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ANZCA Primary MCQs

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In the presence of ADH the highest proportion of water reabsorption occurs in the: A. Proximal convoluted tubule B. loop of Henle C. distal convoluted tubule D. cortical collecting duct E. medullary collecting duct

Which is true? A. Sevoflurane has chlorine and fluorine atoms B. Sevoflurane has a lower oil gas solubility than desflurane C. Sevoflurane has a higher blood gas solubility than desflurane

In order to excrete an osmotic load of 600mOsm/day the minimum daily urine output is: A. 10mls B. 100mls C. 500mls D. 1000mls E. 1200mls

C Max 1400 mOsm/L600/1400 ~500

Which agent is most effective in the treatment of motion sickness A. D2 blockers B. 5HT-3 blockers C. Antihistamines D. Cannabinoids E. Butyrophenones

C - vestibular effects

Increased sympathetic activity causes: A. Increased gastrointestinal peristalsis: B. Pulmonary vasodilation: C. Splanchnic vasodilatation: D. Miosis: E. Piloerection

Regarding thiopentone which of these is INCORRECT: A. decreases CMRO2 by up to 55% B. Lacks depression of airway reflexes and can cause cough

??ANSWER B. A: It is true that thiopentone decreases CMRO2 by up to 55% (Stoelting, 5th ed, p185)B: Laryngeal and cough reflexes ARE supressed by thiopentone, albeit at high doses (Stoelting, 5th ed, p186)

In chronic obstructive airways disease A. Increased total lung capacity B. increased slope of effort dependent portion C. increased vital capacity D. reduced compliance

Overestimation of SaO 2 occurs with: A. Carboxyhaemoglobin B. Fluorescein C. Hyperbilirubinaemia D. HbF E. HbS

Regarding muscles of respiration A. Diaphragm moves 1 cm in normal breathing B. Diaphragm can be an accessory muscle of expiration C. Internal intercostal muscles are inspiratory D. 50% of normal breathing is due to intercostals E. Sternocleidomastoid is an accessory muscle of inspiration that acts by raising the 1st rib

Which of the following is NOT said to be safe in porphyria? A. atropine B. diazepam C. propofol D. droperidol E. suxamethonium

A. Safe according to Acute Porphyria Drug Database (APDD), CEACCPB. Trigger according to Harrison + Yeung (but safe according to APDD)C. Safe (APDD, CEACCP)D. Safe (APDD, Harrison)E. Safe (APDD, CEACCP)[edit]References1. ADDP, http://www.drugs-porphyria.org/index.php2. Porphyrias: implications for anaesthesia, critical care, and pain medicine, CEACCP 2012, 12(3) 128-333. Harrison GG, Meissner PN, Hift RJ. Anaesthesia for the porphyric patient. Anaesthesia 1993; 48: 417-4214. Yeung Laiwah AC, McColl KEL. Management of attacks of acute porphyria. Drugs 1987; 34:604-16.

What sort of Mapleson circuit is an Ayre's T-piece? A. D B. B C. A D. E E. F

ANSWER D. Ayre's T piece is modification of Mapleson E (Davis & Kenny, 5th ed, p244)

What receptors are located in the CTZ A. 5HT-3 and D2 receptors B. ACh and H1 C. Some other wrong options D. ?

ANSWER A See Figure 5.5, Neural Pathways of Vomiting, Power and Kam, 2nd ed, p198Dr Podcast Anti-emetic Agents also says CTZ has 5hT-3 and D2

Characteristics of serotonin syndrome: A. hypothermia B. encephalopathy C. muscle flaccidity D. hypocalcaemia

ANSWER B. A: INCORRECT: hyperthermia B: CORRECT: behavioural changes including confusion and agitation C: INCORRECT: hyperreflexia, clonus D: PROBABLY INCORRECT: but I can't find a reference

Atracurium metabolism (repeat) A. Has an active metabolite. B. Ester metabolism is a minor pathway of elimination C. Metabolism is by Hofmann elimination which is pH dependent ('Did not include temperature')

Answer C (?A) - depend on exact wording. A: incorrect; laudanosine has "no neuromuscular-blocking properties" but may cause seizures (Peck Hill and Williams p.177)B - incorrect; ester metabolism is the major pathway for eliminationI agree, Peck, Hill and Williams & Stoelting both say this - however, Sasada & Smith says the oppositeC - partly correct; 1/3 of metabolism is by Hoffman elimination. Atracurium is stable at a pH of 4 and at 4 degrees, but readily breaks down at physiological pH and temperature.

A patient is in the lithotomy position for laparoscopy. What is NOT a risk factor for compartment syndrome in the lower leg? A. Obesity B. Male gender C. Lithotomy stirrups D. ?Past history of hypertension E. ?

Antihypertensives contraindicated in Pregnancy A. Clonidine B. Ramipril C. Methyldopa D. Hydralazine

20mls of 0.5% Bupivacaine is inadvertently injected into an epidural vein over 30 seconds. The patient is a 30 year old pregnant woman and weighs 60kg. The most likely outcome would be: A. tinnitus and sinus tachycardia B. confusion and atrial ectopics C. grand mal seizure and hypotension D. focal seizure and torsades de pointes E. muscle twitching and heart block

Describe the toxic effects of inhalational anaesthetic A. Sevoflurane metabolism produces TFA? B. Directly related to fluoride ion concentration causing nephrotoxicity C. Compound A is toxic in rats but not in humans.

B (or C watch wording)

Similarities between cardiac and skeletal muscle: A. Resting membrane potentials B. Striations C. Nuclei D. other wrong stuff

B, but maybe A!

Lowest intracellular concentration : A. Na B. HCO3 C. Cl D. Mg E. Ca

Pulmonary capillary pressure trace has: A. a but not c or v waves B. c but not a or v waves C. v but not a or c waves D. a and v waves but not c E. a c and v waves

Ropivacaine: A. Is a pure R isomer B. Is an isomer of bupivacaine C. Provides more motor block than bupivacaine D. Has more toxicity than bupivacaine E. Has similar physicochemical properties to bupivacaine

[Identical] 14A-129 Fluoxetine A. Inhibits acetylcholine B. Inhibits dopamine reuptake C. Inhibits presynaptic uptake of serotonin D. Increases noradrenaline uptakeE. Inhibits Monoamine Oxidase

Answer: C - Inhibits presynaptic uptake of serotoninFluoxetine is a serotonin reuptake inhibitorStoelting's Drugs Used for Psychopharmacologic Therapy

[Identical] 14A-089 Which drug is not presented as a racemic mixture?A. IsofluraneB. EnfluraneC. LignocaineD. BupivicaineE. Methadone

Answer: C - LignocaineRacemic - mixtures of different enantiomers in equal proportionsIsomers- Isoflurane- Enflurane- Bupivicaine- Methadone- HalothaneNot Isomer- Lignocaine (no chiral centre)Product information sheets

[Identical] 14B-148 There is a unidirectional valve in: A. Mapleson A circuitB. Mapleson B circuitC. Mapleson C circuit D. Mapleson D circuit E. No Mapleson circuit

Answer: ENo Mapleson circuit has a uni-directional valveMapleson circuitsThe systems are classified according to the relative positions of 3 components:FGF, APL and gas reservoirMapleson A + B have all componentsMapleson E + F do not have APL valvesMapleson E has no bagMapleson F has an open ended bag. Manual PEEP (for pediatrics)Mapleson A: FGF at operator endFGF --> reservoir --> tubing --> APL --> patient: the volume of the tubing must be > 1 VT and flows must be greater than MV to ensure no rebreathing - expiration the reservoir bag will fill until the pressure opens the APL.Lack system (Coaxial Mapleson A / Magill modification): FGF then reservoir and APL at the same point but attached to an inner tube: outer tube 30mm diam / inner tube 14mm diamMapleson B (distal to proximal): reservoir bag --> tubing --> FGF --> APL --> patient:requires FGF 2 - 3x MV. BAD for spontaneous ventilation.Mapleson C: distal to proximalreservoir bag --> short tube --> FGF --> APL --> patientrequires FGF 2 - 3x MV --> CO2 accumulates over timeMapleson D: distal to proximalreservoir bag --> APL --> tubing --> FGF --> patientMapleson E aka Ayre's T-piece:Tubing --> FGF --> patient. --> the tubing is the reservoir.Mapleson F Jackson Rees: distal to proximalbit of tube --> reservoir bag --> tubing --> FGF --> patientFGF 2 - 3x FGF required.Al-Shaikh - Breathing circuits

Which of the following will readily cross the blood brain barrier? A. Suxamethonium B. Dopamine C. Propanolol D. Edrophonium E. Glycopyrrolate

C Propranolol: Yes. From Stoelting 2nd ed p306: "Beta-blockers may cross the blood-brain barrier to produce side effects. For example, fatigue and lethargy are commonly associated with chronic propranolol therapy."Suxamethonium-No: is charged (and rapidly metabolised). Does not cross BBB but can have indirect effects on brain function (eg apnoea->cerebral hypoxia).Edrophonium-No: It is a quaternary amine so is charged and cannot cross the blood-brain barrier. (In contrast, physostigmine is a tertiary amine anticholinesterase which can cross the BBB).Dopamine-No: From [1]: "Of importance for PD, dopamine, a neurotransmitter that is depleted in PD, does not' pass the BBB but L-dopa does. In the brain L-dopa is converted to dopamine. This is important for treatment of PD symptoms with levadopa alone or in combination with carbidopa." Carbidopa is a dopa decarboxylase inhibitor which inhibits the peripheral conversion of L-Dopa to dopamine (but not centrally as it does not cross the BBB).Neurotransmitters Dopamine and noradrenaline are prevented from crossing BBB due to metabolism by Monoamine oxidase enzyme present on the astrocyte foot processes (dr podcast pharm-BBB)

With respect to calcium absorption: A. Inhibited by Protein/lactose B. Less than 10% ingested is absorbed C. Facilitated by PO4 D. Requires calcium binding mucosal protein E. Occurs due to facilitated diffusion in the upper small bowel

CORRECT ANSWER E. A: INCORRECT: facilitated by protein (Ganong, 24e, ch 26) B: INCORRECT: 30-80% of ingested Ca2+ is absorbed (Ganong, 24e, ch 26) C: INCORRECT: forms insoluble salts with phosphate so absorption is inhibited (Ganong, 24e, ch 26) D: INCORRECT: Ca2+ enters unbound via a receptor (TRPV6) on the intestinal brush border, and the calcium binding protein (calbindin-D9k) is intracellular, not mucosal (Ganong, 24e, ch 21) E: CORRECT:- 'passive entry across the apical membrane, cytosolic diffusion facilitated by vitamin D-dependent calcium-binding proteins, and active extrusion of Ca2+ across the opposing basolateral membrane mediated by a high-affinity Ca2+-ATPase and Na+/Ca2+ exchanger.' (Molina, 4e) 'Calcium is absorbed in the mammalian small intestine by two general mechanisms: a transcellular active transport process, located largely in the duodenum and upper jejunum; and a paracellular, passive process that functions throughout the length of the intestine.' (Bonner)

Which of the following is MOST likely to cause anti-cholinergic syndrome? A. Scopolamine B. Hyoscine C. Atropine D. Glycopyrrolate

Chyoscine=scopolamine > atropine - ****ed

Which of the following is TRUE about tissue macrophages: A. half life <24 hours: B. derived from circulating lymphocytes: C. In the liver they are called histiocytes: D. not found in the brain: E. are important in the first line defence against bacteria

None of the above really, maybe E

All of the following can be used to measure the concentration of a Volatile agent EXCEPT; A. Paramagnetic B. Raman scattering C. Mass Spectrometry D. Infrared,

Milrinone: A. Decreases pulmonary vascular resistance B. Acts by reducing cyclic AMP levels via phosphodiesterase III inhibition C. Is ineffective when given orally D. Is associated with thrombocytopenia in chronic use E. Increases systemic vascular resistance

Drugs with high hepatic clearance: A. Clearance is decreased with low hepatic blood flow B. Clearance does not change with high hepatic blood flow

Hb is a good buffer because: A. Large concentration B. 38 imidazole groups on Histidine residues

Hydrogen ion concentration in plasma with a PH of 7.1 A. 80 nmol B. 40 nmol C. 120 nmol D. 0 nmol : E. ?

Ketamine is: A. a non competitive NMDA receptor antagonist

Side effect 8.4% NaHCO3 administration A. Intracellular acidosis B. Rebound metabolic acidosis C. ... Other options were easy to rule out

Signs of Digoxin overdose A. Visual disturbance B. PR prolongation C. QT lengthening D. Constipation

The effect of severe hypercapnia includes: A. Increased levels circulating catecholamines in plasma B. Increased urine output C. No effect on myocardial contractility D. Shift of OHDC to the LEFT E. Reduce systemic blood pressure

The most immediate source of energy in muscle is: A. ATP in all muscle cell types B. Creatine phosphate in skeletal muscle ATP in cardiac and smooth muscle C. Creatine phosphate in skeletal and cardiac muscle ATP in smooth muscle D. Creatine phosphate in cardiac muscle ATP in skeletal and smooth muscle E. Creatine phosphate in all muscle cell types

What can't be measured with spectrophotometrometry? A. N2: B. volatiles C. C02 D. N20

What is the mechanism of action of tranexamic acid? A. Inhibits inactivation of plasminogen B. ?

Which of the following is not correct: A. the pka of an agent is inversely proportional to the ph of the solution B. the closer the pka to the pH the bigger the change in ionised portion per given change in pH C. Thiopentone will have an increase in the unionised portion in acidosis D. Opiods (or Morphine) will have a decrease in ionised portion in alkalosis E. The excretion of salicylates is increased by acetazolamide

Which of the following statements is NOT correct. A. pKa for a weak acid is inverse of pH B. The closer the pka to plasma pH the greater change in ionisation for a given change in pH C. Thiopentone is more unionised in more acidic solution D. Opioid is more unionised in more alkali solution E. Aspirin more excreted renally with use of azetazolamide

With respect to B12 deficiency: A. B12 is absorbed in terminal ileum B. Due to a lack of ingested intrinsic factor C. B12 is destroyed by gastric acid D. Due to increased erythropoesis E. Due to a lack of vitamin B12 intake for a few weeks

The liver produces all of the following EXCEPT: A. von Willebrand factor: B. Albumin: C. Antithrombin III: D. Fibrin: E. Cholesterol

A (endothelium)

Propofol TCI using Marsh model 'Diprifusor' is affected by which ONE of the following parameters: A. Weight B. Height C. Age D. Weight and age E. Weight and height

AA. True. (PK in Obese Patients, CEACCP 2004)B. False. The TCI pump will not ask you for height.C. False. Age is entered but only to stop you using it in paediatric patients, doesn't actually alter the PK modelD. False. See C.E. False. See B. This is the Schneider model

Hypoxic Pulmonary Vasoconstriction: A. Solely mediated by alveolar PO2 B. Biphasic with INCREASE at 40mins following prolonged hypoxia C. Requires intact neural connections D. Mediated by pulmonary vein smooth muscle contraction E. Unaffected by inhaled nitric oxide & prostacyclin

[Identical] 14B-089 Which drug is NOT a racemic mixtureA. LignocaineB. EnfluraneC. IsofluraneD. BupivacaineE. Methadone

Answer: A - LignocaineRacemic - mixtures of different enantiomers in equal proportionsIsomers- Isoflurane- Enflurane- Bupivicaine- Methadone- HalothaneNot Isomer- Lignocaine (no chiral centre)Product information sheets

[Identical] 15B-025 What can't be measured with spectrophotometry?A. N2B. VolatilesC. C02D. N20E. Ethanol

Answer: A - N2Monatomic molecules can't be measured with spectrophotometry because they do not have infrared spectraHomonuclear diatomic molecules do not posses infrared spectraReference??

Regarding parasympathetic autonomic innervation: A. Post ganglionic fibres are on the walls of viscera B. Post ganglionic fibres are relatively long C. Pre ganglionic neurotransmitters are acetylcholine and noradrenaline D. Commonly affected by spinal block E. Causes constriction of detrusor muscle and urinary sphincter

ANSWER A (or possibly D) A: BEST ANSWER: 'located near or within their effector organs' (Kam, 69) 'fibres pass uninterrupted to ganglia in or near the innervated organ' (Stoelting, 81); although they're not always on the walls of viscera B: INCORRECT: PNS postganglionic fibres are short (Kam, p69) C: INCORRECT: Ach is the only preganglionic neurotransmitter in the ANS (Kam, 67 and 70) D: POSSIBLY CORRECT: Urinary retention is mediated by sacral PNS inhibition by opioids (Stoelting, p249), but would you say that this happens 'commonly'? Miller disagrees, stating that the nausea and vomiting associated with neuraxial blockade is hyperperistalsis from unopposed PNS tone, and that the risk of urinary retention is overstated (p1618) E: INCORRECT: contracts the detrusor muscle (Kam, p69) but relaxes the sphincter (Stoelting, p79)

Cerebral blood flow regulation being most affected by A. pCO2 B. pO2 C. pH D. ?E. ?

ANSWER A or C? PCO2: CBF rises 2-4% for every mmHg rise in PaCO2 (Power and Kam), >200% of normal (Brandis, p64) PO2: Within physiological limits PO2 does not affect CBF (Power and Kam) but increases to 150% of normal with PO2<50mmHg (Brandis, p65) pH: Guyton (761ff) says the effect of CO2 is actually via changes in pH rather than a direct effect of CO2

Left recurrent laryngeal nerve: A. Motor nerve root from accessory nerve B. Hook around aorta anterior to arteriosus ligamentum C. Supply cricothyroid muscle D. Sensory supply to left pharyngeal mucosa

ANSWER A. A: CORRECT: 'The somatic motor fibers that innervate the laryngeal and pharyngeal muscles are located in the nucleus ambiguous and emerge from the medulla in the cranial root of the accessory nerve.' (Wikipedia) B: INCORRECT: the recurrent laryngeal nerve runs posterior to ligamentum arteriosum C: INCORRECT: the cricothyroid is supplied by superior laryngeal n. D: INCORRECT: the recurrent laryngeal n. only supplies the laryngeal mucosa inferior to vocal cords

Fresh frozen plasma FFP A. Contains high sodium load B. Has no factor 5&8 C. Had no albumin D. Needs to be cross matched before use

ANSWER A. A: CORRECT: 173mEq/L B: INCORRECT: FFP contains a lot of Factor 5 and 8, but 'thawed plasma' (that is FFP that is thawed and used 23hrs to 4 days after thawing) has decreased Factor 5 (80% of normal) and decreased Factor 8 (60% of normal) C: INCORRECT: it is whole blood minus platelets and RBCs; still contains albumin D: INCORRECT: group specific is fine, in an emergency even non-group specific is used

Cephalic vein what is NOT correct A. Receive tributary from ulnar forearm B. Lateral to bicep tendon C. Pierce clavipectoral fascia D. Valve at junction of cephalic and axillary vein E. travel between pectoralis major and deltoid muscle

ANSWER A. This question is taken straight out of a section in Anatomy for Anaesthetists (available on the ANZCA online library);'The cephalic vein drains tributaries from the radial border of the forearm, ascends over the lateral side of the antecubital fossa and then lies in a groove along the lateral border of the biceps. The vein dives beneath the deep fascia at the lower border of pectoralis major, lies in a groove between this muscle and deltoid, then finally pierces the clavipectoral fascia to enter the axillary vein. This groove between pectoralis major and deltoid is a conveniently identifiable site for a cut-down when a superior vena caval infusion is required. CLINICAL NOTE Catheters inserted into the cephalic vein frequently fail to enter the axillary vein and superior vena cava because of this sharp curve as it passes through the clavipectoral fascia and because of the valve commonly guarding this venous junction.'

Regarding plasma cholinesterase (pseudocholinesterase) enzyme: A. inhibited 80% by dibucaine B. concentration is increased in the third trimester of pregnancy C. concentration is increased in the neonate D. metabolises lidocaine E. metabolises atracurium

ANSWER A. 'Dibucaine, a local anesthetic, inhibits normal pseudocholinesterase activity by 80%, but inhibits atypical enzyme activity by only 20%.' Chapter 11. Neuromuscular Blocking Agents, Morgan and Mikhail's Clinical Anaesthesiology, 5th edition (Access Medicine Books)

The macula densa is an example of: A. Baroreceptor B. Osmoreceptor

ANSWER A. A: CORRECT: 'macula densa releases more adenosine if the renal perfusion pressure rises... reduces production of the pressure falls' (Power & Kam, 2nd ed, p228). IE, the MD senses changes in perfusion pressure and effects a BP response (via renin -> AT1 -> AT2). This is the definition of a baroreceptor. B: INCORRECT: an osmoreceptor detects changes in osmolarity. The MD doesn't do this; it only senses changes in Na and Cl concentration, irrespective of osmolarity. Mannitol, for example, does not alter tubuloglomerular feedback, even though it increases the osmotic load (Briggs et al)

What is NOT a feature of local anaesthetic activity? A. decreased in alkaline environment B. dependent on uncharged molecules crossing the cell membrane C. relies on action potential inhibition via sodium channel blockade D. deeper block with increasing action potential frequency E. small nerve fibres are more readily blocked than large fibres

ANSWER A. A: FALSE: This is not a feature of LA activity; LAs are weak bases, in an alkaline environment they will be more unionised and therefore more active B: TRUE C: TRUE D: TRUE: The fraction of Na channels that have bound a local anesthetic increases with frequent depolarization (eg, during trains of impulses). This phenomenon is termed use-dependent block. E: TRUE: small diameter increases sensitivity to local anesthetics

What happens when BSL low?... A. Beta-1 stimulation of hepatic cells B. Beta-2 stimulation of hepatic cells C. Beta-2 stimulation of glucagon suppressing insulin D. Beta-2 stimulation inhibiting insulin E. Beta-2 stimulation causing insulin release

ANSWER B- adrenaline/noradrenaline stimulate hepatic eta-2 adrenergic receptors -> increase hepatic glycogenolysis and gluconeogenesis (Exton)

A patient is anaesthetised with 50% oxygen / 50% nitrous oxide and 1% sevoflurane for a tracheostomy. When the surgeon cut into the trachea with diathermy the ETT catches fire. In this case the nitrous oxide is acting as (repeat): A. fuel B. oxidising agent C. smoldering agent D. secondary ignition source by increasing conductivity of the gas mixture E. Smothering agent by increasing the distance between oxygen molecules

ANSWER B. '...oxidizers such as oxygen and nitrous oxide' (Ehrenwerth et al.)Ehrenwerth and Seifert, Chapter 31, Electrical and Fire Safety, Anesthesia Equipment, Principles and Applications, p643 from the ANZCA online library

Role of ADH: A. Inserts aquaporin channels into basolateral membrane of collecting ducts B. Acts on vascular V1a receptors C. Reabsorbs Na and H2O

ANSWER B. A: INCORRECT. Luminal (Kam, p240) B: CORRECT. (Kam, 240, 330-1) C: INCORRECT. H2O yes, but not sodium. The confusion is in the naming of receptors. There are two naming systems in use; V1, V2, V3 and V1a, V1b, V2Name | Location | EffectV1a = V1 | vessels | vasoconstrictionV1b = V3 | brain | ACTH release, olfactory stuffV2 | basolateral membrane of collecting duct cells | inserts aquaporins in luminal membrane

Sympathetic nervous system A. Increases Na reabsorption in the proximal tubule B . Increases efferent arteriole tone to decrease GFR C. Decreases renin release D. Something about the collecting ducts

ANSWER B. A: INCORRECT: decreases GFR so Na reabsorption will decrease B: CORRECT: SNS constricts afferent & efferent arterioles -> reduce RBF + GFR (Power & Kam, 2nd ed, p228)C: INCORRECT: Increases renin release, direct β1 effectD: INCORRECT

What forms the posterior boundary of the epidural space? A. Anterior longitudinal ligament B. Anterior aspect of the laminae C. Supraspinous ligament D. Posterior aspect of the laminae E. Interspinous ligament

ANSWER B. Superiorly: Fusion of the spinal and periosteal layers of dura mater at the foramen magnumInferiorly: Sacrococcygeal membraneAnteriorly: Posterior longitudinal ligament, vertebral bodies and discsLaterally: Pedicles and intervertebral foraminaePosteriorly: Ligamentum flavum, capsule of facet joints, and laminae

Lignocaine: A. Over 50% unionised at pH 7.4 B. Metabolism is dependent on liver blood flow C. ...

ANSWER B. A: 25% unionised at pH 7.4 (Stoelting, 5th ed, p284) B: True (Stoelting, 5th ed, p289)

Describe the effects of isoflurane at 1 MAC during spontaneous ventilation. A.Decreased RR B. Decreased TV C. Normal response to PO2 D. Increased PVRE. Increased airway resistance

ANSWER B. A: FALSE. Volatiles INCREASE RR, decrease TV and overall decrease MV. B: TRUE. Volatiles decrease TV. C: FALSE. Volatiles all impair the normal response to PO2 D: FALSE. Minimal change in PVR, if anything they decrease it.D. FALSE. Volatiles decrease airway resistance and can be used in the treatment of asthma.See Stoelting 5th ed, p125, 131-4

Concerning midazolam which is NOT correct: A. It has a halflife of 3 hours B. it has no active metabolite C. its oral bioavailability is 40-60% D. Something about lipid solubility

ANSWER B. A: INCORRECT. 1.8 to 6.4 hours (mean approximately 3 hours)(drugs.com), elimination half time is 1.9hrs (Stoelting p174)B: CORRECT: midazolam does have an active metabolite; 1-hydroxymidazolam with ½ the activity of the parent compound (Stoelting, p175)C: INCORRECT. Bioavailability is 50% after an oral dose (Stoelting, p174-5)

Regarding Morphine and Tramadol which statement is true? A. Morphine is less potent than tramadol B. Tramadol is less efficacious than morphine C. Tramadol exhibits NMDA receptor antagonism D. Pruritus is a common side effect of tramadol E. Tramadol is a synthetic codeine derivative

ANSWER B. A: INCORRECT: it is 5-10x less potent (Stoelting, p241) B: CORRECT: - In the treatment of mild to moderate pain, tramadol is as effective as morphine or meperidine. However, for the treatment of severe or chronic pain, tramadol is less effective. (Goodman & Gillmans) C: INCORRECT: - 5HT and noradrenaline (Katzung) D: INCORRECT: not listed as a side effect in any major textbook/source E: INCORRECT: synthetic codeine analog (Goodman & Gillman)

Factor not affecting rate of rise of FA/FI ratio: A. Age: B. MAC: C. Cardiac output: D. Solubility

ANSWER B. This question appears to be taken from a section in Miller titled; Factors Modifying the Rate of Rise in Fa/Fi (p544ff)A: Age does affect rise (See graph p547)B: Not mentioned C: CO also affects rise (p545)D: Solubility also affects rise (p544)

What is the lowest value of microshock required to cause VF? A. 1 microAmp B. 10 microAmp C. 100 microAmp D. 1mA E. 10mA

ANSWER C. 150μA (Davis & Kenny, 5th Ed, p183)

Phenoxybenzamine acts at its receptor via (new) A. Competitive antagonism B. Alpha 1 selective C. Acts via an intermediate D. Increased intracellular calcium

ANSWER CA: INCORRECT: non-competitive antagonistB: INCORRECT: has some alpha-1 selectivity (according to Basic and Clinical Pharm + Katzung), but almost all textbooks describe it as non-selective; Goodman and Gilman says phenoxybenzamine and phentolamine are non-selective α receptors antagonistsC: CORRECT: 'phenoxybenzamine forms a reactive ethyleneimonium intermediate that covalently binds to the alpha receptor site resulting in irreversible blockade' (Bryson, p150)D: INCORRECT: agonists at alpha-1 receptors (Gq) increase IC calcium, but phenoxybenzamine is an antagonist so should not increase IC calciumAnswer A is correct according to Drugs in Anaesthesia and intensive care 4th ed "produce irreversible competitive alpha blockade"

Mivacurium: A. is a steroidal muscle relaxant B. offset occurs within 10 minutes of ED95 dose C. often requires reversal with an anticholinesterase D. action may be prolonged by an anticholinesterase

ANSWER D A: INCORRECT: benzoisoquinolinium B: INCORRECT: The ED95 in adults under narcotic-based anesthesia is 0.07-0.08 mg/kg. Duration of clinical effect (time for spontaneous recovery of a single-twitch response to peripheral nerve stimulation to 25% of the control value [T 25]): 70 to 100 mcg/kg— 13 (range, 8 to 24) minutes (1) Time to spontaneous 95% recovery of the twitch response to peripheral stimulation (T 95): 70 to 100 mcg/kg—21 (range, 10 to 36) minutesC: INCORRECT: duration of action is generally too short to 'often' require reversalD: CORRECT: 'Because mivacurium is hydrolyzed by plasma cholinesterase, the possibility that anticholinesterase agents might prolong, rather than reverse, the effects of mivacurium has been considered (2). However, both neostigmine and edrophonium have been shown to reverse the effects of mivacurium, when spontaneous recovery or movement has been observed (1-4)'.

Potential side effects of high dose inhaled steroids include all of the following EXCEPT: A. Oral candidiasis B. HPA-axis inhibition C. Osteopaenia / osteoporosis D. Alopecia E. Dysphonia

ANSWER D. A: SIDE EFFECT: oropharyngeal candidiasis is common (>1%) B: SIDE EFFECT: adrenal suppression can occur with high doses C: SIDE EFFECT: clinical implications concerning risk of osteoporosis and fracture are still unknown. Consider screening adults on long-term high-dose inhaled corticosteroids for osteoporosis. D: NOT A SIDE EFFECT E: SIDE EFFECT: dysphonia is common (>1%)

Midazolam: A. Less lipid soluble than lorazepam B. Ampoule pH alkaline C. Metabolism by demethylation D. Significant first pass metabolism E. Water soluble at physiological pH

ANSWER D. A: INCORRECT: 'lorazepam has slower onset of action than midazolam... because of lower lipid solubility' (Stoelting, p180)B: INCORRECT: pH is 3.5, this keeps it the ring structure open and water soluble (p174) C: INCORRECT: metabolism is by hydroxylation then glucuronidation (Stoelting, p175)D: CORRECT: 50% first pass metabolism, Stoelting calls this a 'substantial first-pass hepatic effect' (p174) E: INCORRECT: no, ring closure at pH>4; lipid soluble

Phenytoin: A. Low protein binding B. Increases Sodium Conductance C. Can not be used as an antiarrhythmic D. Nystagmus sign of toxicity

ANSWER D. A: INCORRECT: 90-93% protein bound (Stoelting, p350)B: INCORRECT: sodium and calcium ion channel blockade (p347)C: INCORRECT: '...plasma phenytoin concentration of 8-16mcg/ml is usually sufficient to suppress cardiac dysrhythmias' (p353)D: CORRECT: adverse SE including nystagmus and ataxia are likely when concentraiton is >20mcg/ml (p353)

One mg of alfentanil is administered to a pregnant woman at term for induction of anaesthesia prior to a caesarean section. What percentage of unionised drug (of alfentanil) will be present in the fetal blood? A. 1% B. 10% C. 50% D. 90% E. 99%

ANSWER D. I couldn't find a single textbook reference to this scenario but from first principles; the pKa of alfentanil is 6.5. Using a pH of 7.25 (foetal pH) and the Henderson-Hasselbalch equation, this gives us a value of 85% unionised. The closest answer is therefore D.

Disinfection; A. removal of microorganisms and unwanted matter from contaminated materials B. prevention of microbial contamination C. complete destruction of all microorganisms including spores D. inactivation of nonsporing organisms using thermal or chemical means E. Occurs before decontamination and sterilisation

ANSWER D. This questions is lifted straight from the ANZCA Guidelines on Infection Control in Anaesthesia (see below).Asepsis: the prevention of microbial contamination of living tissues or sterile materials.Disinfection: the inactivation of non-sporing organisms using either thermal or chemical means. Sterilisation: complete destruction of all micro-organisms, including spores.

Esmolol (new) A. Non selective B. More lipid soluble than propanolol C. Intrinsic sympathomimetic D. Broken down by pseudocholinesterase E. Peak haemodynamic effects in 5 min

ANSWER E Reference 'Full therapeutic effects evolve within 5 minutes' Stoelting, 5th Ed, p482Agree with E-it's cardioselective, no ISA, and organ-independent metabolism by RBC esterases

Which combination is correct with regards to chemotherapeutic agents and their side effects? A. Doxorubicin pulmonary fibrosis B. Bleomycin cardiomyopathy C. Cisplatin pseudocholinesterase deficiency D. Cyclophosphamide monoamine oxidase inhibition E. Vincristine peripheral neuropathy

ANSWER E. A: INCORRECT: doxorubicin is associated with cardiotoxicity, not pulmonary fibrosis B: INCORRECT: bleomycin can cause pulmonary fibrosis, not cardiomyopathy C: INCORRECT: Cisplatin causes neurotoxicity and nephrotoxicity. There are case reports of cyclophosphamide causing pseudocholinesterase deficiency, but not cisplatin. D: INCORRECT: I can't find any association between cyclophosphamide and MAO inhibition E: CORRECT: Neuropathy is caused by a number of different chemotherapy drugs, the most common being vincristine.

Atrial natriuretic peptide (ANP): A. Decreases Na reabsorption in PT B. Increases Na reabsorption somewhere C. Decreases Na reabsorption PT and distal tubules D. Decreases reabsorption in ascending loop of henle E. Relaxes afferent arteriole

ANSWER E: ANP dilates afferent arteriole (Power & Kam, 2nd ed, p228)Directly inhibits sodium reabsorption in collecting ducts (no relevant answer above)Also inhibits renin and aldosterone; so would indirectly inhibit Na reabsorption in DCT (no relevant answer above).

Which of the following are not a mechanoreceptor: A. Golgi Tendon B. Pacinian corpuscles C. Meissner's corpuscles D. Merkel's discs E. Ruffini endings F. Krause Bulbs

ANSWER F. A: Golgi Tendon: tendon tension or rate of change of tension (Guyton p675, 679-80) B: Pacinian corpuscles: vibration (Power & Kam, p53) C: Meissner's corpuscles: light touch (Power & Kam, p53) D: Merkel's discs: continuous touch (Power & Kam, p53) E: Ruffini endings: continuous touch and pressure around joints (Power & Kam, p53) F. Krause Bulbs: 'End-bulbs of Krause' are cold receptors according to Power & Kam (p373). But Guyton says 'Krause's corpuscles' are mechanoreceptors (p573), and Wikipedia says corpuscles and end-bulbs of Krause are different names for the same thing! Having said that, I think this is the best answerI always had ruffini down as the heat themoreceptor ->wiki says Classically regarded as a thermoreceptor, the Ruffinian endings/corpuscle is not actually a thermoreceptor but is rather a mechanoreceptor.

[Identical] 18A-113 Exercise A. CO and skeletal muscle blood flow increase by same percentage B. Blood flow increases in static and dynamic exercise C. Heart rate increases linearly with exercise D. Stroke volume increases linearly with exercise E. Pulse pressure decreases with exercise

Answer A: A: Skeletal muscle constitutes 40% of the total lean body mass and receives less than 20% of the cardiac output at rest, but at maximal muscle contraction it can increase to 80%-90% of the total cardiac output. B: In static muscle contraction muscle blood flow can be significantly reduced, but in rhythmic dynamic muscle contraction blood flow occurs during relaxation between muscle contractions. C: The heart rate increases in a linear manner with the severity of the exercise D: There is also a non-linear increase in stroke volume during exercise. The increase in stroke volume occurs mainly in light to moderate exercise, with only a small further rise in maximal exercise. E: Systolic arterial blood pressure can rise to 190-225 mmHg during exercise. Diastolic blood pressure shows only a small rise, and in some sub- jects it may fall slightly. Consequently, the pulse pressure can increase two- to threefold. Power and Kam - Exercise

[Identical] 18B-115 Mixed venous blood: A. Can be measured from PA catheter B. pO2 75mmHg C. pH higher than arterial D. Has the same oxygen content as shunted blood E. pCO2 52mmHg

Answer: A A: A mixed venous blood gas is a sample aspirated from the most distal port of the PA catheter, offering a mixture of inferior vena cava blood, superior vena cava blood, and the coronary sinuses B: Venous pvO2 40mmHg, SvO2 75%, Cv(O2) 15mL/100mL C: pH lower (7.31-7.41) in mixed venous than in arterial blood D: Shunted blood also includes the Thebesian and bronvhial venous blood E: PvCO2 46mmHg, Cv(CO2) 52mL/100mLNunn's 8th Ed Oxygen

[Identical] 18A-090 FRC A. Reduces 500-1000mL supine B. Decreases with age C. RV + IRV D. Increases when anaesthetised E. Reduction is least in obese patients during anaesthesia

Answer: A A: FRC decreases 500-1000mL when transitioning from sitting to supine B: FRC increases with age C: FRC = ERV + RV D: FRC decreases when anaesthetised and returns to normal some hours post op E: The reduction in FRC is greater in obese patients Nunn's 8th Ed Anaesthesia p27 + 297

[Identical] 18A-032 Ventilatory response to hypoxia blunted at A. 0.1 MAC B. 0.3 MAC C. 0.5 MAC D. 1.0 MAC E. 1.1 MAC

Answer: A - 0.1 MAC A: Attenuated with Halothane at 0.1MAC. Nunn's 8th Ed p293

[Identical] 18A-099 MAC above which impaired response to hypoxaemiaA. 0.1 MACB. 0.3 MACC. 0.5 MACD. 1.0 MACE. 1.1 MAC

Answer: A - 0.1 MACIt is important to realize that even a subanesthetic concentration (0.1 MAC) of inhalational anesthetics profoundly diminishes hypoxic respiratory drive without concurrent use of narcotics.Miller's Pulmonary Pharmacology and Inhaled Anesthetics

[Identical] 19B-088 Percentage unionised of local anaesthetic pKa 8.1 in pH 7.1a. 10%b. 50%c. 75%b. 90%e. 100%

Answer: A - 10%Local anaesthetics are basic drugs.Basic drugs ionise below their pKaAt a pH 1 below the pKa 90% will be ionised + 10% unionised

[Identical] 18A-061 Antihistamine side effectA. Alpha stimulationB. EPSE - extrapyramidal side effectC. HyperthermiaD. ConstipationE. Urinary frequency

Answer: A - AlphaA: Antihistamines (1st generation) have alpha receptor stimulationB: 1st generation antihistamines have been used to treat EPSEC: Serotonin syndrome causes hyperthermiaD: Antisrotonergics cause constipationE: Antihistamines cause urinary retentionStoelting's Antiemetics

[Identical] 18B-050 Which of the following is routinely recommended in cardiac arrest by the ARC? A. 100% oxygen B. amiodarone C. magnesium D. sodium bicarbonate E. vasopressin

Answer: A - 100% oxygen is "routinely" recommended in cardiac arrest A: Cardiac arrest results in decreased delivery of O2. Increasing FiO2 will increase PAO2 -> thus increasing DO2. B: Amiodarone is suggested for refractory VF/pVT (not routinely recommended)"Drugs, including calcium, lidocaine (lignocaine), magnesium (magnesium sulfate heptahydrate), potassium, sodium bicarbonate (and other buffers) may be considered to help manage particular conditions that are associated with patients who have arrested""ANZCOR suggests that vasopressin should not be used instead of adrenaline (epinephrine) in cardiac arrest"ANZCOR guidelines - Medications in cardiac arrest

[Identical] 18A-012 Propofol plasma concentration where 50% response to scalpel.A. 15 ug/mlB. 20 ug/mlC. 25 ug/mlD. 30 ug/mlE. 40 ug/ml

Answer: A - 15mcg/mLThe propofol Cp 50 to prevent movement on skin incision is 16 μg /mLMiller - Intravenous anaesthetics

[Identical] 18B-093 Propofol plasma concentration where 50% response to scalpel.A. 15 ug/mlB. 20 ug/mlC. 25 ug/mlD. 30 ug/mlE. 40 ug/ml

Answer: A - 15ug/mlThe propofol Cp50 to prevent movement on skin incision is 16ug/mlMiller's Intravenous anaesthetic

[Identical] 18A-043 EaEa incidenceA. 1: 3000B. 1: 10 000C. 1: 1000D. 1: 30 000E. 1: 80

Answer: A - 1:3000. Genetic types of pseudocholinesterase deficiencyEu:Eu - 96%, Homozygous normal, normal response, Dibucaine 80Eu:Ea - 4%, heterozygous atypical 1:480, Slightly prolonged duration of sux, Dibucaine 60Ea:Ea - 0.05% 1:3000, homozygous atypical, greatly prolonged duration of sux (8-10hrs), Dibucaine 20Fluride resistant - heterozygous clinically insignificant unless combined with abnormal allele or acquired deficiency, homozygous normal Fluride #60, homozygous atypical Fluride #30Miller's Pharmacology of neuromuscular blocking drugs

[Identical] 14A-059 32g of O2 occupies 22.4L. What does 44g of CO2 occupy? A. 22.4L B. 16.3LC. 30.8LD. 44.8LE. 11.2L

Answer: A - 22.4LOxygen molecular weight = 16 g/molCarbon molecular weight = 12 g/mol1 Mole O2 = 32g1 Mole CO2 = 44g1 mole of any gas = 22.4L at STPReference

[Identical] 18A-076 Spleen auto transfusion A. 250 mL B. 500 mL C. 750 mL D. 1000 mL E. 2000 mL

Answer: A - 250 mLA small amount (150 to 200 mL) of blood is stored in the splenic venous sinuses and can be released by sympathetic nervous system-induced vasoconstriction of the splenic vessels. Release of this amount of blood into the systemic circulation is sufficient to increase the hematocrit 1% to 2%. Stoelting's Gastrointestinal physiology

[Identical] 18A-077 Time to peak effect midazolamA. 3 minutesB. 5 minutesC. 7 minutesD. 11 minutesE. 15 minutes

Answer: A - 3 minutesThe onset of action is rapid with midazolam, usually with a peak effect reached within 2 to 3 minutes of administrationMiller's Intravenous anaesthetics

[Identical] 17A-031 Piped gas wall outletA. 400kPa supplied at wall outletB. Outlet connections are pin indexedC. Oxygen supply connector has white and black flangeD. Cannot be delivered directly to the patientE. Is only stored as a gas

Answer: A - 400kPa supplied at wall outletA: Piped medical gas and vacuum (PMGV) is a system where gases are delivered from central supply points to different sites in the hospital at a pressure of about 400 kPa.B: Wall outlets accept matching quick connect/disconnect Schrader probes and sockets with an indexing collar specific for each gas (or gas mixture).C: Oxygen supply connector has a white flangeD: Piped wall oxygen can be delivered directly to the patient via the Emergency Oxygen Flush button (35-70L/min at 400kPa)E: Oxygen stored in a VIE is stored as liquidAl-Shaikh - Medical gas supply

[Identical] 14A-060 The barometric pressure of air is 247mmHg. What is the pressure of oxygen in moist inspired air? A. 42mmHg B. 6mmHgC. 56mmhGD. 21mmHgE. 11mmHg

Answer: A - 42mmHgAssuming - saturated vapor pressure of water at 37c = 47mmHg- FiO2 = 21%PiO2 = (Patm - PH2O) x FiO2PiO2 = 247 - 47mmHg = 200mmHg200mmHg x 0.21 = 42mmHgReference

[Identical] 16A-018 The arterial pulse pressure wave travels through aorta at a speed of A. 5m/s B. 10m/s C. 15m/s D. 20m/s E. 25m/s

Answer: A - 5 m/s"The blood forced into the aorta during systole not only moves the blood in the vessels forward but also sets up a pressure wave that travels along the arteries. The pressure wave expands the arterial walls as it travels, and the expansion is palpable as the pulse. The rate at which the wave travels, which is independent of and much higher than the velocity of blood flow, is about 4 m/s in the aorta, 8 m/s in the large arteries, and 16 m/s in the small arteries of young adults." - Ganong p542.

