-controlled infusion device targets and maintains a constant effect-site concentration of propofol.</p>
<p>A</p>
<p>Briefly describe the pharmacodynamics of agents used in the treatment of post-operative nausea and vomiting (PONV), with particular reference to their site of action and side effects.</p>
<p>A</p>
<p>Write a brief description of the pharmacology of ropivacaine.</p>
<p>A</p>
<p>Describe the mechanism of action of protamine when used to reverse effects of heparin. Outline the side-effects of protamine.</p>
<p>A</p>
<p>Describe the compensatory mechanisms in a fit person moving from the supine to the standing position.</p>
<p>A</p>
<p>Compare and contrast warfarin and dabigatran with particular emphasis on the patient that presents for surgery.</p>
<p>A</p>
<p>Describe the visceral and somatic pain of labour with particular reference to the anatomy of the pain pathways</p>
<p>A</p>
<p>Using a labelled diagram, describe how a mechanical (non-cassette) variable bypass vaporiser achieves the concentration set on the dial. Describe the mechanisms that compensate for temperature and downstream pressure changes.</p>
<p>A</p>
<p>A) Describe the immediate cardiovascular responses to the sudden loss of 30% of the blood volume in healthy awake person.
<br></br>B) How are these responses different if the patient is undergoing anaesthesia with sevoflurane?</p>
<p>A</p>
<p>(a) Describe the generation and features of a normal awake EEG
<br></br>(b) Briefly discuss the processing performed by quantitative EEG monitors (such as BIS or Entropy) to produce a single number from the EEG.</p>
<p>A</p>
<p>Outline the factors which influence the time taken for loss of consciousness during an inhalational induction of anaesthesia</p>
<p>A</p>
<p>Describe the effects of morbid obesity on the respiratory system.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of ephedrine and norepinephrine (noradrenaline).</p>
<p>A</p>
<p>Discuss the factors affecting duration of action of a local anaesthetic block to a major peripheral nerve.</p>
<p>A</p>
<p>Draw and explain the characteristics of a quantal dose-response curve that describes the major clinical effect of rocuronium. Outline medications and medical conditions that may cause the curve to shift to the left or right.</p>
<p>A</p>
<p>Describe the physiological processes that influence the rate of gastric emptying.</p>
<p>A</p>
<p>Describe the immunology, mediators and pathophysiology of anaphylaxis. Do not discuss management.</p>
<p>A</p>
<p>Describe the clinical effects of non-steroidal anti-inflammatory drugs including the mechanism(s) through which they exert these effects.</p>
<p>A</p>
<p>Describe the determinants of left ventricular myocardial oxygen supply and demand.</p>
<p>A</p>
<p>Describe the pharmacodynamic properties of propofol EXCLUDING its effects on the central nervous system. Describe how these influence clinical use.</p>
<p>A</p>
<p>Write brief notes on the pharmacology of tramadol.</p>
<p>A</p>
<p>Describe the cardiovascular changes that occur with morbid obesity.</p>
<p>A</p>
<p>Outline the theories, both current and discredited, as to how volatile anaesthetic agents cause loss of consciousness.</p>
<p>A</p>
<p>Outline the hazards associated with the use of CO2 absorbents within a circle breathing system and how the risks can be minimised.</p>
<p>A</p>
<p>List the desired and adverse effects of opioids and the corresponding anatomical location of the receptors being activated.</p>
<p>A</p>
<p>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.</p>
<p>A</p>
<p>Justify the dose of propofol you would expect to use to induce anaesthesia in the following scenarios, using pharmacokinetic and pharmacodynamic principles.