[Identical] 18A-034 Total extracellular osmotic pressureA. 5600mmHgB. 25mmHgC. 285mosm/LD. 75% of oncotic pressureE. Is due to diffusion

Answer: A - 5600mmHgA: The total osmotic pressure of plasma is approximately 5545 mm HgB: Total oncotic pressure - 28mmhg C: Osmolality 285mOsm/L (is nC)D: Albumin is responsible for 65-75% of oncotic pressure (which makes up only 25-28mmHg of osmotic pressure)E: Osmotic pressure is the hydrostatic pressure required to resist the movement of solvent molecules (diffusion)Miller's Perioperative fluid and electrolyte therapy

[Identical] 18A-003 How much adrenaline in 1:200 000?A. 5mcg/mlB. 50mcg/mlC. 500mcg/mlD. 50ng/mlE. 500ng/ml

Answer: A - 5mcg/mL1:100,000 = 10mcg/mL1:10,000 = 100mcg/mL1:80,000 = 12mcg/mL1:200,000 = 5mcg/mL

[Identical] 15B-089 How long after commencing a propofol infusion must it be used by:A. 6 hrsB. 12 hrsC. 18 hrsD. 24 hrsE. 30 hrs

Answer: A - 6 hoursDiscard the tubing and vial after 12 hours of an infusion, and 6 hours if you open the vial and don't use it at all Stoelting Intravenous sedatives and hypnotics

[Identical] 14A-046 Renal blood flow in a 70kg man is A. 600 - 650 ml/kidney/minB. Greatest blood flow of all organsC. 58ml/100g/minD. Correlates to metabolic demandE. Is higher during sympathetic outflow

Answer: A - 600 - 650 ml/kidney/minA: Renal blood flow 1% body mass20% cardiac output~1L/min500-600mL/kidney/min~400mL/100g/minB: Liver has greatest blood flow of all organs - 30% of CO = 1500mL/minC: 400mL/100g/minD: Renal blood flow does not correlate to metabolic demandO2 consumption correlates to metabolic demand / Na/K pumpsE: Sympathetic outflow causes incresed vascular resistance and decreased blood flowMiller's 9th Ed - Anesthesia and the Renal and Genitourinary Systems

[Identical] 14A-029 At birth children A RhD negative have high titres to:A. A antigens B. B antigens C. A and RhD antigens D. B and RhD antigens E. none of the above

Answer: A - A antigensRhesus D negative will have no Rhesus antigensABO type A will have A antigens and B antibodiesRhesus positive = Rhesus antigen (no Rhesus antibody)The term Rh +ve refers to the presence of the D antigen.ABO A = A antigen + B antibodyNatural antibodies to A and/or B antigens are found in the plasma of subjects who have red cells that lack the corresponding antigen. Antigen - what the body hasAntibody - what the body is allergic toPower and Kam - Physiology of blood Blood bank - Donateblood.com.au

[Identical] 18B-073 Which antiplatelet has the shortest half life?A. AbciximabB. ClopidogrelC. PrasugrelD. TicagrelorE. Tirofiban

Answer: A - AbciximabHalf livesClopidogrel 8hPrasugrel 7hTicagrelor 7hTirofiban 2hAbciximab 10-15minAspirin 15-30minAbciximab - Shortest half time (given as loading dose -> infusion)Initial half life - <10mins, second phase 30mins, Biological half life - 12-24hours (platelet recovery in 48 hours) significantly long binding time to receptorsHemmings and Egan

[Identical] 15A-056 Which of the following decreases secretion of potassium in the distal convoluted tubuleA. AcidosisB. IV Saline C. AldosteroneD. VasopressinE. Carbonic anhydrase inhibitors

Answer: A - AcidosisA: Acidosis causes an increase in H-K-ATPas activity in the Type A intercalated cells, increasing reabsorption of potassiumB: Na and Cl are handled independently of K in the nephron. But an increased Na load will cause more Na to be pumped out into the lumen by the Na/K/ATPase pumps and therefore more K pumped back into the interstitiumC: Aldosterone -> increased K secretion by 1. Incrased expression of Na-A-ATPase pumps and 2. Stimulation of ROMK channels in the distal nephronD: ADH (Vasopressin) will increase urea and H2O reabsorption in the collecting ductsE: Carbonic anhydrase inhibitors will decrease H+ -> HCO3, This decreases H+ secretion and thus causes a resultant increase in K+/Na+ secretion Vander's 7th ed Various - Renal Regulation of potassium blanace + Regulation of hydrogen balance

[Identical] 18A-107 GabapentinA. Acts at presynaptic L type calcium channelsB. Has similar ataxia and sedation to other antiepileptic medicationsC. Oral bioavailability increases linearly with doseD. Has extensive metabolismE. Acts on GABA receptors

Answer: A - Acts at presynaptic L type calcium channelsA: Acts at presynaptic L type Ca Ch and decreases the release of neurotransmittersB: Reduced ataxia and sedation compared to other antiepileptic medicationsC: Oral bioavailability decreases with doseD: Has minimal metabolismE: Acts at presynaptic L type Ca Ch and decreases the release of neurotransmittersMiller's Non-opioid pain medicationsHemmings and Egan Nonopioid Analgesics

[Identical] 16B-001 Clopidogrel:A. Acts on P2Y12 receptorsB. Works in a different mechanism to ticlopidineC. Should be stopped 24 hours prior to surgeryD. Is reversibleE. Increases cyclic AMP

Answer: A - Acts on P2Y12 receptorsA: Acts on P2Y12B: Works in a similar mechanism to ticlopidine (no longer used)C: Should be stopped 7 days prior to surgeryD: Is irreversibleE: Dipyridamole is an agent that increases cyclin adenosine monophosphateStoelting's Anticoagulants

[Identical] 14A-145 Production of toxic metabolites with nitric oxide is greatest when: A. Administered with 80% O2 B. It is administered above 40ppmC. It combines with haemaglobinD. More likely in patients with heart failureE. All of the above

Answer: A - Adminstered with 80% O2A: NO + O2 -> NO2 in the presence of high concentrations of oxygenB: High concentrations of NO will increase toxicity, not as much as when combined with high O2C: NO + Hb -> methaemaglobinaemiaD: NO should not be used to treat patients with heart failureE: A is the most likelyStoelting's VasodilatorsProduct information sheet

[Identical] 17A-006 How is adrenaline different to noradrenaline? A. Adrenaline has a methyl group B. Adrenaline's effect is mainly terminated by Uptake 1 while Noradrenaline is terminated by Uptake 2 C. Adrenaline metablised by COMT while noradrenaline is not D. Adrenaline is released from post ganglionic sympathetic nerve endings E. Sympathetic nerve fibres to the adrenal medulla release noradrenaline

Answer: A - Adrenaline has a methyl group A: Noradrenaline = Adrenaline minus methyl group on terminal amine B: Uptake 1 : Noradrenaline >> Adrenaline, Uptake 2: Adrenaline >> Noradrenaline C: Both are catecholamines -> metabolised by COMT D: Noradrenaline is released from post ganglionic SNS nerve endings. Adrenaline is released from the adrenal gland E: SNS to adrenal medulla release AcetylCholine to stimulate the release of Adrenaline from the adrenal gland (essentially post ganglionic fibres in adrenal) Hemmings and Egan Vasopressors and InotropesStoeltings Sympathomimetic drugs

[Identical] 18A-057 How is adrenaline different to noradrenaline? A. Adrenaline has a methyl group B. Adrenaline's effect is mainly terminated by Uptake 1 while Noradrenaline is terminated by Uptake 2 C. Adrenaline metablised by COMT while noradrenaline is not D. Adrenaline is released from post ganglionic sympathetic nerve endings E. Sympathetic nerve fibres to the adrenal medulla release noradrenaline

[Identical] 19B-030 Inverse agonista. Affinity > 0 / efficacy < 0b. Affinity < 0 / efficacy < 0c. Affinity < 0 / efficacy > 0d. Affinity > 0 / efficacy > 0

Answer: A - Affinity > 0, efficacy < 0Inverse agonistAffinity > 0Intrinsic activity < 0 (has an opposing effect)Katzung Introduction: The nature of drugs and drug development and regulation

[Identical] 14B-022 Waveforms found in the PAWP trace are: A. All of a v c. B. a v but not c C. a c but not v D. Phase 0 1 2 3 4 E. Phase 0 2 3 4

Answer: A - All of a, v, c A: Pulmonary artery wedge pressure has a similar morphology to right atrial pressure, although the a-c and v waves appear later in the cardiac cycle relative to the electrocardiogram. A wave C wave X descent V wave Y descent. Millers - Cardiovascular monitoring D, E: These are phases of the action potential

[Identical] 15B-096 Propofol TCI using Marsh model 'Diprifusor' is affected by which ONE of the following parameters:A. WeightB. HeightC. AgeD. Weight and ageE. Weight and height

Answer: A - WeightA: Weight is the only covariate in the Marsh modelB: Height not included in Marsh modelC: Age only requested to revent pediatric useD: As aboveE: As aboveMiller's Intravenous Drug delivery systems

[Identical] 14B-037 The waveform in an awake adult at rest with eyes closed and mind wandering:A. alphaB. betaC. thetaD. deltaE. mixture of alpha and beta

Answer: A - Alphaβ Wavesβ waves occur at a frequency of 13 to 30 Hz and a voltage usually of <50 μV. These high-frequency and low-voltage asynchronous waves replace α waves in the presence of increased mental activity or visual stimulation.α Wavesα waves occur at a frequency of 8 to 12 Hz and a voltage of about 50 μV. These waves are typical of an awake, resting state of cerebration with the eyes closed. During sleep, α waves disappear. Because α waves do not occur when the cerebral cortex is not connected to the thalamus, it is assumed these waves result from spontaneous activity in the thalamocortical system.θ Wavesθ waves occur at a frequency of 4 to 7 Hz. These waves occur in healthy children during sleep and also during general anesthesia.δ Wavesδ waves include all the brain waves with a frequency of less than 4 Hz. These waves occur (a) in deep sleep, (b) during general anesthesia, and (c) in the presence of organic brain disease. δ waves occur even when the connections of the cerebral cortex to the reticular activating system are severed, indicating these waves originate in the cerebral cortex independently of lower brain structures.Stoelting 5th Ed - Ch3 - Neurophysiology

[Identical] 14B-001 An ABG given pH of 7.42 / reduced bicarbonate / reduced CO2 A. AltitudeB. COPD C. Metabolic acidosis D. Hyperventilation E. Prolonged vomiting

Answer: A - AltitudeA: Altitude causes a Respiratory alkalosis with metabolic compensationB: COPD causes a respiratory acidosis with metabolic compensationC: Metabolic acidosis causes reduced bicarbonate and reduced CO2 BUT with a reduced pHD: Hyperventilating causes a respiratory alkalosis with minimal metabolic compensationE: Prolonged vomiting causes a metabolic alkalosis with respiratory acidosis compensation

[Identical] 17A-020 Cause of thirstA. Angiotensin IIB. Antidiuretic hormoneC. Low plasma osmolalityD. Sensed by osmoreceptors in aortic arch and carotid arteriesE. Antinaturetic peptide

Answer: A - Angiotensin IIA: AT2 stimulates thirst. B: ADH is release along with the sensation of thirst. ADH does not stimulate thirstC: High plasma osmolality will stimulate thirstD: Osmoreceptors are located in hypothalamus (Paraventricular nucleus, Supraoptic nucleus)E: ANP will inhibit thirstVander's 7th Ed p 134, The centers that mediate thirst are located in the hypothalamus (very close to those areas that produce ADH). The subjective feeling of thirst, which drives one to obtain and ingest water, is stimulated both by reduced plasma volume and by increased body fluid osmolality. The adaptive significance of both are self-evident. Note that these are precisely the same changes that stimulate ADH production, and the receptors—osmoreceptors and the nerve cells that respond to the cardio- vascular baroreceptors—that initiate the ADH-controlling reflexes are near those that initiate thirst. The thirst response, however, is significantly less sensitive than the ADH response.

[Identical] 18A-014 Sodium Metabisulphate isA. antimicrobialB. adjused pHC. prevents oxidationD. prevent hydroxylationE. used as a solvent

Answer: A - Antimicrobial + B - AntioxidantA: Sodium metabisulfite is an antimicrobial addative to propofolB: The formulatiof propofol containing Na metabisulfite has a lower pH, not due to the Na metabisulfiteC: Is also an antioxidant for drugs that contain the phenol or catechol moeitiesD: Does not prevent hydroxylationE: Is not the solvent for propofolNaMetabisulphate - donates sulphur dioxide.Prevent oxidation of the drug. Also considered a "preservative"MacPherson - Pharmaceutics article 2001An antimicrobial - Stoeltings Intravenous sedatives

[Identical] 18A-082 MAP measuredA. Area under pressure curve divided by timeB. 1/3 DBP C. Higher with increased dampingD. Higher with increased reasonanceE. With a 16G radial cannula

Answer: A - Area under pressure curve divided by timeA: MAP can be determined by integrating (calculating the area) a pressure signal over the duration of one cycle, divided by timeB: MAP = 1/3 SBP + 2/3 DBP (assuming HR 60)C: Increased damping leads to a decrease in systolic pressure and an increase in diastolic pressure. Decreased damping causes the opposite. The mean pressure remains the same.D: Increased damping leads to a decrease in systolic pressure and an increase in diastolic pressure. Decreased damping causes the opposite. The mean pressure remains the same.E: Arterial cannulation is with a 20 or 22G cannulaAl-Shaikh Invasive monitoring, Reason: MAP = DBP + 1/3(pulse pressure) Pulse pressure = SBP-DBPMAP is not determined by knowing the CO and SVR, but rather by direct or indirect measurements of arterial pressure. From the aortic pressure trace over time (see figure), the shape of the pressure trace yields a mean pressure value (geometric mean) that is less than the arithmetic average of the systolic and diastolic pressures as shown to the right.MAP from arterial trace= integral of pressure / time

[Identical] 16A-130 Which tocolytic doesn't work by changing intracellular calcium?A. B2 adrenoreceptor agonistsB. GTNC. NSAIDsD. MgE. Calcium channel blockers

Answer: A - B2 adrenoreceptor agonistsA: B2 adrenoreceptor agonists - cAMP, Protein Kinase A, phosphorylate MLCK - relaxation.B: GTN/Nitric oxide donors - activate cGMP -> inhibits MLCKC: NSAIDs - Decreased prostaglandins. Prostaglandins increase intracellular Ca2+ (so NSAIDS prevent this). D: Mg2+ competes with Ca2+, reduces its availabilityE: CCBs - Inhibit the movment of calciumGoodman and Gillman - Introduction to Endocrinology: The Hypothalamic-Pituitary Axis

[Identical] 14B-106 Which organ has no lymphatic vessels? A. Brain B. Stomach C. Kidney D. Heart E. Lung

Answer: A - Brain A: Brain has no lymphatics (although recently found to contain lymph drainage) Only cartilage, bone, epithelium, and tissues of the central nervous system are devoid of lymphatic vessels. Pappano and Wier p152 Stoeltings - Circulatory physiology

[Identical] 14B-080 When GTN is used during acute myocardial ischaemiaA. Effect is mainly via cGMP mediated venodilation and decreased ventricular wall tensionB. Phosphodiesterase inhibitors such as sildenafil decreased the effectivenessC. It may precipitate coronary stealD. Has an increased risk of cyanide toxicityE. causes reversal of hypoxic pulmonary vasoconstriction via cAMP

Answer: A - Effect is mainly via cGMP mediated venodilation and decreased ventricular wall tensionA: GTN - mainly venodilation as well as coronary vasodilation -> decreased ventricular wall tension from dec preloadB: PDEI (sildenafil) may increase vasodilation when used with GTNC: Nitroglycerine is a coronary vasodilator, including relaxation of stenosed vessels -> no coronary steelD: Cyanide toxicity occurs with SNP, not with GTNE: PDE-I (sildenafil) reduces pulmonary vasoconstriction by interacting with cGMPHemmings and Egan Antihypertensive drugs and vasodilators

Surfactant A. Produced by type 1 alveolar cells B. Contains phosphatidylcholine C. ? D. Production stimulated by mineralocorticoids E. Is a lipid surface tension reducing compound

[Identical] 18B-123 Which of the following is true about TRALI?A. CXR appearances show bilateral infiltrateB. Incidence increased in only male plasma donorsC. Diuretics are indicated in the managementD. Most commonly seen after transfusion of packed RBCsE. Infusions can be continued

Answer: A - CXR shows bilateral infiltrateA: Chest X-ray will show bilateral interstitial infiltrates.Acute onset of fever, chills, dyspnoea, tachypnoea, tachycardia, hypotension, hypoxaemia and noncardiogenic bilateral pulmonary oedema leading to respiratory failure during or within 6 hours of transfusion.B: Only blood or plasma from male donors is used in the manufacture of clinical plasma products such as FFP or cryoprecipitate. To further reduce the TRALI risk associated with apheresis platelets Red Cross has moved to a plateletpheresis panel comprised of male donors and female donors who have never been pregnant (nulligravida)C: Diuretics are not indicated in the management of TRALI (but may be useful in fluid overload, a differential diagnosis)D: TRALI has been implicated in transfusion of unfractionated plasma-containing components (red cells as whole blood, platelets and plasma)E: Infusions should be stopped and samples of patient blood (pre and post transfusion) and donor blood should be sent to the lab marked "TRALI investigations"Red Cross website - TRALI

[Identical] 17A-050 Difference between SAN and cardiac myocyte AP A. CaCh influx Phase 0 B. Doesn't have Phase 3 C. Delayed rectifyer K+ channels open at the start of phase 0 D. SAN has fast response action potential E. Propagation speed of action potential in myocyte 0.3-1m/s

Answer: A - CaCh influx Phase 0 A: Phase 0SAN - depolarisation due to Long lasting (L-type) Ca channels. Inward Ca movement Myocyte - depolarisation due to fast Na channels -> Inward Na movement B: Both have phase 3SAN - does not have phase 1 nor 2 C: K+ do not partake in Phase 0 (rectifyer channels open at the end of Phase 0) D: SAN is a slow response AP E: Propagation speed of action potential in myocyte is 1m/secSAN = 0.05 m/s,Atria = 1 m/s,AVN = 0.05 m/s,Bundle of His = 1 m/s,Purkinje fibres = 4 m/s,Ventricles = 1 m/s Power and Kam Cardiovascular physiologyPappano and Wier - Excitation: The cardiac action potential

[Identical] 18A-093 The right vagus nerveA. Can be damaged by jugular cannulationB. Decreases gastric acid secretionC. Enters the thorax between the left carotid and left subclavian arteriesD. Is symetrical with the left vagus nerveE. Crosses the aortic arch more lateral and posterior to the phrenic nerve

Answer: A - Can be damaged by jugular cannulationA: Travels in the carotid sheath and can be damaged by jugular cannulationB: Increases gastric acid secretionC: Right vagus nerve enters between the internal jugular vein and the common carotid sheath, then crosses the subclavian arteryD: Is asymetrical with the left vagus nerveE: The left vagus nerve crosses the aortic arch more lateral and posterior to the phrenic nerveAnatomy for the Anaesthetists - The vagus nerve

[Identical] 15B-024 Overestimation of SpO2 occurs with: A. CarboxyhaemoglobinB. FluoresceinC. HyperbilirubinaemiaD. HbFE. HbS

Answer: A - CarboxyhaemoglobinA: Carboxyhaemoglobin light absorbance profile much more similar to oxyHb than to deoxyHb - interpreted as oxyHb by the algorithm - results in falsely high SpO2B: Fluroesceine may decrease SpO2. Fluoroscent lights may be a source of interferenceC: Billirubin has no effect on pulse oxymetryD: Haemaglobinopathies have no effect on pulse oxymetryAl Shaikh Non-invasive monitoring, Oxy-Hb Crosses the y axis near the deoxy-Hb line but falls steeply around 600 nm to a trough around 660 nm. It then rises as a smooth curve through the isobestic point where it flattens out. This curve must be oxy-Hb as the absorbance of red light is so low that most of it is able to pass through to the viewer, which is why oxygenated blood appears red.Deoxy-Hb Starts near the oxy-Hb line and falls as a relatively smooth curveFluorescein decreases, rest no change (HbF, HbS, hyperbilirubinaemia)Sources of Error1. Poor perfusiondec perfusion - dec signal strength - dec accuracy (part of the low signal-to-noise ratio group, but prob deserves its own heading)2. Arrhythmias and aortic balloon pump3. Different haemoglobinsMethaemoglobin - absorbs red and infrared light at a ratio of 1:1, which is interpreted by the algorithm as a saturation of 85%, resulting in falsely low readings above 85% and falsely high reading below 85%Carboxyhaemoglobin - light absorbance profile much more similar to oxyHb than to deoxyHb - interpreted as oxyHb by the algorithm - results in falsely high SpO2 compared to the true fractional SaO2 (NB the log scale of the commonly drawn absorbance vs wavelength graph hides this relationship)4. Causes of low signal-to-noise ratioIf there is only small signal from arterial pulse - dec accuracyegMalpositioned probe - allows optical shunting (light reaches detector without passing through arterial blood)Movement artefact - inaccurate analysis of pulsationsAmbient light5. Electromagnetic interferenceElectrical equipment such as diathermy may induce currents in the wires of the pulse oximeter, which is interpreted as a signal from the light detector6. Coloured dyes and nail polishArtefactually decSpO2methylene blue indocyanine greenBlack, blue, green nail polish7. Saturations < 75%Due to lack of empirical data for saturations < 75%, estimations are used and the reading is less accurate8. Lag in reading changeDepending on the settings, the displayed SpO2 reading may lag behind the true SO2 by up to 30 secs9. Venous pulsationsProminent venous pulsations may be interpreted as part of arterial pulsation - falsely low SpO2May occur with low systemic vascular resistancehigh airway pressures with IPPV - phasic venous congestionOxy-Hb Crosses the y axis near the deoxy-Hb line but falls steeply around 600 nm to a trough around 660 nm. It then rises as a smooth curve through the isobestic point where it flattens out. This curve must be oxy-Hb as the absorbance of red light is so low that most of it is able to pass through to the viewer, which is why oxygenated blood appears red.Deoxy-Hb Starts near the oxy-Hb line and falls as a relatively smooth curveSources of Error1. Poor perfusiondec perfusion - dec signal strength - dec accuracy (part of the low signal-to-noise ratio group, but prob deserves its own heading)2. Arrhythmias and aortic balloon pump3. Different haemoglobinsMethaemoglobin - absorbs red and infrared light at a ratio of 1:1, which is interpreted by the algorithm as a saturation of 85%, resulting in falsely low readings above 85% and falsely high reading below 85%Carboxyhaemoglobin - light absorbance profile much more similar to oxyHb than to deoxyHb - interpreted as oxyHb by the algorithm - results in falsely high SpO2 compared to the true fractional SaO2 (NB the log scale of the commonly drawn absorbance vs wavelength graph hides this relationship)4. Causes of low signal-to-noise ratioIf there is only small signal from arterial pulse - dec accuracyegMalpositioned probe - allows optical shunting (light reaches detector without passing through arterial blood)Movement artefact - inaccurate analysis of pulsationsAmbient light5. Electromagnetic interferenceElectrical equipment such as diathermy may induce currents in the wires of the pulse oximeter, which is interpreted as a signal from the light detector6. Coloured dyes and nail polishArtefactually decSpO2methylene blue indocyanine greenBlack, blue, green nail polish7. Saturations < 75%Due to lack of empirical data for saturations < 75%, estimations are used and the reading is less accurate8. Lag in reading changeDepending on the settings, the displayed SpO2 reading may lag behind the true SO2 by up to 30 secs9. Venous pulsationsProminent venous pulsations may be interpreted as part of arterial pulsation - falsely low SpO2May occur with low systemic vascular resistancehigh airway pressures with IPPV - phasic venous congestionOxy-Hb Crosses the y axis near the deoxy-Hb line but falls steeply around 600 nm to a trough around 660 nm. It then rises as a smooth curve through the isobestic point where it flattens out. This curve must be oxy-Hb as the absorbance of red light is so low that most of it is able to pass through to the viewer, which is why oxygenated blood appears red.Deoxy-Hb Starts near the oxy-Hb line and falls as a relatively smooth curveAnswer: AReason: Pulse oximetry - Sources of Error- Poor perfusionArrhythmias and aortic balloon pump- Irregular rhythms and aortic balloon pulsations can confuse the processor and result in inaccurate or no readingDifferent haemoglobins- Methaemoglobin - absorbs red and infrared light at a ratio of 1:1, which is interpreted by the algorithm as a saturation of 85%, resulting in falsely low readings above 85% and falsely high reading below 85%- Carboxyhaemoglobin - light absorbance profile much more similar to oxyHb than to deoxyHb - interpreted as oxyHb by the algorithm - results in falsely high SpO2 compared to the true fractional SaO2 (NB the log scale of the commonly drawn absorbance vs wavelength graph hides this relationship)Causes of low signal-to-noise ratio- If there is only small signal from arterial pulse - dec accuracy- eg Malpositioned probe - allows optical shunting (light reaches detector without passing through arterial blood)Movement artefact - inaccurate analysis of pulsationsAmbient lightElectromagnetic interference- Electrical equipment such as diathermy may induce currents in the wires of the pulse oximeter, which is interpreted as a signal from the light detectorColoured dyes and nail polish- Artefactually decSpO2- methylene blue - indocyanine green- black, blue, green nail polishSaturations < 75%- Due to lack of empirical data for saturations < 75%, estimations are used and the reading is less accurateLag in reading change- Depending on the settings, the displayed SpO2 reading may lag behind the true SO2 by up to 30 secsVenous pulsations- Prominent venous pulsations may be interpreted as part of arterial pulsation - falsely low SpO2- May occur with- low systemic vascular resistance- high airway pressures with IPPV - phasic venous congestion- severe tricuspid regurgitationOxy-Hb Crosses the y axis near the deoxy-Hb line but falls steeply around 600 nm to a trough around 660 nm. It then rises as a smooth curve through the isobestic point where it flattens out. This curve must be oxy-Hb as the absorbance of red light is so low that most of it is able to pass through to the viewer, which is why oxygenated blood appears red.Deoxy-Hb Starts near the oxy-Hb line and falls as a relatively smooth curve

[Identical] 16B-002 Which is not a side effect of Amiodarone:A. CardiomyopathyB. ThyrotoxicosisC. Pulmonary fibrosisD. TransaminitisE. Optic neuritis

Answer: A - Cardiomyopathy is not a side effect of amiodaroneSide effects of Amiodarone includeInterstitial lung disease Hyper/othyroidism (similar to thyroxine) Corneal microdeposits, peripheral neuropathies, photosensitivity, blue-grey discoloration of skinCardiomyopathy is not a side effect of amiodarone. Product information sheet

[Identical] 14A-124 Side effects of dantrolene.A. Can cause skeletal muscle fatigueB. Improved treatment of MH with verapamilC. Reduces the time for intubation and ventilationD. Causes hypokalaemiaE. Decreases oral secretions

Answer: A - Causes muscle weaknessA - Causes muscle weaknessB - Should not be co-administered with CCBs especially verapamilC - May prolong the time for intubation and ventilationD - Can cause hyperkalaemia when give not in the setting of MHE - Increases oral secretionsMiller's Neuromuscular Disorders inc MH

[Identical] 14B-096 Drug interactions that inhibitA. Cimetidine and WarfarinB. Phenytoin and OndansetronC. Carbamazepine and AlfentanilD. Thiopentone and KetamineE. Rifampicin and Metoprolol

Answer: A - Cimetidine and WarfarinCimetidine is the only inhibitor on the listPhenytoin, carbamazepine, thiopentone and rifampicin are inducersInhibitors of CYP450 -> less metabolism -> increased drug levelsCommon inhibitors of CYP450Abx - ciprofloaxacin, clarithromycin, erythromycinAntidepressants - Fluvoxamine, Fluoxatine, Duloxatine, Paroxetine, SertralineAntiArrhythmics - Amiodarone, Quinidine, Labetalol, CCBs (Verapamil, diltiazem)Cimetidine (H2 blocker)Common inducers of CYP450SmokingAbx - Rifampacin,CarbamazepineBarbiturates, ethanolIsonizidPhenyotoinStoeltings Drug Metabolism and Pharmacogenetics

[Identical] 14B-084 Prothrombinex: A. Contains coagulation factors II V VII IX XB. Immediately reverses heparinC. Is always administered with Vitamin K D. Is used to treat herparin induced thrombocytopeniaE. Used to treat haemophilia A

Answer: A - Contains coagulation factors II, V, VII, IX, XA: Factors II, IX, X Also contains - Low levels Factor V + VII - Antithrombin III Heparin 192iu B: For the reversal of warfarin, not heparin (protamine)C: Not always given with vitamin K. Vit K should be given to patients on warfarin who are actively bleedingD: May cause HITsE: Is used to treat haemophilia B, not AProduct information sheetRed Cross Product information page

[Identical] 18A-031 Cox2 benefit over Cox1 inhibitorsA. decreased gastric side effectsB. Increased post operative bleedingC. Decreased renal effects D. Inhibition of plateletsE. Increased reactivity in asthmatics

Answer: A - Decreased gastric side effectsA: Decreased gastric side effects with COX2 inhibitorsB: Similar or less post operative bleedingC: Similar renal effectsD: May increase prothrombotic state in chronic use, but not in single dose intraoperativelyE: Decreased reactivity in asthmaticsMiller's - Nonopioid Pain ManagementHemmings and Egan - Nonopioid Analgesic

[Identical] 15B-117 What is NOT a feature of local anaesthetic activity?A. decreased in alkaline environmentB. dependent on uncharged molecules crossing the cell membraneC. relies on action potential inhibition via sodium channel blockadeD. deeper block with increasing action potential frequencyE. small nerve fibres are more readily blocked than large fibres

Answer: A - Decreased in alkaline environmentA - Local anaesthetic drugs are weak basesBases ionise below their pKaLignocaine pKa 7.9 -> higher pH -> more unionised portion and greater activityB: Unionised (uncharged) molecules are lipid soluble and cross cell membranesC: MOA - Na Ch blockadeD: Frequency dependent blockade creates a deeper blockE: Small fibres blocked firstStoeltings Local anaesthetics

[Identical] 18B-125 Changes in pregnancyA. Decreased plasma cholinesteraseB. Increased protein concentrationC. Decreased clotting factorsD. Increased activity of pseudocholinesteraseE. Increased oncotic pressure

Answer: A - Decreased plasma cholinesteraseA: Total circulating proteins increase during pregnancy, this includes plasma cholinesteraseB: Total circulating proteins increase during pregnancy, but the concentrations of total proteins and albumin decrease as a result of haemodilution. C: Pregnancy is associated with increased coagulability and platelet turnover. There is a significant increase in the concentrations of factors VII, VIII, IX, X and fibrinogen.D: Serum pseudocholinesterase activity is reduced by 20%-30% at the end of the first trimester and remains at that level until term.E: Total circulating proteins increase during pregnancy, but the concentrations of total proteins and albumin decrease as a result of haemodilution.Greater platelet production matches the increase in platelet activation and consumption. Overall, the platelet count is slightly reduced (5%-8%) during pregnancy. Fibrinogen levels may double from 3 to 6 g/LThere is an increase in total globulins, especially α-globulin and some β-globulins, but a slight decrease in γ-globulin. Fibrinogen increases from 300 to 450 mg/dL at term. Power and Kam Maternal and neonatal physiology

[Identical] 15B-111 Regarding thiopentone which of these is CORRECT:A. Decreases CMRO2 by up to 55%B. Lacks depression of airway reflexes and can cause coughC. Direct increase in sympathetic drive to the cardiovascular systemD. Is safe for intra-arterial injectionE. Dose increase required in septic patients

Answer: A - Decreases CMRO2 by up to 55%A: Thiopentone is used to create isoelectric EEG in status. Isoelectric EEG is the point at which cerebral metabolic rate is 50% of baselineB: Thiopentone is a respiratory depressantC: Thiopentone causes decreased MAP -> baroreceptor increase in HR. Not direct sympathetic increaseD: Severe consequences of intra-arterial injection include thrombis and necrosisE: Low pH causes increase in keto (lipid soluble) form and fraction of non-ionised drug -> decreased dose requiredMiller's Intravenous anaesthetics

[Identical] 18B-097 FRC: A. Decreases by 500-1000 ml when supine B. Decreases with age C. Decreases with COPD D. Independent of gender for a given height E. Is sum of residual volume + inspiratory reserve volume

Answer: A - Decreases by 500-1000 ml when supine A: FRC decreases 500-1000mL when transitioning from sitting to supine B: FRC increases with age C: FRC increases with COPD (gas trapping) D: For the same body height females have 10% lower FRC E: FRC = RV + ERVNunn's 8th Ed p27

[Identical] 15A-110 Propofol:A. Decreases liver blood flow so decreases its own metabolismB. Has slower clearance in children than adultsC. Has fast redistribution from peripheral to central compartmentD. Has active metabolitesE. Elimination half life of 3 hours

Answer: A - Decreases liver blood flow so decreases its own metabolismA: Propofol decreases hepatic blood flow through haemodynamic depressant effectsB: Children have a relatively larger central compartment volume (50%) and a more rapid clearance (25%)C: Has fast redistribution from central compartment to peripheral compartment (t1/2 alpha 1-8 minutes)D: Propofol is thought to have no active metabolitesE: Elimination half life of 4-23 hoursMiller's Intravenous Anaesthetics

[Identical] 18A-023 Normal Tidal breathing / In normal inspiration A. Diaphragm moves 1cm B. Diaphragm muscle is active in expiration C. SCM moves first rib D. All of the work in inspiration is stored as elastic potential energy for expiration E. 50% of normal breathing is due to intercostals

Answer: A - Diaphragm moves 1cm A: Normal tidal breathing the diaphragm moves inferiorly 1cmTotal excursion of 10cm may occur B: Diaphragm only active in inspiration C: SCM connects mastoid process to the sternum and the clavicle D: Inspiratory work combines both elastic work and non-elastic work (airway and tissue resistance) E: Diaphragmatic contraction is the primary action of normal breathing. The intercostals adjust for the inward pull of the apical ribs.West 9th Ed p96 + p134 Muscles of respiration

[Identical] 15B-012 Healthy young person loses 20% of their blood volume: A. Diastolic pressure decreases B. Increased ADH secretion C. Reduced cerebral blood flow D. Increased urinary sodium excretion E. Irreversible hypotension occurs

Answer: A - Diastolic pressure decreases A: When the blood loss is greater than 20%, both arterial blood pressure and cardiac output decrease rapidly because the compensatory mechanisms become inadequate. B: A 5%-10% decrease in blood volume is required before ADH secretion is stimulated. C: Cerebral blood flow will decrease when arterial blood pressure falls below 50mmHg D: Urinary sodium excretion will decrease with ADH and aldosterone secretion E: Irreversible hypotension can occur with a blood loss greater than 30% of the blood volume. Power and Kam p175

[Identical] 14A-118 Which is a concentrated Amide LAA. DibucaineB. ProcaineC. TertracaineD. ProcainomideE. Cocaine

Answer: A - DibucaineAll amide LAs have 2 'i's in the nameProcainamide is an antiarrhythmic class Ia sodium channel blocker

[Identical] 19B-002 Which of the following does not affect time to peak effect?a.Doseb.Rate of injectionc.Site of injectiond.T ½ keoe.Cardiac output

Answer: A - DoseA: Dose will reduce the time to onset, but no effect on time to peak effectB-EFactors that affect time to peak effect- Rate of injection - Site of injection - Cardiac output - t/2 Keo Stoeltings Basic principles of pharmacologyArticle - Absalom AR, Mani V, De Smet T, Struys MM. Pharmacokinetic models for propofol--defining and illuminating the devil in the detail [published correction appears in Br J Anaesth. 2010 Mar;104(3):393]. Br J Anaesth. 2009;103(1):26‐37. doi:10.1093/bja/aep143

[Identical] 18A-035 FlumazenilA. Duration of action < 2 hrsB. GABAa agonistC. Non-competitive antagonistD. Requires only a single dose to reverse benzodiazapine overdoseE. Has a low hepatic extraction raio

Answer: A - Duration of action <2hoursA: Elimination half life 1.3 hoursB: Flumazenil is a GABAa antagonistC: Flumazenil is a competitive antagonistD: May require an infusion to maintain therapeutic concentration over timeE: Has a high hepatic extraction ratioMiller's Intravenous anaesthetics

[Identical] 18A-060 TramadolA. Effective for post operative shiveringB. No genetic polymorphismC. Increases effectiveness of ondansetronD. More potent than morphineE. Metabolite causes seizures

Answer: A - Effective in post operative shiveringA: Effective in post operative shiveringB: CYP2D6 enzyme involved in metabolism displays genetic polymorphismC: Ondansetron may interfere with the analgesic effect of tramadolD: 1/10th the potency of morphineE: Metabolite M1 has increased potency at opioid receptors. Pethedine's metabolite can cause seizuresAcute Pain Management: Scientific EvidenceMiller's - OpioidsHemmings and Egan - Nonintravenous

[Identical] 14A-090 Emax Refers to?A. EfficacyB. AffinityC. PotencyD. Lethal DoseE. Toxic DoseDraw graphs for each of the above

Answer: A - EfficacyA - Emax is the maximum possible drug effect. Efficacy - measure of the maximal response achievable by a drug once it is bound to its receptorB - Affinity - The relative proportion of the drug that is bound to the receptor. Kd the concentration of the drug when 50% of the receptors are occupied. Affinity = 1/Kd. C - Potency - the relative concentration of a drug to achieve the same effect. ED50 is the median dose for that effect. D - Dose that causes death in 50% of the population (LD50)E - Dose that causes toxic effects in 50% of the population (ED50 for the toxic effect)Affinity - the inverse of the Kd (dissociation constant). Affinity = 1/KdKd = concentration when 50% of receptors are occupied. High Kd = lots of drug required to bind receptors. -> low Kd means less drug required => high affinityPotency - A measure of the amount of drug that is required to produce a maximal effect.Median effective concentration - EC50 - the concentration of a drug required to induce 50% of a maximal responseMedian effective dose - ED50 - dose required to produce a response in 50% of the populationGoodman and Gilman - Pharmacodynamics: Molecular mechanisms of drug action

[Identical] 18B-033 Salbutamol side effects include:A. Elevated lactateB. HyperkalaemiaC. HypoglycaemiaD. Reduced dead spaceE. Bradycardia

Answer: A - Elevated lactateA: Salbutamol can cause elevated lactateB: Salbutamol can cause hypokalaemiaC: Salbutamol can cause reversible hyperglycaemiaD: Salbutamol can increase dead spaceE: Salbutamol can cause tachycardiaProduct information sheet

[Identical] 18A-112 Will cause bradycardia A. Empty ventricle B. Empty atria C. Bainbridge reflex D. Hypotension E. Reduced ocular pressure

Answer: A - Empty ventricle A: Empty ventricle -> results in bradycardia. Benzold Jarish reflex. Bezold-Jarish - Mechanical receptors in ventricular walls -> nonmyleniated C fibres vagal to medulla -> inhibition of SNS -> bradycardia, vasodilation, hypotensionTriad - bradycardia, hypotension and apneoa B: Empty atria -> no reflex C: Bainbridge reflex - infusions of blood or saline accelerated the HR in dogs. Increased venous return (increase in CVP) -> infusions will increase the heart rate. Bainbridge - stretch receptors at junction of venacava and RA and pulm vein and LA -> vagus -> medulla -> inhibition of vagal tone -> SA node -> tachycardia D: Arterial - carotid sinus and aortic arch -> glossopharyngeal/vagus -> medulla -> inc HR, inc TPR E: Pressure on the globe or pulling on the extraocular musculature elicits afferent signals in the short and long ciliary nerves. These signals converge on the Gasserian ganglion, causing a parasympathetic response, notably severe bradycardia. Pappano and Wier Regulation of the heartbeat Hemmings and Egan p487 (Autonomic nervous system: physiology)

[Identical] 18A-062 Regarding Beta blockers which is FALSEA. Esmolol is a nonselective B blockerB. Metoprolol is dependent on CYP polymorphismC. B-blockers potentiate the effect of oral hypoglycaemicsD. Increase the plasma concentrations of digoxinE. Can cause depression and sleep disturbances

Answer: A - Esmolol is a selective beta blockerA: Esmolol is cardio selectiveB: Metoprolol has genetic polymorphism (clinically insignificant - asymptomatic bradycardia as a result of decreased metabolism)C. B-blockers potentiate the effect of oral hypoglycaemicsD. Increase the plasma concentrations of digoxinE. Can cause depression and sleep disturbancesHemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 18A-097 Stored bloodA. Factor 8 reduction by 50% by 24 hoursB. 2 3 dPG 90% reduction by day 14C. Reduced antigenicD. K 30mmol by 1 weekE. Platelets remain functional

Answer: A - Factor 8 reduction by 50% by 24 hoursA: Factors V and VIII levels decrease with storage of whole blood. Factor V decreases 50% by 21 days, while factor VIII decreases exponentially to 75% by 24 hours after collection and 30% after 21 days of storage.B: ATP and 2,3-DPG concentrations fall with time, but at different rates. With CPD-A blood, 2,3-DPG decreases to 50% by 14 days and to 5% by 28 days. ATP decreases slowly to 75% by 28 days.C: Granulocytes lose their phagocytic and bactericidal properties within 4-6 hours after collection, but maintain their antigenic properties.D: After the first 48 hours, there is a slow progressive K+ loss from red cells into the plasma, so that the plasma K+ concentration reaches approximately 30 mmol/L at 28 daysE: Platelets become non-functional within 48 hours in blood stored at 4°CPower and Kam - Physiology of blood

[Identical] 14A-050 Glucose handling by the kidneyA. Freely filtered B. Passively reabsorbed C. Linked to Potassium ions reabsorption D. Equal amounts reabsorbed in all cell E. Only reabsorbed in hypoglycaemia

Answer: A - Freely filteredA - Glucose is freely filteredB - Glucose is actively reabsorbed via secondary active transport due SGLT2 transporters (Na/Gl) and Na/K/ATPase. This saturates in conditions of pathological hyperglycaemiaC - Glucose is linked to sodium reabsorption - Na/Gl symporter and Na/K/ATPaseD - There is a variable Tm in each cell for glucoseE - Glucose is constantly reabsorbed. Tmax is achieved in hyperglycaemia -> the amount secreted will then increaseVander's - 7th ed. Ch4 - Basic transport mechanisms

[Identical] 18A-084 Quantal dose curvesA. Further apart curves means less crossover between toxic and therapeutic effectsB. LD50 denominator in therapeutic indexC. Low therapeutic index means good margin of safetyD. Graphs the percentage response in an individualE. Is the same as a frequency distribution curve

Answer: A - Further apart curves means less crossover between toxic and therapeutic effectsA: Further apart curves means less crossover between toxic and therapeutic effectsB: LD50 is the numebrator in therapeutic indexC: High therapeutic index means good margin of safetyD: Graphs the percentage of the population that exhibits a binary responseE: A summated normal frequency distribution gives a quantal dose response curveGoodman and Gilman Pharmacodynamics: Molecular mechanisms of drug actionThe therapeutic index (TI) (also referred to as therapeutic ratio) is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes toxicity.in animal studies:TI = LD50 / ED50in human studies:TI = TD50 / ED50LD50 - lethal dose in 50% of animalsTD50 - toxic dose in 50% of humansED50 - effective dose in 50%Quantal dose curve - binary outcomesFinds dose required to have 50% of population respond (ED50) and 50% of population die (LD50)LD50:ED50 is therapeutic indexHigh is good.

[Identical] 14B-038 C fibres that transmit peripheral nociceptive signals synapse in the dorsal horn of the spinal cord at:A. Laminae I and IIB. Laminae I and IVC. Laminae III and IVD. Laminae IV and VE. Laminae V and VI

Answer: A - Laminae I and IIC fibres - lamina I, II, -> WDR (V) via 2nd orderAdelta - lamina I, II + WDR (V)Abeta - lamina III, IV + WDR (V)Lamina II - SGRHemmings and Egan 2nd ed - Nociceptive physiology

[Identical] 18A-022 Awake person lateral - dependent lung diaphragm A. Greater excursion on inspiration B. Less cephalad at FRC C. Worsens V/Q matching in the dependent lung D. Increases FRC in the dependent lungE. Less compliant than the non dependent lung

Answer: A - Greater excursion on inspirationA: Greater excursion on inspiration due to higher starting positionB: Dependent diaphragm is more cephalad at FRCC: V/Q matching is improved int he dependent lung due to improved perfusion (gravity) and improved ventilation (more closed starting point)D: FRC decreases in the dependent lungE: Dependent lung is on the steeper part of the compliance curve than the nondependent lungNunn's 8th Ed Pulmonary Surgery Patient Position p487

[Identical] 14A-023 With regard to Doppler estimation of cardiac output which of the following parameters is not required? A. Haematocrit B. Aortic Cross section area C. Velocity of red cells D. Time taken for ejection E. Heart rate

Answer: A - HaematocritDoppler-based methods can be used to estimate SV and cardiac output. Volumetric flow or SV can be calculated as a cylindrical volume as follows:CO = SV x HRSV = LVOT area x Velocity Time IntegralA: Flow will change with haematocrit (due to viscosity) but it is not required to calculate cardiac outputB: LVOT = aortic cross sectional areaC: Velocity is calculated from the doppler, then integrated with respect to timeD: Time is required for the integrationE: Hear rate x Stroke volume = Cardiac outputMiller's 9th ed Perioperative echocardiography, Reason: DopplerTOE dopplerInterrogating flow in the descending aorta.the descending thoracic aorta diameter is either measured using A-mode ultrasound or calculated from a nomogram based on the patient's age, sex, height, and weight. When calculated, the aortic diameter is assumed not to change throughout the cardiac cycle. Limitations: interrogating flow in the descending aorta is only a fraction (~70%) of cardiac output. In order to report total cardiac output the doppler measurement must be calibrated by an alternative method or incorporate empirically determined correction factor of 1.4. The constant is accurate for most patients but doesn't apply universally - such as conditions that redistribute blood flow.Likely to be inaccurate in aortic stenosis, regurgitation or in thoracic aortic disease.Not amenable to patients with esophageal disease.

[Identical] 18A-085 Zero order kineticsA. Half life independent of doseB. A constant proportion eliminated per unit timeC. Half life is proportional to volume of distributionD. Half life is proportional to clearanceE. Half life is proportional to plasma concentration

Answer: A - Half life independent of doseA: Half life in zero order kinetics is independent of doseB: A constant amount of drug is eliminated per unit timeC: Volume of distribution has no impact on half life in zero order kineticsD: Half life in zero order kinetics is inversely proportional to clearance (which decreases with dose)E: Half life in zero order kinetics is inversely proportional to plasma concentrationGoodman and Gilman's Pharmacokinetics: The dynamics of drug absorption, distribution, metabolism, and elimination

[Identical] 18B-102 MannitolA. Half-life dependent on GFRB. Increases the risk of cellular injuryC. Has no effect on extracellular fluid volumeD. Undergoes significant metabolismE. Causes hyperkalemic hyperchloremic acidosis

Answer: A - Half-life dependent on GFRA: Mannitol is completely filtered at the glomeruli -> dependent on GFRB: Mannitol is a free radical scavenger and reduces the risk of cellular injuryC: Increases the extracellular fluid volume (by drawing fluid from the intracellular spaces)D: Does not undergo metabolismE: Causes hypokalaemic hypochloraemia alkalosisStoelting's Diuretics

[Identical] 14A-035 Intrafusal muscle fibres.A. Have contractile mechanisms B. Are the same length as extrafusal fibres C. Are connected in series to extrafusal fibres D. Provide information about muscle tensionE. Have no motor innervation

Answer: A - Have contractile mechanismsA: Intrafusal fibres shorten along with the extrafusal fibres, thus require contractile mechanismsB: Intrafusal muscle fibres are shorter than extrafusal fibresC: Muscle spindles are sensory receptors in skeletal muscles that lie parallel to the regular extrafusal muscle fibres.D: Primary endings detect static (change in length) and dynamic (rate of change in muscle length) changes in muscle, whereas secondary endings detect only static responsesE: y-neurons activate contraction of intrafusal fibresPower and Kam - Physiology of excitable cells, Reason:Intrafusal fibres are shorter than extrafusal fibresThey have contractile fibres at the ends and non contractile fibres in the middle (B is true)Contain both sensory and motor fibresAre in parallel with extrafusal fibres (although also in series)Intrafusal detects changes in length, Golgi detects changes in tensionA muscle spindle is 3-10 mm in length and consists of 3-12 thin intrafusal striated muscle fibres, which are attached at their distal ends to associated extrafusal skeletal muscle. The central regions of each intrafusal fibre form a capsule containing several nuclei and are devoid of actin-myosin elements.

[Identical] 15A-078 Ondansetron most common side effects A. Headache B. Constipation C. SedationD. Hypotension E. Extra pyramidal side effects

Answer: A - HeadacheA: Headache 11%B: Constipation 4%C: In psychomotor testing ondansetron does not impair performance nor cause sedationD: There have been rare reports of hypotensionE: Movement disorders and dyskinesia have been reported in two large clinical trials of ondansetron at a rate of 0.1 - 0.3%Product information sheet

[Identical] 18A-008 Ondansetron commonly causesA. HeadacheB. Constipation C. SedationD. Hypotension E. Extra pyramidal side effects

[Identical] 14B-075 What is the most common side-effect of ondansetron A. Headache B. NauseaC. HypotensionD. QT prolongation E. Dyskinesia

Answer: A - HeadacheA: Headache 11%B: Used to treat nauseaC: Hypotension not mentionedD: Rarely, transient ECG changes including QT interval prolongation have been reported in patients receiving ondansetron E: Movement disorders and dyskinesia have been reported in two large clinical trials of ondansetron at a rate of 0.1 - 0.3%Product information sheet

[Identical] 18A-044 Which of the following drugs not act by increasing intracellular calcium A. Levosimendan B. Digoxin C. Milrinone D. Dopamine E. Glucagon

Answer: A - Levosimendan A: Levosimendan: binds to Trop C -> increases sensitivity to Ca. Opens VG K+ channels -> vasodilation. B: Digoxin - indirect increase in Ca via blockade of Na/K channels -> inc Na -> blockade of Na/Ca channels C: Milrinone - Selective PDE3 I. inhibits the breakdown of cAMP.Inodilator D: Dopamine - catecholamine b1 + a1 agonist -> GsPCR -> inc CaE: Glucagon: GsPCR -> stimulation of adenylate cyclase -> inc cAMP -> increased CaHemmings and Egan Vasopressors and Inotropes

[Identical] 15A-010 Factors that increase coronary blood flow: A. Hypoxia B. Aortic systolic blood pressure C. Hyperthyroidism D. Aortic compliance E. Sympathetic stimulation

Answer: A - Hypoxia A: In endothelial cells, hypoxia activates K ATP channels that signal an increased release of NO to relax vascular smooth muscle B: Aortic diastolic pressure is important in coronary blood flow. 80% of flow occurs in diastole. High aortic systolic pressure will result in potentially reveresed coronary blood flow C: Hyperthyroidism -> tachycardia -> decreased coronary blood flow due to reduced diastolic time D: Increased aortic compliance -> decreased aortic diastolic pressure -> decreased coronary blood flow E: Activation of the cardiac sympathetic nerves directly constricts the coronary resistance vessels. However, the enhanced myocardial metabolism caused by the associated increase in heart rate and contractile force produces vasodilation, which overrides the direct constrictor effect of sympathetic nerve stimulation. Power and Kam p171 Pappano and Wier p205 (Coronary circulation)

[Identical] 18A-027 Increased coronary blood flow due to A. Hypoxia B. Aortic systolic blood pressure C. Hyperthyroidism D. Aortic compliance E. Sympathetic stimulation

[Identical] 18B-107 Coronary blood flow is increased by: A. Hypoxaemia B. Hypotension / Decreased systolic pressure C. Hyperthyroidism D. Increased aortic compliance E. Aortic stenosis

Answer: A - Hypoxia A: In endothelial cells, hypoxia activates K ATP channels that signal an increased release of NO to relax vascular smooth muscle B: Aortic diastolic pressure is important in coronary blood flow. 80% of flow occurs in diastole. High aortic systolic pressure will result in potentially reveresed coronary blood flow C: Hyperthyroidism -> tachycardia -> decreased coronary blood flow due to reduced diastolic time D: Increased aortic compliance -> decreased aortic diastolic pressure -> decreased coronary blood flow E: In aortic stenosis , for example, the entire output of the left ventricle is ejected through a narrow aortic valve orifice. The high flow velocity is associated with a large kinetic energy, and therefore the lateral pressure is correspondingly reduced. Power and Kam p171 Pappano and Wier p205 (Coronary circulation)

[Identical] 15A-124 Suxamethoniums mechanism of actionA. Inactivation of voltage gated sodium channels leading to prolonged depolarisationB. Open channel blockC. Non depolarising blockD. Inactivation of Calcium channelsE. Phase II block

Answer: A - Inactivation of voltage gated sodium channels leading to prolonged depolarisationA: Inactivation of voltage gated sodium channels leading to prolonged depolarisationB: Memantine is an open channel blocker (works like Mg in NMDA receptors). Neostigmine can also cause an open channel block. Suxamethonium opens the channel, but is not considered an open channel blockerC: Depolarising blockadeD: Inactivation of sodium/potassium channels (Ca contributes 2.5% to total permeability)E: Phase I block

[Identical] 17A-065 Haldane effect describes: A. Increased CO2 carriage as deoxHb B. CO2 loading assists with O2 unloading C. Due to altered buffering capacity D. Requires carbonic anhydrase E. The exchange of chloride for bicarbonate

Answer: A - Increased CO2 carriage as deoxyHbA: Haldane effect - deoxyHb binds with greater affinity to CO2B: Bhor effect - CO2 assists with O2 unloading (although more accurately due to the pH decrease)C: Initial thought was that the whole effect was due to altered buffering capacity. Carbamino carriage demonstrated laterD: Formation of carbamino compounds does not require dissolved carbon dioxide to be hydrated and so is independent of CAE: The Cl- and HCO3- exchange is due a facilitated membrane bound protein, called the Hamburger shift. Nunn's 8th ed p155 Carbon dioxide

[Identical] 19B-040 PK aginga. Increased Vd lipophilic drugsb. Increased Vd for hydrophilic drugsc. Pharmacokinetic changes greater in men than womend. Increased clearancee. Concentration - effect relationship shifted to the right

Answer: A - Increased Vd lipophic drugsA: Decreased lean body mass, total body water, contracted plasma volumeB: Increased relative body fatDecreased Vd for water soluble drugsIncreased Vd for lipid soluble drugsC: Pharmacokinetic changes greater in women than menD: Decreased clearanceE: Concentration - effect graph (quantal dose response curve) shifted left. Smaller ED50 in the elderlyHemmings and Egan - Physiology and harmacology of obesity, pediatric, and the elderly

[Identical] 18A-051 MaxalonA. Increased lower oesophageal toneB. Useful in motion sicknessC. Metabolised via CYP3A4D. Effective dose is 10mg IVE. Only acts centrally

Answer: A - Increased lower oesophageal toneA: Increased lower oesophageal toneB: Not useful in motion sicknessC: Metabolised by CYP2D6D: 10mg IV is ineffective as a dose for PONVE: Acts centrally and peripherallyHemmings and Egan Pharmacology of postoperative nausea and vomiting

[Identical] 18B-082 Increase in lactate following adrenaline because: A. Increased glycogenolysis B. Inadequate tissue perfusion due to vasoconstriction C. Increased anaerobic metabolism D. Decreased renal blood flow E. Decreased lipolysis

Answer: A - Increased plasma concentrations of lactate presumably represent adrenaline (epinephrine)-induced glycogenolysis in skeletal muscles A: Increased plasma concentrations of lactate presumably represent adrenaline (epinephrine)-induced glycogenolysis in skeletal muscles B: Lactic acidosis occurs with adrenaline in the absence of tissue hypoxia C: Lactate rise is due to glycogenolysis or inhibition of pyruvate dehydrogenase D: Lactate rise not due to renal blood flow E: Lipolysis is increased with adrenaline Stoeltings Sympathomimetic drugs

[Identical] 18A-002 Which inotropic drug does not act by increasing intracellular Ca2+? A. Levosimendan B. Glucagon C. Digoxin D. Adrenaline E. Milrinone

Answer: A - Levosimendan A: Levosimendan: binds to Trop C -> increases sensitivity to Ca. Opens VG K+ channels -> vasodilation. B: Glucagon: GsPCR -> stimulation of adenylate cyclase -> inc cAMP -> increased Ca C: Digoxin - indirect increase in Ca via blockade of Na/K channels -> inc Na -> blockade of Na/Ca channels D: Adrenaline - b1 receptor agonist -> GsPCR -> inc Ca E: Milrinone - Selective PDE3 I. inhibits the breakdown of cAMP. Inodilator Hemmings and Egan Vasopressors and Inotropes

[Identical] 15B-048 Sympathetic nervous systemA. Increases Na reabsorption in the proximal tubuleB. Increases efferent arteriole tone to decrease GFRC. Decreases renin releaseD. Only stimulates beta-adrenoreceptorsE. Is required for sodium homeostasis

Answer: A - Increases Na reabsorption in the proximal tubuleA: Proximal tubule epithelial cells are innervated by alpha1 and alpha2 adrenergic receptors. This increases the sodium reabsorption in the proximal and distal tubulesB: Increases AFFerent arteriole tone to decrease GFRC: Adrenergic receptors increase renin releaseD: It is unsettled whether Na reabsorption is mediated via alpha or beta adrenoreceptorsE: Na homeostasis functions in transplanted kidneys prior to functional innervationVander's 7th Ed - p109Ganong's Review of medical physiology Ch37 Renal function and micturition

[Identical] 18A-039 Adrenaline increases lactate levels A. Inhibition of pyruvate dehydrogenase B. Reduced peripheral perfusion C. Decreased glycogenolysis D. Decreased gluconeogenesis E. Increased temperature

Answer: A - Inhibition of pyruvate dehydrogenase A: Adrenaline inhibits pyruvate dehydrogenase, shunting pyruvate to lactate B: Lactic acidosis occurs in the absence of tissue hypoxia C: Adrenaline causes increased glycogenolysis D: Adrenaline causes increased gluconeogenesis E: Nil effect on temperatureHemmings and Egan Vasopressors and inotropes

[Identical] 16A-115 Clonidine in peripheral nerve blockA. Inhibits C-fibres and A deltaB. Spinal blocking effectsC. Supraspinal blocking effectsD. Not used in regionalE. Provides not analgesic effects

Answer: A - Inhibits C-fibres and A delta fibresA: Inhibits C-fibres and A delta fibres via hyperpolarisation activated cation currentB: Effects are mediated through supraspinal and spinal α 2 -adrenergic receptors when used neuraxiallyC: Effects are mediated through supraspinal and spinal α 2 -adrenergic receptors when used neuraxiallyD: Can be used in regional anaestheticE: Does provide analgesic effectsMiller's Local AnaestheticsHemmings and Egan Local Anaesthetics

[Identical] 19B-011 What are physiological antagonists?a. Insulin and glucagonb. Morphine and naloxonec. Rocuronium and acetylcholined. Acetylcholine and atropinee. Warfarin and phenobarbitone

Answer: A - Insulin and GlucagonB - DPhysiological antagonism is a form of functional antagonism. Occurs when antagonist acts at a a different receptor to the agonist and opposes the action of the agonistKatzung Basic and Clinical PharmacologyExamplesProtamine + HeparinGlucocorticoids + InsulinAcetylcholine + IsoproterenolTXA + Serotonin E. Phenobarbitone reduces the metabolism of warfarin. It does not antagonise warfarin

[Identical] 14A-066 Closing volume A. Is measured from a single breath N2 washout B. 20% of VC at 65yrs of age C. Late in small airways disease D. Is measured when upper airways close E. Changes with posture

Answer: A - Is measured from a single breath N2 washoutA: Closing volume is measured with Fowler's method phase 4(Closing capacity is measured. Then CV = CC-RV)B: Normal subjects CV = 10% of VC. At 65 y/o CV = 40% of VC (about the same as FRC)C: Early disease in small airways can be sought by using single-breath N2 washoutD: Occurs when lower airways close "the volume of the lung at which dependent airways begin to close"E: Closing capacity is independent of position. FRC changes with position -> FRC will be less than closing capacity when supine at 45y/oWest's Ninth ed p169Nunn's Eighth ed p38 + 48

[Identical] 15A-109 Dexmedetomidine:A. Is opioid sparingB. Is a non-selective alpha 2 agonistC. Is an indirect sympathomimeticD. Its context sensitive half time is independent of the length of infusionE. Leads to decreased blood pressure and increased heart rate

Answer: A - Is opioid sparingA: Demedetomidine augments the effects of opioids by both supraspinal and spinal mechanismsB: Considered selective alpha 2 agonist (1600:1 a2:a1)C: Is an indirect sympathoLYTICD: Context sensitive half time is DEPENDENT on length of infusionE: Leads to decreased blood pressure and bradycardiaHemmings and Egan - Autonomic nervous system pharmacology + Pharmacology of intravenous anaesthetics

[Identical] 14A-146. Almost pure beta adrenoreceptor action occurs with: A. Isoprenaline B. Noradrenaline C. Adrenaline D. Angiotensin II E. Glucagon

Answer: A - Isoprenaline A: Isoprenaline - naturally occurring catecholamine with significant beta activity (large group on terminal amine) B: Noradrenaline - naturally occurring catecholamine with mostly direct (OH on C3 and BC) alpha activity - lack of CH3 group of terminal amine C: Adrenaline - naturally occurring catecholamine with low dose beta and high dose alpha activity D: Angiotensin II acts on angiotensin receptors -> vasoconstriction E: Glucagon - used in beta blocker overdose. GsPCR increase contractility. E: Glucagon - increases cardiac contractility via GPCR (not beta adrenergic receptors) Hemmings and Egan Vasopressors and Inotropes Stoeltings Sympathomimetic drugs

[Identical] 16A-045 Which of the following is correct regarding Raman Scattering:A. It involves the absorption and emission of specific wavelengths of lightB. It is the same as mass spectrometryC. It can't measure the concentration of a gasD. Can measure the concentration of molecules in solutionE: Are not used due to lower accuracy than infrared absorption spectrometry

Answer: A - It involves the absorption and emission of specific wavelengths of lightA: Photons of light from an argon laser (all of the same wavelength) pass through a chamber containing the gas mixture. The light that undergoes Raman scatter (via absorption of photons) is detected, and the change in wavelength is specific to a particular gas. The amount of emitted photons from Raman scattering is proportional to the concentration of vapour/gas.B: Raman scattering is similar but not the same as mass spectrometry. Mass spectrometry causes ions to separate based on their mass and charge. C: Raman scattering can measure the concentration of molecules due to the amplitude of the new wavelengthD: See CE: Raman scattering is more accurate but more expensive than IR absorption spectrometryReference??

[Identical] 18A-094 BuprenorphineA. KOP AntagonistB. high oral bioavailabilityC. Low first pass metabolismD. Inverse agonistE. Lower potency than morphine

Answer: A - KOP antagonistA: Antagonist at delta and kappa opioid receptorsB: Low oral bioavailability (given sublingual to bipass this)C: High first pass metabolismD: Is an agonist/antagonist. Inverse agonists have negative intrinsic activity.E: Higher potency than morphineStoelting's Opioid agonists and antagonists

[Identical] 15A-126 During propofol TIVA which of the following will increase cerebral blood flowA. KetamineB. IsofluraneC. OpioidsD. DexmedetomidineE. Thiopentone

Answer: A - Ketamine will increase cerebral blood flowEffect on CBFIncreases- KetamineDecreases- Thio, propofol, propranolol, edrophoniumHemmings and Egan - Pharmactology of intravenous anaestheticsMiller's Intravenous anaesthetic agentsMiller's Cerebral physiology and the effects of anaesthetic drugs

[Identical] 15A-038 Compared to plasma cerebrospinal fluid (CSF) composition:A. Lower KB. Lower NaC. Higher osmolalityD. Lower chlorideE. Higher HCO3-

Answer: A - Lower K+A: CSF has a lower K+ than plasmaB: CSF has a higher Na+ than plasmaC: CSF has a lower osmolality than plasmaD: CSF has a higher Cl than plasmaE: CSF has a lower HCO3- than plasmapH CSF - 7.33 Plasma 7.41Hemmings and Egan 2nd ed - Central nervous system physiology: Cerebrovascular

[Identical] 15A-076 Esmolol: A. metabolized by plasma esterase B. long effect time C. more lipid soluble than propranolol D. causes significant vasodilation E. high oral bioavailability

Answer: A - Metabolised by plasma esterase A: Metabolised by RBC and plasma esterases B: t/2 9 minutes -> short effect time C: Low lipid solubility D: Causes no vasodilation E: Nil oral bioavailability Hemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 14B-124 Which is true regarding MAO inhibitors A. Moclobemide is a MAO-A inhibitor B. Older agents are reversible MAO-A and MAO-B inhibitors C. MAO inhibitors decrease tyramine uptake by inhibiting GIT MAO D. Selegiline is a MAO-A inhibitor E. Moclobemide is a MAO- B with fewer side effects

Answer: A - Moclobemide is a MAO-A inhibitor A: Moclobemide is a MAO-A inhibitor used to treat depression B: Older agents are generally irreversible, newer agents (Moclobemide) are reversible and can be stopped 24 hours preop C: MOA-Inhibitors reduce the breakdown -> tyramine levels may increase with MAO-I D: Selegaline - MOA-B inhibitor E: Moclobemide is a MAO-A inhibitor used to treat depression Stoelting Drugs used for psychopharmocologic therapy

[Identical] 18A-074 NeonatesA. Thiopentone in neonates will increase the half life of drugs with hepatic metabolismB. Dose reduce suxamethonium C. Midazolam half life longer than adultD. More at risk of paracetamol toxicityE. Free drug concentration of phenytoin will be lower in a neonate than an adult

Answer: A - More at risk of paracetamol toxicityA: Phenobarbital and thiopentone can induce early maturation of fetal hepatic enzymes. In this case, the ability of the neonate to metabolize certain drugs will be greater than expectedKatzung - Special aspects of perinatal and pediatric pharmacologyB: Suxamethonium dose in neonates - 1.5-2mg/kgMiller'sC: Midazolam clearance is similar or higher than adults, terminal elimination half life is similar or shorter than in adults (Product information sheet)However Diazepam t1/2 is longer in neonates than adults (Katzung)D: The ability of the neonate to conjugate bilirubin and drugs with glucuronide is less because of the low activity of hepatic uridine diphosphoglucuronyl transferase.Power and KamE: Protein binding of drugs is reduced in the neonate, as seen with local anesthetic drugs, diazepam, phenytoin, ampicillin, and phenobarbital. Therefore, the concentration of free (unbound) drug in plasma is increased initiallyKatzung - Special aspects of perinatal and pediatric pharmacology

[Identical] 14B-010 In Torsades de Pointes:A. More likely in bradycardia in susceptible individualsB. Preferred treatment: amiodarone infusion protocolC. More likely in hyperkalaemiaD. Treated with Class II antiarrhythmicsE. Prolonged QTc is not a risk factor

Answer: A - More likely in bradycardia in susceptible individualsA: Exacerbating factors include bradycardiaB: Amiodarone prolongs the QTc and increases likelihood of TDPC: More likely with hypOkalaemiaD: Class II antiarrhythmics (Beta blockers) are used for supraventricular tachycardias. TDP is a ventricular tachycardia, VT, treatment of the unstable VT is cardioversion. Stable TDP can be treated with Mg. E: The risk of TDP is increased with a prolonged QTc. Stoeltings antiarrhythmics

[Identical] 18A-033 Intrathecal fentanyl vs morphine A. Morphine given in 10 x the concentration of fentanyl B. Morphine causes respiratory depression 18-24 hrs C. Fentanyl higher segmental block than morphine D. 12hr peak resp depression for fentanyl E. Fentanyl lasts longer than morphine due to lipid solubility

Answer: A - Morphine given in 10x the concentration of fentanylA: Mophine given as 100-150mcg vs fentanyl 10-15mcg B: Morphine causes respiratory depression 6-12 hours post administration C: Morphine has a higher segmental block than fentanyl D: Morphine causes respiratory depression 6-12 hours post administration, fentanyl doesn't last that long E: Duration of action is longer with morphine than fentanyl (morphine remains in the CSF)Stoelting's Opioid agonists and antagonists

[Identical] 18B-010 Which drug has longest t1/2 keo?A. MorphineB. EtomidateC. KetamineD. PropofolE. Thiopentone

Answer: A - MorphineOf these - morphine has the slowest onset time, less lipid soluble. t1/2 keo (mins)Morphine 264OpioidsFentanyl 4.7Alfentanil 0.9Sufentanil 3.0Remifentanil 1.3IV AnaestheticsMidazolam 4.0Ketamine 3.5Propofol 1.7Thiopentone 1.5Etomidate 1.5Miller's Various

[Identical] 18A-103 Fetal circulationA. Most IVC blood goes via LAB. Blood from the ductus arteriosus increases the oxygen content in the aortaC. Sa02 80% umbilical arteryD. SVC blood is the most oxygenated bloodE. Low pressure in the lungs causes the RV blood to flow into the ductus arteriosus

Answer: A - Most IVC blood goes via LAA: IVC blood traverses the RA and drains into the LA via the foramel ovaleB: Patent ductus arteriosus in the fetus diverts deoxygenated blood away from the pulmonary circulation into the aortoaC: SaO2 of the umbilical vein is 80%. SaO2 of the umbilical artery is lowest D: SVC blood is deoxygenated blood from the brain SaO2 42%E: High pulmonary pressures create resistance to flow, diverting RV blood into the DAPower and Kam Maternal and neonatal physiology

[Identical] 18B-053 Rapid infusion of 500 ml fluid will do what to normal baseline curve? A. Move to right (CVP increased / CO increased) B. Tilt/rotate curve up (CVP unchanged / CO increased) C. Tilt curve down (CVP unchanged / CO decreased) D. Move to left (CVP and CO decreased) E. No change

Answer: A - Move to right (CVP increased, CO increased) Increase in volume will shift the venous return curve to the right and up (CVP increased, CO increased) Power and Kam p 159 Pappano and Wier p185 + 189

[Identical] 14B-073 What is an adverse effect of stopping a beta-blocker peri-operatively?A. Myocardial infarctionB. HypoglycaemiaC. Premature labourD. BronchospasmE. Aortic dissection

Answer: A - Myocardial infarctionA: Withdrawal of beta blocker results in inc catecholamine senstivity -> tachycardia + possible MIB: Betablockers may mask the symptoms of hypoglycaemia and increase the risk of hypoglycaemia in diabetic patientsC: Propranolol may increase uterine contractions (used in conjunction with oxytocin decreases c-sections)D: Side effects of Beta blockers include bronchospasmE: Beta blockers may be useful in managing type B aortic dissectionsStoeltings - Sympatholytics, VasodilatorsHemmings and Egan - Antihypertensives

[Identical] 14A-073 Lignocaine as an antiarrythmic is more likely to worsen cardiac failure because of?A. Negative inotropyB. Decreased volume of distribution and Clearance in Cardiac FailureC. Slows AV conductionD. Causes Torsades de PointesE. Causes peripheral vasoconstriction

Answer: A - Negative inotropyA: Lignocaine has negative inotropic activity (although less than other antiarrythmic drugs used for ventricular arrhythmias)B: Cardiac failure may decrease the initial dose and the infusion required by 50% to due decreased hepatic clearanceC: Lignocaine has no significant effect on AV conduction at therapeutic doses (may slow at toxic doses)D: May cause bradyarrythmias and asystole. Used to treat ventricular tachycardias (like TdP)E: At toxic doses lignocaine will cause peripheral vasodilation and direct myocardial depression -> hypotensionStoeltings Antiarrhythmic drugs

[Identical] 17A-010 What are the defining feature of exponential curves? A. Doesn't reach zero B. Changes by fixed amount C. Changes by fixed percent D. Rate increases as time increases E. Rate increases as concentration increases

Answer: A - Never reaches maximumA: An exponential function never reaches the asymptote nor does it ever reach its maximum/minimumPositive exponential growth will forever keep growingPositive exponential decay will forever keep approaching the asymptoteB: The rate of change of an exponential function is not constantC: The rate of change is not a fixed percent per unit timeD: The rate of positive growth increases with time. The rate of positive decay decreases with timeE: The rate of positive growth increases with time. The rate of positive decay decreases with timeGeneric mathematics text book

[Identical] 19B-007 Which is the defining property of an exponential function?a. Never reaches maximumb. Changes by fixed amountc. Changes by fixed percentd. Rate increases as time increasese. Rate increases as concentration increases

[Identical] 14B-103 Which of the following has no effect (or: the least effect) on the ventilatory response to hypoxaemia in the setting of normocapnoea?A. Nitrous oxideB. IsofluraneC. DesfluraneD. HalothaneE. Sevoflurane

Answer: A - Nitrous oxideThe potency of the suppression of HVR has been proposed as the following order: halothane > enflurane > sevoflurane > isoflurane > desflurane.Miller's Pulmonary pharmacology and inhaled anaesthetics

[Identical] 18B-074 Clopidogrel:A. None of the belowB. Half life 18- 36 hrsC. Can decrease vWF in 5% of patientsD. Dose reduce in renal failureE. should be stopped 48 hrs prior to neuraxial blockade

Answer: A - None of the belowA: See below (none true)B: Half life 6 hoursC: Dipyridamole reduces plasma vWF D: No dose reduction in renal failureE: Should be stopped 7 days before neuraxial blockadeProduct information sheetStoelting's Anticoagulants

[Identical] 14A-130 The CNS effects of cocaine areA. Noradrenaline reuptake inhibitionB. Increases dopamine reuptakeC. Acts directly on dopamine receptorsD. No effect of cerebral vasculatureE. Decreased with concurrent monoamine oxidase inhibitors

Answer: A - Noradrenaline reuptake inhibitionA - Cocaine inibits presynaptic reuptake of noradrenaline and dopamineB - Cocaine inibits presynaptic reuptake of noradrenaline and dopamineC - Does not act directly on dopamine receptorsD - Cocaine and its metabolites causes vasoconstriction in the cerebral arteriesE - MAO-I may potentiate the effect of the increase in catecholaminesStoeltings Local anaesthetics

[Identical] 18A-004 Early symptoms of phenytoin toxicity areA. NystagmusB. Ventricular ectopicsC. Grey skinD. HyperkalaemiaE. Lactic acidosis

Answer: A - NystagmusA: Nystagmus is the most common sign of phenytoin toxicityB: Ventricular ectopics occur in digoxin toxicity. Phenytoin can be used to treat digoxin induced ventricular arrhythmiasC: Grey skin is a side effect of amiodaroneD: Hyperkalaemia has minimal effect on phenytoin side effectsE: Lactic acidosis may occur with metforminProduct information sheets

[Identical] 14A-039 The equilibrium potential for any particular ion A. Occurs when there is no net movement of the ion B. Occurs when its intracellular fluid concentration equals its extracellular fluid concentration C. Is caused by intracellular anionsD. Is always negativeE. Is maintained by Na/K ATPase pumps

Answer: A - Occurs when there is no net movement of the ionA: Occurs when there is no net movement of the ionB: The equilibrium potential includes both the electrical and the concentration gradientC: Is the balance between intra and extracellular ionsD: Will vary depending on the ion (K+ -90, Cl- -70m Na+ +60)E: The Na/K APTase pumps will move ions against their gradient and change the membrane potential (not the equilibrium potential)Power and Kam - Resting membrane potential

[Identical] 15B-141 Potential side effects of high dose inhaled steroids:A. Oral candidiasisB. HPA-axis stimulationC. Osteopaenia / osteoporosisD. AlopeciaE. Dysphagia

Answer: A - Oral candidiasis is a potential side effectA: Oral candidiasis is a side effectB: Hypercorticism and adrenal suppression may occur at high dosesC: Link between oral inhaled steroids and bone density is unclearD: Alopecia is not a common side effect of inhaled cortico steroidsE: Vocal changes are rare side effects, swallowing issues are notProduct information sheet

[Identical] 14A-054 Renal water reabsorption occurs predominantly by A. Osmosis B. Active transport C. Facilitated diffusion D. Secondary active transport E. Paracelllular diffusion

Answer: A - OsmosisA: The movement of sodium and anions generates an osmotic drive that causes the reabsorption of waterB: Active transporters move solutes up a chemical gradientC: Facilitated diffusion is driven by concentration gradients where solutes move through uniporter proteins rather than cell membranesD: Secondary active transport involves symporters and antiporters where 1 or more solutes move up a electrochemical gradient. The energy is provided not by ATP but indirectly from the transport of another solute rather than a chemical reactionD: Chloride reabsorption occurs via passive paracellular diffusionVanders 7th Ed variousWater reabsorption is by diffusion through the cell membranes and tight junctions. The reabsorp- tion of sodium and other solutes decreases the osmotic pressure of the luminal fluid, and water is reabsorbed by osmosis. The ascending limb of the loop of Henle is impermeable to water. ADH increases the water permeability of the collecting duct membrane.Power & Kam pg 231

[Identical] 15A-024 Best way to measure breath by breath oxygen A. Paramagnetic analyser B. Fuel CellC. Clarke ElectrodeD. Sniff testE. Hot wire anemometer

Answer: A - Paramagnetic analyserA: Paramagnetic analyser compares oxygen partial pressure to a known gas. It is rapidly responsive and can be used on a breath by breath time frameB: Fuel cell (Electrochemical oxygen analysis) respond slowly to change in oxygen pressure and cannot be used to measure end tidal concentrationsC: Clarke electrode - Used in blood gas machines. Give a partial pressure of oxygen in the blood. Not used for breath to breath measurementD: Sniff test is a fluoroscopy of the diaphragm (real time assessment of diaphragmatic function)E: Hot wire anemometer is used to measure gas flow velocityDorsch et all 1st ed - Gas monitoringAl-Shaikh - 5th ed - Non-invasive monitoring, Paramagnetic analyser O2 cannot be measured with infrared (monoatomic molecule)O2 is paramagnetic - can be drawn into a magnetic field. Due to unpaired electrons in outer shell spinning in same direction. Measures Fi + Fe O2Essentially a comparison between sample gas and known gas (air 20.9% O2)Magnetic pull of the sample gas compare to known gas through a tube. Difference used to calculate PO2 of sample gas. Old - dumbbell arrangement attached to a wire. Spinning dumbbells -> mirror reflects beam of light.May be inaccurate due to N2O - also paramagnetic. Fuel cell also used in anaesthetic machines - not for breath the breathGalvanic O2 analyserCreate a current. Need to be calibrated 2 pointsLimited life span (basically a battery)Poor response time

[Identical] 15B-044 All of the following can be used to measure the concentration of a Volatile agent EXCEPT;A. ParamagneticB. Raman spectroscopy C. Mass SpectrometryD. Infrared absorption spectroscopyE. Peizoelectric absorption

Answer: A - ParamagneticA: The paramagnetic analyser only measures oxygen because oxygen is paramagnetic B: Raman effect can be used to measure volatiles. Laser at gas. Incident light same wavelength. Some light changes wavelength due to Raman scatter. Intensity of a light at a particular wavelength is proportional to the concentration of that gas. C: Mass spectrometry can measure many different gases and compounds D: Infrared analysers measure volatile concentration. Infrared light with spinning wheel. Uses Beer and Lambert laws to measure concentration of each gasE: Peizoelectric absorption vibrates at particular frequencies when haltogenated vapors are disolved in an oil between two electrodesJ. A. Langton, MBBS MD FRCA, A. Hutton, MBBS MRCP FRCA, Respiratory gas analysis, Continuing Education in Anaesthesia Critical Care & Pain, Volume 9, Issue 1, February 2009, Pages 19-23, https://doi.org/10.1093/bjaceaccp/mkn048

[Identical] 17A-007 Cardiac action potential myocyte A. Phase 1 transient outward K current B. Peak voltage 90mV C. Phase 0 due to ligand gated Na channels D. Fast response in SA node E. Phase 4 due to Na/Ca efflux

Answer: A - Phase 1 transient outward K currentA: Phase 1 - due to transient outward K+ currentB: Peak voltage +20mv (RMP for myocyte is -90mV)C: Phase 0 - Depolarisation due to a rise in intracellular Na. Fast voltage gated inward Na channelsopen for a few thousands of a second.D: SA node has slow response cardiac action potentialE: Inward Ca and Inward Na occur during Phase 4 Power and Kam: Cardiovascular physiology

[Identical] 18B-041 Pacemaker potential diagram A. Phase 4 due to K efflux B. Phase 4 due to Na/Ca efflux C. Depolarisation occurs at -80 mV D. Peak height of action potential = nernst potential for sodium E. Phase 2 results from potassium efflux

Answer: A - Phase 4 due to K efflux A:Outward K occurs during Phase 4 B: Inward Ca and Inward Na occur during Phase 4 C:Depolarisation occurs at -50mV D: Peak height is approx. 0mV E: Downward phase in SAN action potential is Phase 3. There is no Phase I (rapid repolarisation) and no Phase 2 (plateau) Power and Kam: Cardiovascular physiology

[Identical] 19B-044 Sugammadexa. Not compatible with ondansetronb. Reverses roc by covalent bondsc. Hexadextrind. Undergoes metabolism prior to renal eliminatione. Light reversal dose 4mg/kg

Answer: A - Physically incompatible with ondansetronA: Physically incompatible with ondansetronB: Reversal via Van de Vaals force binding to RocuroniumC: Modified cyclodextrinD: Undergoes no metabolismE: 4mg/kg for deep reversal (TOF 0 and PTC 1-9)Product information sheet

[Identical] 18A-024 Central anti-cholinergic syndrome treatmentA. PhysostigmineB. BenztropineC. PyridostigmineD. AtropineE. Scopolamine

Answer: A - PhysostigmineA: Physostigmine is a tertiary amine anticholinesterase that crosses into the CNS and can be administered for the treatment of central anticholinergic syndrome.B: Benztropine anti Parkinson's medication that may cause anticholinergic syndromeC: Pyridostigmine is an oral analogue of neostigmine. Used to treat myasthaenia gravis. D: Atropine is an anticholinergic that causes central anticholinergic syndromeE: Scopolamine (Hyoscine) is an anticholinergic that causes central anticholinergic syndrome

[Identical] 15B-038 Regarding parasympathetic autonomic innervationA. Post ganglionic fibres are on the walls of visceraB. Post ganglionic fibres are relatively longC. Pre ganglionic neurotransmitters are acetylcholine and noradrenalineD. Commonly affected by spinal blockE. Causes constriction of detrusor muscle and urinary sphincter

Answer: A - Post ganglionic fibres are on the walls of visceraA: The post ganglionic neurons are located in the wall of the organsB: Post ganglionic fibres are relatively shortC: Pre ganglionic neurotransmitters are acetylcholineD: Less commonly affected by spinal block (as they lay in the cranial nerves and the sacral nerves)E: Parasympathetic stimulation causes contraction of the detrusor muscle and relaxation of the urinary sphincterGuyton and Hall - 14th ed The autonomic nervous system and the adrenal medulla

[Identical] 18A-117 Endocrine function of kidneyA. Produces EPOB. Produces ADHC. Produces Angiontensin IID. Produces aldosteroneE. Produces vitamin D

Answer: A - Produces EPOA: Produces EPO in response to decreased PaO2B: ADH is produced in the hypothalamus and released from the posterior pituitaryC: Angiotensin II is cleaved from angiotensin I in the lungs D: Aldosterone is produced in the adrenal cortexE: Vitamin D is activated in the kidney (D2/D3 is hydroxylated to 1,25 OH 2D)Vander's 7th Ed - various

[Identical] 18A-098 2 3 DPG A. Production reduced in acidosis B. Production reduced in anaemia C. Bound to fetal haemoglobin D. Causes a reduction in the p50 of the dissociation curve E. Is increased in stored blood

Answer: A - Production reduced in acidosisA: Production decrease in acidosis and this corrects the curve to the left. Production is increased in alkalosis. B: 2.3 DPG increases in anaemiaC: 2,3 DPG binds to the beta chains of haemoglobin. Fetal haemoglobin has no beta chainsD: 2,3 DPG causes a right shift in the OHDC, thus increasing the p50E: 2,3 DPG is reduced in stored blood Nunn's 8th Ed p182West 9th Ed p91

[Identical] 16A-071 With digoxin levels in therapeutic range most likely to seeA. Prolonged PRB. Long QRSC. Long QTD. ST-elevationE. Heart block

Answer: A - Prolonged PRA: Digoxin will prolong PR up to 0.25sec at therapeutic levelsB: Minimal effect on QRSC: Shortened QTc at therapeutic levelsD: ST depression is seen at therapeutic levelsE: Heart block occurs at toxic levels of digoxinStoeltings Cardiac Glycosides

[Identical] 18A-013 What is NOT a definite contraindication to Propofol useA. Proven egg allergyB. Disorders of fat metabolismC. Previous hypersensitivityD. Previous anaphylaxisE. Intralipid allergy

Answer: A - Proven egg allergyA: Egg allergy is not a contraindication to the use of propofol (although PI states it is)B: Propofol should not be used for ICU sedation in patients who have severely disordered fat metabolismC: Previous hypersensitivity is a contraindication for any drugD: Previous hypersensitivity is a contraindication for any drugE: The restrictions that apply to INTRALIPID 10% should also be considered when using propofol in the ICU.Product information sheet

[Identical] 14B-049 With maximal secretion of ADH the highest proportion of water reabsorption occurs in the:A. Proximal convoluted tubuleB. Loop of Henle C. Distal convoluted tubule D. Cortical collecting duct E. Medullary collecting duct

[Identical] 15B-050 In the presence of ADH the highest proportion of water reabsorption occurs in the:A. Proximal convoluted tubuleB. Loop of HenleC. Distal convoluted tubuleD. Cortical collecting ductE. Medullary collecting duct

Answer: A - Proximal convoluted tubuleIn the presence of ADH A: 65% reabsorbed in the PCTB: 10% reabsorbed in the Loop of HenleC: 0% reabsorbed in the distal convoluted tubuleD: 18% reabsorbed in the cortical collecting ductE: 7% reabsorbed in the medullary collecting ductMajority of water reabsorption is in the PCT - regardless of ADH or not.Vander's 7th ed Ch6 Basic renal processes for Sodium, Chloride and Water Table 6.2 and Fig 6-7Even in the presence of ADH, the PCT reabsorbs the majority of filtered water (60%).Alt question - The greatest effect of ADH on water reabsorption in the kidney occurs in the medullary collecting ductVsIn the presence of ADH, the highest proportion of water reabsorption occurs in the PCT

[Identical] 18A-029 In the presence of ADH the highest proportion of water reabsorption occurs in the:A. Proximal convoluted tubuleB. Loop of HenleC. Distal convoluted tubuleD. Cortical collecting ductE. Medullary collecting duct

[Identical] 17A-064 Fetal circulation in utero - choose incorrect stemA. Pulmonary = low pressure; systemic = high pressureB. Majority of blow flow from umbilical vein bypasses the liver via the ductus venosusC. 90% of right ventricular output flows through the ductus arteriosusD. Pulmonary and systemic circulations operate in parallelE. Aortic blood saturates at 60%

Answer: A - Pulmonary = low pressure; systemic = high pressureA: Pulmonary pressures in the fetus are high in utero, systemic circulation is low pressureB: Majority of blod flow from the umbilical vein bipasses the liver via the ductus venosisC: The lungs receive about 10% of the right ventricu- lar output because they are collapsed, and pulmo- nary vascular resistance is highD: As a result of the presence of shunts (foramen ovale and ductus arteriosus), RV and LV work in parallel.E: The shunted blood in the descending aorta (PaO2 of 19 to 20 mmHg [2.5-2.7 kPa] and oxygen saturation of 60%)Power and Kam Maternal and neonatal physiology

[Identical] 19B-071 Which of the following will decrease static compliance A. Pulmonary venous congestion B. COPD C. Asthma D. Increased age E. Airway calibre

Answer: A - Pulmonary venous congestion A: Increased pulmonary blood volume -> decreased compliance B: COPD increases lung volumes -> increased compliance C: Asthma - as per COPD D: Decreased elastic tissue with age -> increased compliance E: Airway calibre (or radius) will affect dynamic compliance Nunn's 8th Ed p25 Elastic forces and lung volume

[Identical] 17A-046 CVP waveform what represents C-Wave A. RV contraction B. RA contraction C. RA relaxation D. RV relaxation E. RA filling

Answer: A - RV contraction A: C wave due to closure and bulging of tricuspid valve into RA at start of RV systole B: RA contraction = a wave C: RA relaxation = x descent D: RV relaxation = y descent E: RA filling = v wave Miller's Cardiovascular monitoring Also - Wigger's diagram

[Identical] 18A-119 Patient naked on operating table most heat loss occurs due toA. Radiation to theatre walls and surgical equipmentB. Conduction to operating tableC. Convection to operating tableD. Convection due to air currentsE. Evaporation due to respiration

Answer: A - Radiation to theatre walls and surgical equipmentRadiation, or emitting electromagnetic energy, contributes to about 40%-50% of the heat loss of the body. About 15% of heat loss is through conduction and convection, and 30% is via evaporation (latent heat of vaporization of water = 2.4 MJ/kg or 580 cal/g at 37°C). Heat loss via respiration is approximately 5%.Power and Kam Metabolism, nutrition, exercise and temperature regulation

[Identical] 15B-144 Cephalic vein: what is NOT correctA. Receive tributary from ulnar forearmB. Lateral to bicep tendonC. Pierce clavipectoral fascia D. Valve at junction of cephalic and axillary veinE. Travel between pectoralis major and deltoid muscle

Answer: A - Receive tributary from the ulnar forearmA: Receives tributaries from the radial forearmB: Cephalic vein is lateral to the border of the bicep tendonC. Pierce clavipectoral fascia D. Valve at junction of cephalic and axillary veinE. Travel between pectoralis major and deltoid muscleAnatomy for Anaesthetists - Miscellaneous zones of interest

[Identical] 14B-045 Regarding renal blood flow: A. Renal nerves come from the sympathetic nervous system B. Innervated by the vagus via the hypogastric nerveC. Reduced by a high protein dietD. All noradrenergic fibres end in close proximity to the juxtaglomerular apparatus or renal tubulesE. Autoregulated between a MAP of 40 - 120 mmHg

Answer: A - Renal nerves come from the sympathetic nervous systemA: Autonomic nerves to the kidneys are sympathetic and release noradrenaline on the juxtaglomerular cells and the renal tubular cellsB: Vagus nerve is parasympathetic, little effect on kidneysC: High protein diet will increase renal blood flowD: Most (not all) noradrenergic fibres end near the JG apparatus and the renal tubules. They also affect the afferent arteriolesE: Autoregulation between 80-170mmHgGanong's Review of medical physiology - 26ed ch37 Renal Function and Micturition

[Identical] 17B-059 What hormone is produced by the kidney:.A. ReninB. AngiotensinC. VasopressinD. Anti-diuretic hormoneE. Aldosterone

Answer: A - ReninA: Renin is secreted by the juxtaglomerular cellsB: Antiogensin - LiverC + D: Vasopressin (ADH) - made in hypothalamus, stored post pituitaryE: Aldosterone - Adrenal glandVanders 7th Ed - p21

[Identical] 18B-138 Pneumotachograph:A. Requires temperature compensationB. Measures volumeC. Requires turbulent flowD. Not dependent on humidityE. Uses Seebeck effect

Answer: A - Requires temperature compensationA: The effects of density and viscosity (which depend on temperature) can alter the accuracy of a pneumotachographB: Pneumotachograph is a device used to measure gas flow (Not volume, volume can be calculated by integrating flow with respect to time)C: Flow is calculated from a pressure differential, the flow must be laminarD: Changes in ambient temperature, or addition of other gases to the mixture, thereby changing the overall viscosity or density, may cause flow to become turbulent.E: Seebeck effect:The Seebeck effect is a phenomenon in which a temperature difference between two dissimilar electrical conductors or semiconductors produces a voltage difference between the two substances. A thermocouple uses the Seebeck effect as does a hotwire anemometer (which measures flow based on temperature change) Thin metal wires heated to 90C which are cooled by flow of gas. this changes their electrical resistance and the change is proportional to flow.Al-Shaikh Non-invasive monitoring

[Identical] 18B-059 Resistance in arteriole compared to venule of same length: A. Resistance higher in arteriole B. Resistance proportional to r^2 C. Resistance higher in venule D. Higher in capillaries E. Higher in parallel circuits

Answer: A - Resistance higher in arteriole A: The greatest pressure drop occurs in the arterioles. It follows that the greatest resistance to flow resides in the arterioles because the total flow is the same through the various series components of the circulatory system. There is also the greatest pressure differential in arterioles compared to venules -> R = (P1-P2)/Q B: Resistance proportional to r^4 C: Venules might be thought to have higher viscosity due to Hamburger effect, but due to the non-Newtonian nature of blood this has less impact D: The reason that the highest resistance does not reside in the capillaries (as might otherwise be suspected from Fig. 6.9 ) is related to the relative numbers of parallel capillaries and parallel arterioles,E: Parallel circuits have lower resistance that those in series. The resistance per unit length (R/l) for individual small blood vessels in the cat mesentery.arterioles, R/l = 1.02 × 10 6 D −4.04 and venules, R/l = 1.07 × 10 6 D −3.94 Pappano and Wier - HemodynamicsHagen Poiseulle: R = 8nl/ pi x r^4Viscosity increases in venous blood due to Hamburger effect but viscosity is variable due to the non-Newtonian nature of blood.