<br></br>(a) 4 year old child weighing 15kg (25%)
<br></br>(b) 75 year old man weighing 70kg (25%)
<br></br>(c) 40 year old man weighing 70kg with severe hypovolaemic shock (50%)</p>
<p>A</p>
<p>Outline the pharmacology of intravenous metoprolol.</p>
<p>A</p>
<p>Discuss the determinants of renal blood flow.</p>
<p>A</p>
<p>Describe the determinants of left ventricular myocardial oxygen supply and demand.</p>
<p>A</p>
<p>Describe the respiratory response to hypoxaemia in both the awake and anaesthetised patient.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of neostigmine and sugammadex.</p>
<p>A</p>
<p>Define and describe LUNG compliance. Discuss the difference between static and dynamic compliance.</p>
<p>A</p>
<p>(a) Describe the mechanisms by which heat is transferred between the body and its environment (30%)
<br></br>(b) Describe methods by which body heat may be conserved under anaesthesia (70%)</p>
<p>A</p>
<p>Describe platelets and their role in haemostasis.</p>
<p>A</p>
<p>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.</p>
<p>A</p>
<p>Briefly describe the principles (50%) and sources of error (50%) in the measurement of arterial blood pressure using an automated oscillometric non-invasive monitor.</p>
<p>A</p>
<p>Discuss the factors that affect oxygen transport from the alveoli to the tissues.</p>
<p>A</p>
<p>Describe the effects of sevoflurane on the respiratory system.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of suxamethonium and rocuronium.</p>
<p>A</p>
<p>Describe the maternal cardiovascular changes that occur during pregnancy.</p>
<p>A</p>
<p>Outline the adverse effects which could occur following the rapid transfusion of ten (10) units of packed red cells.</p>
<p>A</p>
<p>Using opioids as examples, describe and illustrate with graphs, what you understand by the terms “potency”, “efficacy”, “partial agonist”, “competitive antagonist” and “therapeutic index”.</p>
<p>A</p>
<p>Briefly outline the functions of the kidney.</p>
<p>A</p>
<p>Describe the autonomic innervation of the heart (60%), and the effects of autonomic stimulation on cardiac function (40%).</p>
<p>A</p>
<p>Outline the mechanisms of action of the drugs, with examples, which increase myocardial contractility.</p>
<p>A</p>
<p>Describe the pharmacology of midazolam.</p>
<p>A</p>
<p>Outline the normal physiological control of blood glucose in a nondiabetic adult.</p>
<p>A</p>
<p>List the drugs which affect uterine tone and outline the adverse effects of these agents.</p>
<p>A</p>
<p>Describe the factors determining transdermal uptake of drugs (50%). Briefly outline the advantages and disadvantages of transdermal administration of drugs (50%).</p>
<p>A</p>
<p>Describe the physiological role of prostaglandins on smooth muscle throughout the body.</p>
<p>A</p>
<p>Explain the effects of intermittent positive pressure ventilation on cardiac output.</p>
<p>A</p>
<p>Describe the cardiovascular changes that occur with ageing.</p>
<p>A</p>
<p>Discuss the effects of pregnancy on the respiratory system that are relevant to the practice of anaesthesia. Include in your answer how these effects influence the conduct of anaesthesia.</p>
<p>A</p>
<p>Describe the ways in which carbon dioxide is carried in the blood.</p>
<p>A</p>
<p>Discuss the cerebral effects of prolonged anaesthesia in steep head down position.</p>
<p>A</p>
<p>Outline the clinical laboratory effects of renal function. What are the limitations of each test?</p>
<p>A</p>
<p>Explain how a metabolic acidosis develops in hypovolaemic shock. Describe the consequences of this metabolic acidosis for the body.</p>
<p>A</p>
<p>20mls of 1% ropivacaine is inadvertently administered intravenously over 15 seconds to a 60yo, 60kg woman. Describe the potential complications and mechanisms of this. Do not discuss treatment.</p>
<p>A</p>
<p>Draw on a single graph wash in curves for the first half hour administration of 70% nitrous oxide, 6% desflurane and 2% sevoflurane. Explain why the curves are different for each agent (80%). Describe and explain the effect on these curves with a) A doubling of alveolar ventilation and b) A doubling of cardiac output. (20%)</p>
<p>A</p>
<p>Describe the effect of sevoflurane on the following regional circulations: Cerebral, coronary, pulmonary, hepatic and uteroplacental. Do not discuss specific organ effects.</p>
<p>A</p>
<p>Describe the principles of how a computer controlled infusion device targets and maintains a constant effect site concentration of propofol.</p>
<p>A</p>
<p>Outline the factors that determine the rate of recovery from non-depolarising neuromuscular block.</p>
<p>A</p>
<p>Outline the principles of antibiotic prophylaxis for surgical site infections using cefazolin in knee joint replacement surgery as an example.</p>
<p>A</p>
<p>Describe the metabolism and excretion of tramadol, including the implications for clinical practice.</p>
<p>A</p>
<p>Explain the reasons why a pulse oximeter may give incorrect readings.</p>
<p>A</p>
<p>Explain how cardiac output is measured using a thermodilution technique.</p>
<p>A</p>
<p>Draw a pressure volume loop for the left ventricle in a normal adult. Outline the information that can be obtained from such a loop.</p>
<p>A</p>
<p>Discuss the potential adverse effects of suxamethonium.</p>
<p>A</p>
<p>Describe the normal regulation of cerebral blood flow and outline physiological factors which may alter it. DO NOT discuss the effect of medications or pathology.</p>
<p>A</p>
<p>Draw and label a lead II electrocardiogram (ECG) tracing for one cardiac cycle, indicating normal values. What is the PR interval and what factors influence it?</p>
<p>A</p>
<p>Outline the theories, both current and discredited, as to how inhalational anaesthetic agents cause loss of consciousness.</p>
<p>A</p>
<p>Outline the safety features of currently used mechanical variable bypass vaporisers.</p>
<p>A</p>
<p>Propofol and remifentanil target controlled infusions are often given together as a total intravenous anaesthesia technique. Discuss pharmacological reasons why this is a useful combination.</p>
<p>A</p>
<p>Describe how morbid obesity might affect washout after inhalation anaesthesia</p>
<p>A</p>
<p>Briefly explain the cardiovascular effects of central neuraxial blockade.</p>
<p>A</p>
<p>Using ropivacaine and lignocaine as examples, explain the pharmacokinetic principles that affect speed of onset and duration of action of local anaesthetics.</p>
<p>A</p>
<p>Discuss the physiological responses to administration of 2 litres of Hartmann's solution intravenously over 1 hour to a conscious, healthy, euvolaemic 70kg adult.</p>
<p>A</p>
<p>Describe the respiratory and cardiovascular changes associated with a carbon dioxide pneumoperitoneum for laparoscopic surgery.</p>
<p>A</p>
<p>Draw the oxygen-haemoglobin and carbon dioxide-haemoglobin dissociation curves on the same axis (partial pressure vs. content). Compare and contrast these two curves.</p>
<p>A</p>
<p>Briefly outline the roles of the hypothalamus.</p>
<p>A</p>
<p>Discuss the role of paracetamol in multi-modal analgesia(50%). Explain paracetamol metabolism and the mechanism of toxicity (50%). Do not discuss management of toxicity.</p>
<p>A</p>
<p>Describe the anatomy and relations of the right internal jugular vein as relevant to performing central venous cannulation</p>
<p>A</p>
<p>Outline the possible reasons for prolonged paralysis induced by an intravenous dose of 1 mg/kg of suxamethonium.</p>
<p>A</p>
<p>Compare and contrast povidone iodine and alcoholic chlorhexidine as skin antiseptic agents.</p>
<p>A</p>
<p>Discuss possible causes for the PaCO2 differing from the ETCO2 in an anaesthetised, intubated patient on IPPV.</p>
<p>A</p>
<p>Compare and contrast the effects of sevoflurane and nitrous oxide on the cardiovascular system.</p>
<p>A</p>
<p>Describe the mechanisms that facilitate oxygen and carbon dioxide exchange in the placenta.</p>
<p>A</p>
<p>Describe how the effects of warfarin can be reversed when URGENT surgery is indicated (40%). For each option discuss the advantages and disadvantages (60%).</p>
<p>A</p>
<p>Describe the washout of desflurane from a patient following six hours of general anaesthesia. Draw a graph to illustrate the description.</p>
<p>A</p>
<p>Describe the process by which increased tissue demand for oxygen leads to an increase in cardiac output.</p>
<p>A</p>
<p>Outline the effects of opioids injected into the spinal intrathecal space using both fentanyl and morphine to illustrate your answer.</p>
<p>A</p>
<p>Describe the ionic basis of automaticity in the pacemaker cells of the sino- atrial node.</p>
<p>A</p>
<p>An infusion of 50mls of 50% dextrose is given to a healthy 70kg adult. Describe the possible metabolic pathways for the dextrose.</p>
<p>A</p>
<p>Using a labelled diagram, describe how a self-inflating bag-valve-mask resuscitation device works.</p>
<p>A</p>