[Identical] 18A-025 Metformin ceased 24-48 hrs pre-op becauseA. Risk of lactic acidosisB. Long plasma half lifeC. Increased CVS riskD. Risk of hypoglycaemiaE. All of the above

Answer: A - Risk of lactic acidosisA: Metformin may cause lactic acidosisB: Short half life - excreted unchanged within 12 hoursC: Should be given with caution to patients with increased CVS risk due to risk of lactic acidosisD: Does not cause hypoglycaemiaE: See AStoelting's Drugs that alter glucose regulation

[Identical] 16B-135 Zero order kinetics:A. Same amount of the drug removed from the body per unit timeB. Same proportion of drug removed from the body per unit timeC. Is an exponential processD. Rate of drug removal increases linearly over timeE. Half life is independent on dose

Answer: A - Same amount of drug removed from the body per unit timeA: Zero order kinetics = The rate of clearance is a constant. A constant amount of drug is removed per unit timeB: Zero order kinetics - an increasing proportion of drug is removed from the body per unit time C: Zero order kinetics is a linear processD: Rate of drug removal is constantE: Half life is not fixed and is dependent on dose and plasma concentration. Rang and Dales Pharmacology - PharmacokineticsStoeltings Basic principles of pharmacology

[Identical] 18A-050 Arterial and Venous: at a given diameter and length - Resistance isA. SameB. Artery > veinC. Artery < veinD. Greatest increase in resistance in the venous systemE. Arterial system has the greatest capacitance

Answer: A - SameA: Resistance per unit length is the same in arteries and veins for the same vessel diameter.B: The greatest drop in pressure occurs in the arterioles due to the sharp decrease in diameter. However - Resistance per unit length is the same in arteries and veins for the same vessel diameter.C: Venous blood has a higher haematocrit due to CO2 -> increased viscosity. Resistance = 8 x length x viscosity / pi r^4Venous blood may have an increased resistance when taking the Poiseuille equation into account(This is not mentioned in the texts)D: The greatest increase in resistance is in the arterial system. E: The venous system has a high capacitance. (this does not change the resistance per unit length for the same diameter)Pappano and Wier - Hemodynamics + The Circulatory system

[Identical] 14A-078. Nitric Oxide:A. Is scavenged by Red Blood CellsB. Is therapeutic in concentrations of 0.06-0.23 ppmC. Is administered with Oxygen as a carrier gas to enable delivery of accurate concentrationsD. Is a treatment for methemoglobinaemiaE. has a MAC of 104

Answer: A - Scavenged by red blood cellsA: NO is released from RBCs then reabsorbed by RBCsB: Therapeutic concentrations range from 10-20ppmC: Inhaled NO + O2 -> NO2 which may cause pulmonary toxicityD: NO causes methemoglobinaemiaE: NitROUS oxide has a MAC of 104

[Identical] 14A-140 Which agent does not act via cAMPA. DigoxinB. Dopamine / dopexamine / dobutamineC. Isoprenaline D. GlucagonE. Adrenaline

Answer: A- digoxin works directly by Na/K ATPase inhibition to increase intracellular Ca & indirectly mAChR stimulation- B agonists (isoprenaline, dopamine, dopexamine, dobutamine, adrenaline) and glucagon work via Gs which is AC/cAMP second messenger systemStoeltings Sympathomimetic Drugs

[Identical] 16A-103 Regarding Inhalational anaesthetic Nitrous OxideA. supports combustion of flammable agentsB. critical temperature 32 deg CC. vapour pressure 5 atm at 20 deg CD. no significant effect on cardiovascular systemE. made from ammonium sulphate

Answer: A - Supports combustion of flammable agentsA: Strongly supports combustionB: Critical temperature 36.4cC: Vapor pressure ~51atm at 20c (the same pressure as in the tank 5100kpa)D: N2O has no significant effect on cardiovascular systemE: Made from ammonium nitrate (not sulphate)Product information sheet Miller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity Stoelting's Inhaled anaesthetics

[Identical] 14B-000 Surfactant A. Surface tension is inversely proportional to surfactant concentration B. Lung compliance decreases with surfactant C. Is produced by alveolar type 1 cells D. Stabilises alveoli to allow smaller alveoli to empty into larger ones E. Increases surface tension in smaller alveoli to promote stability

Answer: A - Surface tension is inversely proportional to surfactant concentration A: More surfactant -> less surface tension. (or less surfactant -> more surface tension + less compliance) B: Compliance increases with surfactant (or decreases with less surfactant) C: Surfactant is produced by Type II pneumocytes D: Surfactant stabilises small alveoli. Preventing small alveoli from emptying into larger ones. (Nunn's p19 Fig2.1)Alveoli with low compliance will fill first. Then empty into alveoli with high compliance. E: Surfactant decreases surface tension and promotes stability. West's 9th Ed Ch7 Surface Tension, Nunn's p19

[Identical] 16A-051 In hypovolaemia:A. Sympathetic stimulation directly increases Na+ reabsorption in the proximal tubuleB. Renin is secreted by juxtamedullary nephronsC. Sympathetic stimulation only affects the afferent arteriolesD. There is rapid change in sodium reabsorptionE. Venous compliance increases

Answer: A - Sympathetic stimulation directly increases Na+ reabsorption in the proximal tubuleA: Sympathetic stimulation stimulates sodium reabsorption in the proximal tubule by a-adrenoreceptors. Activates sodium-hydrogen anti porter and the Na-K-ATPaseB: Sympathetic stimulation in response to hypovolaemia relies on the renin-angiotensin system to be activated via the release of renin secretion via beta1 receptors (in response to baroreceptor reflex detecting low systemic cardiovascular presures). Renin is released from granular cells in the afferent arterioleC: Sympathetic stimulation affects both afferent and efferent arteriolesD: Sodium reabsorption is a late response to hypovolaemiaE: Venous compliance decreases to reduce the potential volume for venous bloodVander's 7th ed Ch7 Regulation of blood pressure

[Identical] 18A-079 Esmolol peakA. 5minB. 10minsC. 15minsD. 30 secondsE. 1 minute

Answer: A - TTPE 5 minutes

[Identical] 17A-022 Therapeutic indexA. Taken from quantal dose curveB. Killing animals of some sortC. Ratio of ED95:ED50D. Ratio of number treated:number with therapeutic effectE. Ratio of maximum dose:therapeutic dose

Answer: A - Taken from a quantal dose curveA: Therapeutic index is the ratio of dose that cause death in 50% of the population to the dose that causes the therapeutic effect in 50% of the population. Thus a quantal dose curveB: Therapeutic index is percentage of human populationC: Therapeutic index is LD50:ED50D: Therapeutic index is a ratio of the doses, not the number needed to treatE: Therapeutic index is LD50:ED50Miller's Basic principles of pharmacologyStoeltings Basic princples of pharmacology

[Identical] 14B-021 Which of the following devices are most commonly used in breath-to-breath analysis of O2 in anaesthetic breathing circuits:A. The Paramagnetic oxygen analyserB. Clarke electrode C. Fuel cellD. Gas chromatography E. Mass Spectroscopy

Answer: A - The Paramagnetic oxygen analyserA: Paramagnetic analyser compares oxygen partial pressure to a known gas. It is rapidly responsive and can be used on a breath by breath time frameB: Clarke electrode - Used in blood gas machines. Give a partial pressure of oxygen in the blood. Not used for breath to breath measurementC: Fuel cell (Electrochemical oxygen analysis) respond slowly to change in oxygen pressure and cannot be used to measure end tidal concentrationsD: Gas chromotography could be used to measure anaesthetic levels in the bloodE: Mass spectroscopy is not fast enough for breath to breath, and is too expensiveDorsch et all 1st ed - Gas monitoringAl-Shaikh - 5th ed - Non-invasive monitoring, Paramagnetic analyser O2 cannot be measured with infrared (monoatomic molecule)O2 is paramagnetic - can be drawn into a magnetic field. Due to unpaired electrons in outer shell spinning in same direction. Measures Fi + Fe O2Essentially a comparison between sample gas and known gas (air 20.9% O2)Magnetic pull of the sample gas compare to known gas through a tube. Difference used to calculate PO2 of sample gas. Old - dumbbell arrangement attached to a wire. Spinning dumbbells -> mirror reflects beam of light.May be inaccurate due to N2O - also paramagnetic. Fuel cell also used in anaesthetic machines - not for breath the breathGalvanic O2 analyserCreate a current. Need to be calibrated 2 pointsLimited life span (basically a battery)Poor response time

[Identical] 14A-150 A pericardial effusion post insertion of a CVC is at decreased risk if the tip of the CVC is at: A. The angle of Louis B. The transverse sinus C. The oblique sinus D. T6 vertebra E. Tricuspid valve

Answer: A - The angle of LouisA: The angle of Louis sits above the mediastinum. This is an appropriate height for a CVC tip to be at. B: The transverse sinus, which lies between the superior vena cava and left atrium posteriorly and the pulmonary trunk and aorta in front. This is too far in.C: The oblique sinus, which is bordered by the two right and two left pulmonary veins, reinforced below and on the right by the inferior vena cava, and which forms a recess between the left atrium and the pericardium. This is below the right atriumD: T6 is below the superior margin of the pericardiumE: The tip of a CVC should not penetrate the heart to the depth of the tricuspid valve. Anatomy for Anaesthetists - The pericardium

[Identical] 18A-040 FiO2 / Breathing devicesA. With increased patient RR Hudson mask will result in lower FiO2 delivered than selectedB. Venturi is a variable performance device / venturi flow increased to obtain increased FiO2C. Nasal prongs limited by not having an oxygen reservoirD. Can deliver FiO2 1.0 with non-rebreather maskE. The FiO2 for a Hudson mask is only dependent on the flow rate

Answer: A - With increased patient RR Hudson mask will result in lower FiO2 delivered than selectedA: Hudson maks (Variable performance mask) will deliver a decreased FiO2 with an increased respiratory rateB: Venturi operated devices are fixed performance devicesC: With Nasal Prongs the nasopharynx acts as a reservoirD: Non-rebreather masks - Higher variable FiO 2 (0.6-0.8) can be achieved with such masks.E: The FiO 2 is determined by the oxygen flow rate, the size of the oxygen reservoir and the respiratory patternAl-Shaikh - Masks and oxygen delivery devices

[Identical] 16A-117 What is the protein binding of lignocaine?A. 40%B. 70%C. 80%D. 90%E. 25%

Answer: B - 70%Stoelting Local anaesthetics

[Identical] 16A-047 Glomerulotubular balance refers to:A. The maintenance of the proportion reabsorbed to filtered loadB. The matching of urine output to GFRC. The regulation of GFR by the macula densaD. Urine output maintained constant in the face of changing GFRE. Urine output:GFR ratio maintained despite changes in RPP

Answer: A - The maintenance of the proportion reabsorbed to filtered loadA: Glomerulotubular Balance refers to the phenomenon whereby a constant fraction of the filtered load of the nephron is resorbed across a range of Glomerular Filtration Rates (GFR). In other words, if the GFR spontaneously increases, the rate of water and solute resorption in the tubule proportionally increases, thus maintaining the same fraction the filtered load being resorbed.B: GTB - a constant fraction of the filtered load is resorbedC: The change is caused by processes other than changes in GFR (macula densa will effect the GFR)D: GTB - a constant fraction of the filtered load is resorbed. The change is caused by processes other than changes in GFR (macula densa will effect the GFR). Has no affect on urine output maintenance. E: Has no effect on urine output maintenanceVander's 7th Ed p120 - Glomerulartubular balance

[Identical] 16A-006 Magnesium:A. The normal plasma values are 0.9-1.25mmol/LB. Is mostly reabsorbed in the renal proximal tubulesC. Does not suppress uterine toneD. Is a direct respiratory depressantE. Facilitates the actions of calcium

Answer: A - The normal plasma values are 0.9-1.25mmol/LA: The normal plasma values are 0.9-1.25mmol/LB: Seventy-five percent is freely filtered at the glomerulus, and proximal tubule reabsorption is minimal, with 60% to 70% being reabsorbed at the thick ascending loop of Henle and 10% reabsorbed under regulation in the distal tubuleC: Historically has been used for tocolysis. Calcium antagonist and so will suppress uterine toneD: Respiratory effects of Mg - Smooth muscle relaxation. Pharmacologic use of Mg 2+ is in acute bronchospasm. E: Physiologic competitive antagonism of Ca 2+ . This is mediated through inhibition of L-type Ca 2+ channels and extracellular local modification of membrane potential, preventing the intracytoplasmic influx of Ca 2+ from both the ECF and intracellular sarcoplasmic reticulum stores.Miller's Perioperative fluid and electrolyte therapy

[Identical] 19B-032 Nitrous oxide is stored in a cylinder at sea level at 20 degrees C. It is half full.A. The pressure gauge will show the SVP of nitrous oxideB. The pressure gauge will show 2200kPaC. It is stored in the gas phaseD. The pressure is independent of temperatureE. Unlikely to cause combustion with rust and oil

Answer: A - The pressure guage will show the SVP of nitrous oxideA: N2O is stored as the liquified gas, the gas will be at SVP and this will show on the pressure guage (51bar or 5100kPa)B: The pressure guage will show 5100kPaC: It is stored in the liquid phaseD: The pressure will increase with increasing temperatureE: May cause combustion with oil and rustProduct information sheet

[Identical] 14A-016 Regarding the splanchnic circulation A. There is a countercurrent exchange mechanism in the intestinal villi B. Includes blood flow to the gut / liver / kidney / spleen and adrenal gland C. Cholecystokinin decreases blood flow D. Parasympathetic stimulation causes vasoconstriction E. Portal vein PO2 increases during a meal

Answer: A - There is a countercurrent exchange mechanism in the intestinal villi A: The direction of the blood flow in the capillaries and venules in a villus is opposite to that in the main arteriole. This arrangement constitutes a countercurrent exchange system . B: Splanchnic circulation provides blood flow to the gastrointestinal tract, liver, spleen and pancreas C: Gastrin and cholecystokinin augment intestinal blood flow, and these hormones are secreted when food is ingested D: The neural control of the mesenteric circulation is almost exclusively sympathetic. -> constriction of the mesenteric arterioles, precapillary sphincters and capacitance vessels. Receptors - a1 adrenergic and B2. A1 causes constriction while b2 causes dilation. E: Portal venous PO2 will decrease post a mealPappano and Wier - Special circulations

[Identical] 18A-078 170kg 170cm patient intubation dose of rocuroniumA. TBWB. IBWC. LBW via the jame's equationD. LBW another equationE. Based on TOF

Answer: A - Total body weight or B - Ideal body weightProduct information sheets varyPfeizer - Total body weightSandoz - Ideal body weight

[Identical] 15A-103 The interaction of these two drugs is mediated by increased serotonin: A. Tramadol and imipramine B. Moclobemide and morphineC. Pethidine and tranylcypramine D. Fluvoxamine and metoclopramide E. Fentanyl and ondansetron

Answer: A - Tramadol and imipramineA: Imipramine - TCA used for depression. SSRI + SNRITramadol - SSRI, SNRI, opioidB: Moclebemide - MAO A inhibitor. Morphine has no effect on SerotoninC: Pethidine - OpioidTranalcipramine - MOA inhibitor D: Fluvoxamine - SSRI for OCDMetoclopramide - AntidopaminergicE: Fentanyl - opioid. No 5HTOndansetron - 5HT antagonist. -> might have some interaction with serotoninProduct information sheets

[Identical] 18A-056 Ephedrine A. Use in hypotension limited by tachyphylaxis B. Naturally occuring C. Catecholamine D. Metabolised by MAO in the GIT E. Decreases coronary blood flow

Answer: A - Use in hypotension is limited by tachyphylaxis A: Use in hypotension is limited by tachyphylaxis B: Ephedrine is a synthetic sympathomimetic C: Ephedrine is not a catecholamine D: Ephedrine is resistant to metabolism by MOA in the GIT -> can be given orally. (Has some metabolism by MOA in the liver)E: Ephedrine increases coronary blood flow Stoeltings - Sympathomimetic drugs

[Identical] 18A-071 Herbals interaction choose correction optionA. Valerian - Benzodiazepine-like withdrawalB. St John wart - Enzyme inhibitionC. Ginseng - Increases blood sugarD. Gingko - Increases sedationE. Ginger - Increased risk of ventricular arrhythmias

Answer: A - Valerian - Benzodiazepine like withdrawalA: Valerian - Benzodiazepine like-withdrawalB: St John's wart - Enzyme inductionC: Ginseng - increased risk of bleeding and hypoglycaemiaD: Gingko - Inhibits platelet activating factorE: Ginger - Increased risk of bleedingEphedra - increased risk of ventricular arrhythmias with halothane. Miller's, Anesthetic implications of complementary and alternative therapies

[Identical] 18A-091 Link chemo drug with side effect it causesA. Vincristine and peripheral neuropathyB. Doxorubicin and pulmonary fibrosisC. Bleomycin and cardiomyopathyD. Cisplatin and pseudocholinesterase deficiencyE. Cyclophosphamide and monoamine oxidase inhibition

Answer: A - Vincristine and peripheral neuropathyA: Vincristine - Peripheral neuropathyB: Doxorubicin - CardiotoxicityC: Bleomycin - Pneumonitis (rarely fibrosis)D: Cisplatin - CCF, myocarditisE: Cyclophosphamide - CCF, tachyarrhythmiasRang and Dales Anticancer drugs

[Identical] 15B-065 Neonatal tidal volume per kgA. 3mlsB. 7mlsC. 15mlsD. 20mlsE. 30ml

Answer: B - 7mls/kgTV is about 20 mL (5 to 6 mL/kg), and the respiratory rate is about 30 breaths/min.Power and Kam Maternal and neonatal physiology

[Identical] 18B-140 Stopping B blockers perioperatively:A. increased sensitivity to catecholaminesB. HypoglycaemiaC. Premature labourD. BronchospasmE. Aortic dissection

Answer: A - Withdrawal of beta blocker results in inc catecholamine senstivity -> tachycardia + possible MIA: Withdrawal of beta blocker results in inc catecholamine senstivity -> tachycardia + possible MIB: Betablockers may mask the symptoms of hypoglycaemia and increase the risk of hypoglycaemia in diabetic patientsC: Propranolol may increase uterine contractions (used in conjunction with oxytocin decreases c-sections)D: Side effects of Beta blockers include bronchospasmE: Beta blockers may be useful in managing type B aortic dissectionsStoeltings - Sympatholytics, VasodilatorsHemmings and Egan - Antihypertensives

[Identical] 17A-024 Xenon - which is most incorrectA. xenon is a greenhouse gasB. it is not an ideal inhalational anaesthetic agentC. MW 131D. requires specialised vapouriserE. xenon is not a trigger for malignant hyperthermia

Answer: A - Xenon is not a greenhouse gasA: Xenon is entirely unreactive in the biosphere. B: Xenon approaches an ideal anaesthetic agentC: MW is 131D: Xenon requires a special vaporiser and monitoring systemE: Xenon does not trigger malignant hyperthermiaMiller's Inhaled anaesthetic uptake, distribution, metabolism and toxicity

[Identical] 16A-141 Muscarinic receptors: A. M1 activation decreases potassium flux in the neuron B. M1 activation decreases gastric acid synthesis C. M2 increases intracellular cAMP D. M2 selectively blocked by pirenzapin E. M3 activation reduces vomiting

Answer: A - activtion decreases potassium flux in a neuron Odd numbered Muscarinic receptors - GqEven numbered Muscarinic receptors - GiM1 receptors - autonomic ganglia, CNS, gastric parietal cells and airway, increased Gastric acid secretionGq receptor -> increased IP3/DAG -> IP3 causes SR release of Ca -> increased intracellular Ca + decreased K conductanceM3 receptors - bronchial smooth muscle, induces emesisGq receptorM2 receptors - cardiac (slows heart rate, decreases contractility)Gi receptor - (opposite of Gs) Inhibit cAMP -> Increased K+ conductance, decreased Ca conductance Pirenzapine - selective M1 (Google)Stoeltings Neurophysiology

[Identical] 15B-134 Fresh frozen plasma (FFP)A. Contains high sodium loadB. Has no factor 5 & 8C. Had no albuminD. Needs to be cross matched before useE. Does not contain fibrinogen

Answer: A - contains a high sodium loadA: Na 173 mEq/LB: FFP contains all soluble clotting factors (including labile CF V and VIII and fibrinogen), albumin, Ig's and naturally-occurring anticoagulants (Eg. ATIII, protein C/S) It's plasma. C: FFP contains all soluble clotting factors (including labile CF V and VIII and fibrinogen), albumin, Ig's and naturally-occurring anticoagulants (Eg. ATIII, protein C/S) It's plasmaD: FFP should be group specific (Ie. ABO) but does NOT need to be cross-matchedE: FFP contains all soluble clotting factors (including labile CF V and VIII and fibrinogen), albumin, Ig's and naturally-occurring anticoagulants (Eg. ATIII, protein C/S)Various sources, can be used to treat coagulopathy and protein C deficiencythawed has decreased Factor 5 (80% of normal) and decreased Factor 8 (60% of normal)- it is whole blood minus platelets and RBCs; still contains albumin- group specific is fine, in an emergency even non-group specific is used

[Identical] 15B-121 Regarding plasma cholinesterase (pseudocholinesterase) enzyme:A. inhibited 80% by dibucaineB. concentration is increased in the third trimester of pregnancyC. concentration is increased in the neonateD. metabolises lidocaineE. metabolises atracurium

Answer: A - inhibited 80% by dibucaineA: Dibucaine inibits the normal enzyme by approxiately 80%B: Pregnancy lowers the activity of plasmacholinesteraseC: Concentration is may be decreased in the neonate due to lower protein synthesisD: Lidocaine is metabolised in the liver (Amide local anaesthetic)E: Atracurium is metabolised by plasma esterasesMiller's Pharmacology of Neuromuscular blocking drugsStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 18B-026 LabetalolA. non-selective beta blocker and a1 antagonistB. has no intrinsic sympathomimeic activityC. Is not membrane stabilisingD. Minimal metabolismE. Reduces uterine blood flow

Answer: A - non-selective beta blocker and alpha1 antagonistA: on-selective beta blocker and alpha1 antagonistB: has minor intrinsic sympathomimeic activity at beta2 in smooth muscle (Hemmings and Egan)C: Membrane stabilisingD: Extensive hepatic metabolismE: Uterine blood flow is preservedHemmings and egan antihypertensive drugs and vasodilators + autonomic nervous system pharmacology

[Identical] 19B-035 Compared to pH 7.4A. pH 7.1 has double hydrogen ionsB. pH 6.0 has 10x less hydrogen ionsC. pH 8.0 will have more ionised basic drugD. pH 7.1 has 3x more hydrogen ionsE. pH 6.4 is better physiologically because it is the pKa of carbonic acid

Answer: A - pH 7.1 has double the hydrogen ionsA: 0.3 change in pH = double of H+ ionsB: 1.0 change in pH = 10x increase H+ ionsC: Basic drugs ionise below their pKa. An increase in pH to 8.0 will increase the unionised fraction of a basic drugD: 0.3 change in pH = double of H+ ionsE: pKa of carbonic acid is 6.4, this is not better physiologically Miller's Perioperative acid base balance

[Identical] 16A-002 Blood gas machine directly measures:A. pH pCO2 pO2B. BE pCO2 pO2C. pO2 pCO2 HCO3-D. HCO3- pH pO2E. pO2 HCO3 pH

Answer: A - pH, pCO2, pO2The measured parameters are:1. arterial blood oxygen partial pressure2. arterial carbon dioxide partial pressure3. the pH of the arterial blood.Al-Shaikh - Additional equipment used in anaesthesia and intensive care

[Identical] 17A-070 Gingko biloba affects clotting howA. platelets B. clotting factorsC. vitamin - KD. inhibits warfarinE. all of the above

Answer: A - plateletsGingko - inhibits platelet activating factor and prevents platelet aggregation

[Identical] 14B-029 The liver produces all of the following EXCEPT: A. von Willebrand factor B. AlbuminC. Antithrombin III D. FibrinE. Factor VII

Answer: A - von Willebrand factorA: vWF is synthesised in the endotheliumB, C, D, E: Albumin + Fibrin + Antithrombin III + Factor VII are synthesised in the liverGuyton and Hall 14th ed - The Liver (Substances used in blood coagulation)

[Identical] 17A-044 Best place to sample Mixed Venous Blood A. Pulmonary artery B. Right ventricle C. Left atrium D. SVC E. IVC

Answer: A Mixed venous blood is all the blood returning to the heart and includes thebesian veins, coronary blood and systemic blood. Mixed venous oxygen saturation ( Sv⎯⎯O2Sv¯O2 ) is the O 2 saturation of blood at the proximal pulmonary artery. Miller's - Respiratory Monitoring

[Identical] 14A-045 The affect of ADH in the kidney A. Aquaporin insertion on the basolateral membrane B. Cause constriction of extraglomerular mesangial cells C. Act on V1A receptors / V2 receptorsD. Act on receptors on the basolateral membraneE. Act on Gi protein coupled receptors

Answer: A: Aquaporins are inserted on the apical (luminal) membraneB: Angiotensin II causes constriction on the glomerular mesangial cells reducing GFRC: V1A (V1) receptors are on smooth muscle (not in the kidneys) V2 (V2) receptors are in the kidneysD: V1 receptors are in the basolateral membrane of the principal cellsE: ADH receptors are GsPCR and GqPCR Vander's 7th Ed - various

[Identical] 17A-059 CO change at term pregnancyA. 40% increase in COB. HR increases more than SVC. Due to increased contractility secondary to oestrogenD. Due to an increase in afterloadE. Due to a doubling of uteroplacental circulation

Answer: AA: Cardiac output increases to >40% at termB: Heart rate increases 20% at term. Stroke volume increases 40% at termC: Oestrogens increase myometrial contractility, and this may be one of the triggers for parturition. Oestrogen increases plasma volume more than contractilityD: Total peripheral vascular resistance decreases by 30% at the 12th week and 35% by the 20th week and then remains at 30% below non-pregnant valuesE: A large proportion of the cardiac output is directed to the uteroplacental circulation that increases its blood flow 10-fold to about 750 mL/min at term.Power and Kam Maternal and neonatal physiology, Cardiac output increases progressively throughout pregnancy to approximately 40%- 45% above non-pregnant values at the 12th to the 28th week, reaches a peak of 50% during the 32nd to the 36th week and then decreases slightly (to 47% above non-pregnant values) after that. HR increases 20%Stroke volume increases 40%Due to increased venous return and increased vascular volume caused by oestrogens.

[Identical] 18A-055 Anaesthetic Machine safetyA. O2 last in at rotameter / flowmeterB. On/off switch coveredC. When oxygen failure device alarms all other gases cut offD. User can turn off oxygen failure alarm easilyE. Nitrous oxide can be supplied with <21% oxygen

Answer: AA: If the anaesthetic machine incorporates a gas flowmeter bank, oxygen must be the last gas to enter the common gas manifold at the top of the flowmeter tubesB: An "on/off" switch, if present, must be protected from unintended activation or deactivation.C: When high pressure gas supply systems are in use, an oxygen supply failure warning device must be present on the anaesthetic machine. This must - Cut off the supply of gases other than air or oxygen to the common fresh gas outlet.D: When high pressure gas supply systems are in use, an oxygen supply failure warning device must be present on the anaesthetic machine. This must: Cancel the alarm only when the oxygen supply pressure has been restored to a level above that at which the device was activated.E: If the anaesthetic machine is capable of delivering nitrous oxide, the machine must not deliver a hypoxic mixture. When oxygen and nitrous oxide are the only gases used, the machine must prevent delivery of a gas mixture with an oxygen concentration below that of ambient airANZCA Statement on the Minimum Safety Requirements for Anaesthetic Machines and Workstations for Clinical Practice PS54

[Identical] 15A-072 Brown fat metabolism: A. Metabolism is autonomically mediated B. Mediates its effects by insulation of neck vessels (passive heat production) C. Occurs without oxygenD. Produces heat by uncoupling of oxidative phosphorylation outside of the mitochondria E. Results in the production of large amounts of ATP and heat

Answer: AA: Non-shivering thermogenesis is stimulated by catecholamines. B: NST - BmR is increased 2-3x due to active energy productionC: Brown fat metabolism requires oxygenD: Presence of large amounts of non-esterified fatty acids uncouples mitochondrial phosphorylation from respiration, and energy is lost directly as heat.E: Recycling of triglycerides and fatty acids leads to increased ATP turnover. Lipolysis and re-esterification result in ATP hydrolysis and heat produc- tion.Power and Kam 7th Ed - p 386

[Identical] 18B-099 All of following true about plasma proteins except:A. Buffer 50% of blood CO2B. Involved drug transport by binding to globulinsC. Plasma proteins are crucial for coagulationD. Fibrinolysis depends on proteinsE. The primary contributor to oncotic pressure is albumin

Answer: AA: Plasma proteins are amphoteric and dissociate in the pH range of 7-7.8, with a net negative charge. Thus, they can accept H+ ions, although this buffering function is minor compared with other buffering systems in blood.B: Drugs are bound to albumin and globulinsC: Coagulation factors are proteinsD: Various plasma proteins, including prothrombin and fibrinogen, are involved in the coagulation cascade.E: Quantitatively, albumin is the most impor- tant plasma protein for oncotic pressure because of its low molecular weight and high concentration compared with other plasma proteins.Power and Kam - Physiology of blood

[Identical] 18B-022 Morphine metabolites include nor-morphone. Nor prefix implies:A. Removal of methyl groupB. GlucuronidationC. Phase 1D. Phase 2E. Renal metabolism

Answer: ANor = removal of a methyl groupOxidative dealkylation

[Identical] 18B-088 Healthy person breathing 100% oxygen is most likely to produce following effect: A. Arterial pH 7.5 - 7.6 B. PaO2 somewhere between 450 - 650 mmHg C. Venous partial pressure of oxygen 60-80 mmHg D. Arterial blood oxygen content will increase by 13% E. PaO2 >100mmHg with a 35% shunt

Answer: B A: Increasing FiO2 will not affect pH B: pAO2 = FiO2 (pBar - pH2O) - pACO2 / RFiO2 = 21% -> pAO2 = 100mmHgFiO2 = 100% -> pAO2 = 663mmHgpaO2 will be slightly less due to VQ scatter and Venous Admixture C: Mixed venous doesn't change much when FiO2 increased to 100%. Normal PvO2 = 40mmHgThis is due to the total oxygen content in blood only increasing slightlyCaO2 = 1.306 x [Hb] x SaO2 + 0.003 x paO2 D: CaO2 = 1.306 x [Hb] x SaO2 + 0.003 x paO2The dissolved fraction will increase0.003 x 100 = 0.30.003 x 600 = 1.8The total content won't increase dramatically.Normal caO2 = 20mL/100An increase by 1.8mL is an increase of 9% E: Shunt >35% cannot reach PaO2 >100mmHg even with 100% FiO2

[Identical] 15B-061 Hypoxic pulmonary vasoconstriction: A. Solely mediated by alveolar PO2 B. Biphasic with increase at 40mins following prolonged hypoxia C. Requires intact neural connections D. Mediated by pulmonary vein smooth muscle contraction E. Unaffected by inhaled nitric oxide & prostacyclin

Answer: B A: Mediated by both mixed venous O2 + alveolar O2 B: Time course of pulmonary vasoconstriction - see Nunn's fig 6.8 p99 C: Still functional in excised lung D: Contraction of pulmonary arteries, not veins E: Inhibitors of HPV include NO and PGI2 Nunn's 8th Ed p98-100

[Identical] 14B-004 The last part of the heart to depolarise after atrial depolarisation: A. Left apex of endocardium B. LV base C. RV base D. Left apex epicardium E. Right apex endocardium

Answer: B - LV baseThe last portions of the ventricles to be excited are the posterior basal epicardial regions and a small zone in the basal portion of the interventricular septum. Pappano and Wier - Automaticity: Natural excitation of the heart Path of conductionSA NodeAtriaAV nodeBundle of HisPerkinje Fibres- Endocardial surface- Intraventrcular septum papillary muscle- Epicardial surfaces- Outside of RV- Apex- Bases R before L Power and Kam

[Identical] 16A-138 NMDA receptorsA. Stimulated by ketamineB. Needs GABA for activationC. Facilitated by magnesiumD. Present pre & post synapticallyE. Blocked by methadone

Answer: B + EA - Ketamine is a non-competitive NMDA antagonistB - Requires Glutamate, Glycine and a voltage change to activateC - Magnesium plugs the poreD - Post synaptic receptorE - d-Methadone acts as an NMDA antagonistANZCA Acute Pain Management: Scientific EvidenceMiller's Opioids

[Identical] 16A-105 In a healthy adult MAC awake for halothane is?A. 0.1% volB. 0.3% volC. 0.6% volD. 0.8% volE. 1.0% vol

Answer: B - 0.3%HalothaneMAC = 0.75%MAC Awake = 0.5MAC -> MAC Awake halothane = 0.3%

[Identical] 14B-042 Optimal damping for a measurement system is D: A. 1.0B. 0.64C. 0.5 D. 0.32 E. 0.13

Answer: B - 0.64B: The monitoring system should be able to apply an optimal damping value of 0.64.Al-Shaikh Invasive monitoring, Answer: BDamping coefficientthe damping coefficient is estimated by measuring the overshoot or rise time The Primary FRCA Structured oral Exam Guide IDampingDamping describes the resistance of a system to oscillation resulting from a change in input. A system that rises quickly will tend to overshoot but one that rises too slowly is of questionable clinical value.Damping prevents the system from approaching its natural frequency and hence resonating.Under-damped: the output changes quickly in response to a step change in input but overshoots then oscillates around the true value before settling. This prolongs the time delay until the true value is evident.Critically damped: D = 1 the response and the rise time are longer than under-damped but there is no overshoot and minimal oscillations.Overdamped: damping greater than critical. The response would be so slow that it has no clinical value.Optimally damped D = 0.64 - 64% of the energy from the input is removed from the system.At this point the measurement system shows uniform response to about 88% of natural frequency

[Identical] 18B-024 Normal intracellular concentration of Chloride?A. 2 mmolB. 10 mmolC. 100 mmolD. 110 mmolE. 0.1 mmol

Answer: B - 10 mmolMiller's Perioperative fluid and electrolyte therapy

[Identical] 16A-132 Morphine metabolismA. 30% is metabolised to morphine-3-glucuronideB. 10% is metabolised to morphine-6-glucuronideC. codeine is not a metaboliteD. excreted unchanged via kidneysE. morphine-6-glucuronide is an active metabolite that is less potent than morphine

Answer: B - 10% is metabolised to morphine-6-glucuronideA: 75-85% metabolised to M3GB: 10% metabolised to M6GC: A very small amount is metabolised to codeineD: Only 1-2% unchanged renally excretedE: M6G is more potent than morphineStoelting's Opioid agonists and antagonists

[Identical] 18A-058 Blood Volume in arterial system A. 5% B. 10% C. 20% D. 40% E. 60%

Answer: B - 10%The volume of blood normally present in all veins is about 2,500 mL, whereas the arterial system contains only about 750 mL of blood when the mean arterial pressure is 100 mm Hg.750mL / 5000 mL = 15%The systemic circulation contains about 80% of the blood volume, with the remainder present in the pulmonary circulation and heart. Of the blood volume in the systemic circulation, about 64% is in veins and 7% is in the cardiac chambers. Stoeltings - Circulatory physiology

[Identical] 18B-092 Loss of response to verbal stimulation occurs in healthy 25 yo male with no premedication at propofol blood concentration of:A. 1 ug/mlB. 2.5 ug.mlC. 4 ug/mlD. 5 ug/mlE. 10 ug/ml

Answer: B - 2.5 ug/ml The blood levels of propofol alone for loss of consciousness are 2.5 to 4.5 μg/mLMiller's Intravenous Anaesthetics

[Identical] 18A-009 Lignocaine 20ml 1% 1:200 000 adrenalineA. 200mg Lignocaine and 50ug adrenalineB. 200mg Lignocaine and 100ug adrenalineC. 20mg Lignocaine and 100ug adrenalineD. 20mg Lignocaine and 50ug adrenalineE. 200mg Lignocaine and 20ug adrenaline

Answer: B - 200mg Lignocaine and 100ug adrenaline20mL 1% Lignocaine = 20mL x 10mg/mL = 200mg20mL 1:200,000 Adrenaline = 20mL x 5mcg/mL = 100mcg

[Identical] 15B-063 What minimum level of shunt cannot reach PaO2 100mmHg A. 15% B. 25% C. 35% D. 45% E. 55%

Answer: B - 25% See Isoshunt diagram Nunn's 8th Ed p127 Distribution of pulmonary ventilation and perfusion

[Identical] 18A-004 How many kiloJoules are required to increase temperature by 1C in a 100kg man?A. 100kJB. 350kJC. 1000kJD. 3500kJE. 10kJ

Answer: B - 350 kJReason: Specific heat capacity of the human body is 3500 J/(kg.K)To raise 100kg body by 1C would require 100 x 3,500 = 350,000J per degreespecific heat = the amount of heat per unit mass required to raise the temperature by 1 degree (Celcius or Kelvin)Reference??

[Identical] 16A-012 What is the end systolic volume of the RV in a 70kg man? A. 20-30ml B. 50-70ml C. 120-130ml D. 10-20ml E. 40-50ml

Answer: B - 50-70mLLVEDV = RVEDV = 120-130mLLVESV = RVESV = 50-70mLSV = 50-80mL Power and Kam p134

[Identical] 15B-133 The CSHT for alfentanil TIVA of 4 hours duration is?A. 30 minsB. 60 minsC. 90 minsD. 120 minsE. 260 mins

Answer: B - 60 minutesAlfentanil CSHT plateaus at 200mins -> 60 minutesStoelting's Opioids

[Identical] 18B-084 Rocuronium elimination:A. 70% renalB. 70% biliaryC. metabolised to 3-desmethyl rocD. metabolised to 3-15-desmethylrocE. more lipid soluble than vecuronium

Answer: B - 70% biliaryRocuronium30% eliminated in the urine70% eliminated in bile (unchanged)Minimal metabolism -> mostly water soluble (17-deasecetyl-rocuronium), none detected in the plasmaVecuronium - more lipid soluble

[Identical] 16A-085 Epsilon-aminocaproic acid (EACA)A. Is a synthetic activator of thrombolysisB. Acts by directly inhibiting plasminogen activationC. Can only be given by IV routeD. Reversal of thombolysisE. Irreversibly binds to lysin-binding site on plasminogen

Answer: B - Acts by directly inhibiting plasminogen activationA: Epsilon-aminocaproic acid (EACA) binds reversibly to plasminogen by its lysin-binding site, inhibiting its association with fibrin. Thus inhibit fibrinolysisB: The lysine analogs act by competitively inhibiting the binding site on plasminogen, leading to inhibition of plasminogen activation as well as preventing plasminogen binding of fibrin, therefore impairing fibrinolysis.C: AMICAR is the oral form of EACAD: Potential role in managing bleeding (intracranial hemorrhage post thrombolytic therapy), however, t1/2 of thrombolytics is <20minutes. Therefore EACA/TXA does not specificaly "reverse" thrombolysis, but may reduce bleeding. E: Reversibly binds to lysin-binding site on plasminogen Miller's Anaesthesia for Orthopedic surgery + Patient Blood Management: CoagulationProduct information sheet for Thrombolytics

[Identical] 15B-053 Role of ADH:A. Inserts aquaporin channels into basolateral membrane of collecting ductsB. Acts on vascular V1a receptorsC. Reabsorbs Na and H2OD. Insert aquaporin 1 proteins in the apical membraneE. Causes polyuria

Answer: B - Acts on V1a receptorsA: Insert aquaporin 2 proteins in the apical membrane B: ADH (vasopressin) acts on V1a receptors on blood vesselsC: ADH causes H2O resporption (nil effect on Na resorption)D: Insert aquaporin 2 proteins in the apical membrane (other aquaporin proteins are constitutive in the basal membrane)E: ADH reduces urine outputVander's 7th ed - variousHemmings and Egan 2nd ed - Endocrine Physiology

[Identical] 17B-058 Mode of action pregabalin:A. Acts on GABA receptorsB. Acts on voltage-gated calcium channelsC. Increases uptake 2 of noradrenalineD. Increases Substance P releaseE. Acts on voltage-gated sodium channels

Answer: B - Acts on voltage-gated calcium channelsA: Acts on Calcium channelsB: Acts on a2-delta ligands of voltage gated calcium channelsC: Reduces the release of neurotransmitters by decreasing intracelluar calciumD: Decreases the release of Substance PE: Acts on a2-delta subunit of of voltage gated Calcium channelsMiller's Non-opioid pain medicationsHemmings and Egan Nonopioid Analgesics

[Identical] 17B-006 Serum Na+ 120 / K+ 6.6:A. Primary hyperaldosteronismB. Adrenal failureC. Water intoxicationD. Severe dehydrationE. Loop diuretic overdose

Answer: B - Adrenal failureA: Primary hyperaldosteronism - Aldosterone promotes H+ secretion, K+ secretion, Na+ reabsorptionB: Adrenal failure - impaired Na+ reabsorption, K+ secretion -> hypernatraemia, hyperkalaemiaC: Water intoxication - Dilutional hyponatraemia, normokalaemiaD: Devere dehydration - May cause hyponatraemia or hypernatraemiaE: Loop diuretic overdose - Hyponatraemia, hypokalaemia, Aldosterone is secreted in response to hyponatraemia and hyperkalaemia. Adrenal failure reduces the release of aldosteroneAdrenal failure leads to lack of aldosterone action which would normally stimulate Na+ reabsorption and K+ secretion by the principal cells of the cortical collecting ducts-> adrenal failure -> inc K+ and dec Na+

[Identical] 16A-088 Glycerol is added to propofol to?A. Alter its pHB. Alter its osmolalityC. Prevent bacterial contaminationD. As an emulsifying agentE. As a lipid solvent

Answer: B - Alter its osmolalityA: Sodium hydroxide to change the pHB: 2.25% of glycerol as a tonicity-adjusting agentC: EDTA added for its bacteriostatic activitiesD: 1.2% purified egg phospholipid added as emulsifierE: 10% soybean oil is the solventMiller's Intravenous anaesthetic

[Identical] 15B-036 REM sleepA. Easily rousable stateB. Always comes after NREMC. Becomes more frequent toward end of sleep cycleD. There is no movement in REM sleepE. Heart rate and respiratory rate are regular

Answer: B - Always comes after NREMA: Sleep is defined as unconsciousness from which a person can be aroused by sensory or other stimuli. It is to be distinguished from coma, which is unconsciousness from which a person cannot be aroused.REM sleep is more difficult to arouse a person from by sensory stimuli than during slow wave sleepB: REM always follows non-REM sleepC: REM occurs every 90 minutes and lasts 5-30 minutes depending on how rested you areD: Extremem inhibition of peripheral muscles and irregular muscle movements and rapid movements of the eyes occurE: Heart rate and respiratory rate are irregular in REM sleepGuyton and Hall - 14th ed - States of Brain activity, - more difficult to rouse from REM sleep- start with Stage 1 NREM and progress to Stage 2, 3 and sometimes 4, before REM sleep- As the person becomes more rested through the night, the duration (not the frequency) of the REM bouts increase

[Identical] 19B-083 What forms the posterior boundary of the epidural space?A. Anterior longitudinal ligamentB. Anterior aspect of the laminaeC. Supraspinous ligamentD. Posterior aspect of the laminaeE. Interspinous ligament

Answer: B - Anterior aspect of the laminaeAnterior - Posterior longitudinal ligament (vertebral bodies + discs)Posterior - Ligamentum flavum + laminaLateral - pedicles + foramenAnatomy for Anaesthetists

[Identical] 15B-142 What forms the posterior boundary of the epidural space?A. Anterior longitudinal ligamentB. Anterior aspect of the laminaeC. Supraspinous ligamentD. Posterior aspect of the laminaeE. Interspinous ligament

Answer: B - Anterior aspect of the laminaeThe posterior aspect of the space is limited by the laminae and overlying ligamentum flavum, and at the sides by the pedicles of the vertebral arches and the intervertebral spaces. The front of the space is formed by the bodies of the vertebrae, the intervertebral discs and the posterior longitudinal ligament. The ligamentum flavum is 2-5 mm thick in cadavers and is divided by the vertebral spines into two parts, one arising from each lamina.Anatomy for anaesthetists - The spinal meninges

[Identical] 17A-025 Rhesus blood groupA. Present on all tissuesB. Antibodies rarely formed without exposureC: Are IgM antibodiesD. Only Rh D causes significant antigen-antibody reactionsE. Anti-D immunoglobulin should be administered to all Rhesus -ve patients receiving Rhesus +ve blood transfusion

Answer: B - Antibodies rarely formed without exposureA: Rh antigens are only present on RBCsB: Unlike ABO antibodies, anti-Rh D antibodies generally only produced after exposureC: Rh antibodies are IgGD: While Rhesus D is the subtype most likely to cause a significant reaction, the other subtypes can also precipitate an incompatablility reactionE: Anti-D is only indicated for women of child-bearing age, to prevent potential formation of anti-D antibodies which may cause a problem if in a future pregnancy the foetus is Rh D positive

[Identical] 18B-002 Sugammadex reversesA. rocuroniumB. vecuroniumC. rocuronium and vecuroniumD. rocuronium vecuronium pancuroniumE. rocuronium and cisatracurium

Answer: C - rocuronium and vecuroniumSugammadex is capable of reversing Rocuronium and Vecuronium Not used for reversal of PancuroniumStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 18B-090 Sodium metabisulfite:A. prevents decomposition via hydrolysisB. prevents decomposition via oxidationC. adjused pHD. used as a solventE. antimicrobial

Answer: B - Antioxidant + E - AntimicrobialA: Does not prevent hydroxylationB: Is an antioxidant for drugs that contain the phenol or catechol moeitiesC: The formulation of propofol containing Na metabisulfite has a lower pH, not due to the Na metabisulfiteD: Is not the solvent for propofolE: Sodium metabisulfite is an antimicrobial addative to propofolNaMetabisulphate - donates sulphur dioxide.Prevent oxidation of the drug. Also considered a "preservative"MacPherson - Pharmaceutics article 2001An antimicrobial - Stoeltings Intravenous sedatives

[Identical] 14A-018 When comparing radial artery and aorta waveforms. A. Aorta has higher systolic B. Aorta has lower systolic C. Aorta has higher MAP D. Radial has bigger incisura E. Radial wave occurs earlier

Answer: B - Aorta has lower systolic A: Aortic waveform has a lower systolic than radial B: Aortic waveform has a lower systolic than radial C: Mean arterial pressure remains relatively constant, decreasing only slightly distally D: The high-frequency components of the pulse, such as the incisura (the notch that appears at the end of ventricular ejection), are damped out and soon disappear E: Radial wave will be slightly delayed Pappano and Wier - The arterial system Hemmings and Egan - Cardiovascular physiology: Integrative function

[Identical] 14B-005 When comparing radial artery and aortic waveforms A. Aortic wave has higher systolic pressure B. Aortic wave has lower systolic pressure C. Aortic wave has higher mean arterial pressure D. Radial wave has bigger incisura E. Radial wave occurs earlier

[Identical] 15A-111 BarbituratesA. Protein binding parallels lipid solubility hence oxybarbiturates are more protein bound/lipid solubleB. Aspirin will decrease protein binding of thiopentoneC. Uremia does not effect thiopentoneD. pH does not affect protein binding of barbituratesE. Oxybarbiturates are more ionised at physiological pH

Answer: B - Aspirin will decrease protein binding of thiopentoneA: Thiobarbiturates are more highly protein bound than oxybarbituratesB: Aspirin has higher affinity to albumin than barbiturates and will decrease the protein binding of thiopentoneC: Uremia reduces the induction dose of barbituratesD: pH influences protein binding. Peak protein binding occurs at pH 7.5. Acidic plasma -> less protein binding and more availabile drugE: Oxybarbiturates are 25% ionised at pH 7.4. Thiobarbiturates are 50% ionised at pH 7.5Miller's Intravenous Anaesthetics

[Identical] 15B-110 Which combination is correct with regards to chemotherapeutic agents and their side effects?A. Doxorubicin -> pseudocholinesterase deficiencyB. Bleomycin -> pulmonary fibrosis C. Cisplatin -> pseudocholinesterase deficiencyD. Cyclophosphamide -> monoamine oxidase inhibitionE. Vincristine -> monoamine oxidase inhibition

Answer: B - Bleomycin -> pulmonary fibrosisA: Doxorubicin - CardiotoxicityB: Bleomycin - Pneumonitis (rarely fibrosis)C: Cisplatin - CCF, myocarditisD: Cyclophosphamide - CCF, tachyarrhythmiasE: Vincristine - Peripheral neuropathyRang and Dales Anticancer drugs

[Identical] 18B-126 Angiotensin converting enzyme inhibitors interfere with metabolism ofA. angiotensinogenB. bradykininC. dopamineD. reninE. nitric oxide

Answer: B - Bradykinin breakdown is inhibited by ACE inhibitorsNo effect on nitric oxide nor dopamine.Hemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 14A-131 Aspirin: A. COX2 selective B. Bronchospasm from leukotrienes C. Cytochrome 2D6 metabolism D. Less gastrointestinal symptoms than celecoxibE. Has a half life of 7-10 days

Answer: B - Bronchospasm from leukotrienesA: Aspirin is Cox non specificB: Blocks AA to Prostaglandins + TXA2 => more AA available to form leukotrienes (lipoxygenase) that may cause bronchospasmC: CYP2D6 is for opioids. Not for aspirin. D: Celecoxib is COX 2 specific, less GIT side effects than aspirinE: Half life 15 minutes. Product information sheetMiller's Acute post operative painStoelting's Anticoagulants

[Identical] 18B-039 Neostigmine causes:A. decreased oral secretionsB. bronchospasmC. meiosisD. constipationE. tachycardia

Answer: B - BronchospasmNeostigmine Side effects (Cholinergic effects)Due to increased Ach at nAchR + mAchRParasympathetic effects predominantlyDUMBELLS- Diarrhoea- Urination- Miosis (not meiosis)- Bradycardia/asystole- Bronchospasm- Emesis- Lacrimation- SweatingProduct information sheet

[Identical] 15A-114 Ketamine:A. reduces cerebral blood flowB. causes direct myocardial depressionC. causes bronchoconstrictionD. reduces pharyngeal secretionsE. is a competitive antagonist at NMDA receptors