<p>Describe the time course between an intravenous injection of a general anaesthetic agent to loss of consciousness. Explain the delay using pharmacokinetic principles.</p>
<p>A</p>
<p>Describe the adverse effects of neostigmine.</p>
<p>A</p>
<p>Discuss the effects of ageing on the respiratory system.</p>
<p>A</p>
<p>Briefly explain the principles of Doppler ultrasound used to measure cardiac output</p>
<p>A</p>
<p>Describe the alterations to the physiology of the nervous system in the older patient and outline the consequent effects on pain perception</p>
<p>A</p>
<p>Describe the mechanism of action of G-proteins</p>
<p>A</p>
<p>Outline the mechanism of secretion of hydrochloric acid by the stomach. Briefly describe how secretion of hydrochloric acid by the stomach is controlled.</p>
<p>A</p>
<p>a) Describe the immediate cardiovascular responses to the sudden loss of 30% of the blood volume in a healthy awake person. b) How are these responses different if the patient is undergoing anaesthesia with sevoflurane?</p>
<p>A</p>
<p>Draw and label a lead II electrocardiogram (ECG) tracing for one cardiac cycle, indicating normal intervals and values. What is the PR interval and what factors influence it?</p>
<p>A</p>
<p>Discuss respiratory system compliance and outline factors that affect it.</p>
<p>A</p>
<p>Describe the physiological mechanisms by which the renal collecting duct is able to produce both dilute and concentrated urine.</p>
<p>A</p>
<p>Describe the determinants of left ventricular myocardial oxygen supply and demand.</p>
<p>A</p>
<p>Draw and label a normal capnograph to show the phases of the respiratory cycle. (30%) List and briefly describe what information can be obtained from the capnograph. (70%)</p>
<p>A</p>
<p>Describe the effect of pregnancy, at term, on wash-in of volatile anaesthetic agents</p>
<p>A</p>
<p>Discuss the adverse environmental effects of anaesthetic agents in current use</p>
<p>A</p>
<p>Discuss factors that influence the toxicity of local anaesthetics when used for topical anaesthesia of skin and mucosa.</p>
<p>A</p>
<p>Discuss the structure and function of the NMDA receptor and briefly describe the interaction of ketamine with this receptor</p>
<p>A</p>
<p>Using opioids as examples describe and illustrate with graphs what you understand by the terms "potency", "efficacy", "partial agonist", "competitive antagonist", and "therapeutic index".</p>
<p>A</p>
<p>500ml of 20% mannitol is administered intravenously to a neurosurgical patient. Outline the cerebral, circulatory and renal effects including potential problems associated with its use.</p>
<p>A</p>
<p>Describe the principles (50%) and sources of error (50%) in the measurement of arterial blood pressure using an invasive arterial line and transducer</p>
<p>A</p>
<p>Mallampati score is a diagnostic test for difficult intubation with a sensitivity of 30% and specificity of 90%. Describe how this information and other statistics related to this test can be used in predicting difficult intubation. How does the prevalence of difficult intubation affect the performance of the test?</p>
<p>A</p>
<p>Discuss the pharmacokinetic implications of severe chronic kidney disease, using examples of drugs used in anaesthesia to illustrate your answer.</p>
<p>A</p>
<p>Describe the advantages and disadvantages of using nitrous oxide as part of a general anaesthetic</p>
<p>A</p>
<p>Describe the individual effects of propofol and sevoflurane on the cerebral metabolic rate of oxygen consumption (CMRO2) and cerebral blood flow (CBF).</p>
<p>A</p>
<p>Outline the physiology of blood groups that allows O negative packed cells to be safely transfused to most patients.</p>
<p>A</p>
<p>Describe the factors that affect afterload for each of the right and the left ventricles.</p>
<p>A</p>
<p>Describe the peripheral and central nervous system pathways that lead to the perception of pain following a laceration to the thumb.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of metaraminol and adrenaline (epinephrine).</p>
<p>A</p>
<p>Describe the anatomy of the neonatal airway, and what implications this has for airway management.</p>
<p>A</p>
<p>Describe the V/Q ratio at the apex and base of the upright lung. How does this affect regional gas exchange?</p>
<p>A</p>
<p>Explain the onset and offset of neuromuscular block at the diaphragm, larynx, and adductor pollicis, after an intubating dose of vecuronium. What are the clinical implications of these differences?</p>
<p>A</p>
<p>Describe how Non-Steroidal Anti-Inflammatory Drugs exert their therapeutic and adverse effects (70%). Outline the advantages and disadvantages of using COX-2 selective agents (30%).</p>
<p>A</p>
<p>Explain how a pulse oximeter works. Do NOT discuss the potential sources of error.</p>
<p>A</p>
<p>Define the terms “tolerance” and “tachyphylaxis” (30%). Discuss the mechanisms by which these can develop, giving relevant examples (70%).</p>
<p>A</p>
<p>List the major classes of oral hypoglycaemic drugs and provide an example for each class. Briefly outline their mechanism of action and major side effects.</p>
<p>A</p>
<p>Discuss how the body handles a metabolic acidosis.</p>
<p>A</p>
<p>Describe the respiratory responses to hypoxaemia in both the awake and anaesthetised patient.</p>
<p>A</p>
<p>Describe closing capacity and its relationship to airway closure. Explain its clinical significance and measurement.</p>
<p>A</p>
<p>Outline the pharmacology of cancer chemotherapeutic agents with reference to problems caused during the perioperative period.</p>
<p>A</p>
<p>Write short notes contrasting the cardiovascular effects of propofol and ketamine seen clinically.</p>
<p>A</p>
<p>Describe the pathogenesis and management of paracetamol toxicity.</p>
<p>A</p>
<p>Explain the effects of intermittent positive pressure ventilation on cardiac output.</p>
<p>A</p>
<p>Briefly outline the mechanisms by which ACE inhibitors and angiotensin receptor blockers produce a) their therapeutic effects b) potential adverse effects</p>
<p>A</p>
<p>a) Define "volume of distribution". What factors influence the size of the volume of distribution? b) How may it be used in the calculation of a loading dose? What assumptions are made in this calculation?</p>
<p>A</p>
<p>Describe the pharmacology of dexmedetomidine.</p>
<p>A</p>
<p>Draw, label and describe the waveforms and pressures that are seen in each anatomical location during insertion of a pulmonary artery catheter.</p>
<p>A</p>
<p>Explain how local anaesthetics prevent the conduction of action potentials within a major peripheral nerve.</p>
<p>A</p>
<p>Describe the normal regulation of cerebral blood flow and outline physiological factors which may alter it. DO NOT discuss the effect of medications or pathology.</p>
<p>A</p>
<p>Describe the effects of sevoflurane on the respiratory system.</p>
<p>A</p>
<p>Discuss the relative advantages and disadvantages of using morphine and fentanyl for post- operative Patient Controlled Analgesia (PCA).</p>
<p>A</p>
<p>Discuss possible causes for the PaCO2 differing from the ETCO2 in an anaesthetised, intubated patient on IPPV.</p>
<p>A</p>
<p>Explain the physiological effects of acute hypercapnia, caused by hypoventilation.</p>
<p>A</p>
<p>Describe the effects of perioperative hypothermia. DO NOT discuss mechanisms of heat loss.</p>
<p>A</p>
<p>For each of the following, describe the features that ensure the safe delivery of oxygen during anaesthesia a) cylinders b) pipeline supply c) anaesthesia machines</p>
<p>A</p>
<p>Briefly outline the potential immunological effects of transfusing packed red cells.</p>
<p>A</p>
<p>Discuss factors that determine the time to awakening after cessation of a propofol target controlled infusion (TCI).</p>
<p>A</p>
<p>Classify anti-emetic drugs according to their mechanism of action. Give examples and describe side effects of each class.</p>
<p>A</p>
<p>Describe the factors determining transdermal uptake of drugs. Using examples, outline the advantages and disadvantages of transdermal administration of drugs.</p>
<p>A</p>
<p>Compare and contrast the effects of the right lateral position (right side down) on lung ventilation and perfusion in a healthy 70 kg patient who is a) Awake, breathing spontaneously b) Anaesthetised, paralysed, with IPPV</p>
<p>A</p>
<p>Draw and label a graph of a normal basic viscoelastic test of clotting function. What information about the physiology of clotting is depicted in this graph? How will the graph be altered by hyperfibrinolysis?</p>
<p>A</p>
<p>On the same axes, draw wash-in curves for the first 30 minutes administration of: • 70% nitrous oxide • 6% desflurane • 2% sevoflurane. Explain why the curves are different for each agent.</p>
<p>A</p>
<p>Using a labelled diagram, describe how a self-inflating bag-valve-mask resuscitation device works.</p>
<p>A</p>
<p>Discuss the potential adverse effects of suxamethonium.</p>
<p>A</p>