Answer: B - Causes direct myocardial depressionKetamineA: Increases CBFB: Is a direct negative inotropeC: Causes broncodilationD: Increases pharyngeal secretionsE: Is a non-competitive NMDA antagonistHemmings and Egan - Pharmactology of intravenous anaestheticsMiller's Intravenous anaesthetic agentsMiller's Cerebral physiology and the effects of anaesthetic drugs

[Identical] 16A-048 Renal acid secretion is altered by changes in:A. Adrenal medullary hormone secretionB. Changes in intracellular pCO2C. GFRD. Sodium concentrationE. Tubular reabsorption

Answer: B - Changes in intracellular pCO2The task for the kidney is to replace the lost bicarbonate by generating new bicarbonate from CO2 and water (being careful to excrete the hydrogen ion that is created at the same time). In essence, the process is as follows: Hydrogen ions and bicarbonate are produced from carbon dioxide and water within cells. Hydrogen ions are secreted and combine with the conjugate base of buffers in the tubular lumen other than bicarbonate.A - Aldosterone is released from the cortex, not the medulla. Medulla secretes adrenaline and noradrenalineB - Increased CO2 -> drives CO2 + H2O -> H+ + HCO3-C - GFR has no influence on H+ secretionD - H+ is linked to K+ excretion not sodiumE - Vander's 7th Ed p167

[Identical] 18A-083 SVPA. Sevo higher than enfluraneB. Depends on temperatureC. Desflurane has a lower SVP than SevofluraneD. Occurs at boiling pointE. Changes with altitude

Answer: B - Depends on temperatureA: SVP sevoflurane is the lowest of the volatilesB: SVP changes with temperatureC: SVP desflurane is the highest of the volatilesD: SVP changes with temperature and equals boiling point when SVP = atmospheric pressureE: Does not change with pressure/altitudeMiller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity

[Identical] 15A-118 EMLA is a local anaesthetic solution thatA. Consists of a mixture of local anaesthetics that are water soluble above room temperatureB. Consists of a base and its respective local anaesthetics in an emulsionC. 20% ionisation of prilocaine and lignocaineD. causes vasodilationE. should not be left on longer than 1 hour

Answer: B - Consists of a base and its respective local anaesthetics in an emulsionA - EMLA is an emulsion at room temperatureB - Consists of a base (NaOH) and its respective local anaesthetics in an emulsionC - 5% lidocaine-prilocaine cream (2.5% of each)D - Causes vasoconstrictionE - Can be left on for >2hrs for skin graft harvestingStoeltings Local anaesthetics

[Identical] 18B-003 Zero order kinetics:A. Constant proportion drug eliminated per unit timeB. Constant amount drug eliminated per unit timeC. Half life is proportional to volume of distributionD. Half life is proportional to clearanceE. Half life is proportional to plasma concentration

Answer: B - Constant amount of drug eliminated per unit timeA: First order kinetics - a constant proportion of drug eliminated per unit timeB: A constant amount of drug is eliminated per unit timeC: Volume of distribution has no impact on half life in zero order kineticsD: Half life in zero order kinetics is inversely proportional to clearance (which decreases with dose)E: Half life in zero order kinetics is inversely proportional to plasma concentrationGoodman and Gilman's Pharmacokinetics: The dynamics of drug absorption, distribution, metabolism, and elimination

[Identical] 15B-062 Surfactant A. Produced by Type 1 alveolar cells B. Contains dipalmitoyl phosphotidylcholine C. Prevents large alveoli emptying into small alveoli D. Production stimulated by mineralocorticoids E. Is a lipid surface tension reducing compound

Answer: B - Contains dipalmitoyl phosphotidylcholine A: Surfactant is produced by type 2 pneumocytes B: Contains DPPC (dipalmitoyl phosphotidylcholine) C: Prevents small alveoli emptying into large alveoli D: Production stimulated by glucocorticoids E: Is a phospholipid with protein compound (not just a lipid) West's 9th Ed Ch7 Surface tension, Nunn's 8th Ed p18

[Identical] 16A-133 Opioids effects except which of the followingA. Decreased GIT motilityB. Decreased GIT secretionC. Increased circular muscle contractionD. Increased GIT absorptionE. Nausea and vomiting

Answer: B - Decreased GIT secretionA: Morphine decreases the peristaltic contractions in the small and large intestineB: Morphine may also cause nausea and vomiting by increasing gastrointestinal secretionsC: Opioids may cause spasm of the spincter of OddiD: The decreased passage of intestinal contents may increase water absorption. Decreased gastric emptying may decrease drug absorption (depends on wording of question)E: Opioids cause nausea and vomiting due to stimulation of the chemoreceptor trigger zone

[Identical] 18B-114 Which of the following is not a normal cardiovascular change of aging? A. Decreased left ventricular compliance B. Decreased left ventricular afterload C. Decreased max HR D. Increased incidence arrhythmias E. Decreased heart rate variability

Answer: B - Decreased LV afterload A: LV compliance decreases B: LV afterload increases due to stiffening of the arteries (aortic compliance reduces) C: Max HR decreases (220-age) D: Arrhythmias occur more frequently due to fibrosis of the myocytes E: HR variability is decreases Miller's - Geriatric anaesthesia Hemmings and Egan - Physiology and pharmacology of obesity, pediatrics and the elderly

[Identical] 15B-105 Describe the effects of isoflurane at 1 MAC during spontaneous ventilation.A. Decreased RRB. Decreased TVC. Normal response to PO2D. Increased PVRE. Increased airway resistance

Answer: B - Decreased TVA: Volatiles cause an increase in RRB: Volatiles cause a decrease in TVC: Volatiles decrease the hypoxic responseD: Volatiles can assist in inhibiting PVRE: Volatiles reduce airway resistanceMiller's Pulmonary pharmacology and inhaled anaesthetics

[Identical] 18B-127 In comparison to ketorolac / parecoxib:A. Impairs renal functionB. Decreased gastric ulcerationC. Similar effect on plateletsD. Lower cardiovascular riskE. All of the above

Answer: B - Decreased gastric ulcerationA: Both impair renal functionB: Parecoxib - COX-2 selective NSAID. Less GI ulcerationC: Platelets have no COX 2. Parecoxib will have no effect on plateletsD: Parecoxib will have a higher cardiovascular riskE: See BHemmings and Egan Nonopioid analgesics

[Identical] 15A-119 Bupivacaine is inadvertently injected into the caudal vein during a caudal anaesthetic in a 2wk old neonate. Increased risk of toxicity compared to the adult is primarily due to:A. Increased permeability of the blood/brain barrierB. Decreased hepatic clearanceC. decreased volume of distributionD. decreased alpha1 acid-glycoproteinE. respiratory acidosis

Answer: B - Decreased hepatic clearanceB - Terminal half life may be 8-12hours in neonates due to mmature hepatic enzyme systemsMiller's Local Anaesthetics

[Identical] 14A-013 With IPPV the predominant decrease in CO is due to? A. ↑PVR B.↓ VR C. Impaired RV function D.↓ LV distensibility E. ↑LV afterload

Answer: B - Decreased venous return A: PVR is not impacted by IPPV directly B: Rising intrathoracic pressure impairs systemic venous return and RV preload C: RV function is not changed D: During the inspiratory phase of a positive pressure breath, the increase in intrathoracic pressure simultaneously decreases LV afterload while increasing total lung volume which displaces blood from the pulmonary venous reservoir forward into the left side of the heart and increases LV preload. The increase in LV preload and decrease in afterload produce an increase in LV stroke volume, an increase in cardiac output E: During the inspiratory phase of a positive pressure breath, the increase in intrathoracic pressure simultaneously decreases LV afterload while increasing total lung volume which displaces blood from the pulmonary venous reservoir forward into the left side of the heart and increases LV preload Miller's - Cardiovascular monitoring

[Identical] 18B-038 Ototoxicity of aminoglycosidesA. Depends on peak plasma concentrationB. Depends on area under the curveC. Results from time dependent killingD. Results from concentration dependent killingE. Has a long half life

Answer: B - Depends on area under the curveA: Ototoxicity occurs with long term use of gentamicin, rather than peak plasma concentrationB: Area under the curve (time at high plasma concentration) is proportional to ototoxicityC: Gentamicin exhibits post antibiotic effect, allowing for doses less frequent than their half life would suggest. (this reduces ototoxicity)D: Gentamicin also exhibits concentration dependent killing (this increases ototoxicity, but not as significant as the area under the curve)E: Gentamicin has a short half life (2-3 hours)Katzung Antibiotics Stoelting's Antimicrobials, Antiseptics, Disinfectants, and Management of Perioperative Infection

The CSHT for alfentanil TIVA of 4 hours duration is? A. 30 mins B. 60 mins C. 90 mins D. 120 mins E. 260 mins

[Identical] 18B-017 Desflurane:A. MW greater than isofluraneB. metabolised less than isofluraneC. does not produce trifluoroacetic acidD. approaches FA = FI slower than halothane at 6L/minE. causes renal damage

Answer: B - Desflurane is metabolised less than IsofluraneA: Isoflurane MW 184 > Desflurane MW 168B: Isoflurane metabolised > DesfluraneC: Desflurane does produce TFAD: Desflurane approaches FA = FI faster than other volatilesE: Desflurane causes hepatic damage (rare) and nil renal damageMiller's Inhaled anaesthetic uptake, distribution, metabolism and toxicity

[Identical] 15A-066 Regarding muscles of respiration A. Diaphragm can be an accessory muscle of expiration B. Diaphragm moves 1 cm in normal breathing C. Internal intercostal muscles are inspiratory D. 50% of normal breathing is due to intercostals E. Sternocleidomastoid is an accessory muscle of inspiration that acts by raising the first rib

Answer: B - Diaphragm moves 1 cm in normal breathing A: Diaphragm is inspiratory muscle. Plays no part in expiration B: In normal tidal breathing, the level of the diaphragm moves about 1 cm C: External intercostals - inspiratoryInternal intercostals - expiratory D: Diaphragmatic contraction is the primary action of normal breathing. The intercostals adjust for the inward pull of the apical ribs. E: SCM attaches to the sternum + clavicle. Not to the first rib (that is the scalenes)West 9th Ed p96 Muscles of respiration

[Identical] 15B-113 Which of the following is NOT said to be safe in porphyria?A. atropineB. diazepamC. propofolD. droperidolE. suxamethonium

Answer: B - Diazepam is potentially unsafe in porphyria. Unsafe in porphyria: - Barbiturates, Ketamine (relative), Etomidate, Clonidine, Ketorolac, Diclofenac, Phenytoin, Erythromycin, Diazepam, Midazolam. Miller's Metabolic diseases

[Identical] 14B-114 Which is an amide local anaesthetic?A. cocaineB. dibucaineC. procaineD. tetracaineE. procainamide

Answer: B - DibucaineAll amide LAs have 2 'i's in the nameProcainamide is an antiarrhythmic class Ia sodium channel blocker

[Identical] 14A-109 Ketamine:A. direct alpha- & beta- adrenoreceptor receptor agonistB. direct sympathetic ganglia stimulationC. competitive NDMA antagonistD. commonly causes histamine releaseE. positive direct ionotrope.

Answer: B - Direct sympathetic ganglia stimulationA: Ketamine causes indirect stimulation of alpha and beta adrenoreceptors via activation of the sympathetic nervous system B: Ketamne produces a direct cardiodepressive, negative inotropic effect next to an indirect stimulatory effect due to activation of the sympathetic systemC: Non-competitive NMDA antagonistD: Ketamine can antagonise the spasmodic effects of histamineE: It produces a direct cardiodepressive, negative inotropic effect Miller's Intravenous anaesthetics

[Identical] 16A-129 AspirinA. binds stronger to albumin than salicylic acidB. displaces warfarin from its binding siteC. bioavailability increases with foodD. regularly crosses the BBB to cause its effectE. must be hydrolysed to salicylic acid to have its effect

Answer: B - Displaces warfarin from its binding siteA: At clinical concentrations, from 50% to 90% of the salicylate is bound to plasma proteins especially albumin, while acetylsalicylic acid itself is bound to only a very limited extent.B: Drugs that bind to protein binding sites should also be used cautiously since ASA may displace drugs from their protein binding site.C: Food decreases the gastric pH -> decreased bioavailabilityD: May cross the blood brain barrier, although in small amountsE: Does not need to be hydrolysed to have its effectProduct information sheetPeck & Hill

[Identical] 14B-043. One mole of nitrous oxide and one mole of carbon dioxide: A. Have the same massB. Each contain the same number of molecules in one moleC. CO2 will occupy greater volume than N2O at same temperature and pressure D. Have the same density E. Have the same viscosity

Answer: B - Each contain the same number of molecules in one moleA: 1 mole = same number of particles. Molecular mass is different => mass of 1 mole will be differentB: 1 mole = same number of particles (Avegadro's Constant)C: 1 mole occupies 22.4L at STPSame number of moles => same volumeD: Molecular mass is different => for the same volume the density will be differentE: Viscosity relates to forces between particles. N2O and CO2 will have different attraction and repulsion forces => different viscosityReference??

[Identical] 18A-070 DabigatranA. ProdrugB. Effects ecarin timeC. Requires a 75% dose reduction in renal failure D. Has oral bioavailability of 80%E. Has a half life of 8 hours

Answer: B - Effects ecarin timeA: Dabigatran etexilate is the prodrug for dabigatranB: At recommended doses dabigatran prolongs coagulation time as measured by the: activated partial thromboplastin time (aPTT), thrombin time (TT) and ecarin clotting time (ECT).C: Not indicated in CrCl <30mL/minD: Oral bioavailability of 6%E: Half life is ~13 hoursProduct information sheet

[Identical] 18B-104 Which of the following does not explain time dependence of alveoli? A. Redistribution of gas from non compliant to compliant alveoli B. Engorgement of pulmonary capillaries on inspiration C. Recruitment of alveoli D. Surfactant is surface active E. Stress relaxation

Answer: B - Engorgement of pulmonary capillaries on inspirationFactors that explain time dependence- Changes in surfactant activity- Stress relaxation of lung tissue- Redistribution of gas- Recruitment of alveoli. Engorgement of pulmonary capillaries will affect lung compliance, but is not a time dependent factor Nunn's 8th Ed p24 "Causes of time dependence of pulmonary elastic behaviour"

[Identical] 15A-087 Metformin: A. Causes hypoglycaemiaB. Excreted unchangedC. Lactic acidosis: incidence 50 per 1000 patient years D. Increases hepatic gluconeogenesisE. Causes constipation

Answer: B - Excreted unchangeA: Metformin rarely causes hypoglycaemiaB: Excreted unchange (90% of oral dose in 12 hours)C: Lactic acidosis: approximately 0.03 cases/1000 patient-years, with approximately 0.015 fatal cases/1000 patient-yearsD: Decreases gluconeogenesisE: Causes nausea and diarrhoeaProduct information sheetStoelting's Drugs that alter glucose regulation

[Identical] 18A-042 Cytochrome CYP2D6A. Poor metabolisers have zero enzyme ability 10% AsiansB. Extensive metabolisers 1 or more normal allele 80% CaucasiansC. Ultrarapid metabolisers multiple normal alleles 20% caucasionsD. Codeine to morphine by glucuronidationE. Oxycodone to morphine by dealkylation

Answer: B - Extensive metabolisers 1 or more normal allele 80% CaucasiansA, B, C:Approximate frequencies of these phenotypes for the Caucasian population are 5% to 10% for poor metabolizers 10% to 15% for intermediate metabolizers 65% to 80% for extensive metabolizers 5% to 10% for ultrarapid metabolizers D: Codeine - Demethylation of C3 to morphineE: Oxycodone - Demethylation to oxymorphoneHemmings and Egan Adverse drug reactionsHemmings and Egan Drug metabolism and pharmacogentics

[Identical] 18A-002 CryoprecipitateA. Good for Jehovas WitnessesB. Factor VIII Fibrinogen vWFC. Used for the reversal of warfarinD. Used as volume expanderE. Has a shelf life of 12 months at room temperature

Answer: B - Factor VIII, Fibrinogen, vWFA: Cryoprecipitate is prepared from plasma derived from both whole blood and apheresis donations. Not for JWsB: Cryoprecipitate contains most of the factor VIII, fibrinogen, factor XIII, von Willebrand factor and fibronectin found in fresh frozen plasma.C: Reversal of warfarin needs all clotting factors - found in FFP or Prothrombin XD: Not used for volume expansionE: Cryoprecipitate has a shelf-life of 12 months when stored at -25º C or below.Red Cross Blood website, Fresh frozen plasma is slowly thawed at a temperature between 1-6 ˚C and the resulting cold-insoluble recovered and then refrozen.One unit of apheresis cryoprecipitate is approximately equivalent to 2 units of whole blood cryoprecipitate.Reason: Contains most of the Factor VIII, Fibrinogen, Factor XIII, von Willebrand Factor fibronectin from fresh frozen plasma. Derived from whole blood or collected via apheresis, is prepared by thawing fresh frozen plasma between 1-6C and recovering the precipitate. The cold-insoluble precipitate is refrozen.One unit of cryoprecipitate apheresis is approximately equivalent to 2 units of cryoprecipitate derived from whole blood

[Identical] 15A-029 Haemoglobin structure is A. Two porphyrin rings with 2 Fe3+ ions B. Four porphyrin rings with 4x Fe2+ ions C. Two porphyrin rings qith 2x Fe 2+ ions D. Four porphyrin rings with 4x Fe3+ ions E. Two porphyrin rings with 4 x Fe 2+ ions

Answer: B - Four porphyrin rings with 4x Fe2+ ionsHaemaglobin- 4 porphyrin rings- 2a 2b globin chains- 4 Fe in 2+ state (ferrous)West 9th Ed p78 - Gas transport in blood

[Identical] 15A-006 The likelihood of gas flow being less turbulent:A. Gas viscosity less B. Gas temperature increased C. Tube radius increased D. Reynolds > 2000 E. Tube has bifurcation

[Identical] 14A-043 Gas flow is less likely turbulent if A. Gas viscosity less B. Gas temperature increased C. Tube radius increased D. Reynolds > 2000 E. Tube has bifurcation

Answer: B - Gas temperature increasedReynold's number: Re = pvd / n(p = density, v = velocity, d = diameter of tube, n = viscosity)Turbulant flow occurs if Density increasesVelocity increasesDiameter increasesViscosity decreasesA: Decreased viscosity -> increased Reynold's number -> more likely to be turbulentB: Increased temperature -> increased viscosity of gases (although decreased viscosity of liquids) -> less likely to be turbulentC: Increased radius -> increased Reynold's number -> more likely to be turbulentD: Higher Reynold's number -> more likely to be turbulentE: Bifurcation -> disruption of air flow -> more likely to be turbulent, Reason: ??Increased temperature -> inc particle movement -> more turbulent flowo Re < 2000 = laminar flow, Re > 3000 = turbulent flow, Re in between = transitional Decreased viscosity -> more turbulent flowReynold's number >2000 beginning of turbulent flowBifurcation -> more turbulence- With laminar flow:H-P equationFlow = (ΔP x πr4)/8ηlo Flow is proportional to pressure and radius to 4th power o Flow is inversely proportional to length and viscosityResistance = 8ηl / (ΔP x πr4)

[Identical] 15B-056 Gas flow is less likely to be turbulent withA. Gas viscosity less B. Gas temperature increased C. Tube radius increased D. Reynolds > 2000 E. Tube has bifurcation

[Identical] 15A-050 Which of these is most completely re-absorbed in the kidneys A. AlbuminB. GlucoseC. Calcium D. Potassium E. Sodium

Answer: B - GlucoseVander's - 7th ed - Ch 1Under normal conditions all glucose is co-transported from the lumen of the tubule by SGLT2 transporter along with sodium (secondary active transport)Renal clearance of glucose = 0 per dayThese reach max capacity at BSL of about 16mmol/l and but from 12mmol glucose will appear in urinePower and Kam

[Identical] 15A-005 The juxtaglomerular apparatusA. Macula densa is located in the proximal thick ascending loop of HenleB. Granular cells are in the wall of the afferent arterioleC. Mesangial cells are inside Bowman's capsuleD. Mesangial cells are baroreceptorsE. Is stimulated by the parasympathetic and the sympathetic nervous system

Answer: B - Granular cells are in the wall of the afferent arterioleA: The macula densa cells are in the distal thick ascending limb or at the start of the distal convolutionB: Granular cells are in the wall of the afferent arterioleC: Mesangial cells are in the basement membraneD: Mesangial cells respond by contracting and relaxing. They are not sensing cellsE: The JGA is stimulated by the sympathetic nervous systemVander's 7th ed Ch7 Control of sodium and water excretion

[Identical] 18B-019 Fetal A. Hb 140 g/L in neonateB. Hb 190 g/L in neonateC. HbF 50% at birthD. HbA highest at birthE. P50 HbF = 90mmHg

Answer: B - Hb 190 g/L in the neonateA: Hb 190 g/L in the neonateB: Hb 190 g/L in the neonateC: HbF 90% in the fetus to 35/40 then is 75-80% at birthD: HbA is lowest at birth and is at adult levels at 6/12E: p50 HbF = 19mmHg (left shifted OHDC)The mean haemoglobin concentration of the newborn is about 17 to 18 g/dL, and this may rise by 1 to 2 g/ dL in the first days of life as a result of the excretion of fluids. A week after birth, the haemoglobin con- centration returns to 18 g/dL and then decreases steadily to about 11 to 12 g/dL at 4-8 weeks due to a decrease in red cell massPower and Kam Maternal and neonatal physiology

[Identical] 16A-118 EMLA creamA. contains procaineB. always causes methaemoglobinaemia in neonatesC. Should be used on cracked skinD. 5% formulationE. Causes vasodilation

Answer: D - 5% formulationA - EMLA contains lidocaine-prilocaineB - Can cause methaemoglobinaemia in neonatesC - Should not be used on broken skin due to increased absorptionD - 5% formulation (2.5% lignocaine 2.5% prilocaine)E - Causes vasoconstrictionStoeltings Local anaesthetics

[Identical] 17B-003 ABG pH 7.46 / HCO3- 14 / pCO2 20 A. DKA B. High altitude C. Chronic COPD D. Hyperaldosteronism E. Vomiting

Answer: B - High altitudeA: DKA will cause a metabolic acidosis with respiratory compensation BUT a low pHB: Altitude causes a Respiratory alkalosis with metabolic compensationC: COPD causes a respiratory acidosis with metabolic compensationD: Hyperaldosteronism causes H+ wasting - metabolic alkalosis with respiratory compensationE: Prolonged vomiting causes a metabolic alkalosis with respiratory acidosis compensation

[Identical] 14A-040 CSF with respect to plasmaA. Higher K+B. Higher Na+C. Higher proteinD. HCO3- similarE. Higher pH

Answer: B - Higher Na+A: CSF has a lower K+ than plasmaB: CSF has a higher Na+ than plasmaC: CSF has a lower protein than plasmaD: CSF has a lower HCO3 than plasmaE: CSF has a lower pH than plasmapH CSF - 7.33 Plasma 7.41Hemmings and Egan 2nd ed - Central nervous system physiology: Cerebrovascular

[Identical] 16B-008 If cardiac output and oxygen consumption remains the same which of these would lead to an increased in mixed venous O2 tension A. Alkalosis B. Hypercapnea C. Reduced 23 DPG D. Hypothermia E. None of the above,

Answer: B - HypercapneaIncreased PCO2 -> an increase in H+ Acidosis causes an increase in PvO2 via a right shift in the OHDCA shift to the right will benefit venous PO2 (increase PvO2). Provided that the arterial PO2 is not critically reduced. Nunn's 8th Ed p182

[Identical] 17A-026 Likely change in massive transfusion of whole blood:A. HypokalamiaB. HypocalcaemiaC. Increased 2 3-DPG in rbcsD. Increased clotting riskE. Alkalosis

Answer: B - Hypocalcaemia- Massive transfusion causes:A: Hyperkalaemia - b/c stored blood has ‚Inc plasma K+ (up to 30 mmol/L at 30 days) due to leakage from RBCB: Hypocalcaemia - due to citrate toxicityC: Inc Hb affinity for O2 - b/c stored blood has decreased 2,3-DPG levelsD: Coagulopathy - due to dilutional thrombocytopaenia (which occurs first) and dilution of clotting factors, and NOT due to decreased Ca2+E: Metabolic acidosis - b/c stored blood becomes acidotic (pH 6.5)Power and Kam - Physiology of blood

[Identical] 18A-001 Salbutamol causesA. HyperkalaemiaB. HypokalaemiaC. Improves V/Q mismatchD. Reduced dead spaceE. Lactic acidosis

Answer: B - HypokalaemiaA: Potentially serious hypokalaemia may result B: Potentially serious hypokalaemia may result C: May increase dead spaceD: Salbutamol has no effect on the pulmonary ventilation/perfusion ratio,E: Lactic acidosis has been reported very rarely in association with high therapeutic dosesProduct information sheet

[Identical] 18A-038 Salbutamol side effectA. BradycardiaB. Increased lactateC. Inceased potassiumD. HypoglycaemiaE. Reduced dead space

Answer: B - Increased lactateA: Salbutamol causes tachycardiaB: Salbutamol may increase lactateC: Salbutamol may cause hypokalaemiaD: Salbutamol may cause hyperglycaemiaE: Salbutamol can increase dead space Product information sheet

[Identical] 14B-067 Turbulent flow is less likely with: A. Decreased viscosity B. Increased temperature C. Increased radiusD. Reynold's number greater than 2000 E. Bifurcation of airway

Answer: B - Increased temperatureTurbulent flow occurs when Reynold's number is >4000: (D)Re = pvd / n(p = density, v = velocity, d = diameter of tube, n = viscosity)Turbulant flow occurs if - Density increases- Velocity increases- Diameter increases (C)- Viscosity decreases (A)Viscosity of a gas will increase with increasing temperature -> decreasing the likelihood of turbulent flowBifurcation of the airway causes turbulent flowPower and Kam - p81, o Re < 2000 = laminar flow, Re > 3000 = turbulent flow, Re in between = transitional Decreased viscosity -> more turbulent flowReynold's number >2000 beginning of turbulent flowBifurcation -> more turbulence- With laminar flow:H-P equationFlow = (ΔP x πr4)/8ηlo Flow is proportional to pressure and radius to 4th power o Flow is inversely proportional to length and viscosityResistance = 8ηl / (ΔP x πr4)

[Identical] 18B-078 REM sleep:A. Has Kappa complexes in EEGB. Increases in duration in later part of nightC. Increases with ageD. Follows stage 4 non-REME. Is predominantly theta waves

Answer: B - Increases in duration in later part of nightA: Kappa complexes occur in stage 2 non REM sleepB: As a person becomes more rested through the night, the durations of REM bouts increaseC: REM sleep decreases with ageD: Does not always occur following stage 4 non REM, may occur after stage 3E: REM sleep is predominantly beta wavesGuyton and Hall - 14th ed - States of Brain activity, K complexes present in deep sleep (NREM) stages 2 and 3 predominantly. Has increased presence in benzodiazepine use.Durations a REm sleep increase with sleep duration. Cycle every 90mins and last for 5-30mins.REM can occur at any time during the cycle, but usually after 90-110mins after being asleep.- As the person becomes more rested through the night, the duration (not the frequency) of the REM bouts increaseIt is called paradoxical sleep because the brain is quite active and skeletal muscle contractions occur and is associated with a rapid, low-voltage and irregular (desynchronized) EEG, which resembles the recording of cerebral activity seen in alert animals and humans.REM sleep lasts for 5‚Äì30 minutes and occurs at approximately 90 minutes.REM sleep is thought to be produced by sleep centres in the locus coeruleus and in the raphe nuclei of the pontine reticular formation. It is associated with large phasic waves called pontogeniculo- occipital spikes from the pons that pass rapidly to the geniculate body and then to the occipital cortex.REM sleep is mediated by norepinephrine (noradrenaline). There are several important features of REM sleep:- dreaming occurs and can be recalled,- muscle tone is substantially decreased,- heart rate and respiration become irregular,- muscle contractions such as REMs and bruxism occur,- brain metabolism is increased by as much as 20%,- the EEG shows brainwaves that are characteristic of the waking state, and- glucocorticoid production is increased.

[Identical] 15A-037 Cerebral blood flowA. Indirectly proportional to glucoseB. Increases with neuronal activityC. Equals mean arterial pressure minus intracranial pressureD. Equals 30% of cardiac outputE. Increases with increased age

Answer: B - Increases with neuronal activityA: CBF increases proportionally to CMRO2 (brain uses ~10% of glucose delivered to it) CBF does not decrease with increased blood sugarB: CBF increases proportionally to CMRO2 (especially to regional areas)C: CBF = (MAP-ICP)/ResistanceD: CBF = 15% of CO (50mL/100g/min)E: CBF decreases with agePower and Kam 3rd ed - Ch2Stoeltings 5th ed - Ch3 Neurophysiology

[Identical] 18A-016 Tranexamic acid which is falseA. Inhibits PlasminogenB. Inhibits FibrinC. Causes seizuresD. Only available IVE. High oral bioavailability

Answer: B - Inhibits fibrinA: TXA inhibits the activation of plasminogen to plasminB: TXA inhibits the activation of plasminogen to plasminC: Rare cases of seizures noted on post market surveillanceD: Available in oral and IVE: 60% oral bioavailabilityProduct monographKatzung Drugs used in disorders of coagulation (EACA = tranexamic acid)

[Identical] 18B-135 Renal blood flow is primarily controlled by the resistance in:A. Renal arteryB. Vasa recta and peritubular capillariesC. Afferent and efferent arteriolesD. Basement membraneE. Tubules

Answer: C - Afferent and efferent arteriolesThe greatest control of renal blood flow is due to the change in calibre of the afferent arterioles. Controled by - neural and humoral factorsGanong's Review of Medical Physiology, 26ed - Renal function and micturition

[Identical] 14B-112 A complication of IV infusion of 8.4% NaHCO3 is: A. Hypotonicity B. Intracellular acidosis C. Ionised hypocalcaemia D. Rebound acidosisE. Hypoventilation

Answer: B - Intracellular acidosisA: IV HCO 3 − brings a significant Na + content and therefore osmotic load. This may lead to hyperosmolar hypernatremia, ECF expansion, and volume overload. Causes hyperosmolality, not hypertonicity. B: Most of the HCO 3 − administered is converted to CO 2 the excess CO 2 may also diffuse into the intracellular space, aggravating intracellular acidosis.C: After a rapid large volume transfusion of citrate-stored blood (>1.5 mL/kg/min) or fresh frozen plasma, ionized hypocalcemia may occur as a result of citrate chelation.D: If renal HCO 3 − distribution is impaired, there may be an "overshoot" toward metabolic alkalosis once the underlying disease process causing the initial acidosis is resolvedE: Most of the HCO 3 − administered is converted to CO 2 , with two important consequences. First, excess CO 2 requires excretion by hyperventilation. Converted HCO 3 − of 100 mEq represents an excess of 2.24 L of CO 2 to be exhaled, which may present a significant physiologic challenge to critically ill patients with preexisting ventilatory impairmentMiller's Perioperative fluid and electrolyte therapy, 8.4% NaHCO3- 100mEq Na and HCO3- 8.4g NaHCO3HCO3- causesHyernatraemia (hypertonic solution)HypocalcaemiaHyperosmolalityRebound alkalosis

[Identical] 16A-004 In an ABG base excess is:A. A measure of the amount of cellular buffersB. Is calculated when PCO2 is 40mmHgC. Is negative when pH is above 7.40D. Is the difference between HCO3- measured and standard HCO3E. moves in the opposite direction to HCO3

Answer: B - Is calculated when PCO2 is 40mmHgB: 'Base excess' is defined as amount of strong acid or base required to titrate fully saturated whole blood at 37 C and PaCO2 40 mmHg to a pH of 7.4 (normally 0 +/-2 mEq/L)- Used to measure metabolic component of pH shift - preferred over plasma HCO3

[Identical] 14B-094 A drug which is a weak base with a pKa of 8.6A. Will be rapidly absorbed in the stomachB. Is mostly ionised in plasmaC. Be lipid solubleD. Not be renally excretedE. Will cross the blood brain barrier

Answer: B - Is mostly ionised in plasmaBasic drugs ionise below their pKA. At physiological pH 7.4 and stomach pH 3.0 this drug will be significantly ionised A - Ionised drugs are not well absorbedB - This drug will be mostly ionised in plasmaC - Will not be lipid soluble (will be water soluble)D - Will be renally excretedE - Will not cross the blood brain barrierStoeltings Basic Principles of Pharmacology

[Identical] 15B-127 Concerning midazolam which is NOT correct:A. It has a half- life of 3 hoursB. It has no active metaboliteC. Its oral bioavailability is 40-60%D. Higher lipid solubility than lorazepamE. Time to peak effect 3 minutes

Answer: B - It has no active metaboliteA: Half life 3-4 hoursB: Midazolam has active metabolites (1-hydroxymidazolam)C: Oral bioavailability is ~50%D: Midazolam is the most lipid soluble of the benzodiazapinesE: Time to peak effect is 2-3 minutesMiller's Intravenous anaesthetics

[Identical] 18B-008 AlfentanilA. More lipid soluble than fentanylB. Less potent than fentanylC. Longer half-time than fentanylD. Smaller Ke0 than fentanylE. Larger volume of distribution than fentanyl

Answer: B - Less potent than fentanylA. Less lipid soluble than fentanyl B. Less potent than fentanyl (1mg vs 100mcg)C. Shorter half-time than fentanyl (shorter duration of action)D. Larger Ke0 than fentanyl (faster diffusion into the brain)E. Smaller volume of distribution than fentanyl (due to lower lipid solubility)Stoelting's Opioid agonists and antagonists

[Identical] 14B-107 An ideal property of neuromuscular blocking drug for rapid sequence induction is:A. Low ED95B. Low potencyC. Small volume of distributionD. Organ-independent eliminationE. Hofmann degredation

Answer: B - Low potencyA - Low ED50 equates to lower dose -> slower onsetB - Low potency -> allows for larger dose -> faster onsetBowman's principleC - Volume of distribution is roughly the same for all neuromuscular blocking agentsD - Elimination has no bearing on onsetE - Metabolism has no bearing on onsetStoeltings Neuromuscular Blocking Drugs and Reversal AgentsHemmings and Egan Pharmacokinetic and Pharmacodynamic principles for intravenous anaesthetics (Influence of dose on bolus onset and offset)Hemmings and Egan Neuromuscular blockers and reversal drugs

[Identical] 15B-107 Factor not affecting rate of rise of FA/FI ratioA. AgeB. MACC. Cardiac outputD. SolubilityE. Alveolar ventilation

Answer: B - MACA: Age will change the relative compartment sizes, thus will change FA/FIB: MAC does not directly affect FA/FIC: Increased cardiac output will slow the onset and rise of FA/FID: Decreased solubility reaches equilibration fasterE: Increased AV will increase the rate of rise of FA/FIMiller's Pulmonary pharmacology and inhaled anaesthetics

[Identical] 18B-032 Exercise: A. B blockers prevent mild-mod exercise B. Max HR is unchanged by atropine C. Skeletal muscle blood flow and cardiac muscle blood flow increase in equal proportion D. Systolic blood pressure increases by 15-20% E. Stroke volume increases linearly

Answer: B - Max HR is unchanged by atropine A: If a β -adrenergic receptor-blocking agent is given, exercise performance is impaired in subjects with transplanted hearts. The β-adrenergic receptor antagonist opposes the cardiac acceleration and enhanced contractility caused by increased amounts of circulating catecholamines. Hence the increase in cardiac output necessary for maximal exercise performance is limited.Beta blockers used in greyhounds with denervated hearts their racing performance is severely impaired.Once max SV is reached the increase in CO is due to HR. This may be in severe exercise.Pappano - mild to moderate exercise due to withdrawal of vagal nerve activity -> increasing SNS stimulation B: Atropine blocks PNS tone (antimuscarinic) -> SNS tone can still reach max HREvers. "Although atropine increases the resting heart rate, the maximal heart rate achieved by exercise is unchanged." C: Skeletal muscle blood flow increases up to 15-20xCardiac blood flow increases up to 2-3xD: SBP increases 130 - 200mmHg. ~ 30-40%MAP increases 90-120 ~15-20% E: There is also a non-linear increase in stroke volume during exercise. The increase in stroke volume occurs mainly in light to moderate exercise, with only a small further rise in maximal exercise. Pappano Evers and Maze Power and Kam

[Identical] 16A-142 Intravenous clonidineA. May cause HTN and tachycardiaB. May cause bradycardiaC. Same dose given orally is less effective compared to IVD. Effective at inhibiting the symapthomimetic response to phaeochromocytoma manipulationE. Antegrade amnesia to the same extent as diazepam

Answer: B - May cause bradycardiaA: Clonidine may cause transient hypertension and bradycardiaB: May cause bradycardiaC: Oral bioavailability is almost 100% (reference)D: Nil effect on pheochromocytoma (Inc catecholamines from adrenal, not from sympathetic nerve endings)E: Clonidine has anxiolytic effects with no significan amnesic effect (reference)

[Identical] 14A-051 The regulation of GFR is not influenced by A. Juxtaglomerular apparatus B. Mean arterial pressure C. Afferent arteriole D. Efferent arteriole E. Macula densa

Answer: B - Mean arterial pressureA: JGA will affect the basement membrane and alter the filtration coefficient KfB: MAP has no effect on GFR (within the autoregulation ranges of 70-130mmHg)C: Increased constriction of the afferent arteriole will decrease the glomerular hydrostatic pressure -> decreased GFRD: Increased constriction of the efferent arteriole will increased the glomerular hydrostatic pressure -> increased GFRE: Macula densa has feedback to the basement membrane and alters the filtration coefficient KfVander's 7th ed Ch2 - Direct determinants of GFR

[Identical] 16A-015 Total peripheral resistance A. Is 17 times that of pulmonary vascular resistance B. Measured in dynes.s.cm-5 C. Equals CO/(MAP - CVP) D. Varies with lung volume E. Measured by body plethysmography

Answer: B - Measured in dynes.s.cm-5 A: Average SVR = 1200Average PVR = 80SVR = 15 x PVR B. Units are dyn.sec/cm^5. Normal value 700-1600 dyn.s/cm^5 or dyn.s.cm^-5(mmHg /L /min = woods units normal = 9-20 woods units) C: Peripheral resistance = dP / QWhere dP = MAP - RAP D: Pulmonary vascular resistance varies with lung volume E: Body plethysmography measures deadspace Pappano and Wier p129 Power and Kam p141

[Identical] 15B-115 Lignocaine:A. Over 50% unionised at pH 7.4B. Metabolism is dependent on liver blood flowC. Ester local anaestheticD. Class III antiarrhythmicE. Less hydrophilic than bupivacaine

Answer: B - Metabolism is dependent on liver blood flowA: Lignocaine pKa 7.9, weak base -> ionise below the pKa. 50% ionised when pH = pKaB: Amide local anaesthetics are metabolised in the liver and are flow dependentC: Amide local anaestheticD: Class Ia antiarrhythmicE: More hydrophilic than bupivacaineProduct information sheetStoeltings Antiarrhythmic drugs

[Identical] 17A-019 Which drugs are affected by plasma cholinesterase deficiencyA. Methylprednisolone / esmolol B. Mivacurium / procaine C. Remifentanil / suxamethoniumD. Rocuronium / vecuroniumE. Ondansetron / lignocaine

Answer: B - Mivacurium, procaineDrugs metabolised by plasma cholinesteraseMivacurium Ester local anaesthetics - procaineSuxamethoniumDiamorphine AspirinMethylprednisoloneNot metabolised by plasma cholinesteraseRemifentanil - non specific esterasesRocuronium - no metabolismVecuronium - Hepatic -> Active, more potent metabolitesEsmolol - Erythrocyte cytosol enzymesStoeltings Adverse drug reactionsProduct information sheets

[Identical] 15B-009 Torsades de Pointes: A. Results from SVT B. More likely in bradycardia in susceptible patients C. Treated with 150mg of amiodarone over 30 minutes D. Results from HYPERmagnesaemia E. Caused by hyperkalaemia

Answer: B - More likely in bradycardia in susceptible patients A: Results from Early Afterdepolarisations, not from SVT B: More likely in bradycardia, hypokalaemia and prolonged QT syndromes C: Amiodarone will increase the risk of Torsades due to blocking potassium channels (Class II antiarrhythmic drugs) and causing prolonged QT D: Results from hypokalaemia, hypomagnesaemia E: Results from hypokalaemia, hypomagnesaemia Stoelting 5th ed p519 Pappano and Wier p39 (Automaticity: Natural excitation of the heart)

[Identical] 14A-117 Local anaesthetic prepared as Hydrochloride becauseA. More stable in solutionB. More water soluble in acidic pHC. Make solution isotonicD. Shows tautomerismE. Bacteriostatic

Answer: B - More water soluble in acidic pHA: Acidic solution is important if adrenaline is added because it is unstable at alkaline pHB: Local anaesthetics are more soluble in water when prepared as hydrochloride salts (basic drugs that ionise in acidic solution)C: Local anaesthetics are isotonic and require no tonicitiy agentD: Local anaesthetics do not show tautomerism (see Midazolam)E: Preservatives are weak acids with pKAs of 4-5. They are most effective in acidic environments. Not all local anaesthetics come with preservative. Stoeltings Local Anaesthetic

[Identical] 14A-107 After 20mins induction with 66% nitrous & 1.2% sevoflurane at surgical incision there is a 5% chance of?A. opening eyesB. movement (withdrawal reflex)C. purposeful movementD. inc HRE. awareness

Answer: B - Movement (Withdrawal reflex)A: Eyes open at MAC Awake = 0.3MACB: 5% chance of movement to painful stimuli occurs at MAC95 = 1.3MACC: Purposeful movement occurs at <0.3MACD: Sevoflurane will increase HR only at >1.5MACE: MAC awareness occurs at 0.4-0.6MACMAC is additiveMAC Nitrous 66% = 0.6 MACMAC Sevo 1.2% = 0.6 MACTotal MAC = 1.2MAC 1.2 = 95% confidence of patient not movingCompared to MAC 1 = 50% confidence patient not movingStoelting's Inhaled anaesthetics

[Identical] 18A-040 Recurrent Laryngeal NerveA. Sensory innervation superior to vocal cordsB. Muscles of the larynx except cricothyroid muscleC. Motor nerve root from accessory nerveD. Hook around aorta anterior to arteriosus ligamentumE. Sensory supply to left pharyngeal mucosa

Answer: B - Muscles of the larynx except the cricothyroid muscleA: Recurrent laryngeal supplies the laryngeal mucosa inferior to vocal cordsB: The cricothyroid is supplied by superior laryngeal n.C: Recurrent laryngeal nerve originates from the vagus nerveD: The recurrent laryngeal nerve runs posterior to ligamentum arteriosumE: Recurrent laryngeal supplies the laryngeal mucosa inferior to vocal cordsAnatomy for the Anaesthetist

[Identical] 14A-071 The major heat production in an adult A. Skeletal muscle activity B. NaKATPase activity C. Thyroid hormone activity D. Catecholamine activity E. Specific dynamic action of food

Answer: B - NaK ATPas activityA: In activity- Major production of body heat is via skeletal muscle contraction (as it is the largest organ in the body whose metabolic activity varies substantially)B: At restMost energy is consumed through osmoregulation - Na/K ATPase pumpsCells need energy for work including muscle contraction, biosynthesis, active transport across membranes and generation of heat. Of these, the main consumer is the membrane sodium/ potassium ATPase pumpC: Thyroid hormones act on mitochondrial and nuclear receptors in most tissues and regulate the activity of membrane-bound Na+/K+-ATPase, which balances metabolic heat production with heat loss within the thermoneutral zone.Power and KamD: Catecholamine activity will increase the BMR but does not produce heatE: BMR will rise 10-15% post prandially due to the specific dynamic action of fooddue to oxidative deamination in the liverPower and Kam Basal metabolic rate

[Identical] 18A-087 MivacruriumA. Always needs reversal with neostigmineB. 3 x ED95 does NOT cause histamine releaseC. Block is non-depolarisingD. Is an aminosteroidE. Metabolised at 50% the rate of suxamethonium by plasmacholinesterase

Answer: C - Block is non-depolarisingA: Noes not always need reversalB: 3x ED95 is likely to cause histamine releaseC: Block is non-depolarisingD: Is a benzylisoquinoloniumE: Is metabolised at 70-80% the rate of suxamethoniumMiller's Pharmacology of neuromuscular blocking drugsProduct information sheet

[Identical] 18B-058 Test with high specificity:A. Varies with incidenceB. Negative result means disease is unlikely C. High positive predictive valueD. High negative predictive valueE. Increases with increasing prevelance

Answer: B - Negative result means disease is unlikelyA: Incidence will affect negative and positive predictive valuesB: Negative test means the disease is unlikelyC: Specificity does not impact on PPVD: Specificity does not impact on NPVE: Specificity does not change with prevelanceSensitivity = TP/TP + FNPeople with the disease who test positiveHigh sensitivity has a low FN rateSpecificity = TN / FP + TNPeople without the disease who test negativeHigh specificity has a low FP ratePositive predictive valueLikelihood of having the disease if patient tests positiveNegative predictive valueLikelihood of not having a disease if patient tests negative

[Identical] 19B-050 Which is least likely to change airway resistance?a. Methoxyfluraneb. Nitrous oxidec. Sevofluraned. Desfluranee. Isoflurane

Answer: B - Nitrous oxideB: N2O causes the least change to airway resistanceD: Desflurane mildly increases airway resistanceA, C, E: Other volatiles will cause bronchodilationMiller's Pulmonary pharmacology and inhaled anaesthetics

[Identical] 18B-031 Severe liver failure:A. dose of sux should be reducedB. no adjustment to cisatracurium doseC. mivacurium metabolism will be unchangedD. dose reduction for rocuroniumE. All of the above

Answer: B - No dose adjustment to cisatracurium doseA: Hepatic failure may lead to lower concentration of plasma cholinesterases. This may prolong duration of suxamethonium. Dose should not be reduced in rapid sequence inductionB: Cisatracurium is metabolised by Hofmann elimination. No dose adjustment requiredC: Mivacurium's metabolism will be reduced due to reduced plasma cholinesterasesD: Rocuronium's elimination (70% biliary) may be reduced and duration prolonged. Induction dose should remain the sameProduct information sheets

[Identical] 14A-120 Treatment of endocarditis with Vancomycin A. Gram positive and negative bacteria B. Not as good as penicillin for methicillin sensitive staphyloccus C. Not suitable for oral outpatient Rx D. Can be dialysed with renal failure E. All of the above

Answer: B - Not as good as penicillin for methicillin sensitive staphyloccusA: Vancomycin is not effective in vitro against gram negative bacilli, mycobacteria or fungi.B: Vancomycin is effective against methicillin-resistant staphylococci and is widely distributed in the body. However, penicillins are still more effective against methicillin-susceptible strains.C: Suitable for outpatient oral for treatment of C. Difficile, but not absorbed orally so not suitable for treatment of endocarditisD: Is not dialysiableE: See above (B is true, A, C, D are not true)Stoelting's Antimicrobials, Antiseptics, Disinfectants, and Management of Perioperative InfectionProduct information sheetHemmings and Egan Infection, antimicrobial drugs and anesthesia