<p>Compare and contrast the pharmacology of ephedrine and norepinephrine (noradrenaline).</p>
<p>A</p>
<p>Discuss the physiological effects of infusing 2 litres of Hartmann's solution over 1 hour in a conscious, healthy, euvolaemic 70kg adult.</p>
<p>A</p>
<p>Describe the pharmacology of midazolam relevant to its use for pre-medication.</p>
<p>A</p>
<p>Briefly outline the structure and function of the blood brain barrier.</p>
<p>A</p>
<p>Define cardiac preload, and describe its determinants</p>
<p>A</p>
<p>Discuss how the responses to opioid medications are altered in the elderly. Explain using pharmacokinetic and pharmacodynamic principles.</p>
<p>A</p>
<p>On the same axes, draw the oxy-haemoglobin dissociation curve for both foetal and adult haemoglobin. Explain why these curves are different, and the physiological advantages of these differences.</p>
<p>A</p>
<p>Briefly outline the physiology of the hormones produced within, or activated by, the kidney. DO NOT discuss autocrine or paracrine substances.</p>
<p>A</p>
<p>Discuss the factors that influence coronary blood flow.</p>
<p>A</p>
<p>Discuss the pharmacology of dantrolene relevant to its use in the treatment of malignant hyperthermia.</p>
<p>A</p>
<p>Name the cartilages of the larynx (20%). Discuss the anatomy of the airway relevant to performing an awake bronchoscopic intubation via the nasal route (80%).</p>
<p>A</p>
<p>Outline the effects of liver failure on drug kinetics and dynamics (2011A03).</p>
<p>A</p>
<p>Discuss the physiological factors that determine intracranial pressure (ICP) and describe how changes in posture affect ICP (2004A15)</p>
<p>A</p>
<p>Describe the cardiovascular response to a sustained valsalva maneouvre. What can be learnt about a patient’s cardiovascular function from observing this response?</p>
<p>A</p>
<p>Compare and contrast the clinically significant cardiovascular and central nervous system effects of desflurane and sevoflurane (2011b01).</p>
<p>A</p>
<p>Describe the effects of alpha 2 adrenoreceptor agonists relevant to anaesthesia</p>
<p>A</p>
<p>Outline the pathology of acute anaphylactic reactions with reference to the mediators released and their effects. Outline the role of adrenaline and its mechanisms of action in treating anaphylaxis</p>
<p>A</p>
<p>Outline the systemic cardiovascular response to exercise</p>
<p>A</p>
<p>Explain the concept of time constants and relate these to “fast” and “slow ” alveoli</p>
<p>A</p>
<p>Explain how the kidney handles glucose. Describe the physiological consequences of glycosuria.</p>
<p>A</p>
<p>Define “Venous Admixture”. Briefly explain how venous admixture influences arterial oxygen tension and how an increase in inspired oxygen concentration may effect this.</p>
<p>A</p>
<p>Describe the important determinants of work of breathing in an adult human at rest. Explain how to minimise work of breathing.</p>
<p>A</p>
<p>Describe the factors that affect airways resistance.</p>
<p>A</p>
<p>What are the major classes of oral hypoglycaemic agents? Outline their mechanisms of action and possible side effects.</p>
<p>A</p>
<p>What are the advantages and disadvantages of xenon as an anaesthetic agent?</p>
<p>A</p>
<p>Classify isomers. Briefly write an account of their significance in drugs used in anaesthesia.</p>
<p>A</p>
<p>Describe how suxamethonium and non-depolarising neuromuscular blocking agents produce their adverse cardiovascular effects.</p>
<p>A</p>
<p>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?</p>
<p>A</p>
<p>Sevoflurane and fentanyl are a common anaesthetic drug combination. Discuss pharmacological reasons why it is useful to use them together.</p>
<p>A</p>
<p>Describe the pharmacology of midazolam.</p>
<p>A</p>
<p>Draw a diagram of the larynx, as it would be seen at direct laryngoscopy. Label the important anatomical structures.</p>
<p>A</p>
<p>Describe the cough reflex.</p>
<p>A</p>
<p>Write brief notes on innate and acquired immunity.</p>
<p>A</p>
<p>Compare and contrast lung function in the neonate with that in an adult.</p>
<p>A</p>
<p>Briefly explain the cardiovascular responses to central neuraxial blockade.</p>
<p>A</p>
<p>How does a fall in temperature influence blood gas solubility and acid base values?</p>
<p>A</p>
<p>Briefly describe the structure of mitochondria. Outline the metabolic processes that occur in mitochondria.</p>
<p>A</p>
<p>Explain how oxygen supply of organs is maintained during isovolaemic haemodilution.</p>
<p>A</p>
<p>How does warfarin exert its anti-coagulant effect? What methods can be used to reverse the effects of warfarin prior to surgery?</p>
<p>A</p>
<p>Compare and contrast propofol and sevoflurane for maintenance of anaesthesia with respect to kinetics, cardiovascular and central nervous system effects.</p>
<p>A</p>
<p>Define the terms “tolerance” and “tachyphylaxis”. Discuss the different mechanisms by which tolerance can develop, giving examples where appropriate.</p>
<p>A</p>
<p>Outline the acute adverse effects of opioid receptor agonists. Describe the mechanisms of the acute adverse effects of opioid receptor agonists.</p>
<p>A</p>
<p>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?</p>
<p>A</p>
<p>List agents that can reduce bronchiolar tone and explain the mechanisms of action with examples.</p>
<p>A</p>
<p>Classify the toxic effects of local anaesthetic drugs. Detail the potential for, and mechanisms of, toxicity of prilocaine.</p>
<p>A</p>
<p>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?</p>
<p>A</p>
<p>Outline the mechanisms by which the kidney maintains potassium homeostasis.</p>
<p>A</p>
<p>Outline the important features of the lymphatic circulation.</p>
<p>A</p>
<p>Discuss the physiological causes of early post-operative hypoxaemia.</p>
<p>A</p>
<p>Using an example of exponential decay, define and outline the important features of an exponential function.</p>
<p>A</p>
<p>Detail the protective and regulatory roles of the liver.</p>
<p>A</p>
<p>Describe the fuel sources used during early and sustained fasting in humans.</p>
<p>A</p>
<p>Briefly outline the differences between the pulmonary circulation and the systemic circulation.</p>
<p>A</p>
<p>Outline the pharmacology and clinical uses of methadone.</p>
<p>A</p>
<p>Discuss the factors that influence metabolic rate</p>
<p>A</p>
<p>Give a brief account of the physiological consequences of hypothermia.</p>
<p>A</p>
<p>Discuss the physiological basis of vomiting. List the medications that can be used for rescue of post-operative vomiting in the recovery room, and their mechanism of action</p>
<p>A</p>
<p>What are the physiological effects of performing a laparoscopic procedure requiring pneumoperitoneum in the steep head-down trendelenberg position?</p>
<p>A</p>
<p>Describe the action of unfractionated heparin (30%). What is the definition of 1 unit of heparin? (10%). Discuss the adverse effects of heparin. (60%)</p>
<p>A</p>
<p>How is carbon dioxide absorbed from a circle circuit? What are the hazards associated with this absorption?</p>
<p>A</p>
<p>Discuss the mechanism of action of paracetamol and its clinical effects (50%). Describe paracetamol toxicity (25%) and its management (25%).</p>
<p>A</p>
<p>List and briefly describe the ways that cardiac output can be measured (50%). Describe in detail ONE method commonly used during cardiac surgery (50%).</p>
<p>A</p>
<p>Define local anaesthetic toxicity (20%). What are the potential clinical adverse effects (30%)? How should this patient be managed? (50%)</p>
<p>A</p>
What are the potential side effects of propofol and its formulations?
A
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.
A
Outline the safety features of currently used plenum vaporisers.
A
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.
A
Explain the effects of intermittent positive pressure ventilation on cardiac output.
A
Outline the pharmacological management of bronchoconstriction in acute severe asthma. Include mechanisms of action and potential adverse effects.
A
Describe the local anatomy relevant to the performance of a lumbar epidural block.
A
Describe the principles of surgical diathermy.
A
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.
A
List the pharmacodynamic differences between tramadol and morphine.
A
Compare and contrast the management of an overdose of aspirin with that of an overdose of paracetamol.
A
Describe the alterations to the physiology of the nervous system in the older patient and outline the consequent effects on pain perception.
A
Compare and contrast the pharmacology of Normal Saline and 4% Albumin.
A
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
A
Indicate the sequence of the physiological changes to the fetal circulation at birth and briefly describe the mechanisms that account for these changes.
A
Explain the effects of intermittent positive pressure ventilation on cardiac output.
A
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.