[Identical] 14A-027 Initial closure of the ductus arteriosus is due to A. Left to right shunt B. O2 dependent smooth muscle contraction C. Increased aortic pressureD. Increasing prostaglandinsE. Thrombosis

Answer: B - O2 dependent smooth muscle contractinoA: The Ductus Arteriosus is a right to left shunt in the fetus and a left to right shunt in the neonate. B: Inc PaO2 and dec PGs cause the DA to closeThe ductus arteriosus, with dense spirally arranged smooth muscles in its media, constricts in response to the increasing Pao2 after the first breath and the closure of foramen ovale and to the decreasing concentrations of circulating and locally produced prostaglandins E1 and E2.C: Aortic pressure has little to do witht he closure of the DAD: Decreasing prostaglandins cause closure of the DAE: This physiological closure occurs within 10-15 hours, and permanent closure takes place in 2 to 3 weeks by thrombosis and fibrosis.Power and Kam Transitional circulation at birth

[Identical] 15B-114 Which ONE of the following is TRUE?A. Hartmann's solution contains 150 mmol/L NaB. Osmolality of Normal Saline is 308 mosm/LC. pH of Normal Saline is 7.35 -> 7.45D. Osmolality of Hartmann's solution is 308 mosm/LE. Rapid infusion of Hartmann's solution can cause lactic acidosis

Answer: B - Osmolality of Normal Saline is 308A: Hartmann's solution contains 130 mmol/L NaB: Osmolality of Normal Saline is 308 mosm/LC: pH of Normal Saline is 5 (or 6 in vitro)D: Osmolality of Hartmann's solution is 273 mosm/LE: Excessive volumes of CSL may cause acidosis, but not necessarily a rapid rateMiller's Perioperative fluid and electrolyte therapy

[Identical] 14B-149 A patient is anaesthetised with 50% oxygen / 50% nitrous oxide and 1% sevoflurane for a tracheostomy. When the surgeon cut into the trachea with diathermy the ETT catches fire. In this case the nitrous oxide is acting as:A. Fuel B. Oxidising agent C. Smothering agent D. Secondary ignition source by increasing conductivity of the gas mixture E. Smothering agent by increasing the distance between oxygen molecules

Answer: B - Oxidising agentA: The fuel is the ETTB: N2O acts as an oxidising agentC: A smothering agent is something like Argon (a non flammable noble gas)D: A secondary ignition source might include a spark plug (two circuits, one with battery, one with the spark)E: Smothering is "oxygen exclusion", N2O does not act as a smothering agentBOC gases N2O product information sheet

[Identical] 15A-014 A patient is anaesthetised with 50% oxygen / 50% nitrous oxide and 1% sevoflurane for a tracheostomy. When the surgeon cut into the trachea with diathermy the ETT catches fire. In this case the nitrous oxide is acting as:A. Fuel B. Oxidising agent C. Smothering agent D. Secondary ignition source by increasing conductivity of the gas mixture E. Smothering agent by increasing the distance between oxygen molecules

[Identical] 15B-145 A patient is anaesthetised with 50% oxygen / 50% nitrous oxide and 1% sevoflurane for a tracheostomy. When the surgeon cut into the trachea with diathermy the ETT catches fire. In this case the nitrous oxide is acting as (repeat):A. fuelB. oxidising agentC. smoldering agentD. secondary ignition source by increasing conductivity of the gas mixtureE. Smothering agent by increasing the distance between oxygen molecules

[Identical] 18A-047 BladderA. SNS relaxes urinary sphincter and contracts the detrusor muscleB. PNS relaxes urinary sphincter and contracts the detrusor muscle C. PNS contracts urinary sphincter and contracts the detrusor muscleD. SNS contracts urinary sphincter and contracts the detrusor muscleE. SNS relaxes urinary sphincter and relaxes the detrusor muscle

Answer: B - PNS relaxes urinary sphincter and contracts the detrusor muscleA: SNS contracts the urinary sphincter and relaxes the detrusor muscleB: Parasympathetic stimulation causes contraction of the detrusor muscle and relaxation of the urinary sphincterC: Parasympathetic stimulation causes contraction of the detrusor muscle and relaxation of the urinary sphincterD: SNS contracts the urinary sphincter and relaxes the detrusor muscleE: SNS contracts the urinary sphincter and relaxes the detrusor muscleGuyton and Hall - 14th ed The autonomic nervous system and the adrenal medulla

[Identical] 19B-080 Which drug has the highest oral bioavailabilitya. Endoneb. Paracetamolc. Morphined. Metoprolole. Furosemide

Answer: B - ParacetamolMorphine - 25%Metoprolol - 50%Furosemide - 60%Oxycodone - 60-70%Paracetamol - 80-88%Product information sheets

[Identical] 16A-079 The best indication of a patient that is adequately treated with phenoxybenzamine:A. Complaint of nasal stuffinessB. Postural hypotensionC. Stabilisation of blood pressureD. Decreased haematocritE. Hypovolaemia

Answer: B - Postural hypotensionA: Nasal stuffiness occurs, not an indication of adequate treatmentB: Postural hypotension shows that blockade of a1 receptors is adequate (antagonises increased catecholamines from pheochromocytoma)C: Blood pressure is unstable when adequately treatedD: Haematocrit decreases as vascular fluid increases. Not used as an indication for adequacy of treatementE: Volume state is not an indication of treatementStoeltingsMiller'sHemmings and Egan

[Identical] 15A-039 Skeletal muscle action potential:A. Potassium efflux before peak depolarisationB. Resting membrane potential -80mVC. Na channels open at -30mVD. Potassium channels have resting / activated and inactivated statesE. Potassium channels undergo a 500-1000-fold change in conductance with repolarisation

Answer: B - Potassium efflux begins prior to maximum depolarisationA: See image below - K+ channels open before the peak of maximum depolarisationB: Sodium channels return to resting state at -90mV (see image below)C: Sodium channels open at -90mVD: Potassium channels have open and closed. Sodium channels have open, closed and resting (or resting, activated and inactivated)E: The conductance of an ion is the reciprocal of its electrical resistance in the membrane and is a measure of the membrane permeability to that ion. The potassium conductance increases 10 fold. The ratio of sodium to potassium conductance increases more than 1000 fold. Guyton and Hall 14th ed - Membrane potentials and action potentialsGanong 26 ed ch4 Excitable tissue: Nerve Muscle

[Identical] 14A-033 What is true regarding nerve action potentials?A. Sodium channels open at -80 mVB. Potassium efflux begins prior to maximum depolarisationC. Sodium channels return to resting state at -30 mVD. Potassium channels have resting activated and inactivated statesE. Potassium channels undergo a 500-1000-fold change in conductance with repolarisation

Answer: B - Potassium efflux begins prior to maximum depolarisationA: Sodium channels open at -70mVB: See image below - K+ channels open before the peak of maximum depolarisationC: Sodium channels return to resting state at -80mV (see image below)D: Potassium channels have open and closed. Sodium channels have open, closed and resting (or resting, activated and inactivated)E: The conductance of an ion is the reciprocal of its electrical resistance in the membrane and is a measure of the membrane permeability to that ion. The potassium conductance increases 10 fold. The ratio of sodium to potassium conductance increases more than 1000 fold. Guyton and Hall 14th ed - Membrane potentials and action potentialsGanong 26 ed ch4 Excitable tissue: Nerve, Phase 1 The curve should cross the y axis at approximately -70mV and should be shown to rapidly rise towards the threshold potential of -55 mV.Phase 2 This portion of the curve demonstrates the rapid rise in membrane potential to a peak of +30 mV as voltage-gated Nachannels allow rapid Naentry into the cell.Phase 3 This phase shows rapid repolarization as Nachannels close and K channels open, allowing K efflux. The slope of the downward curve is almost as steep as that seen in phase 2.Phase 4 Show that the membrane potential 'overshoots' in a process known as hyperpolarization as the Na/K pump lags behind in restoring the normal ion balance.RMP (Stoelting/Power & Kam)smooth muscle -50 to -60 mVneuron -70 mV (CNS) -90 mV (large peripheral)cardiac muscle -85 to -95 mVskeletal muscle -90 mVThreshold potentialsnerve -55 mVSA node -40 mVmyocyte -65 to -70 mVskeletal muscle -55 mV

[Identical] 14B-026 Which of the following are vitamin K dependent? A. von Wilebrand factor (vWF)B. Protein CC. Factor V D. Factor XIIE. Antithrombin III

Answer: B - Protein CVitamin K dependent CLOTTING factors are II, VII, IX, XProteins C & S are anticoagulant factors that depend on vitamin KProthrombin is vitamin K dependentPower and Kam - various

[Identical] 15A-145 Bronchial artery supplies: A. Provide a low pressure flow to lung parenchyma B. Provide blood to all bronchioles down to the respiratory bronchioles C. Are branches from the intercostal arteries D. Provides blood supply to both visceral and parietal pleura E. Is required to supply to lung parenchyma

Answer: B - Provide blood to all bronchioles down to the respiratory bronchioles A: The pulmonary blood circulation is a low pressure flow. The Bronchial artery is systemic pressures B: The lung has an additional blood system, the bronchial circulation that supplies the conducting airways down to about the terminal bronchioles. C: The blood supply to the lung itself, to its lymph nodes, to the bronchi and to the visceral pleura is entirely provided by the bronchial arteriesArise from the aortic arch D: The bronchial arteries supply blood to the bronchi and connective tissue of the lungs. They travel with and branch with the bronchi, ending about at the level of the respiratory bronchioles. They anastomose with the branches of the pulmonary arteries, and together, they supply the visceral pleura of the lung in the process E: The lung can function without the bronchial circulation (as in post transplant) West 9th Ed p 9, Anatomy for anaesthetists pg 76

[Identical] 18A-064 After a big meal increased blood to splanchnic circulation by A. Cardiac output increases B. Redistribution from other regions C. Spleen pushes blood out D. Peripheral vasoconstriction E. Decreased adenosine

Answer: B - Redistribution from other regions A: Cardiac output may decrease post prandially with increased parasympathetic output B: Dilation of the splanchnic circulation -> low resistance circuit -> increased flow in preference to other areas. Caused by Gastrin + Cholecystekinin C: Splenic contraction occurs with increased sympathetic outflow D: Peripheral vasoconstriction occurs with incresed sympathetic outflow, but does not increase splanchnic circulation E: Adenosine may increase hepatic arterial supply in the semireciprocal system Pappano and Wier - Special circulations

[Identical] 14B-082 Which of the following is the most harmful effect of Atropine in children?A. HypotensionB. TachycardiaC. HyperthermiaD. HypertensionE. Hyperkalaemia

Answer: C - HyperthermiaIncreased temperature in children due to lack of sweating due to atropineHemmings and Egan - Autonomic nervous system pharmacology

[Identical] 16A-081 Milrinone:A. Increases contractility by increasing phosphodiesterase activityB. Reduces pulmonary vascular resistance by inhibition of myosin light chain kinaseC. Can cause profound hypotension via nitric oxide releaseD. Prolonged infusion causes thrombocytopeniaE. Causes ventricular arrhythmias by increased beta 1 activity

Answer: B - Reduced pulmonary vascular resistance by inhibition of myosin light chain kinaseA: Increases contractility by INhibiting the breakdown of cAMPB: Increased cAMP in smooth muscle -> inhibition of MLCK -> relaxationC: Causes hypotension via MLCK, not via NO releaseD: Amrinone causes thrombocytopenia, milrinone does notE: Milrinone has no beta1 activity. Hemmings and Egan Vasopressors and Inotropes

[Identical] 14A-143 Which automatically stops current when saline drips on to a powerboard: A. Line isolation monitor B. Residual current device C. Isolated transformer D. Equipotential earthingE. Class B equipment

Answer: B - Residual current deviceA: LIM will alarm if the prospective hazard current >10mA but will not break the circuitAlarms before current gets too high. Used in areas where power cannot be interrupted. Has a guage. B: Residual current device - RCD will trip the circuit breaker within 40ms of detecting a leakage current of 5-10mARCD - switch that senses current flowing to earth -> leakage of current. Testable switchC: An isolation transformer is incorporated into the LIM setup isolates the circuit from earthD: Equipotential earthng ensures than all metalwork is at or near zero voltage. Under fault conditions all metalwork will increase to the same potential, resulting in no flow of current and no shock. E: Type B equipment may be Class I, II or III, designed to have low leakage currents (0.5mA for Class I, 0.1mA for Class II) Not safe for direct connection to the heartAl Shaikh - Electrical safety

[Identical] 14B-146 Which automatically stops current flow when saline drips on to a powerboardA. Line isolation monitorB. Residual current device C. Isolated transformer D. Equipotential earthing E. Type B equipment

[Identical] 17B-010 Mivacurium:A. Offset 10 minsB. Reverse with neostigmineC. Reverse with sugammadexD. Neostigmine prolongs blockE. Does not cause histamine release

Answer: B - Reverse with neostigmineA: 75% recovery time 21 minutesB: Reverse with neostigmineC: Sugammadex does not reverse mivacuriumD: Neostigmine is used to reverse mivacurium E: Mivacurium may cause histamine releaseProduct information sheet

[Identical] 14B-147 Which of the following are branches of the Aorta A. Right coronaryB. Right brachiocephalic C. Right carotidD. Right subclavian E. Inferior thyroid

Answer: B - Right BrachiocephalicA: The right coronary arises from the anterior aortic sinusB: The right brachiocephalic arises from the aortaC: The right carotid arises from the brachiocephalicD: The right subclavian arises from the brachiocephalicE: Inferior thyroid artery arises from the subclavian arteriesAnatomy for Anaesthetists - Great vessels of the head and neck

[Identical] 18B-087 Midazolam:A. Prepared in ampoule with alkaline pHB. Ring structure is closed at physiological pHC. Less lipid soluble than lorazepamD. Inactive metaboliteE. Metabolised by oxidation

Answer: B - Ring structure is closed at physiological pHA: Prepared in an acidic ampuleB: Ring structure is closed at physiological pH (open in acidic environments)C: Midazolam is the most lipiphilic of the benzodiazapinesD: Midazolam has active metabolites (1-hydroxymidazolam)E: Metabolised by hydroxylationMiller's Intravenous anaesthetics

[Identical] 15B-071 Inability for anaesthetised patients to generate heat due toA. Insufficient brown fatB. Skeletal muscle relaxationC. Dilated peripheral vesselsD. Heat loss due to radiationE. Increased threshold to cold

Answer: B - Skeletal muscle relaxationA: Brown fat (non-shivering thermogenesis) is still possible under anaesthesiaB: Anaesthesia prevents shivering through skeletal muscle relaxationC: Vasodilation is responsible for distribution of heat rather than heat generationD: Radiation is responsible for loss of heat rather than heat generationE: General anaesthesia increases the interthreshold range by decreasing the thermoregulatory threshold to cold by approximately 2.5°C and increasing the threshold temperature by approximately 1.3°CThe only thermoregulatory responses available to anaesthetized, paralysed and hypothermic patients are vasoconstriction and non-shivering thermogenesis.Power and Kam 3rd ed - p385

[Identical] 14B-017 Long term response to hypertension is via alteration of A. Aldosterone system B. Smooth muscle relaxation C. Renin angiotensin system D. Capillary fluid shifts E. Renal-Body response mechanism

Answer: B - Smooth muscle relaxationHypertension is characterised by a persistent elevation of TPR. A given volume increment produces a greater pressure increment (pulse pressure) when the arteries are more rigid than when they are more compliant.In essential hypertension, the increase in peripheral resistance is achieved by arteriolar vasoconstrictionThis - due to an alteration of smooth muscle relaxation. Pappano and Wier p133

[Identical] 15A-134 Regarding pethidine's metabolite norpethidine:A. elimination half-life is shorter than pethidineB. stimulates the CNSC. analgesic effect twice that of pethidineD. responsible for most of the analgesia of pethidineE. is the result of conjugation

Answer: B - Stimulates the CNSA: Elimination of norpethidine is longer than that of pethidineB: Causes excitation of the CNSC: Analgesia of norpethidine is half that of pethidineD: Analgesia of norpethidine is half that of pethidineE: Is the result of demethylationProduct information sheet

[Identical] 18A-048 Hartmann's contentsA. Metabolic acidosis can be explained using the Henderson hasselbalch equationB. Contains 5 CalciumC. HypotonicD. pO2 160mmgE. Na 140

Answer: C - HypotonicA: Metabolic acidosis is explained through the addition of Cl. Hyperchloraemic metabolic acidosisB: CSL contains 2mmol/L CalciumC: Osmolality plasma - 295. Osmolality CSL - 273. CSL is mildly hypotonic. D: No O2 in CSLE: CSL contains 129mmol/L SodiumNote - values may be slightly different depending on sourcesCSLNa 129K 4Cl 109lactate 29Ca 2Hemmings and Egan 2nd ed - Intravascular volume replacement therapy

[Identical] 16A-143 The bronchial arteries A. Are require to supply the parietal pleura B. Supply connective tissue of the bronchi C. Branch off the carotid arteries D. Two left bronchial arteries branch off the posterior aortaE. None of the above

Answer: B - Supply connective tissue of the bronchi A: The lung can function without the bronchial circulation (as in post transplant) B: The lung has an additional blood system, the bronchial circulation that supplies the conducting airways down to about the terminal bronchioles. C: The bronchial arteries supply blood to the bronchi and connective tissue of the lungs. They travel with and branch with the bronchi, ending about at the level of the respiratory bronchioles. Arise from the aortic arch. They anastomose with the branches of the pulmonary arteries, and together, they supply the visceral pleura of the lung in the process. D: The bronchial arteries supply blood to the bronchi and connective tissue of the lungs. They travel with and branch with the bronchi, ending about at the level of the respiratory bronchioles. Arise from the aortic arch. They anastomose with the branches of the pulmonary arteries, and together, they supply the visceral pleura of the lung in the process E: See B West 9th Ed p 9Anatomy for anaesthetists pg 76

[Identical] 16A-096 Context sensitive half time isA. The time for total body drug concentration to decrease by 50% after stopping infusionB. The time for plasma concentration to decrease by 50% after stopping infusionC. The time for an effect site concentration to fall from 80% to 20%D. The time taken for the effect site to reach half the plasma concentrationE. The time taken for a patient to wake after TIVA

Answer: B - The time for plasma concentration to decrease by 50% after stopping infusionCSHTThe time taken for the plasma concentration to fall by 50% after the cessation of an infusion designed to maintain a constant plasma concentration.Hemmings and Egan - Pharmacokinetic and Pharmacodynamic principles of intravenous anaesthetics

[Identical] 18B-054 Use of phentolamine will do what to baseline curve? A. Move to right B. Tilt curve up C. Tilt curve down D. Move to left E. No change

Answer: B - Tilt curve up Phentolamine - anti aramine or a1 antagonistUse - treatment of pheochromocytoma Decrease peripheral vascular resistance. This tilts the curve up. Power and Kam p159 Pappano and Wier p186

[Identical] 19B-008 Vascular function curve - effect of phentolamine? A. Move to right B. Tilt curve up C. Tilt curve down D. Move to left E. No change

Answer: B - Tilt curve up Phentolamine - anti aramine or a1 antagonistUse - treatment of pheochromocytoma Decrease peripheral vascular resistance.This tilts the curve up. Power and Kam p159 Pappano and Wier p186

[Identical] 17A-005 NMT supramaximal stimulusA. At least 50mVB. To recruit all fibres and to exclude any other cause of weaknessC. To ensure each muscle fibre contracts with maximal forceD. Used in awake patient to test for residual paralysisE. Creates the maximal force in a whole muscle

Answer: B - To recruit all the fibres and to exclude any other causes of weaknessA: Of sufficient amplitude to recruit all fibresB: If a nerve is stimulated with sufficient intensity, all fibers supplied by the nerve will react, and the maximum response will be triggered. MillerC: Muscle fibres contract with an all or none pattern. D: Not used in an awake patient due to painE: Creates maximal force in the muscle fibres stimulated, not the whole muscleMiller's Neuromuscular monitoring

[Identical] 15A-022 Which drug combination has an interaction involving increased serotonin A. Morphine and Atracurium B. Tramadol and Fluoxetine C. Cisapride and OndansetronD. Fluvoxamine and OndansetronE. Fentanyl and chlorpromazine

Answer: B - Tramadol and FluoxetineA: Morphine and atracurium - nil action on serotoninB: Tramadol - SSRI, SNRI, OpioidFluoxetine - SSRIC: Cisapride - prokinetic serotonergic 5HT4Ondansetron - anti-serotonergicD: Fluvoxamine - SSRI for OCDOndansetron - anti-serotonergicE: Fentanyl - opioid. No 5HTChlorpromazine - anti-serotonergicProduct information sheets

[Identical] 15B-135 Regarding Morphine and Tramadol which statement is true?A. Morphine is less potent than tramadolB. Tramadol is less efficacious than morphineC. Tramadol exhibits NMDA receptor antagonismD. Pruritus is a common side effect of tramadolE. Tramadol is a synthetic codeine derivative

Answer: B - Tramadol is less efficacious than morphineA: Tramadol is less potent than morphineB: Tramadol is less efficacious than morphineC: Tramadol has some (but very very minimal) NMDA antagonismD: Pruritis is a minor side effect of tramadol. Tramadol is also used to treat neuraxial opioid induced pruritisE: Tramadol is a synthetic codeine analogue (not derivative)Miller's Acute post operative painMiller's OpioidsProduct information sheet

[Identical] 16B-102 Carbon monoxide production is increased with:A. Using Sevoflurane instead of DesfluraneB. Using desiccated soda limeC. Using less NaOH and KOHD. Using Sodalime instead of BaralymeE. Decreased fresh gas flows

Answer: B - Using desiccated soda limeA: Sevoflurane does not contain CHF3 moeity. Desflurane does. Sevoflurane does not produce CO with sodalimeB: Carbon monoxide occurs when Desflurane, Isoflurane, Enflurane are used with very dry granules when the water content is less than 1.5% in soda lime or less than 5% in barylimeC: The association of strong alkalis such as KOH and NaOH to the production of carbon monoxide has led to the subsequent removal of KOH and reduction in amounts of NaOH used.D: Carbon monoxide occurs when Desflurane, Isoflurane, Enflurane are used with very dry granules when the water content is less than 1.5% in soda lime or less than 5% in barylimeE: Carbon monoxide production occurs when the system is left unused for a long period of time, e.g. overnight or during weekends, or when a small basal flow from the anaesthetic machine occurs.Al-Shaikh - Breathing systemsCO is formed with volatiles containing CFH2 moeities. This includes - Desflurane, Isoflurane, Enflurane. Does not include SevoIncreases with- Dry soda lime- Increased NaOH, KOH- Baralyme (cf soda lime)- Increased fresh gas flows (dries out sodalime)

[Identical] 18B-113 Which of the following would not reduce interference in ECG monitoring? A. Insulated cables B. Using short cables C. ECG leads with copper screens D. Preventing shivering E. Placing ECG dots over bony prominences

Answer: B - Using short cables A: Insulated cables prevents electromagnetic interferance B: Using long cables and twisted leads (regecting the induced signal as common mode) reduces interferance C: ECG leads with copper screens prevent electrostatic induction and capacitance coupling D: Shivering produces artifacts E: ECG dots on bony prominences reduces artifacts from respiration Al-Shaikh - Non-invasive monitoring

[Identical] 15A-137 The context sensitive half-time of alfentanil in a 37yo woman undergoing a 4 hour operation would be closest to:A. 4 minutesB. 10 minutesC. 30 minutesD. 60 minutesE. 120 minutes

Answer: D - 60 minutesAlfentanil CSHT plateaus at 200mins -> 60 minutesStoelting's Opioids

[Identical] 18B-110 Vaccume insulated evaporator - what is incorrect?A. Has feature to allow controlled release of liquid oxygen if pressure too lowB. When pressure too high alarm activates refrigeration system to cool VIEC. Surrounded by low pressure chamber to keep gas coolD. Contents remaining may be determined by weightE. Delivers oxygen to the hospital at 400 kPa

Answer: B - When pressure too high, alarm activates refrigeration system to cool VIEA: An electronically controlled valve opens when there is an excessive demand on the system. This allows liquid oxygen to evaporate by passing through superheaters made of uninsulated coils of copper tubing.B: A safety valve opens at 1700 kPa allowing the gas to escape when there is a build-up of pressure within the vessel. This can be caused by underdemand for oxygen. There is no alarm activatedC: A thermally insulated double-walled steel tank with a layer of perlite in a vacuum is used as the insulation. It can be described as a giant thermos flask, employing the same principles.D: The storage vessel rests on a weighing balance to measure the mass of the liquid using a tripod weighing scale. As the VIE's weight when empty (tare) is known, the weight of the liquid oxygen can be calculated.E: A pressure regulator allows gas to enter the hospital pipelines and maintains the pressure through the pipelines at about 400 kPa.Al-Shaikh - Medical gas supply

[Identical] 18B-109 Medical oxygen as supplied as dry gas because if it contained water vapour then the water vapor:A. Decreases the oxygen supplyB. Would freeze when gas expandsC. Can condense in the pipelineD. Contains impurities or contaminants E. Reduces the FiO2 by 47mmHg

Answer: B - Would freeze when gas expandsB: The gases and vapours should be free of water vapour when stored in cylinders. Water vapour freezes and blocks the exit port when the temperature of the cylinder decreases on opening. P=kT -> as pressure decreases temp decreases -> H2O vapor would freeze when gas expandsAl-Shaikh - Medical gas supply

[Identical] 15A-133 Alfentanil elimination half-life is prolonged in:A. hypoalbuminaemiaB. administration of erythromycinC. caucasian childrenD. renal failureE. slow acetylators

Answer: B - administration of erythromycinA: Alfentanil is 92% bound to pasma proteins. Hypoalbuminaemia increases the free fraction available for metabolism decreasing the half lifeB: Available human pharmacokinetic data indicate that the metabolism of alfentanil may be inhibited by erythromycin, prolonging the half lifeC: Alfentanil is metabolised by CYP3A4, not 2D6D: The volume of distribution and clearance of the free fraction is similar in renal failure patients and healthy controls.E: Alfentanil is metabolised by N-and O-dealkylation, not acetylation. (Hydralazine is prolonged in slow acetylators)Product information sheet

[Identical] 18B-055 Anaphylaxis:A. can be ruled out if serum tryptase not elevatedB. can occur on first exposure to drugC. type ii IgE mediatedD. produces vasoconstriction and reduced blood flow to peripheriesE. mediated primarily by basophils

Answer: B - can occur on first exposure to drugA: Serum tryptase is is an indication of mast cell degranulation, not specific to anaphylaxisB: Can occur on first exposure to a drug but requires prior sensitisation to a compound with similar structuree.g pholcodeine and rocuroniumC: Type I hypersensitivity reactionD: Produces vasodilation and distributive shockE: Mediated primarily by mast cells, also involves basophilsStoeltings Adverse drug reactions

[Identical] 14B-117 CephazolinA. is a third-generation cephalosporinB. doesn't penetrate the blood brain barrier so cannot be used for neurosurgery C. only covers gram-positive cocciD. is a potent bacteriostatic agentE. do not require dose adjustment in renal impairment

Answer: B - doesn't penetrate the BBBA: Cephazolin is a first generation cephalosporinB: Cephazolin does not penetrate the BBBC: Covers Strep + Staph (most gram positive) and some gram negativeD: Cephazolin is primarily bacteriocidalE: Dose is reduced in renal failureKatzung Beta-lactam and other cell wall and membrane active antibiotics

[Identical] 14B-091 The log-dose response curve for a partial agonist looks likeA. like the curve for an inverse antagonistB. like the curve for a full agonist with an antagonistC. like the curve of a full agonist shifted to the rightD. like the curve of a drug with negative intrinsic activityE. like the curve of a full agonist shifted to the left

Answer: B - like the curve of a full agonist with an antagonist - When used with a full agonist, a partial agonist can exert an agonist or antagonist effect:o (i) Additive agonist effect - when used with low doses of a full agonist (shifts curve up)o (ii) Competitive antagonist effect - when used with high doses of full agonists (Ie. full agonist needs to displace partial agonist to restore maximal effect) (shifts curve down)Hemmings and Egan Mechanisms of Drug Action

[Identical] 18B-057 SpecificityA. true pos/(true pos + false neg)B. true neg/(false pos + true neg)C. true pos/(true pos + false pos)D. true neg/(false neg + true neg)E. true neg/(true neg + true neg)

Answer: B - true neg/(false pos + true neg)A: Sensitivity = = TP/TP + FNThe likelihood of testing positive if the patient has the diseaseB: Specificity = = TN / FP + TNThe likelihood of testing negative if the patient does not have the diseaseC: Positive predictive value = TP / TP + FPThe likelihood of having the disease if the test is positiveD: Negative predictive value = TN / FN + TNThe likelihood of not having the disease if the test is negativeE: not a statistical equation

[Identical] 15A-051 For a substance to have greater clearance than Inulin: A. It must be completely filtered at glomerulus B. Must be secreted in the tubules C. Must be completely re-absorbed D. Should be lipid solubleE. Must have a negative charge

Answer: B- Inulin is a substance freely filtered by the glomerulus only (neither secreted nor reabsorbed by tubules) - its clearance = GFR- For a clearance > GFR - substance needs to be freely filtered by glomerulus and secreted by tubulesVander's 7th ed. Ch3 - Clearance

[Identical] 14A-053 Renal clearance A. Inulin as its MW ~70kDa B. Reduced GFR results in reduced creatinine clearance C. PAH excreted less than inulin D. Plasma creatinine underestimates GFR E. Exercise is associated with a decrease creatinine clearance

Answer: B- Reduced GFR results in reduced creatinine clearanceA: Inulin's molecular weight is 3500-5500 Da (variable due to length of the chain)B: CrCl reduces with reduced GFRC: PAH is filtered and secreted -> excreted more than inulin which is only freely filtered and not secretedD:Creatinine overestimates GFR (as it is secreted and filtered)E: Exercise causes an inc Plasma [Cr] -> increased filtered -> inc estimated GFRVander's 7th Ed Ch7 Clearance

[Identical] 19B-003 Which of the following has the highest relative change CSF:Plasma?A. BicarbonateB. ChlorideC. GlucoseD. CalciumE. Potassium

Answer: D - CalciumA: HCO3 - 1.01 CSF:PlasmaB: Chloride - 1.34 CSF:PlasmaC: Glucose - 0.64 CSF:PlasmaD: Calcium - 0.49 CSF:PlasmaE: Potassium - 0.63 CSF:PlasmaGanong 26ed Circulation through special regions. Table 33-2

[Identical] 14A-010 Regarding cutaneous circulation all of the following are true EXCEPT: A. AV anastomoses do not exhibit basal tone B. It is supplied by the sympathetic and parasympathetic nervous system C. Neural input is more important than metabolic control D. There is a countercurrent exchange in the extremities E. Increased temperature has a local and systemic effect on blood vessels

Answer: B. A: In contrast to AV anastomoses, the resistance vessels in the skin exhibit some basal tone. AV anastomoses become maximally dilated when sympathetic tone is removed B: Parasympathetic vasodilator nerve fibers do not innervate the cutaneous blood vessels. Supplied by only the sympathetic ns. C: AV anastomoses do not appear to be under metabolic control, and they fail to show reactive hyperemia or autoregulation of blood flow. D: The proximity of the major arteries and veins permits considerable heat exchange (countercurrent) between artery and vein. E: Direct application of heat to the skin produces not only local vasodilation of resistance and capacitance vessels and AV anastomoses but also reflex dilation in other parts of the body. Pappano and Wier - Special circulations

[Identical] 14A-091 According to receptor theoryA. Irreversible antagonists bind to all spare receptorsB. Competitive antagonists have no intrinsic activityC. Partial agonists have decreased affinityD. Spare receptors do not relate to sensitivity of drug bindingE. Kd is the ratio of bound drug to receptor: unbound drug to receptor

Answer: B. A - Irreversible antagonists/agonists - bind to a receptor (probably covalently) or alter a receptor completelyB - Competitive antagonists have affinity of 1, intrinsic activity of 0C - Partial agonists have affinity of 1, intrinsic activity <1 and may act as non-competitive antagonistsD - Spare receptors - exist where maximal effect is achieved when only a fraction of the receptors are occupied thus leaving "spare receptors".E - Kd - the concentration at which 50% of the receptors are occupied. Unoccupied:occupied is equal. Stoeltings - Basic principles of pharmacologyGoodman and Gilman's Pharmacodynamics: Molecular mechanisms of drug action

[Identical] 16A-125 Which of the following crosses the blood brain barrierA. AcetazolamideB. PropranololC. DopamineD. EdrophoniumE. Suxamethonium

Answer: BA - Acetazolamide - inhibits carbonic anyhdrase to affect CO2 to affect CBF. Does not cross the BBBB - Propranolol - lipid soluble beta blocker.C - Dopamine - cannot cross. L Dopa canD +E - Edrophonium + Sux - polar molecules that can't cross.Drug Product information sheets

[Identical] 14B-108 Macula densa cells are: A. BaroreceptorsB. OsmoreceptorsC. In the efferent arteriolesD. Chemoreceptors E. In the proximal thick ascending limb

Answer: BA: Barorecetors in the kidneys are the Granular cells (not the Macula Densa cells)B: Macula densa cells in the thick ascending limb sense sodium chloride delivery by changing the uptake of salt, with subsequent osmotic swellingC: Granular cells are in the afferent arteriolesD: Macula densa cells in the thick ascending limb sense sodium chloride delivery by changing the uptake of salt, with subsequent osmotic swellingE: The macula densa cells are in the distal thick ascending limb or at the start of the distal convolutionVander's 7th ed Ch7 Control of sodium and water excretion

[Identical] 15B-049 The macula densa is an example of:A. BaroreceptorB. OsmoreceptorC. MechanoreceptorD. Retinopathy E. Positive feedback loop

Answer: BA: Barorecetors in the kidneys are the Granular cells (not the Macula Densa cells)B: Macula densa cells in the thick ascending limb sense sodium chloride delivery by changing the uptake of salt, with subsequent osmotic swellingC: Not a mechanoreceptorD: Not part of the eyeE: Macula densa is an example of a negative feedback loopVander's 7th ed Ch7 Control of sodium and water excretion

[Identical] 17A-048 bipolar diathermy - choose incorrectA. Current travels through the bodyB. Cant cutC. Cant operate immersed in bloodD. Used in coagulationE. Small distance through body

Answer: BA: Current travels through the bodyB: Can cut - with less cutting ability than monopolarC: Can operate in bloodD: Can be used in coagulationE: Travels a small distance through the body Al-Shaikh- Electrical safety

[Identical] 18A-026 Pulse oximetry accuracyA. Ear lobe more accurate to measure cardiac output in vasoconstricted peripheriesB. Finger most accurateC. Bilirubin effects accuracy D. Fetal Hb affects accuracyE. Methylene blue provides a falsely high reading

Answer: BA: Ear lobes may also be vasoconstricted. Generally ear probes have a lower accuracy than finger probesB: Finger probes are the most accurateC: Bilirubin has no effect on SpO2 readingsD: HbF has no effect on SpO2 readingsE: Methylene blue creates a falsely low readingMalhotra P, Shaw L, Barnett J, et alP179 Patient safety alert: a prospective study on 100 patients highlighting inaccuracy of pulse oximeter finger probes used on ear lobesThorax 2018;73:A198Al-Shaikh - non invasive monitoring

[Identical] 15B-005 Which of these increases vasopressin (ADH) secretion?A. Increase in arterial BPB. Moving to erect positionC. Increased pressure veno/atria junctionD. Reduced plasma osmotic pressureE. Increase ECF volume

Answer: BA: Increase in arterial BP will increase firing from baroceptors -> decreased ADH secretionB: Moving to erect position will decrease firing from baroceptors -> increased ADH secretion C: Increased pressure veno/atria junction will increase the secretion of ANP and decrease the secretion of ADHD: Reduced plasma osmotic pressure will reduce the secretion of ADHE: Increase ECF volume will reduce the secretion of ADHVarious texts - Endocrinology, CVS reflexes, renalGuyton and Hall Hemmings and EganPower and Kam, Reason: increase BP will decrease ADHincreased venoatrial pressure will increase ANPThe PRIMARY driver of ADH secretion from the Post. Pit is plasma osmolarity. Standing (orthostatic hypotension) is mostly compensated by baroreceptor reflex. ADH as a hormone system would be too slow to correct this.Reduced plasma osmotic pressure, and hence, reduced plasma osmolarity would DECREASE ADH secretion. Hence the only option that would increase ADH is moving to erect posture with its (transient) decrease in low pressure (and high pressure) baroreceptor output.

[Identical] 18A-052 N2O cylinder pressureA. Pressure follows Boyle's LawB. SVP at 20 deg celC. contents proportional to pressureD. Has a filling ration of 0.5E. Is stored as a liquid and gas at 40c

Answer: BA: Pressure in a Nitrous cylinder equals SVP (Follow's Boyle's Law P1V1 = P2V2 when the volume is low)B: Pressure in a Nitrous cylinder equals SVP (Follow's Boyle's Law P1V1 = P2V2 when the volume is low)C: Contents are not proportional to pressure. Pressure is equal to SVPD: Has a filling ration of 0.75 in cool climates, 0.67 in warmer climatesE: Is only a gas at 40c (critical temperature is 36.5c)Al-Shiekh - Medical Gas supply

[Identical] 17A-025 Rhesus blood groupA. Present on all tissuesB. Rarely forms without exposureC. Are made up of IgG antibodiesD. Anti-D immunoglobulin should be administered to all Rhesus -ve patients receiving Rhesus +ve blood transfusionE. Only Rhesus D class causes transfusion reactions

Answer: BA: Rh antigens, unlike the ABO groups, are only present on red blood cells.B: Rhesus antibodies generally form after exposure. Rh blood group is inherited from the parentsC: Rh antibodies are immune, 'warm' and IgG in originD: Rh+ blood should not be given to Rh- patientsE: All blood types can cause transfusion reactionsPower and Kam - Red blood cells, - Unlike ABO antibodies, anti-Rh D antibodies generally only produced after exposure- While Rhesus D is the subtype most likely to cause a significant reaction, the other subtypes can also precipitate an incompatablility reaction- Anti-D is only indicated for women of child-bearing age, to prevent potential formation of anti-D antibodies which may cause a problem if in a future pregnancy the foetus is Rh D positive

[Identical] 15A-129 Which drugs cross the blood brain barrier?A. AcetazolamideB. AlprazolamC. AmilorideD. AmoxycillinE. Azithromycin

Answer: BDrugs that act on the brain must cross the BBBAlprazolam is a benzodiazepine acting on the brain.Drug product information sheets

[Identical] 15B-057 Pulmonary Vascular resistance A. Same as Systemic vascular resistance as both sides of the heart receive the same cardiac output B. Influenced only by alveolar oxygen tension C. Increased by increasing airway pressures D. Decreased with increasing lung volumes E. Resistance = Flow / Pressure

Answer: C A: Flow is the same in pulmonary and systemic circulation.Pressure difference in pulmonary circulation is 10mmHg (15-5mmHg)Therefore the resistance is also lower in the pulmonary circulation.Nunn's p93 B: HPV is affected by pAO2, but also pvO2Nunn's p 98 C: Increasing airway pressures -> compression of extra alveolar vessels -> increasing PVRStarling resister mechanismNunn's p95West p49 D: PVR is lowest at FRC. Increasing or decreasing lung volume -> increased PVR Nunn's p94E: Resistance = dP/Q Nunn's p92

[Identical] 14B-064 Symptoms to expect in severe hypercapnoea? A. Can be reliably diagnosed on clinical examination B. Hypotension C. Hypertension D. Decreased ventilation E. Intracellular acidosis

Answer: C - HypertensionA, B, C, D Clinical signs of hypercapnoea- Hyperventilation- Hypertension (not a reliable sign)- Muscle twitch + flap- Convulsions- Comatose pCO2>90- Cannot be diagnosed reliably on clinical examination Nunn's Hypercapnia in clinical practice p324 C: Increased paCO2 -> buffering with intracellular proteins will maintain a normal pH

[Identical] 15A-148 Lowest level of microshock for VF A. 0.001 mAB. 0.01 mAC. 0.1 mAD. 1 mA E. 10 mA

Answer: C - 0.1mAMicroshock requires 0.05-0.1 mA to cause VF Al-Shaikh - Electrical safety

[Identical] 15B-147 What is the lowest value of microshock required to cause VF?A. 0.001 mAB. 0.01 mAC. 0.1 mAD. 1 mA E. 10 mA

Answer: C - 0.1mAMicroshock requires 0.05-0.1 mA to cause VFAl-Shaikh - Electrical safety

[Identical] 17B-038 pH 6.0 equals [H+] ofA. 10nmol/LB. 100nmol/LC. 1000nmol/LD. 10mmol/LE. 100mmol/L

Answer: C - 1000 nmol/LpH 7.4 = 40nMol H+pH 7.0 = 1 x 107 mmol/L = 100 nmol/LpH 6.0 = 1 x 106 mmol/L = 1000 nmol/LH+ doubles for every 0.3 decrease in pHOr changes by factor of 10 for every 1 change in pHMiller's Perioperative Acid-Base Balance

[Identical] 19B-087 What is the % sevoflurane in air when fully saturated at room temp at sea levela. 5%b. 10%c. 21%d. 79%e. 100%

Answer: C - 21%SVP sevoflurane = 157mmHgBarometric pressure at sea level = 760mmHg157/760 x 100 = 21%Miller's Inhaled anaesthetics: Delivery systems

[Identical] 18A-019 Sevo concentration at in TEC 5 vaporizer at 20 degreesA. 16%B. 18%C. 21%D. 35%E. 100%

Answer: C - 21%Sevo SVP @ 20c = 157mmHgpercentage = 157/760 x 100 = 21%Miller's - Inhaled Anesthetic uptake, distribution, metabolism and toxicity

[Identical] 14A-061 What percentage of venous admixture is an increase in FiO2 unable to compensate for? A. 15% B. 25% C. 35% D. 45% E. 55%

Answer: C - 35% (assuming target PaO2 = 100mmHg)Isoshunt diagram Nunn's p127 and West p69. Unable to compensate for a shunt fraction >50% at all, however, unable to compensate to a paO2 >100mmHg for a shunt fraction <35%

[Identical] 18A-063 In Apnoea CO2 rises per minute by A. 1 mmHg B. 2 mmHg C. 4 mmHg D. 8 mmHg E. 10 mmHg

Answer: C - 4mmHg / minDuring apnea, arterial, alveolar and mixed venous P co 2 values remain close, and, with recirculation of the blood, increase together at a rate of about 3-6 mm Hg.min −1 Nunn's 8th Ed - Carbon Dioxide

[Identical] 18A-110 ED50A. 50% of maximal responseB. 50% receptor occupancyC. 50% of subjects will have full responseD. 50% of subject will not dieE. Time taken to reach 50% plasma concentration

Answer: C - 50% of subjects will have full responseA: ED50 Quantal while ED50 GradedB: KD - the drug concentration when 50% receptor occupancy occursC: ED50 is the dose at which there is a 50% probability of responseD: LD50 - the dose at which there is likelihood of 50% of the population dyingE: Half life or half time is the time taken for plasma concentration to reach 50%Hemmings and Egan - Mechanisms of drug actionStoeltings Basic principles of pharmacologyMillers Basic principles of pharmacology

[Identical] 15B-052 In order to excrete an osmotic load of 600mOsm/day the minimum daily urine output is:A. 10mlsB. 100mlsC. 500mlsD. 1000mlsE. 1200mls

Answer: C - 500mLsTherefore, the min- imal volume of water1 in which this mass of solute can be dissolved is roughly 600 mmol/1400 mOsm/L 5 0.43 L/day.Vander's 7th Ed p83Mandatory solute load is 600mOsmol/day. Maximum urinary concentration of the kidney is 1400mOsmol/kg H2O (same concentration is medullary interstitium!). So 600mOsmol/1400mOsmol/kg H2O = 430ml of obligatory urine loss

[Identical] 15B-075 Phenoxybenzamine acts at its receptor viaA. Competitive antagonismB. Alpha 1 selective actionC. Acts via an intermediateD. Increased intracellular calciumE. Presynaptic action

Answer: C - Acts via an intermediateA: Irreversible non-competitive antagonismB: Non-selective a1 >> a2 actionC: A prodrug that is converted to its active formD: Decreases intracellular calciumE: Postsynaptic action

[Identical] 18B-004 Thermoneutral zone best described byA. Ambient temperature changes not sensed by the conscious mindB. Core body temp range that is maintained by only behavioural activitiesC. Ambient temps over which metabolic rate increase is minimalD. Core body temperature between which metabolic increase is minimalE. Ambient temperature where core body temperature is maintained with involuntary muscle contractions

Answer: C - Ambient temps over which metabolic rate increase is minimalA: Changes in temperature can be sensed by the cortexB: Core body temperature is maintained by skin flow changes only within the thermoneutral zoneC: The thermoneutral zone is the range of envi- ronmental temperatures over which metabolic heat production is minimal and thermoregulation is maintained by vasomotor activity. D: Interthreshold range is the core body temperature between which metabolic increase is minimalE: Involuntary muscle contractions will occur outside the thermoneutral zoneNeonates: 32-34¬∞C nude Adults: 27-31 ¬∞C Power and Kam 2nd Ed Metabolism, nutrition, exercise and temperature regulation

[Identical] 19B-090 Supramaximal stimuli:a.Volts at amount more than enough to depolarise single nerveb.Volts at amount more than enough to depolarise whole muscle supplied by nervec.Amps at amount more than enough to depolarise single nerved.Amps at amount more than enough to depolarise whole muscle supplied by nerve

Answer: C - Amps at amount more than enough to depolarise a single nerveIt is the current magnitude that determines whether the nerve depolarizes or not, so delivering a constant current is more important than delivering a constant voltage as the skin resistance is variable (Ohm's law).Al-Shaikh

[Identical] 16A-109 KetamineA. Weak bronchodilator effectB. Mainly works as a spinal anaestheticC. Analgesic at subanaesthetic dosesD. Is a competitive antagonist at NMDA receptorsE. Reduces bronchial secretions

Answer: C - Analgesic at subanaesthetic dosesA - Stong bronchodilator effectB - Spinal analgesic and Supraspinal anaestheticC - Analgesic at subanaesthetic dosesD - Non-competitive NMDA antagonistE - Increases bronchial secretionsMiller's Intravenous Anaesthesics

[Identical] 18B-021 Which of the following constrict both afferent and efferent arteriole of kidney?A. ADHB. ANPC. Angiotensin IID. AldosteroneE. All of the above

Answer: C - Angiotensin IIA: ADH has minimal effect on the afferent and efferent arteriolesB: ANP relaxes the afferent arteriole - proomiting increased filtration. C: Antiotensin II decreases calibre of both AA and EA (AA>EA)Events initiated by fluid loss from the body end with 3 changes that lower GFR: increased constriction of the afferent and efferent arterioles (induced by the renal nerves and angiotensin II)D: Aldosterone is required for sodium reabsorption. It does not directly affect the afferent and efferent arteriolesE: See C

[Identical] 15B-076 Which agent is most effective in the treatment of motion sicknessA. D2 blockersB. 5HT-3 blockersC. AntihistaminesD. CannabinoidsE. Butyrophenones

Answer: C - Antihistamines Efficacy against motion sickness might give H1 antagonists an important role for ambulatory patients Hemmings and Egan(Note anti-cholinergics have been shown to be the most effective - Stoelting's Antiemetics)

[Identical] 15A-112 Ketamine is not commonly used as a sole drug infusion for TIVA because:A. It has insufficient hypnotic effect for general anaesthesiaB. It provides insufficient analgesic effectC. Approximately 30% of patients can experience emergence phenomenaD. An infusion of 0.3mg/kg/hr is sufficient to maintain unawarenessE. Higly water soluble

Answer: C - Approximately 30% of patients can experience emergency phenomenaA - Ketamine produces dose-related unconsciousness and analgesiaB - Ketamine provides important postoperative analgesiaC - Approximately 10-30% of patients can experience emergency phenomenaD - Analgesic infusions range between 0.3-0.5mg/kg/hr. Anaesthetic infusions range between 5-20ug/kg/minE - Highly lipid solubleMiller's Intravenous anaesthetic

[Identical] 15A-001 Carotid sinus massage is used in SVT to: A. Increase vagal outflow to the SA node B. Decreased sympathetic stimulation to the SA node C. Increased vagal outflow to the AV node D. Decrease sympathetic stimulation to the AV node E. ?

Answer: C - Atrial paroxysmal tachycardia may be terminated by parasympathetic nervous system stimulation of the heart with drugs or by carotid sinus massage.SVT is due to AV nodal re-entry. Carotid massage increases vagal tone to the AV node and attempts to increase the refractory time. Stoeltings - Cardiac physiology

[Identical] 16A-064 Hypoxic pulmonary vasoconstriction is: A. A linear response B. Affected by bronchial blood C. Augmented by hypervolemia D. Affected by respiratory alkalosis but not metabolic alkalosis E. Is neurally mediated

Answer: C - Augmented by hypervolemiaA: Non linear response to low O2B: Mediated by mixed venous blood (pulmonary arterial) and alveolar O2C: Hypovolaemia will decrease the pulmonary artery pressures thus worsening the effect of pulmonary vasoconstrictionD: Alkalosis, whether respiratory (hypocapnia) or metabolic in origin, causes pulmonary vasodilatation and attenuates HPVE: HPV is not neuraly mediatedNunn's 8th Ed p98

[Identical] 18B-139 Regarding neuraxial anaesthesia:A. Paramedian approach has a lower first pass success rate than midline in elderlyB. Paramedian approach has a higher first pass success rate than midline in youngC. Paramedian approach avoids the interspinous ligamentD. Requires a more cephalad angulation than midline approachE. Requires "walking" off the pedicles

Answer: C - Avoids the interspinous ligamentA - Higher success rate in the elderlyB - Unclear if higher first pass success in the youngC - When the paramedian technique is applied, the spinal needle should traverse the skin, subcutaneous fat, paraspinous muscle, ligamentum flavum, dura mater, subdural space, and arachnoid mater and then pass into the subarachnoid space.D - Paramedian requires less cephalad angulation than midline approachE - Requires walking off the laminaAnatomy for anaesthetistsNYSORA website

[Identical] 16A-075 Esmolol has the following properties:A. intrinsic sympathomimetic activity (ISA)B. high lipid solubilityC. Beta1 selectiveD. membrane stabilising propertiesE. all of the above

Answer: C - Beta 1 selectiveA: Nil intrinsic sympathomimetic activityB: Low lipid solubilityC: Beta 1 selectiveD: Nil membrane stabilising propertiesE: FalseHemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 17A-001 MOA of lignocaineA. Binds during open activated - conformational closed in activatedB. Binds open inactivatedC. Binds closed inactive stateD. Binds extracellularlyE. Binds in rested-closed state

Answer: C - Binds in closed inactive stateBy selectively binding to sodium channels in inactivated-closed states, local anesthetic molecules stabilize these channels in this configuration and prevent their change to the rested-closed and activated-open states in response to nerve impulses.Stoelting Local anaesthetics

[Identical] 19B-037 What happens to boiling point and SVP of water if atmospheric pressure doubles?a.BP increases / SVP increasesb.BP increases / SVP decreasesc.BP increases / SVP no changed.BP decreases / SVP decreasese.BP no change / SVP no change

Answer: C - Boiling point increases, Saturated vapor pressure has no changeBoiling pointThe boiling point of a liquid is defined as the temperature at which vapor pressure equals atmospheric pressure and the liquid begins to undergo rapid vaporization.As the atmospheric pressure doubles the boiling point will also increase. Vapor pressureVapor pressure is not affected by changes in atmospheric pressureSVP is dependent on temperature - GuyLussac's LawA doubling of atmospheric pressure will not affect the vapor pressureMiller's Inhaled anesthetics: delivery systems

[Identical] 18B-034 Side effects of chemotherapy are true EXCEPT:A. Anthracyclines such as daunorubicun and doxorubin can cause acute myocarditisB. Anthracyclines such as daunorubicin and doxorubin can cause chronic dilated cardiomyopathyC. Bone marrow suppression does not inhibit platelet productionD. Pulmonary oxygen toxicity following bleomycin is a life-long phenomenonE. Vincristine causes both peripheral and autonomic neuropathy

Answer: C - Bone marrow suppression does not inhibit platelet productionA: Anthracyclines such as daunorubicun and doxorubin can cause acute myocarditisB: Anthracyclines such as daunorubicin and doxorubin can cause chronic dilated cardiomyopathyC: Bone marrow suppression variably inhibits platelet productionD: Pulmonary oxygen toxicity following bleomycin is a life-long phenomenonE: Vincristine causes peripheral and autonomic neuropathy Stoelting's Chemotherapeutic drugs

[Identical] 18A-030 Neostigmine side effectA. Urinary retentionB. ConstipationC. BronchospasmD. Reversal of a phase I blockE. Tachycardia

Answer: C - BronchospasmSide effects of neostigmine occur due to increased Acetyl CholineParasympathetic effectsDUMBELLS- Diarrhoea- Urination- Meiosis- Bradycardia/asystole- Bronchospasm- Emesis- Lacrimation- Sweating

[Identical] 14A-148. A mobile phone is: A. Class 1 equipment B. Class 2 equipment C. Class 3 equipment D. Cardiac protected equipment E. Body protected equipment

Answer: C - Class 3 equipmentClass 1 - insulation between live parts and exposed conductive parts. Must be connected to earth wire by a plug (These are the devices that will have 3 prongs on the plug that goes into the wall). Fuses that melt and disconnect the electrical circuit in the event of a fault. - example: Class 2 - double insulated - if the first layer of insulation fails then the second layer prevents contact with live parts - earth wire not required (2 prongs on the plug that goes into the wall)Class 3 - no risk of gross electric shock due to extra-low voltage (SELV - voltage not exceeding 25V AC or 60V dc). Microshock can occur. Equipment may have an internal power source (battery) or connected to mains power through a step-down transformer - example mobile phoneBody protected - maximum leakage current is 100uA for Class II and 50uA for Class I.Cardiac protected - maximum leakage current is 10uA for Class II and 5uA for Class IAl-Shaikh - Electrical safety

[Identical] 18B-036 AntibioticsA. Cephazolin kills most oral aerobesB. Penicillin kills most gram negative rodsC. Clindamycin is effective against anaerobesD. First generation cephalosporins are ineffective against gram negative rodsE. MSSA should be treated with vancomycin

Answer: C - Clindamycin is effective against anaerobesA: Anaerobic bacteria - Penicillin, Clindamycin, Metronidazole (Vancomycin in penicillin allergy)B: Gram negative rods (E.coli, Klebsiella, Proteus) - First/second generation cephalosporins, quinolones or aminoglycosidesC: Anaerobes - Anaerobic bacteria - Penicillin, Clindamycin, Metronidazole (Vancomycin in penicillin allergy)D: Gram negative rods (E.coli, Klebsiella, Proteus) - First/second generation cephalosporins, quinolones or aminoglycosidesE: Methicillin sensitive staph. aureus - treated with Penicillin, cephalosporins (Vancomycin if allergic to penicillin)Katzung - Clinical use of antimicrobial agents (table 51.1)

[Identical] 15A-140 With regards to opioid metabolism which of the following is true?A. Primarily reductive hepatic metabolism of phenylpiperidine derivativesB. Morphine / tramadol / and hydromorphone are metabolised to active metabolitesC. Codeine / oxycodone and tramadol are metabolised by CYP2D6 to active metabolitesD. Pethidine / tramadol and oxycodone have metabolites with seizure-like activityE. Renarcotisation occurs more frequently after the reversal of fentanyl than morphine

Answer: C - Codeine / oxycodone and tramadol are metabolised by CYP2D6 to active metabolitesA: Phenylpiperidine derivatives - Fentanyl, XXfentanils. Have primarily hepatic oxidation + hydrolysis + glucuronide formation (not reduction)B: Morphine - active metabolitesTramadol - active metabolitesHydromorphone - metabolites can cause neuroexcitatory effects, nil analgesiaC: Codeine, oxycodone and tramadol are metabolised by CYP2D6 to active metabolitesD: Pethidine has metabolites with seizure-like activity. Tramadol can cause seizures Oxycodone has no active metabolite that causes seizuresE: "Renarcotization" occurs more frequently after the use of naloxone to reverse longer-acting opioids such as morphine Miller's Opioids

[Identical] 14A-011 Vagal stimulation causes A. Decreased conduction time B. Increase atrial myocardial conduction C. Decreased Atrial Ventricular nodal conduction D. Decreased left peak intraventricular pressures E. Increased intracellular cAMP

Answer: C - Decreased Atrial Ventricular nodal conduction A: Vagal stimulation causes a prolongation of AV node conduction time B: Vagal stimulation does not affect atrial myocardium conduction (only nodal) C: right vagal stimulation impedes AV conduction D: Decreased heart rate -> increased filling of the LV -> increased LV pressures E: Vagal stimulation causes reduced cAMP Pappano and Wier - Regulation of heartbeat

[Identical] 16A-093 What is the rationale for using a decreased dose of propofol for infusion in the elderly?A. Increased sensitivity to central effectsB. Decreased VdC. Decreased clearanceD. Increased ke0E. Increased bioavailability

Answer: C - Decreased clearanceInfusion depends on clearance- Clearance decreass in the elderly- Dose rate = target concentration x clearanceInduction dose depends on sensitivity- Sensitivity to GABA agents is increased in the elderly- Elderly patients require a lower induction dose (25% to 50% decrease) as a result of a smaller central distribution volume and decreased clearance rate and increased pharmacodynamic activity.Stoeltings Basic Principles of PharmacologyKatzung Pharmacokinetics and pharmacodynamics: Rational dosing & the time course of drug actionHemmings and Egan - Pharmacokinetic and Pharmacodynamic principles of intravenous anaesthetics (Infusion back end kinetics) Physiology and pharmacology of obesity, pediatrics and the elderly

[Identical] 14B-011 During raised intrathoracic period of Valsalva manoeuvre: A. Decreased heart rate B. Systemic vascular resistance (SVR) is decreased C. Decreased preload D. Prolonged decrease in blood pressure E. A square wave response is seen

Answer: C - Decreased preload A: Heart rate increases during phase 2 due to decreased venous return/preload B: SVR is increased during phase 2 due to decreased cardiac output and barroreceptor response C: Preload is decreased due to increased intrathoracic pressure D: Blood pressure decreases then increases and SVR increases to compensate E: A square wave response is seen in cardiac failure Power and Kam - Cardiovascular physiology

[Identical] 18A-100 Volatile agents causeA. Decreased respiratory rateB. Decreased CBFC. Decreased tidal volumeD. Increase response to hypercapniaE. Increased upper airway tone

Answer: C - Decreased tidal volumeA: Increased respiratory rateB: Increased CBFC: Decreased tidal volumeD: Decreased response to hypercapniaE: Decreased upper airway toneMiller's Pulnonary pharmacology and inhaled anaestheticsMiller's Inhaled anaesthetic uptake, distribution, metabolism, and toxicity

[Identical] 19B-031 Lowest to highest blood gas partition coefficienta. Desflurane < Sevoflurane < N2Ob. Sevoflurane < Desflurane < N2Oc. Desflurane < N2O < Sevofluraned. N2O < Desflurane < Sevofluranee. Sevoflurane < N2O < Desflurane

Answer: C - Desflurane < N2O < SevofluraneBlood gas partition coefficientsDes 0.45N2O 0.47 (N2O is faster due to administering a greater volume, not due to its Bl:Gas)Sevo 0.69Miller's Inhaled anaesthetic uptake, distribution, metbabolism and toxicity

[Identical] 16A-094 Regarding half life in 1 compartmental modelA. Dependent on plasma concentration of the drugB. Directly proportional to clearanceC. Directly proportional to VdD. Inversely roportional to the area under the curveE. Proportional to the rate constantEquation relating half life clearance and volume of distribution

Answer: C - Directly proportional to VdA: First order kinetics has a constant proportion of drug removed, thus concentration has no influence in half lifeB: t1/2 is inversely proportional to clearanceC: t1/2 is directly proportional to clearancet/2 = 0.693 x Vd / ClD: Cl = x0 / AUC Therefore t1/2 is directly proportional to AUCE: t1/2 is inversely proportional to the rate constantStoeltings Basic Principles of Pharmacology

[Identical] 17A-018 Mivacurium x3 ED95A. Depolarising blockB. Prolonged by anticholinesteraseC. Doesn't need to be reversedD. Hoffmann degradationE. Adductor pollicis muscle blocked earlier than corrugator supercilii

Answer: C - Doesn't need to be reversedA: Non-depolarising blockadeB: Not prolonged by neostigmine (unless neostigmine given at profound levels of neuromuscular blockade)C: Mivacurium does not "need" to be reversed. 75% recovery time without reversal 12minutes, with reversal 7 minutes. D: Does not undergo Hofmann degredationE: Corrugator supercilii blocked earlier than adductor pollicisProduct information shetMiller's Pharmacology of Neuromuscular blocking drugs

[Identical] 16A-087 Which drug increases gastric emptyingA. OmeprazoleB. AtropineC. DomperidoneD. MidazolamE. Prochlorperazine

Answer: C - DomperidoneA: Omperazole is a PPI, not a prokineticB: Atropine inhibits gastric emptying (anthcholinergic)C: Domperidone is similar to metoclopramide that acts as a dopamine antagonist that stimulates peristalsis in the GI tract, speeds gastric emptying and increase LOS Tone.D: Midazolam is a benzodiazapineE: Prochlorperazine is also a dopamine antagonist but is not known to increase gastric emptying.Stoelting Gastrointestinal motility drugs

[Identical] 18B-130 ED50 is:A. Dose at which 50% of receptors occupiedB. Dose producing 50% of max responseC. Dose producing max response in 50% of populationD. Dose producing death in 50% of the population E. Based on individual responses

Answer: C - Dose producing max response in 50% of the populationA: Kd50 is the plasma concentration when 50% of the receptors are occupiedB: EC50 is the plasma concentration in an individual causing 50% of the maximal responseC: ED50 is the median dose producing maximal (or the desired) response in 50% of the populationD: LD50 is the median lethal dose E: ED50 is based on responses in a populationGoodman and Gilman Individual and population pharmacodynamics

[Identical] 18B-060 External jugular veinA. Has tributaries from facial veinB. Drains into internal jugular veinC. Drains into subclavian veinD. Descends in superficial fascia at the floor of the posterior triangleE. Runs deep to the sternocleidomastoid muscle

Answer: C - Drains into the subclavian veinA: Facial vein drains into the internal jugular veinB: Drains into the subclavian veinC: Drains into the subclavian veinD: Descends in superficial fascia at the roof of the posterior triangleE. Runs superficial to the sternocleidomastoid muscleAnatomy for anaesthetists - Heart and great veins of the neck

[Identical] 14B-062 Decreased FRC during anaesthesia A. Reduces to 24-28% supine B. Partially due to increased distribution of blood from periphery to intra thoracic vessels C. Due to reduced cross sectional area of the chest wall D. Related to loss of end expiratory diaphragm tone E. Greater due to muscle relaxation

Answer: C - Due to reduced cross sectional area of the chest wall A: FRC decreases 15-20% in anaesthesia B: Shift of blood from peripheral circulation into the chest has not been demonstrated on CT and is unlikely to be the cause of decreased FRC C: Reduction in chest cross sectional area relates to a corresponding decrease in lung volume by 200mL D: In theory the cephalad movement of the diaphragm would reduce FRC. Studies show it is a change in shape, not position that occurs in anaesthesia E: The change in FRC is the same in paralysed and non-paralysed patients under anaesthesia Nunn's 8th Ed p297

[Identical] 18B-091 Which is not absolute contraindication to propofol?A. Propofol hypersensitivityB. Disordered fat metabolismC. Egg allergyD. Soy bean hypersensitivityE. Intralipid allergy

Answer: C - Egg allergyA: Previous hypersensitivity is a contraindication for any drugB: Propofol should not be used for ICU sedation in patients who have severely disordered fat metabolismC: Egg allergy is often thought not a contraindication to the use of propofol (Although PI states it is)D: Soy bean hypersensitivity is a contraindication to propofolE: The restrictions that apply to INTRALIPID 10% should also be considered when using propofol in the ICUProduct information sheet

[Identical] 18A-068 ClonidineA. Increases salivationB. OBA 30-60% moderateC. Imidazoline receptor antagonistD. Increase MACE. Increase effect of tricyclic antidepressants

Answer: C - Imidazoline receptor antgonistA: Decreased salivationB: Almost 100% oral bioavailabilityC: alpha 2 receptor is an imidazoline receptorD: Clonidine and Dexmedetomidine reduce anaesthetic requirementsE: TCAs interfere with the action of clonidineMiller's - Anaesthetic implications of concurrent diseases (Antihypertnsive drugs)

[Identical] 14B-120 Atracurium metabolismA. Has no metabolitesB. Hofmann degradation solely dependent on pHC. Ester hydrolysis independent of plasma cholinesteraseD. Has a longer half life than rocuronium E. Occurs in the liver

Answer: C - Ester hydrolysis independent of plasma cholinesteraseA: Laudanosine is a metabolite of AtracuriumB: Hofmann degredation is dependent on pH and temperatureC: Ester hydrolysis independent of plasma cholinesteraseD: Has a terminal half life of 20minutes (rocuronium between 60-120 minutes)E: Occurs in the plasmaMiller's Pharmacology of Neuromuscular blocking drugsStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 18A-106 1st generation Histamine 1 antagonists do not causeA. AntiemeticB. AnticholinergicC. ExtrapyramidalD. AntiserotoninE. Prolonged QTc

Answer: C - Extramyramidal A: 1st Generation H1 antagonists are used as antiemeticsB: H1 antagonists have antimuscarinic effectsC: H1 antagonists may be used to treat extrapyramidal effectsD: 1st Generation H1 antagonists have antiserotonin effectsE: 1st Generation H1 antagonists can prolong QTStoelting's Gastrointestinal motility drugsMiddleton's Allergy - Principles and Practice

[Identical] 14A-030 Which of these are vitamin K dependent clotting factorsA. Protein C B. Factor VIII C. Factor X D. vWF E. Factor V

Answer: C - Factor XVitamin K dependent CLOTTING factors are II, VII, IX, XProteins C & S are anticoagulant factors that depend on vitamin KProthrombin is vitamin K dependentPower and Kam - various

[Identical] 14A-006 ADH secretion is increased A. Only when there is a 10% increase in plasma osmolality B. With decrease in extravascular volume C. Following nausea and vomiting D. With acohol injestionE. With a change in position from standing to supine

Answer: C - Following nausea and vomitingA: A 1% to 2% increase in osmolarity is sufficient to increase ADH secretion.B: Increased plasma osmolarity is the primary stimulus for ADH secretion; however, other factors—such as left atrial distention, circulating blood volume, exercise, and certain emotional states—can also alter ADH release.C: Nausea and vomiting will increase plasma osmolality causing ADH secretion to increaseD: Alcohol will dilute plasma and reduce ADH secretionE: Standing to supine will increase the impulses from the baroreceptors -> decreased ADH secretionHemmings and Egan - Endocrine physiologyGuyton and Hall - Pituitary hormones and their control by the hypothalamus

[Identical] 18A-005 How is therapeutic index calculatedA. Ratio of ED95:ED50B. Calculated from the degree of overlap of the quantal curves for death and desired effectC. From quantal dose LD50/ED50D. Ratio of number treated:number with therapeutic effectE. Ratio of maximum dose:therapeutic dose

Answer: C - From quantal dose LD50/ED50A: Ratio of LD50:ED50B: Calculated from the difference between LD50 and ED50C: From quantal dose LD50/ED50D: Has nothing to do with the number needed to treatE: Ratio of lethal dose to therapeutic dose for 50% of the population. Stoeltings Millers, Basic principles of pharmacology

[Identical] 18B-129 Therapeutic index:A. Larger therapeutic index implies no overlap of curvesB. Calculated from the degree of overlap of the quantal curves for death and desired effectC. From quantal dose LD50/ED50D. Ratio of number treated:number with therapeutic effectE. Ratio of maximum dose:therapeutic dose

Answer: C - From quantal dose LD50/ED50A: The overlap of the curves depends on the LD1:ED95 ratio and the gradient of the curvesB: Calculated from the ratio of the LD50/ED50. Not from the degree of overlapC: From quantal dose LD50/ED50D: Has nothing to do with the number needed to treatE: Has nothing to do with the maximum dose. Stoeltings. Millers, Basic principles of pharmacology

[Identical] 14A-092 All are second messengers EXCEPTA. IP3B. DAGC. G proteinsD. cGMPE. NO

Answer: C - G ProteinsG Proteins are not second messengers. They stimulate second messengersImportant second messengers include cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), calcium ions, and inositol phosphates (IP3).Katzung Drug receptors and PharmacodynamicsHemmings and Egan Mechanisms of drug action

[Identical] 17A-053 Which of these increase gastric emptyingA. VIPB. GIPC. Gastrin D. Somatostatin E. Secretin

Answer: C - GastrinA: VIP - causes smooth muscle relaxation in the upper GI and increases motility in the intestine. B: GIP (Glucose dependent insulinotropic peptide, or gastric inibitory peptide) - inhibits gastric emptyingC: Gastrin increases gastric emptyingD: Somatostatin - decreases gastric emptyingE: Secretin - released from mucosa of dodenum in response to acid. Mild effect on GI motility, reduces gastric emptying and stimulates pancreatic secretion of bicarbonateCCK also decreases gastric emptyingPower and Kam 3rd editionGuyton and Hall 14th ed

[Identical] 14B-102 Which of the following has no effect on MAC:A. CyclosporinesB. Local anaestheticsC. GenderD. EthanolE. Hyperthermia

Answer: C - GenderA: Cyclosporines increase MACB: Lidocaine, a sodium channel blocker, decreases MACC: Gender has no effect on MACD: Acute Ethanol decreases MACE: Hyperthermia increases MACStoelting's Inhaled anaesthetics

[Identical] 16A-005 Lymph: A. Has a higher protein content than plasma B. Has a lower fat content than plasma C. Has a significant amount of clotting factors D. The gastrointestinal tract is the area with the highest protein content E. Has an insignificant proportion of lymphocytes

Answer: C - Has a significant amount of clotting factorsLymph contains A: Lower protein content than plasma (due to proteins remaining in the vascular circulation) B: Higher fat content (due to absorption of micelles from the GIT) C: Significant amount of clotting factors D: GIT is the area with the highest fat content E: Has a significant amount of lymphocytes Ganong 23ed p535 Pappano and Wier p152

[Identical] 15A-135 BuprenorphineA. henbane derivativeB. low lipid solubilityC. high Mu affinityD. little first pass metabolismE. less potent than morphine

Answer: C - High Mu opioid affinityA: Thebaine derivativeB: High lipid solubilityC: Mu affinity 50x that of morphineD: High first pass metabolism (given sublingual to bipass this)E: High potency compared to morphineStoelting's Opioid agonists and antagonistsProduct information sheet

[Identical] 16A-102 Regarding Inhalational anaesthetic Sevoflurane:A. Chloride and Fluride ions in structureB. Vapour pressure more than Desflurane at 20 degC. Higher fat solubility than DesD. Lower blood solubility than DesE. Lower boiling point than enflurane

Answer: C - Higher fat solubility than DesA: Sevoflurane has no chlorine atoms, only flourineB: Sevoflurane SVP 157 Desflurane SVP 664C: Sevoflurane oil:gas ~50 Desflurane oil:gas 19 (lowest)D: Sevoflurane blood:gas 0.65 Desflurane blood:gas 0.45 (lowest)E: Sevoflurane boiling point 58c Enflurane boiling point 56cMiller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity

[Identical] 18B-006 Effects of Sevoflurane at 1 MAC:A. Decreased PaCO2B. BronchoconstrictionC. Impaired ventilatory response to hypoxaemiaD. Increases regional heterogeneity of the perfusion distributionE. Increases MV due to an increase in respiratory rate

Answer: C - Impaired ventilatory response to hypoxaemiaA: Sevoflurane at 1MAC increases PaCO2 due to decreased minute ventilation (reduced TV mostly)B: Sevoflurane causes bronchodilationC: Sevoflurane impairs the ventilatory response to hypoxaemiaD: Sevoflurane reduces regional heterogeneity of the perfusion distributionE: Respiratory rate increases but MV decreases due to a decrease in TVMiller's Pulmonary Pharmacology and Inhaled Anesthetics

[Identical] 14B-002 If the pH of a solution changes from 7.4 to 7.1 what is happening to the hydrogen ion concentration?A. Decrease by approximately 75%B. Increase by approximately 150% C. Increase by approximately 100% D. Increase by approximately 20%E. No increase due to the effect of a buffer

Answer: C - Increase by approximately 100% For every 0.3 increase pH -> [H+] doubles (or increases by 100%)For every 1 increase in pH -> [H+] increases by factor of 10x

[Identical] 18B-089 Glycerol is added to propofol to:A. Adjust pHB. To provide antimicrobial propertiesC. Increase osmolarityD. Non-aqueous solventE. To increase water solubility

Answer: C - Increase osmolarityA: Sodium hydroxide to change the pHB: EDTA added for its bacteriostatic activitiesC: 2.25% of glycerol as a tonicity-adjusting agentD: 10% soybean oil is the solventE: 1.2% purified egg phospholipid added as emulsifierMiller's Intravenous anaesthetic

[Identical] 15B-013 What is the initial response to moving from supine to erect A. Increased SV B. Increased CO C. Increased SVR D. Increased MAP E. Increased CVP

Answer: C - Increased SVRSitting to standing -> blood pooling in the legs -> decreased baroreceptor firing -> increased SNS outflow -> decreased skin blood flowMore localised response - arterial constriction due to increased venous congestionLater changes -> an increased activation of RAAS to retain fluid Stoelting's - Circulatory physiology

[Identical] 18B-001 Decrease in cardiac output causes decrease in end-tidal CO2 because: A. Decreased O2 uptake B. Decreased mixed venous PCO2 C. Increased alveolar dead space D. Increased Bhor effectE. Increased Haldane effect

Answer: C - Increased alveolar dead spaceC: Decreased CO -> increased West Zone 1 -> increased dead space -> decreased ventilation -> decreased ETCO2West's 9th Ed p45 Blood flow and metabolism

[Identical] 19B-038 With regards to IPPV A. Increasing resp rate won't change minute volume in VCV B. Inspiratory time determines tidal volume in PCV C. Increased compliance will increase tidal volume in PCV D. Inspiratory hold will increase deadspace E. Time constant = resistance / compliance when flow is constant

Answer: C - Increased compliance will increase tidal volume in PCV A: In Volume control mode minute ventilation = TV x RR. Increasing RR will increase the minute volume B: Assuming a constant compliance time has no influence on tidal volume in PCV. At a constant pressure volume will also be constant. (However if the time is less than that required to reach equilibrium increasing time will increase TV.) C: Compliance = dV/dP. An increase in compliance -> an increase in volume for the same pressure D: Inspiratory hold will reduce deadspace due to gas redistribution E: Time constant = Resistance x Compliance Nunn's 8th Ed - Respiratory Support and ARtificial Ventilation p455

[Identical] 16B-003 After administration of Neostigmine Suxamathonium will have:A. Reduced potencyB. Increased potencyC. Increased durationD. Decreased durationE. Extrajunctional effects

Answer: C - Increased durationNeostigmine may prolong the effect of suxamethoniumProduct information sheet for Suxamethonium

[Identical] 15B-017 Normal CVS physiology in elderly: A. Increased arterial elasticity B. Increased DBP C. Increased pulse pressure D. Increased ventricular compliance E. Faster diastolic filling time

Answer: C - Increased pulse pressurePulse pressure increases due to decreased compliance in the vessels A: Compliance decreases -> pressure increases -> pp widens B: Diastolic pressure decreases due to reduced elastic recoil of arteries C: Compliance decreases -> pressure increases -> pp widens D: Ventricles have lower compliance E: Ventricular filling is slower (V dP/dT) due to stiffer ventricles Pappano and Wier p128-134

[Identical] 18A-089 Torsades de pointesA. Increased risk of VFB. Increased risk of AFC. Increased risk of VTD. Decreased risk in bradycardiaE. Increased risk in hyperkalaemia

Answer: C - Increased risk of VTA: Torsades de pointes is polymorphic Ventricular Tachycardia (VT)B: Torsades de pointes is polymorphic Ventricular Tachycardia (VT)C: Torsades de pointes is polymorphic Ventricular Tachycardia (VT)D: Increased risk of TDP in bradycardiasE: Increased risk in hypOkalaemiaStoletings

[Identical] 16A-113 Sodium thiopentalA. Has a slower blood:brain equilibrium time than PropofolB. Has greater amnesic properties than DiazepamC. Increases Cl- conductance at the post synaptic membraneD. Has predominantly activate metabolitesE. Has a quicker offset than Methexitone

Answer: C - Increases Cl- conductance at the post synaptic membraneA: Propofol t1/1 ke0 = 1.7, Thiopental = 1.5 (Faster)B: Benzodiazepines have greater amnestic properties than thiopentalC: MOA - activation of GABA receptors -> increased Cl conductanceD: Metabolites of thiopental are predominantly inactiveE: Methohexitone has a faster offset than thiopentalProduct information sheetMiller's Intravenous anaesthetics

[Identical] 16A-106 Desflurane is not used in a closed head injury because?A. It decreases cerebral blood flowB. It increases epileptiform EEG activityC. It increases ICPD. It increases CMRO2E. Increases MAP

Answer: C - Increases ICPA: Desflurane 0.5-2.0 MAC produces dose related increases in cerebral blood flowB: No EEG gross motor seizures are observed with desfluraneC: Desflurane 0.5-2.0 MAC produces dose related increases in cerebral blood flow and thus ICPD: Desflurane decreases CMRO2E: Desflurane may cause transient increases in sympathetic activity with associated increases in HR + MAP at >6% and a decrease in MAP at 1.2MACProduct information sheet

[Identical] 19B-036 FRC A. Increases by 500-1000 ml when supine B. Decreases with age C. Increases with COPD D. Independent of gender a given height and weight E. Is sum of residual volume + inspiratory reserve volume

Answer: C - Increases with COPD A: FRC decreases 500-1000mL when transitioning from sitting to supine B: FRC increases with age C: FRC increases with COPD (gas trapping) D: For the same body height females have 10% lower FRC E: FRC = RV + ERV Nunn's 8th Ed p27

[Identical] 16A-140 In regards to the pulmonary circulation:A. Calcium channel blockers cause vasoconstrictionB. Phosphodiesterase inhibitors cause vasoconstrictionC. Inhaled prostacyclin (PGI2) causes vasodilation without systemic effectsD. Inhaled NO increases ventilation to less well perfused regionsE. Sildenafil takes several days to reach peak effect

Answer: C - Inhaled prostacyclin (PGI2) causes vasodilation without systemic effectsA: Calcium channel blockers (in high doses) lower PVR due to vasodilation.B: PDE inibitors are used to treat pulmonary hypertension.C: "Inhaled prostacyclin decreases PVRI and PAP with maintenance of favorable systemic pressures" (Stoelting).D: Inhaled NO acts on well ventilated areas, but does not increase ventilation.E: Sildenafil has high oral bioavailability and has onset at 15 minutes and peak effect at 2 hoursStoeltings Circulatory physiologyHemmings and Egan Pulmonary Vasodilators

[Identical] 19B-045 How does atropine cause hyperthermia?A. Increased skeletal muscle actionB. Increased respiratory exchange ratioC. Inhibition of sweatingD. Adults are more susceptible than childrenE. Inhibition of the thermoregulatory centre

Answer: C - Inhibition of sweatingOccasionally, therapeutic doses dilate the cutaneous blood vessels, particularly in the "blush" area (atropine flush), and may cause atropine "fever" due to suppression of sweat gland activity in infants and small childrenProduct information sheet

[Identical] 14A-074 PhenoxybenzamineA. Does not cross the BBBB. Good absorption with predictable OBAC. Inhibits post-synaptic a1 > a2 (non-selective alpha block)D. Alpha block is not prolongedE. Causes bradycardia at high doses

Answer: C - Inhibits post synaptic a1 > a2 (non-selective alpha block)A: Has central side effects -> crosses the BBBB: Poor absorption and unpredictible OBA due to being a prodrugC: Non-selective a1>a2 blockadeD: Irreversible non-competitive blockade -> long durationE: Causes baroreceptor induced tachycardia from hypotensionStoeltingsMiller's Hemmings and Egan

[Identical] 15A-021 Fluoxetine: A. Inhibits noradrenaline and serotonin reuptake B. Inhibits dopamine reuptake C. Inhibits presynaptic uptake of serotonin D. Increases noradrenaline uptakeE. Inhibits Monoamine Oxidase

Answer: C - Inhibits presynaptic uptake of serotoninFluoxetine is a serotonin reuptake inhibitorStoelting's Drugs Used for Psychopharmacologic Therapy

[Identical] 19B-009 Which does not act at a GPCR?a. Adrenalineb. Glucagonc. Insulind. Acetylcholinee. ADH

Answer: C - InsulinA: Adrenaline - alpha + beta receptorsBeta - GsPCRB: Glucagon - GsPCR as an inotropeC: Insulin - tyrosine kinase receptorsD: Ach acts onnACh - ligand gated ion channelsmACh - muscarinic M1+3 GqPCRE: Antidiuretic hormone acts on V1 GsPCRGoodman Gilman Molecular mechanism of drug action

[Identical] 14A-077 Metoclopramide: A. Antagonises the actions of acetylcholine B. Decreases gastric acid secretions C. Is a Dopamine Antagonist D. Does not cross the Blood Brain Barrier E. Does not cross the Placenta

Answer: C - Is a dopamine antagonistA: Sensitises tissues to the action of acetylcholineB: Has minimal effect on gastric, biliary and pancreatic secretionsC: Has dopamine antagonist activityD: Can cross the blood brain barrier, causing extra-pyramidal reactionsE: Can cross the placentaStoeltings Gastrointestinal motility drugs

[Identical] 16A-107 After prolonged anaesthesia elevation in arterial carboxy-Hb can be caused by soda lime that:A. Is too coldB. Has reduced amount of potassium hydroxideC. Is too dryD. Is too wetE. Has reduced amount of sodium hydroxide

Answer: C - Is too dryA: Heat is a biproduct of the exothermic reaction of sodalime absorbing exhaled carbon dioxide.B: The association of strong alkalis such as KOH and NaOH to the production of carbon monoxide has led to the subsequent removal of KOH and reduction in amounts of NaOH used.C: Carbon monoxide occurs when Desflurane, Isoflurane, Enflurane are used with very dry granules when the water content is less than 1.5% in soda lime or less than 5% in barylimeD: Carbon monoxide occurs when Desflurane, Isoflurane, Enflurane are used with very dry granules when the water content is less than 1.5% in soda lime or less than 5% in barylimeE: The association of strong alkalis such as KOH and NaOH to the production of carbon monoxide has led to the subsequent removal of KOH and reduction in amounts of NaOH used. Al-Shaikh - Breathing systems

[Identical] 15A-086 Spironolactone:A. K sparing effect by potentiating of aldosterone receptorsB. PO its therapeutic effect is complete by 24 hoursC. K sparing effect antagonised by NSAIDsD. Causes increased K movement across luminal membraneE. Risk of hyperkalaemia with B blockers

Answer: C - K sparing effect antagonised by NSAIDsSpironolactoneA: Aldosterone antagonist in the DCT + CDB: t/2 20hours (with multiple active metabolites)C: NSAIDS may reduce the efficacy of spironolactoneD: Causes reduced K movement across the luminal membraneE: Hyperkalaemia worse with ACEIStoeltings - DiureticsProduct information sheet

[Identical] 17B-035 Anaesthetic machine check:A. Level 1 check should be performed prior to initiation of every caseB. Level 2 check does not include checking the service labelC. Level 2 check includes checking that the reserve O2 cylinder is connected and turned offD. Level 3 check includes checking the ventilation systemE. Level 3 check includes checking the scavenging system

Answer: C - Level 2 check includes checking that the reserve O2 cylinder is connected and turned offA: Level 1 check - is to verify that the system is functional and complies with the relevant Australian or New Zealand standards. It should be performed by a suitably qualified person on all anaesthesia delivery systems before initial use and following service or repair. The check should be performed on the following componentsB: The first step in a Level 2 check is to check the service labelC: Level 2 check includes checking that the reserve O2 cylinder is connected and turned offD: Level 3 check is before each case and involves checking the vaporiser, breathing system (if it has been changed), IV devices, other devices in 4.8 of PS31 (does not include ventilator)E: Level 2 check includes checking the scavenging system, not included in a Level 3 checkANZCA PS31 - Guidelines on Checking Anaesthesia Delivery Systems

[Identical] 16A-089 Which of these is not presented as a racemic mixture?A. BupivicaineB. IsofluraneC. LignocaineD. EnfluraneE. Ketamine

[Identical] 18B-013 Lignocaine at plasma concentration 5 microg.mlA. SeizuresB. AsymptomaticC. Tingling lipsD. Cardiovascular collapseE. Apnoea

Answer: C - Tingling lipsPlasma Lignocaine concentration ug/mL1-5 Analgesia5-10 Circumoral numbness, tinnitus, skeletal muscle twitching, systemic hypotension, myocardial depression10-15 Seizures, unconsciousness15-25 Apneo, coma>25 Cardiovascular depressionStoeltings Local Anaesthetic

[Identical] 18A-114 Interstitial oedema prevented by A. Hydrostatic pressure B. Oncotic pressure C. Cardiac output D. Lymph flow E. The reflection coefficient

Answer: C - Lymph flow A: Hydrostatic pressure -> primarily drives fluid into the interstitium B: Oncotic pressure - Increasing colloid pressure may not lead to reabsorption of fluid from the ISF into the plasmaMiller's - Perioperative Fluid and Electrolyte Therapy C: Cardiac output - Cardiac output will assist with flow, but not prevent interstitial oedema D: The lymphatics act as a safety factor against edema because lymph flow can increase 10- to 50-fold when fluid begins to accumulate in the tissues. E: The Reflection coefficient is the degree to which the tendency of a macromolecule to cross the endothelial barrier is resisted. (prevents movement of macromolecules) Guyton and Hall - Regulation of Fluid compartments

[Identical] 18B-020 Fetal circulationA. Sa02 80% umbilical arteryB. SaO2 of aorta is increased by blood from ductus arteriosusC. Majority of IVC blood passes into left atrium via foramen ovaleD. Low pressure in the lungs causes the RV blood to flow into the ductus arteriosusE. SVC blood is the most oxygenated blood

Answer: C - Majority of IVC blood passes into left atrium via foramen ovaleA: SaO2 of the umbilical vein is 80%. SaO2 of the umbilical artery is lowest B: Patent ductus arteriosus in the fetus diverts deoxygenated blood away from the pulmonary circulation into the aortoa. this lowers the SaO2 of the aortaC: IVC blood traverses the RA and drains into the LA via the foramel ovaleD: High pulmonary pressures create resistance to flow, diverting RV blood into the DAE: SVC blood is deoxygenated blood from the brain SaO2 42%Power and Kam Maternal and neonatal physiology

[Identical] 18A-080 NMDA receptorA. Glutamate required as co-agonistB. Mg acts as an agonistC. Methadone is an antagonistD. Ketamine is an agonistE. Is voltage gated

Answer: C - Methadone is an antagonist at the NMDA receptorA: Glycine is a co-agonist for the NMDA receptorB: Mg is an antagonistC: Methadone is an antagonistD: Ketamine is an antagonistE: A progressive increase in action potential output from the dorsal horn cell is seen with each stimulus and this rapid increase in responsiveness during the course of a train of inputs has been termed "wind-up"Acute pain management: Scientific evidence 4th ed, NMDA receptor an ionotropic glutamate receptor- Requires glycine as a co-agonist- Mg2+ prevents activation by blocking the central ion channel. Mg removed by partial membrane depolarisation through increasing stimulation of AMPA and NK-1 receptor- Methadone is an NMDA antagonist

[Identical] 14B-104 Which inhalational agent is most likely to cause renal damage?A. SevofluraneB. DesfluraneC. MethoxyfluraneD. Damage is not linked to duration of exposureE. Nitrous Oxide

Answer: C - MethoxyfluraneMethoxyflurane causes high output renal failure and is related to duration of exposureEnflurane may cause some renal failureMiller's Inhaled anaesthetic uptake, distribution, metabolism, and toxicity

[Identical] 18B-029 Methaemoglobinaemia is caused by all of the following exceptA. BenzocaineB. ParacetamolC. Methylene blueD. MetoclopramideE. Phenytoin

Answer: C - Methylene blueMethylene blue is the treatment for methaemoglobinaemia. The others are causes.

[Identical] 14B-119 Pre treatment with dantrolene causes:A. Urinary retentionB. BradycardiaC. Muscle weaknessD. Increased cardiac contractilityE. Skeletal paralysis

Answer: C - Muscle weaknessA: May cause osmotic diuresis due to high dose of mannitol in preparationB: May cause tachycardiaC: Causes muscle weaknessD: May cause heart failureE: Does not cause paralysisProduct information sheet

[Identical] 15A-075 Ceasing metoprolol preoperatively can cause: A. premature labour B. bradycardia C. myocardial ischaemia D. hypoglycaemia E. bronchospasm

Answer: C - Myocardial Ischaemia C - ceaseing beta blockers abruptly may precipitate angina or even myocardial infarction All others are side effects of beta blockersHemmings and Egan Antihypertensive drugs and vasodilators Stoeltings Sympatholytics

[Identical] 16A-074 Labetalol:A. Alpha and beta antagonist + partial alpha agonismB. Alpha antagonism greater than beta antagonismC. No Alpha2 antagonismD. Low oral bioavailabilityE. Intrinsic sympathomimetic activity

Answer: C - No alpha 2 antagonismA: Selective alpha1 + non-selective beta antagonismB: Beta antagonism greater than alphaC: Selective alpha1 + non-selective beta antagonism (no alpha2 activity)D: High oral bioavailabilityE: No intrinsic sympathomimetic activityHemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 19B-012 Which of these has the smallest relative blood (or plasma) volume/kg?a.Neonateb.Elderlyc.Obese middle aged persond.6yo childe.Pregnant woman

Answer: C - Obese middle aged personObesity -> decreased relative blood volume (increased absolute blood volume)Even less than elderlyLargest to smallestPregnancy - ~90mL/kg (inc 50%)Neonate - 90mL/kgChild - 80mL/kgAdult (M/F) - 75/65mL/kgElderly - ~65mL/kg male (approx 10-15% decreased TBW)Obese - 60mL/kgHemmings and Egan Pharmacology and Physiology of obstetric anaesthesiaHemmings and Egan Physiology and pharmacology of obesity, pediatrics, and the elderly

[Identical] 18B-117 Which is the following is a safety requirement of anaesthetic machines?A. Low pressure supply alarm when oxygen supply pressure falls below 410 kPaB. Oxygen supply failure alarm must be user cancellableC. Oxygen must be the last gas to exit the common gas manifoldD. When oxygen supply failure alarm sounds supply of all other gases must be cut offE. Back-up oxygen supply must automatically activate when oxygen supply failure occurs

Answer: C - Oxygen must be the last gas to exit the common gas manifoldA. In modern machines if the oxygen supply falls below 200kPa the low pressure supply alarm sounds.B. Supply failure alarm must not be user cancellable. It will cease when the oxygen supply is re-establishedC. O2 must the last gas to exit the common gas manifold - prevention of hypoxic mixturesD. The oxygen failure supply alarm will interrupt the flow of all other gases when it comes into operation. Atmospheric air is allowed to be delivered to the patient, without carbon dioxide accumulation. It should be impossible to resume anaesthesia until the oxygen supply has been restored. E. Backup O2 cylinder must be manually turned onAl-Shaikh - The anaesthetic machine

[Identical] 18A-015 Regarding Propofol formulations Glycerol is added to:A. Alter pHB. Increase water solubilityC. To increase tonicityD. Act as antimicrobial agentE. As a lipid solvent

Answer: C - To increase tonicityA: Sodium hydroxide to change the pHB: 1.2% purified egg phospholipid added as emulsifierC: 2.25% of glycerol as a tonicity-adjusting agentD: EDTA added for its bacteriostatic activitiesE: 10% soybean oil is the solventMiller's Intravenous anaesthetic

[Identical] 14A-037 Compare sympathetic and parasympathetic system.A. Sympathetic and parasympathetic have opposing actionsB. Sympathetic - erection Parasympathetic - ejaculationC. Parasympathetic - short postganglionic fibres lying within close proximity to organsD. 25% of parasympathetic nerve fibres are in the vagus nerveE. Post ganglionic fibres of sympathetic nerves are all adrenergic

Answer: C - Parasympathetic - short, postganglionic fibres lying within close proximity to organsA: Not all actions of sympathetic and parasympathetic are opposingB: Sympathetic - ejaculation. Parasympathetic - erectionC: Parasympathetic - short, postganglionic fibres lying within close proximity to organsD: 75% of parasympathetic nerve fibres are in the vagus nerveE: Sympathetic nerve fibres release both noradrenaline and acetylcholine (sweat glands and adrenal glands)Guyton and Hall 14th ed The Autonomic nervous system and the adrenal medulla

[Identical] 18A-020 ADH choose incorrectA. Used to treat diabetes insipidusB. Used to treat refractory shock in anaphylaxisC. Part of the ALS CPR protocolD. Used to treat hypotension in sepsisE. Has mulptiple routes of administration

Answer: C - Part of the ALS CPR protocolA: Patients with high intracranial pressures develop DI. Treated with desmopressin, an analogue of ADHB: Vasopressin may be added to refractory hypotension in anaphylaxis (ASCIA Guidelines - acute management of anaphylaxis)C: Vasopressin offers no advantage as a substitute for epinephrine in cardiac arrest and thus has been removed from the adult cardiac arrest algorithmD: Vasopressin deficiency has been shown to contribute to vasodilation in septic shock, and low-dose vasopressin (0.01-0.05 unit/min) improves mean arterial pressure, decreases catecholamine vasopressor requirement, and may spare renal function in severe septic shock.E: Vasopressin can be administered intramuscularly or intravenously.Miller's - CPR and ACLSHemmings and Egan - Endocrine physiologyHemmings and Egan - Vasopressors and inotropes

[Identical] 16A-101 Serotonin causesA. BronchodilationB. Increased gastric motilityC. Platelet contractionD. Inhibition of nociceptive nerve endingsE. Uterine relaxation

Answer: C - Platelet contractionEffects of serotonincontraction of other smooth muscle (bronchi, uterus)increased gastrointestinal motility (direct excitation of smooth muscle and indirect action via enteric neurons)platelet aggregationstimulation of peripheral nociceptive nerve endingsRang and Dale's 5-Hydroxytryptamine and the pharmacology of migraine

[Identical] 18B-027 Propofol infusion rate is decreased in the elderly becauseA. Decreased VdB. Increased ke0C. Propofol clearance is reducedD. Increased CNS sensitivity to propofolE. Smaller central compartment volume

Answer: C - Propofol clearance is reducedMIR (Maintenance infusion rate) = Clearance x plasma concentrationMIT = Cl x CpClearance is reduced in the elderly.Loading dose = Volume of distribution x plasma concentrationStoeltings Basic Principles of Pharmacology. Katzung Pharmacokinetics and pharmacodynamics: Rational dosing & the time course of drug action. Hemmings and Egan - Pharmacokinetic and Pharmacodynamic principles of intravenous anaesthetics (Infusion back end kinetics)Physiology and pharmacology of obesity, pediatrics and the elderly

[Identical] 15A-071 Thermoneutral Zone: A. Range of body temperatures which occur with exerciseB. Range of peripheral temperatures which occur with no energy expenditure C. Range of environmental temperatures where metabolic rate is minimal D. Range of metabolic rates over which...E. Range of core temperatures over which...