A
Outline the safety features of currently used plenum vaporisers.
A
Discuss the physiological significance of the blood-brain barrier.
A
Outline the role of the kidneys in the regulation of body water.
A
Briefly describe the breakdown of haemoglobin after red cell lysis.
A
Describe the physiological effects of endogenous glucocorticoids.
A
Describe the effects of resonance and damping on an invasive arterial blood pressure tracing.
A
Using cephazolin as an example in joint replacement surgery, outline the principles of antibiotic chemoprophylaxis for surgical site infections.
A
List the classes of drugs that may be used to manage an intra-operative hypertensive crisis and briefly outline the mechanisms of action.
A
Describe how non steroidal anti-inflammatory drugs exert their clinical effects. Outline the advantages and disadvantages in using COX-2 selective agents.
A
Explain how differences in the pharmacokinetics of alfentanil and fentanyl can influence the way they are administered intravenously.
A
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.
A
List the drugs that affect uterine tone, and outline the adverse effects of these agents.
A
What are the potential side effects of propofol and its formulations?
A
Classify and discuss the pharmacology of anti-platelet drugs
A
List and discuss the methods of measuring temperature
A
Discuss the anatomy of the right femoral triangle with respect to venous cannulation. List the structures potentially damaged during the procedure.
A
Describe the circle breathing system.
A
Outline the role of carbon dioxide in the maintenance of ventilation.
A
Outline the protective and regulatory functions of the liver.
A
A surgeon wishes to use topical local 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 these drugs can be used safely? What are the potential toxic effects of cocaine and how does lignocaine and adrenaline affect these?
A
Sevoflurane and fentanyl are a common anaesthetic drug combination. Discuss pharmacological reasons why it is useful to use them together.
A
Describe the role of baroreceptors in the control of systemic arterial pressure.
A
Briefly outline the effects of sevoflurane on skeletal, smooth and cardiac muscle tissues. Include how these effects are mediated and their clinical significance
A
List the classes of drugs that may be used to manage an intra-operative hypertensive crisis and briefly outline the mechanisms of action.
A
What are the physiological consequences of decreasing functional residual capacity by one litre in an adult?
A
Outline the physiological changes that may explain why an otherwise well patient may have a reduced urinary output intraoperatively.
A
Discuss the relative advantages and disadvantages of using morphine versus fentanyl for post-operative Patient Controlled Analgesia (PCA).
A
Describe the time course between an intravenous injection of a general anaesthetic agent to loss of consciousness. Explain the delay using pharmacokinetic principles.
A
Discuss factors influencing the recovery and reversal of neuromuscular blockade induced by rocuronium.
A
Describe the determinants of venous return and the effect general anaesthesia would have on these.
A
Compare and contrast the effects of general and neuraxial anaesthesia on thermoregulation.
A
Describe the vascular anatomy of the antecubital fossa (arterial and venous).
A
Describe the washout of desflurane from a patient following six hours of general anaesthesia. You may wish to use a graph to illustrate the description.
A
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.
A
Describe an active anaesthetic gas scavenging system.
A
Describe the physiology of the pain pathways and how drugs may modulate the perception of pain.
A
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.
A
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
A
Outline the important pharmacological considerations when stopping warfarin and commencing prophylactic (low dose) low molecular weight heparin (LMWH) in the peri-operative period.
A
What lower limit of SpO2 would you accept in an ASA1 young male under general anaesthesia? Explain your reasons for choosing this value.
A
How is renal blood flow regulated? What are the physiological effects of angiotensin II?
A
Describe the cardiovascular changes that occur with morbid obesity.
A
Explain the Bohr and Haldane effects in trans-placental gas exchange.
A
Briefly explain the changes that occur in stored whole blood.
A
Outline the effects of intravenously administering 500 ml of 20% mannitol. Outline the potential problems associated with its use.
A
Write brief notes on the physiological changes associated with sleep.
A
Explain the difference between perfusion limitation and diffusion limitations in the transfer of gas between alveolus and pulmonary capillary. Outline the factors that determine whether gas transfer is perfusion or diffusion limited.
A
Describe the properties of surfactant and relate these to its role in influencing respiratory mechanics.
A
Describe the effect of obesity on pharmacokinetics and the potential clinical implications, providing relevant examples.
A
Explain the changes in Functional Residual Capacity (FRC) that take place with administration of anaesthesia.
A