Answer: C - Range of environmental temperatures where metabolic rate is minimal- Thermoneutral zone is defined as the range of ambient temperatures in which core body temperature is maintained without an increase in metabolic rate and O2 consumption (Ie. body heat production) above a resting level- Basal heat production equals heat lossPower and Kam 7th Ed p384

[Identical] 17A-062 Peripheral chemoreceptors: A. Respond to Sp02 B. Slow speed of response C. Respond to acidosis D: Have equal blood flow to carotid sinus E. Linear response to PaO2

Answer: C - Respond to acidosis A: Peripheral chemoreceptor respond to paO2 rather than SpO2 B: Fast to respond C: Carotid bodies responds to dec pH, dec paO2 and inc paCO2Aortic bodies respond to paCO2 + paO2 only D: Carotid bodies have the highest blood flow per 100g of any tissue E: Non-linear response to PaO2 below 60mmHg Nunn's p66 Peripheral chemoreceptors

[Identical] 14A-151 Noradrenalines' action is first offset / terminated by A. Metabolised by COMT B. Metabolised by MAO C. Reputake into the nerve terminus D. Renal excretion E. Uptake into post synaptic nerve

Answer: C - Reuptake into nerve terminusOffset of NAd Uptake 1 - Nerve terminal reuptake -> then recycled or metabolised by MOA Uptake 2 - Diffusion away from thenerve -> systemic metabolism by COMT Hemmings and Egan Vasopressors and InotropesStoeltings Sympathomimetic drugs

[Identical] 15A-007 Sugammadex causes effective reversal ofA. RocuroniumB. VecuroniumC. Rocuronium and VecuroniumD. Rocuronium vecuronium and pancuroniumE. None of the above

Answer: C - Rocuronium and VecuroniumSugammadex is capable of reversing Rocuronium and Vecuronium Not used for reversal of PancuroniumStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 17B-023 Dead space increases with: A. Atelectasis B. Pulmonary hypertension C. Salbutamol use D. Use of circle circuit vs t piece E. Supine positioning

Answer: C - Salbutamol use A: Atelectasis will increase shunt, not dead space B: Pulmonary hypertension will increase shunt, not dead space C: Bronchodilation will increase anatomical dead space D: T piece has larger dead space than a circle circuit E: Supine position has 1/3 less deadspace than sitting Nunn's 8th Ed p122 - Factors affecting deadspace

[Identical] 15B-103 Which is true?A. Sevoflurane has chlorine and fluorine atomsB. Sevoflurane has a lower oil gas solubility than desfluraneC. Sevoflurane has a higher blood gas solubility than desfluraneD. Sevoflurane has a lower boiling point than enfluraneE. Sevoflurane has a higher saturated vapor pressure than desflurane

Answer: C - Sevoflurane has a higher blood gas solubility than desfluraneA: Sevoflurane has no chlorine atoms, only flourineB: Sevoflurane oil:gas ~50 Desflurane oil:gas 19 (lowest)C: Sevoflurane blood:gas 0.65 Desflurane blood:gas 0.45 (lowest)D: Sevoflurane boiling point 58c Enflurane boiling point 56cE: Sevoflurane SVP 157 Desflurane SVP 664Miller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity

[Identical] 15B-122 Mivacurium:A. is a steroidal muscle relaxantB. offset occurs within 10 minutes of ED95 doseC. requires reversal with an anticholinesteraseD. action may be prolonged by an anticholinesteraseE. intubating dose is 0.5mg/kg

Answer: C - requires reversal with an anticholinesteraseA: Benzylisoquinolonium muscle relaxantB: Offset 21 minutesC: Requires reversal with an anticholinesteraseD: Action not prolonged with neostigmineE: Intubating dose 0.15mg/kg

[Identical] 14A-042 What has the greatest immediate effect on metabolic rate? A. Carbohydrate metabolism B. Fat metabolism C. Skeletal muscle activity D. Hepatic enzyme activityE. Increased T3/T4

Answer: C - Skeletal muscle activityA: Carbohydrate metabolism is a net energy gain, rather than energy lossB: Fat metabolism is has a minor increase in metabolic rateDiet-induced thermogenesis is energy expended during the digestion and assimilation of food and is greater for protein (30%) compared with carbo- hydrate (4% to 5%) or fat (1% to 2%).C: The resting metabolic rate of skeletal muscle is 1.5-2 mL O2 per minute per kilogram. During maximal muscle exercise, the skeletal muscle metabolic rate can exceed 150 mL O2 per minute per kilogram (100x increase in metabolic rate)D: Hepatic enzyme activity has minimal increase in overall metabolic rateE: Excessive amounts of T3 and T4 can increase the basal metabolic rate (BMR) by 60%-100%.Power and Kam - various

[Identical] 17A-012 Lumbar spinal insertion - correct order of layers encounteredA. Skin > posterior longitudinal ligament> interspinous ligament> ligamentum flavum> epidural space> CSFB. Skin> subcutaneous tissue> interspinous ligament> anterior longitudinal ligament> CSFC. Skin> subcutaneous tissue> supraspinous ligament> interspinous ligament> ligamentum flavum> CSFD. Skin> infraspinous ligament> superior ligament> CSFE. Skin> posterior longitudinal ligament> infraspinous ligament> ligamentum flavum> epidural space> CSF

Answer: C - Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, CSFLayers traversed· Skin· Subcutaneous tissue· Supraspinous ligament· Interspinous ligament· Ligamentum flavum· Duramater· CSFAnatomy for Anaesthetists - Vertebral canal and its contents

[Identical] 18B-108 Regarding size E Oxygen cylinders which is not true:A. Increased temp increases pressureB. Pressure decreases as oxygen is usedC. Stored as gas above liquid under high pressure in cylinderD. Nozzle cools as oxygen is usedE. Pressure must be stepped down by a regulator for use

Answer: C - Stored as gas above liquid under high pressure in cylinderA: Pressure will incresae with increased temperature (in a fixed volume) Boyles law - P=kT B Pressure will decrease with decreased volume of gas (for a constant temperature). P1V1 = P2V2 C. Size E cylinders store oxygen as compressed gas. VIE stores oxygen as a liquidD. Temperature will decrease with decreased pressure (in a fixed volume) Boyles law - P=kT. E: Cylinder pressure is 13,700 kPa and needs to be stepped down to 400kPa (the pipeline pressureAl-Shaikh - Medical gas supply

[Identical] 18B-068 Which of the following acts via GPCR?A. InsulinB. DexamethasoneC. SufentanilD. RocuroniumE. Digoxin

Answer: C - SufentanilA: Insulin - Tyrosine kinase receptorsB: Dexamethasone - Intracellular steroid receptorsC: Sufentanil - GiPCRD: Rocuronium - nAChR (non specific cation channels)E: Digoxin - Na/K ATPase pump inhibitorGoodman Gilman Molecular mechanism of drug action

[Identical] 16A-049 UreaA. Can be used to measure intracellular space by the dilution principleB. Responsible for 80% of renal medullary osmolality of 1400mOsm/kgC. Synthesised in the liver from ammoniaD. Formation via urea cycle produces 4ATP/molecule of urea synthesisedE. Reabsorption by the nephron is 20% of the filtered load

Answer: C - Synthesised in the liver from ammoniaA - Urea is highly permeable and can cause transient shifts in fluid volume between intraceullular and extracellular fluids. Thus, is not a useful indicator for measuring the intracellular space. Diultion principle - Based on conservation of mass. A mass of indicator is injected into a compartment and is allowed to disperse. The concentration is then measured. Guyton and Hall - Textbook of medical physiology 14th ed - Regulation of body fluid compartments. B - The inner medullary interstitial urea concentration is high and accounts for 650 mOsmol/kg H2O of the total osmolality of 1400 mOsmol/kg H2O of the fluid present (with sodium and chloride account- ing for most of the remainder)C - Urea is synthesised from ammonia in the liver by the urea cycle, an energy-dependent process utilizing three ATP molecules per urea molecule synthesised.D - Urea is synthesised from ammonia in the liver by the urea cycle, an energy-dependent process utilizing three ATP molecules per urea molecule synthesised.E - In all, 60% of the urea in the glomerular filtrate is reabsorbed by the nephron.Power and Kam 3rd edition - Various

[Identical] 17B-064 Methods to measure dead space A. Fowler's method measures physiological dead space B. Bohr equation calculates anatomical dead space C. The end tidal - arterial pCO2 difference gives an index of alveolar dead space D. Alveolar dead space results from underventilated alveoli E. Anaesthetised patients will have a decreased deadspace

Answer: C - The end tidal - arterial pCO2 difference gives an index of alveolar dead space A: Fowler's method measures anatomical deadspace B: Bohr equation calculates physiological deadspaceVd/Vt = (paCO2 - pECO2) / paCO2 C: The end tidal - arterial pCO2 difference gives an index of alveolar dead space D: Alveolar dead space results from underperfused alveoli E: Anaesthetised patients have a similar or increased total deadspace (due to apparatus dead space increasing and anatomical deadspace decreasing) Nunn's 8th Ed p120 Dead space

[Identical] 15A-070 Airway Resistance: A. Decreases with decreasing viscosity B. Increases with increasing lung volume C. The pressure difference between the alveoli and mouth divided by flow D. Is dominated by the small airways E. Mediated by alpha receptors

Answer: C - The pressure difference between the alveoli and mouth divided by flowA: The majority of airway flow is turbulent down to the 11th airway generation.Viscosity has no bearing on resistance in turbulent flow.In lamina flow Q= (D x dP) / (L x n)Increasing viscosity -> increasing resistanceB: Increasing lung volume -> decreasing airway resistanceC: Resistance = dP / FlowD: Overall airway is dominated by the resistance of the larger airways (due to the total cross sectional area, not the cross sectional area of a single airway)E: Mediated by B2 adrenoreceptors (causing bronchoconstrictionNunn's 9th Ed p34 - Respiratory system resistance

[Identical] 18A-006 Propofol effect site concentration for unconsciousness in 25yo healthy male:A. 1 ug/mlB. 1.5 ug/mlC. 2 ug/mlD. 4 ug/mlE. 10ug/ml

Answer: C - The propofol Cp 50 for loss of response to verbal command in the absence of any other drug is 2.3 to 3.5 μg/mL.Miller's Intravenous Drug delivery systems

[Identical] 14A-048 Renal structure most vulnerable to Hypoxic injury A. Glomerulus B. Proximal Convoluted TubuleC. Thick ascending limb of the loop of HenleD. Distal Convoluted Tubule E. Collecting Ducts

Answer: C - Thick ascending limb of the loop of HenleTALH is in the medulla - also has ATP requiring Na/K/Cl pumps. The medulla has a low blood flow compared to the cortex (2.5mL/g)

[Identical] 16A-144 Which is incorrect regarding the tracheaA. Runs posterior to the aortaB. Posterior folds of connective tissueC. Anterior to a branch of brachiocephalic arteryD. Epithelium is pseudostratified columnar epitheliumE. Bifurcates at the level of T5

Answer: C - Trachea runs anterior to the brachiocephalic arteriesA: Runs posterior to the aortaB: Posterior folds of connective tissueC: Posterior to a branch of brachiocephalic arteryD: Epithelium is pseudostratified columnar epitheliumE: Bifurcates at the level of T5Anatomy for Anaesthetists - The Trachea

[Identical] 15A-080 Adminstration of clonidine can causeA. TachycardiaB. ApnoeaC. Transient HypertensionD. SeizuresE. Delirium

Answer: C - Transient HypertensionA: Causes baro-receptor induced bradycardia (from tansient hypertension)B: Sedation without apnoeaC: Transient hypertension occurs due to alpha 1 stimulation (220:1 a2:a1)D: Nil increase in seizure activityE: Sedation with minimal deleriumMiller'sStoeltingsHemmings and Egan

[Identical] 14B-039 Glucose produced from glycogen:A. Stores can last for 8 hours at normal activity levels B. Stimulated by cGMP-linked glucagon receptorC. Under the control of glucose-6-phosphataseD. Stimulated by insulin via tyrosine kinaseE. Occurs in the mitochondria of skeletal muscle

Answer: C - Under the control of glucose-6-phosphataseA: Glycogen stores in the liver (70-100 g) and the muscle (400 g) are rapidly exhausted within 24 hours, and thereafter glucose is obtained by gluconeogenesis. B: Glucagon receptor - GsPCR. Glucagon, an important lipolytic hormone, activates hormone-sensitive lipase in adipose tissue via cAMP.C: Glucose 6 phosphatase - the last enzyme in the chain of glycogen -> G6P -> Glucose. The distinct reactions that occur in gluconegenesis include the hydrolytic reactions convert- ing glucose-6-phosphate to glucose (catalysed by glucose-6-phosphatase) and fructose-1-6- diphosphate to fructose-6-phosphate and the conversion of pyruvate to phosphoenolpyruvateD: In the liver, insulin stimulates the gene expression of enzymes involved in glucose utilization (glucokinase and pyruvate kinase) and inhibits the gene expression of enzymes involved in glucose production (glucose- 6-phosphatase and phosphoenol carboxykinase).E: Glycogenolysis occurs in the cytoplasm - not the mitochondriaGlycogenolysis in the muscle causes Glucose- 6-phosphate to be produced, but as muscle lacks glucose-6-phosphatase this does not directly increase blood glucose. The glucose-6-phosphate is converted to lactate or pyruvate, which becomes a major precursor for hepatic gluconeogenesis.Power and Kam - Various (mostly endocrine physiology)

[Identical] 16B-131 A neonate generates large intrathoracic pressure changes in the first few breaths. These are required because of:A. High lung complianceB. Low Chest wall complianceC. Viscous resistance of bronchiolar fluidD. Low surface tension at viscid bronchoalveolar fluid interfaceE. High elastic recoil of the lungs

Answer: C - Viscous resistance of bronchiolar fluidA: Lung compliance is low prior to first breath - High pressures are required to generate volume. Compliance = dV / dPB: The chest wall is very compliant because of the soft ribcage of the infant.C: High viscous forces between the bronchiolar fluid require high pressure changes to create volume changes. D: At the first breath, the baby must first overcome enormous surface tension forces at the gas-liquid interface in the alveoli.E: The inward recoil of the lungs is slightly lower than that of adults.Power and Kam Maternal and neonatal physiology, At the first breath, the baby must first overcome enormous surface tension forces at the gas-liquid interface in the alveoli Although surfactant, which reduces these surface tension forces, is produced during the last few weeks of a normal pregnancy, a massive inspiratory effort is still required by the baby to generate large negative intrathoracic (-60 to -70 cmH2O) pressures to inflate the lungs. Power and KamAt birth, the walls of the alveoli are at first collapsed because of the surface tension of the viscid fluid that fills them. More than 25mHg of negative inspiratory pressure in the lungs is usually required to oppose the effects of this surface tension and to open the alveoli for the first time. Once the alveoli open, however, further respiration can be affected with relatively weak respiratory movements. Fortunately, the first inspirations of the normal neonate are extremely powerful; they are usually capable of creating as much as 60mmHg negative pressure in the intrapleural space

[Identical] 16A-080 Regarding the use of vasopressin in cardiac arrest: A. Causes vasodilation in skeletal muscle and skin B. Half-life of 10 seconds after intravenous injection C. Causes splanchnic vasoconstriction D. Metabolised by the liver E. Cannot be used with noradrenaline

Answer: C - causes splanchnic vasoconstriction (Potentially D - Metabolised by the liver) A: Causes vasoconstriction in skeletal muscle and skin and can cause digital ischaemia B: Vasopressin half life between 4-20 minutes C: Causes splanchnic vasoconstriction -> Terlipressin (synthetic vasopressin) treatment of varices D: Inactivated in liver and kidneys by enzymes (peptidases) E: Used as an adjunct to NAd in shocked patientsHemmings and Egan Vasopressors and InotropesStoeltings Sympathomimetic drugs

[Identical] 15B-118 20mls of 0.5% Bupivacaine is inadvertently injected into an epidural vein over 30 seconds. The patient is 30 years old pregnant and weighs 60kg. The most likely outcome would be:A. tinnitus and sinus tachycardiaB. confusion and atrial ectopicsC. grand mal seizure and hypotensionD. focal seizure and torsades de pointesE. muscle twitching and heart block

Answer: C - grand mal seizure and hypotension20mL x 0.5% = 5mg/mL x 20mL = 100mgCp (assume Vdc = 5L) = 100,000/5000 = 20ug/mLThe typical plasma concentration of bupivacaine associated with seizures is 4.5 to 5.5 μg/mLStoelting Local anaesthetic

[Identical] 15B-040 Cerebral blood flow regulation being most affected byA. pCO2B. pO2C. pHD. MAPE. ICP

Answer: C - pHA: CO2 will increase CBF, 2-4% for every mmHg rise of CO2. However, if pH is corrected by bicarbonate shift into the CSF the CBF will reduce (even in the presence of high pCO2) May increase to 2x normal. B: Low PO2 will cause an increase in CBF. The impact of this is less than that of CO2 (1.5x increase in flow)C: Increased H+ will cause vasodilation. If corrected CBF will return to normal. This has a greater effect on CBF than CO2 and O2D: MAP only affects CBF outside the autoregulatory rangeE: ICP is not involved in regulation of blood flow. Increased ICP will cause decreased CBF in an unregulated mannerGuyton and Hall 14th ed Cerebral Blood flow, cerebrospinal fluid and brain metabolism, when pH corrects cbf corrects. Even for a lower CO2. PCO2: CBF rises 2-4% for every mmHg rise in PaCO2 (Power and Kam), >200% of normal (Brandis, p64)PO2: Within physiological limits PO2 does not affect CBF (Power and Kam) but increases to 150% of normal with PO2<50mmHg (Brandis, p65)pH: Guyton (761ff) says the effect of CO2 is actually via changes in pH rather than a direct effect of CO2 although pCO2 has a greater effectReferencesPower & Kam, revised ed Guyton & Hall, 11th ed

[Identical] 18B-065 Plasma flow from vasa recta as compared to elsewhere A. Increased osmolarity same volume B. Decreased osmo / same volume C. Same osmolarity / increased volume D. Increased osmoloarity / decreased volume E. Same osmolarity / same volume

Answer: C - same osmolarity / increased volthe vasa recta plasma flow out of the medulla always exceeds the plasma flow in Vanders Vasa recta- Descending - salt is absorbed and water is lost -> osmolality of 1200mosm/L at the hairpin- Ascending - salt is lost and water is gained -> osmolality of 320mosm/L There is an increase osmolality (300-320) and an increase in volumePower and Kam p237

[Identical] 16A-062 Static compliance: A. Equals pulmonary elastance B. Is affected by airways resistance C. Is affected by surface tension D. Equals chest wall and lung compliance E. Equals pressure change divided by volume change

Answer: C. A: Elastance is the inverse of compliance B: Dynamic compliance is affected by airway resistance (not static compliance C: Static lung compliance depends on- Surface tension- Elastic forces of the lung- Lung volume- Posture- Pulmonary blood volume- Age- Disease D: Total compliance is made up lung and chest wall compliance1/total = 1/lung + 1/chest wall E: Compliance = dV/dPChange in volume per unit pressure Nunn's 9th Ed p26 - Elastic forces and Lung Volumes (static compliance)

[Identical] 16B-007 Witnessed arrest / shockable rhythum / defibrillator immediately available. Choice of energy for shock for the first 3 shocks: A. Monophasic - Combination of 200J / 300J / 360J B. Monophasic - Combination of 200J / 300J / 360J C. Biphasic - 200J / 200J / 200J D. Biphasic - 200J / 200J / 360J E. Biphasic - 200J / 360J / 360J

Answer: C. Monophasic - 360J Biphasic - 200J• Monophasic: the energy level for adults should be set at maximum (usually 360Joules) for all shocks.• Biphasic waveforms: the default energy level for adults should be set at 200J for all shocks. Other energy levels may be used providing there is relevant clinical data fora specific defibrillator that suggests that an alternative energy level provides adequate shock success (e.g. Usually greater than 90%) ANZCOR Guideline 11.4 - Electrical Therapy for Adult Advanced Life Support

[Identical] 18B-018 Cerebral blood volumeA. 20% increase in CBF causes 20% in cerebral blood volumeB. propofol decreases CBV by decreasing MAPC. thiopentone decreases CBV by decreasing cerebral metabolic rateD. ICP is not related to cerebral blood volumeE. Sevoflurane increases CBV at <1MAC

Answer: CA - 50% inc in CBF will cause 20% increase in CBVB - Propofol decreases CBV by decreasing CMRO2 and thus CBFC - Thiopentone decreases CBV by decreasing cerebral metabolic rateD: Intracranial pressure is related to cerebral blood volume. E - Decreased CMRO2 -> decreased CBF <1MACIncreased vasodilation -> increased CBF >1MACHemmings and Egan - Pharmactology of intravenous anaestheticsMiller's Intravenous anaesthetic agentsMiller's Cerebral physiology and the effects of anaesthetic drugs

[Identical] 14B-019 Regarding the Resting Membrane Potential (RMP) of the nerve cell: A. K+ ions Nernst Potential -70mVB. Na+ ion Nernst Potential -61mVC. Is temperature dependent D. The conductance ratio of Na:K is about 500 fold E. Na/K ATPase pump contributes significantly to the generation

Answer: CA: K+ potential ~-90mVB: Na+ potential ~+60mV C: Where T is temperature. E is the Nernst potential for an ion. This is temperature dependent. The diffusion coefficient of an ion is temperature dependentD: At resting membrane potential the conductance of all ions is approximately 0. The membrane conductance of K+ is 100x greater than Na+. (Goldman-Hodgkin-Katz form of Nernst equation with the relative permeabilities of K and Na)E: Na/K ATPase pump contributes ~4mV to the membrane potentialPower and Kam - Resting Membrane potential

[Identical] 17A-072 Propofol syringe in infusion max duration allowedA. 3 hrsB. 6hrsC. 8hrsD. 12hrsE. 24hrs

Answer: D - 12 hoursDiscard the tubing and vial after 12 hours of an infusion, and 6 hours if you open the vial and don't use it at all Stoelting Intravenous anaestheticsProduct information sheet

[Identical] 14A-110 Ketamine is not commonly used as an IV infusion because:A. at high dose does not cause adequate anaesthesiaB. half-life greater than 80 minutes not suitable for infusionC. H20 solubleD. 30% emergence phenomenaE. provides analgesia but not adequate anaesthesia

Answer: D - 30% Emergence phenomenaA: Causes adequate anaesthesia at low doses (1-2mg/kg bolus dose for induction)B: Distribution half life of 11-17 mins. Elimination half life of 2-3 hours. C: Highly lipid soluble. Vd 3L/kgD: 10-30% have emergence phenomena following TIVA infusionsE: Provides both analgesia and anaesthesiaMiller's Intravenous anaesthetics

[Identical] 15A-055 The minimum pH that the urine can create is A. 3.0B. 3.5C. 4.0 D. 4.5 E. 5.0

Answer: D - 4.5Second, there is a minimum urinary pH—approximately 4.4—that can be achieved.Vander's 7th Ed p169

[Identical] 18B-101 Saturated water vapour at 37C contains how much water?A. 4.4 g/m3B. 44 mg/m3C. 4.4 g/cm3D. 44 g/m3E. 44 mmHg

Answer: D - 44 g/m3Water content of saturated vapour at 37°C = 44g/m^3

[Identical] 18B-083 Homozygous abnormal plasma cholinesterase will lead to sux block for how long:A. 30 minB. 1 hrC. 2 hrD. 8 hrE. 16 hr

Answer: D - 8 hoursGenetic types of pseudocholinesterase deficiencyEu:Eu - 96%, Homozygous normal, normal response, Dibucaine 80Eu:Ea - 4%, heterozygous atypical, Slightly prolonged duration of sux, Dibucaine 60Ea:Ea - 0.05% 1:3000, homozygous atypical, greatly prolonged duration of sux (8-10hrs), Dibucaine 20Fluride resistant - heterozygous clinically insignificant unless combined with abnormal allele or acquired deficiency, homozygous normal Fluride #60, homozygous atypical Fluride #30Miller's Pharmacology of neuromuscular blocking drugs

[Identical] 15B-018 The venous pressure in the ankle of an adult standing at rest is A. 4.5mmHg B. 9mmHg C. 45mmHg D. 90mmHg E. 150mmHg

Answer: D - 90mmHg85-90mmHg above normal CVP Power and Kam p155 - Supine position → hydrostatic pressures in cerebral vessels, aortic root and foot vessels are equal (Ie. PART 100 mmHg and PVEN 15 mmHg)- When going to upright position → hydrostatic pressures in vessels of feet ↑by 120 cmH2O (or 85-90 mmHg (as 1 cmH2O = 0.75 mmHg)) as foot is 120 cm below level of heart (Ie. PART 190 mmHg and PVEN 100 mmHg in foot)- Brain is higher than heart by 30 cm in standing position → so vascular pressures in brain are 30 cmH2O (or 22 mmHg) lower than the pressures in aortic root (90 mmHg) or RA (2 mmHg) → thus, PART 68 mmHg and PVEN -20 mmHg at brain

[Identical] 16A-011 What is the pressure in a vein in the ankle of a standing adult at rest? A. 4.5 mmHg B. 9mmHg C. 45mmHg D. 90mmHg E. 150mmHg

Answer: D - 90mmHg85-90mmHg above normal CVP (3-8mmHgPower and Kam p155 - Supine position → hydrostatic pressures in cerebral vessels, aortic root and foot vessels are equal (Ie. PART 100 mmHg and PVEN 15 mmHg)- When going to upright position → hydrostatic pressures in vessels of feet ↑by 120 cmH2O (or 85-90 mmHg (as 1 cmH2O = 0.75 mmHg)) as foot is 120 cm below level of heart (Ie. PART 190 mmHg and PVEN 100 mmHg in foot)- Brain is higher than heart by 30 cm in standing position → so vascular pressures in brain are 30 cmH2O (or 22 mmHg) lower than the pressures in aortic root (90 mmHg) or RA (2 mmHg) → thus, PART 68 mmHg and PVEN -20 mmHg at brain

[Identical] 16A-070 Initial drop in temperature on induction of GA due toA. Cold IV fluidsB. Anaesthetic gasesC. Radiation to nearby cold objectsD. AV cutaneous vasodilatationE. Inhibition of behavioural responses

Answer: D - AV cutaneous vasodilatation (perhaps A as the primary cause)A: Cold IV fluids will affect temperature over a longer duration than initiallyB: Anaesthetic gases will cause the vasodiation as well as blunt the hypothalamic responses to changes in both core and environmental temperatureC: Radiation is responsible for the linear second phase of temperature reductionD: Redistribution hypothermia is responsible for the initial decrease in core temperature over the first 30 to 60 minutes after induction of general anesthesia. The degree of core temperature decrease is related to the degree of thermoregulatory vasoconstriction preoperatively. Deabatable as to whether the anaesthetic gases cause the vasodilation and blunting of hypothalamus which then causes the AV cutaneous vasodilation. Hemmings and Egan 2nd ed Thermoregulation, normal physiology, anesthetic effects, and perioperative considerations, Reason: Phase I Initial rapid drop due to REDISTRIBUTION of heat from core to periphery. Phase II Heat loss > metabolic heat production, pt is POIKILOTHERMICPhase III Plateau in temp represents eitheri) New steady state where heat loss = productionii) Heat loss still > production, but v/c -> CONSTRAINS HEAT TO CENTRAL COMPARTMENT, core temp remains stable while periph temp continues to fallHemmings and Egan 2nd ed Thermoregulation, normal physiology, anesthetic effects, and perioperative considerations

[Identical] 16A-053 Antidiuretic hormone secretion is REDUCED byA. NauseaB. HypoxiaC. DopamineD. AlcoholE. Hypotension

Answer: D - AlcoholA: Nausea will reduce intravascular volume and reduce firing of baroreceptors -> increased ADHB: Hypoxia will increase sympathetic outflow -> increased ADH releaseC: Dopamine will increase the release of ADHD: Alcohol inhibits ADH secretionE: Hypotesion will reduce baroreceptor firing -> increased ADHVarious texts - Endocrinology, CVS reflexes, renalGuyton and Hall Hemmings and EganPower and Kam

[Identical] 16A-001 Strong plasma ions;A. Usually anionsB. Usually cations C. pKa 7.4D. Almost completely dissociateE. Include phosphate

Answer: D - Almost completely dissociateA: Stong ions can be anions and cationsB: Stong ions can be anions and cationsC: pKa of strong ions is usually far from physiological pH (7.4)D: The degree of dissociation of substances in water determines whether they are strong acids or strong bases.E: Phosphate is not a strong ion. It is a weak acid buffer (as is albumin)Miller's Perioperative Acid-Base Balance, Stewart approachStrong ion difference, total [ ] weac acids, pCO2 in solution- Strong cations include Na+, K+, Mg2+ and Ca2+- Strong anions include Cl-, lactate and ketone bodiesStrong ions are defined by being completely dissociated. pKa is when 50% is dissociated. They can be anions or cations.

[Identical] 14B-118 Co-adminstration of which of these drugs are likely to decrease action / and duration of the non-depolarising neuromuscular blockers?A. AminoglycosidesB. Volatile ethersC. Volatile alkanesD. AminopyridinesE. Magnesium

Answer: D - AminopyridinesFactors affecting duration of NMB- PharmacologicalVolatiles, Aminoglycosides, Lithium, Local anaesthetics (variable), CCBs- PhysiologicalAcidosis, hypothermia, hypokalaemia, hypocalcaemia, hypermagnasaemia, Female, neonates, Myasthenia Gravis,Shorten durationPhenytoin/carbamazepine (aminopyridine derivative)

[Identical] 18A-088 AmiodaroneA. Beta receptor antagonistB. Increased mortality with metoprololC. Treatment for Torsades de PointesD. K channel blockerE. Decreases flecainide concentration

Answer: D - Amiodarone is a K channel blockerA: Both alpha and beta antagonistB: Decreased mortality when used in conjunction with beta blockersC: Can prolong QTc and precipitate TDPD: Class III antiarrhythmic -> K channel blockadeE: Increases flecainide concentrationStoeltings - Antiarrhythmic drugs

[Identical] 14A-044 All are SI derived except A. Joules B. Litres C. Pascal D. Ampere E. Newton

Answer: D - AmpereThe 7 SI 'base' units are Second (time) Metre (length) Mole (amt of substance)Ampere (current) Candela (luminous intensity)Kilogram (mass)Kelvin (temperature)- Other SI units are 'derived', such as Newton, Coloumb, Joules, Pascal, Watts, Hertz, Volts, Etc.

[Identical] 14B-044 All of the following are derived SI units EXCEPT:A. JoulesB. LitresC. Pascal D. Ampere E. Newton

[Identical] 15A-044 Which is NOT a derived SI unit: A. JouleB. LitreC. Pascal D. Ampere E. Newton

[Identical] 14B-079 Regarding use of Intralipid for reversal of systemic toxicity of Local AnaestheticsA. "Lipid Sink" effect is due to trapping of an aqueous drug in an aqueous mediumB. Propofol can be used as a substitute if Intralipid is not availableC. A loading dose of 2.5ml/kg of 10% intralipid is usedD. An infusion of 0.25ml/kg/min 20% intralipid can be started after the bolus if requiredE. Reversal effect is only due to the lipid sink

Answer: D - An infusion of 0.25ml/kg/min 20% intralipid can be started after the bolus if requiredA - Lipid sink - sequestrtion of lipiphilic local anaesthetics and a bolstering of fatty acid metabolism in cardiomyocytes. (Hemmings and Egan)B - Propofol is used to reduce seizure activity, not as a substitute for intralipidC - Loading dose of 1.5mL/kg 20% lipid emulsionD - Infusion of 0.25mL/kg of 20% continued for at least 10 minutes after circulatory stability is attainedE - Reversal mechanism of lipid sink is unclear. Amiodarone for arrhythmias, adrenaline for cardiac supportStoeltings Local anaestheticsHemmings and Egan Loca anaesthetics

[Identical] 19B-069 Vocal cords attach to A. Superior horn thyroid cartilage B. Inferior horn thyroid cartilage C. Corniculates D. Arytenoid E. Cricoid

Answer: D - Arytenoid. The vocal cords attach Anteriorly, Thyroid cartilage Posteriorly - Arytenoid cartilage The superior and inferior horns of the thyroid cartilage have no interaction with the vocal cords Anatomy for anaesthetists p24

[Identical] 15A-150 Bipolar diathermy:A. Not a cause of intra-operative firesB. Same current density as monopolar at the active electrode. C. Cannot be used for cutting.D. Associated with surgical fires.E. Doesn't work when immersed in blood.

Answer: D - Associated with surgical firesA: Can be a source for fire (especially in airway surgery)B: More localised current density at a lower amplitudeC: Not usually used for cutting, but can be used for cuttingD: Can be associated with surgical firesAl-Shaikh - Electrical safety

[Identical] 15B-010 Carotid sinus massage is used in SVT to: A. Decrease sympathetic stimulation of SA node B. Increase vagal outflow to SA node C. Decrease sympathetic stimulation to AV node D. Increase vagal outflow to AV node E. Decrease conductivity

Answer: D - Atrial paroxysmal tachycardia may be terminated by parasympathetic nervous system stimulation of the heart with drugs or by carotid sinus massage. D: SVT due to AVNRT -> increased refractory period at the AV node -> inhibition of the SVT Stoeltings - Cardiac physiology

[Identical] 14B-095 Transdermal drug deliveryA. Has reliable pharmacokineticsB. Is suitable for water soluble drugsC. Is quick to reach target plasma concentrationD. Avoids first pass metabolismE. Has high incidence of side effects

Answer: D - Avoids first pass metabolismA - Has unreliable pharmacokineticsB - Is suitable for drugs with combined water and lipid solubilityC - Is slow to reach target plasma concentrationsD - Avoids first pass metabolismE - Has a low incidence of side effectsStoeltings Basic principles of Pharmacology

[Identical] 14A-028 Bile: A. Is produced in the gall bladder B. Is hypertonic solution C. Contains fat soluble vitamins D. Is alkaloticE. Over 1L is secreted per day

Answer: D - Bile is alkaloticA: Bile is produced in the liver hepatocytesB: Bile is transiently hypertonic on initial formation, then isotonicC: Bile does not contain fat soluble vitamins - it is used to help digest fat soluble vitaminsD: Bile is made up of bile acids, bile pigments, and other substances dissolved in an alkaline electrolyte solution that resembles pancreatic juicepH of bile is 8.0E: 500mL is secreted per dayGanong 26 ed - Transport & metabolic functions of the liver, Produced in the liverHypotonic (100-200mmol/L)Does not contain vitamins (is used to absorb fat soluble vitamins), [Identical] 15B-032 The liver produces all of the following EXCEPT:A. von Willebrand factorB. AlbuminC. Antithrombin IIID. FibrinE. Cholesterol, Answer: A - von Willebrand factorA: vWF is synthesised in the endotheliumB, C, D, E: Albumin + Fibrin + Antithrombin III + Cholesterol are synthesised in the liverGuyton and Hall 14th ed - The Liver (Substances used in blood coagulation)

[Identical] 15A-074 Adenosine and amiodarone:A. Both class III anti-arrythmicsB. both cause bronchospasm & tachycardiaC. Half life 10 secs & 10 hrs respectivelyD. Slow AV conduction & prolong pr intervalE. Both used for treatment of svt & vt

Answer: D - Both slow AV conduction and prolong the PR intervalA: Adenosine is a Class V anthiarrhythmic. Amiodarone is a class IV (with features of the other classes)B: Bronchospasm is a side effect of adenosine. Amiodarone may lead to ventricular tachyarrythmias including TDP but also AV nodal blockade and heart block. C: Half life of adenosine - 10 seconds. Half life of amiodarone - 29 daysD: Both drugs will slow AV conduction and prolong the PR intervalE: Amiodarone - SVT + VT. Adenosine - only SVT. Stoeltings - Antiarrhythmic drugs

[Identical] 18A-067 TEG/ROTEMA. Can use same flow chartB. Lysis time increases in hyperfibrinolysisC. ROTEM uses a cup and pistonD. Both translate mechanical resistance to sensor movement within a sample of whole blood to an electronic waveform subject to quantitative analysisE. Specific activators are the same between TEG and ROTEM

Answer: D - Both translate mechanical resistance to sensor movement within a sample of whole blood to an electronic waveform subject to quantitative analysisA: Flow charts are different between TEG and ROTEMB: Lysis time will decrease with hyperfibrinolysisC: TEG uses a cup and pistonD: Both translate mechanical resistance to sensor movement within a sample of whole blood to an electronic waveform subject to quantitative analysisE: The specific activators are different between TEG and ROTEMMiller's - Patient Blood Management: Coagulation

[Identical] 18A-109 Lignocaine IV 200mg bolusA. Symptoms are worse with hypocapnoeaB. Seizure at 5mcg/ml plasma concentrationC. Increased threshold for neurotoxicity with mexiletineD. CNS before CVS toxicity symptomsE. Shortened seizure duration with SSRIs

Answer: D - CNS before CVS toxicity symptomsA - Seizure thresholds are decreased with hypercapnoeaB - Seizures occur at plasma concentrations >10ug/mLC - Mexiletine and other antidysrhthmic drugs may reduce seizure thresholdD - CNS symptoms typically occur prior to CVS symptomsE - Increased serotonin may decrease seizure threshold and prolong duration of seizuresStoeltings Local Anaesthetics

[Identical] 18A-054 Intrathecal PethidineA.causes bradycardiaB. acute tolerance treatment for remifentanilC. causes miosisD. can be used as sole agent for surgeryE. increased nausea and vomiting compared to morphine

Answer: D - Can be used as sole agent for surgeryA: Causes tachycardiaB: Ketamine reduces remifentanil hyperalgesiaC: Causes mydriasis due to structural similarity to atropineD: Can be used as sole agent intrathecally due to its ability to block sodium channels similar to local anaestheticsE: Decreased nausea and vomiting compared to morphineStoelting's Opioid Agonists and antagonists

[Identical] 14B-150 A substance with a HIGH Specific Heat Capacity: A. Has high thermal energy for its temperatureB. Is a poor conductorC. Is a poor insulator D. Can have a large amount of heat energy added to it to yield a resultant per unit temperature changeE. Can be used as a heat sink

Answer: D - Can have a large amount of heat energy added to it to yield a resultant per unit temperature changeA: A substance with a high heat capacity will have a low thermal energy for its temperature. B: Conductivity is the ability of a substance to transmit heat energy, often used as heat sinksMetals are good conductors (after they're heat capacity has been filled)C: A substance with a high heat capacity will store heat energy, within a range they are good insulators, outside that range they are good conductorsD: Heat capacity - the amount of energy (joules) required to increase the temperature of an object by 1degree. E: A heat sink is a conductor of heat energy away from one substance towards another, Like a "bucket": a larger bucket needs more heat energy to be added to it but then has a bigger temperature changeOnce SHC is filled, then it is a conductorSpecific heat capacity is highest in:Stored whole bloodred blood cellsmuscle tissuewaterairB: High specific heat capacity makes a good conductor. Able to transfer heat within the object from hot to cool zone. Used as heat sinks. C: High specific heat capacity makes a good insulator. Low conductance makes a good insulator.

[Identical] 18A-096 Which would reduce duration/effectiveness of NDMRA. HypocalcaemiaB. HypermagnesaemiaC. Volatile anaestheticsD. CarbamazapineE. RSI dose of rocuronium

Answer: D - Carbamazapine rduces the duration of NDMRAll other factors listed prolong the duration of NMDRFactors affecting duration of NMB- PharmacologicalVolatiles (central effect on a motor neurons, inhibition of postsynaptic nAchR, augmentation of antagonists affinity at receptor), Aminoglycosides (presynaptic), Lithium, Local anaesthetics (variable), CCBs- PhysiologicalAcidosis, hypothermia, hypokalaemia, hypocalcaemia, hyperMg (presynaptic CaCh), Female, neonates, Myasthenia Gravis,Shorten durationPhenytoin/carbamazepine (aminopyridine derivative)Miller's Pharmacology of Neuromuscular blocking drugsStoeltings Neuromuscular blocking drugs

[Identical] 16B-004 Which of these is not a concern for anaesthesia with Nitrous OxideA. Methionine depletionB. Folate metabolismC. Absorption atelectasisD. Cardiac morbidityE. Post operative nause and vomiting

Answer: D - Cardiac morbidityA: Nitrous oxide inhibits methionine synthase -> decreased methionineB: Methionine synthase is used in the metabolism of folateC: Nitrous oxide causes absorption atelectasisD: Cardiac morbidity is not increased with the use of Nitrous oxide (ENIGMA II study)E: Nitrous oxide increases the risk of PONV Miller's Inhaled anaesthetic uptake, distribution, metabolism and toxicity

[Identical] 18B-049 Heart rate is decreased by: A. Inspiration B. Ventricular stretch receptors C. Atrial stretch receptors D. Carotid baroreceptors E. Peripheral chemoreceptors

Answer: D - Carotid baroreceptors A: The cardiac rate accelerates during inspiration and decelerates during expiration B: Reduced stretch of the ventricular walls -> Bezold-Jarish reflex -> inhibition of the SNS -> bradycardia, vasodiation, hypotension. C: Atrial stretch leads to the release of ANP -> diuretic and natriuretic effect on kidneys + vasodilation. The Bainbridge reflex is a compensatory reflex resulting in an increase in heart rate following an increase in cardiac preload in the Right Atrium. Increased stretch causes tachycardia. D: Carotid baroreceptors - Increased stretch in the baroreceptors will decrease SNS outflow -> reduced HR E: The primary reflex effect of arterial chemoreceptor excitation is to stimulate the medullary vagal center and thereby decrease HR. Pappano and Wier - Regulation of the Heartbeat Cardiac reflexesArterial - carotid sinus and aortic arch -> glossopharyngeal/vagus -> medulla -> inc HR, inc TPR Bezold-Jarish - Mechanical receptors in ventricular walls -> nonmyleniated C fibres vagal to medulla -> inhibition of SNS -> bradycardia, vasodilation, hypotensionBainbridge - stretch receptors at junction of venacava and RA and pulm vein and LA -> vagus -> medulla -> inhibition of vagal tone -> SA node -> tachycardia

[Identical] 18B-133 1L of Hartmanns at room temperature contains:A. Calcium 5 mmol/LB. Osmolality 300-308 mosm/LC. Na 140 mmol/LD. Cl 109 mmol/LE. Glucose 5 mmol/L

Answer: D - Cl 109 mmol/LCSLNa 129K 4Cl 109lactate 29Ca 2Osmolality 273No glucoseHemmings and Egan 2nd ed - Intravascular volume replacement therapy

[Identical] 17B-004 Contents in Hartmann's valuesA. Na+ 139mmol/LB. K+ 3mmol/LC. HCO3- 29mmol/LD. Cl- 109mmol/LE. Mg2+ 2mmol/L

Answer: D - Cl- 109mmol/LNote - subtle variations between suppliers. CSLNa 129K 4Cl 109Lactate (HCO3) 29Ca 2Product information sheetHemmings and Egan 2nd ed - Intravascular volume replacement therapy

[Identical] 17A-034 Morphine metabolitesA. 30% M3GB. 60% M6GC. excreted unchanged via kidneysD. codeine is one of the metabolitesE. M6G is an active metabolite that is less potent than morphine

Answer: D - Codeine is a metabolite of morphineA: 75-85% metabolised to M3GB: 10% metabolised to M6GC: A very small amount is metabolised to codeineD: Only 1-2% unchanged renally excretedE: M6G is more potent than morphineStoelting's Opioid agonists and antagonists

[Identical] 18B-085 MAC is a concept designed to:A. Allow easy addition of inhalation agentsB. Make it easier to use the anaesthetic machineC. Reduce the possible side effects of volatile anaestheticsD. Comparative term to assess different volatiles effect on same endpointE. Assess pharmacogenetic differences between patients

Answer: D - Comparative term to assess different volatiles effect on same endpointA: MAC allows for addition of volatile anaesthetics, not its primary designB: MAC displayed on the anaesthetic machine does reduce the cognitive load, not its primary designC: MAC prevents overdosing patients and may reduce the side effects, not its primary designD: MAC is a comparative term used to assess different volatile effects on the same endpointE: MAC has no relationship to pharmacogenetic differencesStoelting's Inhaled anaesthetics

[Identical] 19B-006 In zero order kineticsa. Half life is proportional to volume of distributionb. Half life is proportional to clearancec. Half life is proportional to plasma concentration d. Constant amount drug eliminated per unit timee. Constant proportion drug eliminated per unit time

Answer: D - Constant amount of drug eliminated per unit timeA: Volume of distribution has no impact on half life in zero order kineticsB: Half life in zero order kinetics is inversely proportional to clearance (which decreases with dose)C: Half life in zero order kinetics is inversely proportional to plasma concentrationD: A constant amount of drug is eliminated per unit time in zero order kineticsE: First order kinetics - a constant proportion of drug eliminated per unit timeGoodman and Gilman's Pharmacokinetics: The dynamics of drug absorption, distribution, metabolism, and elimination

[Identical] 16A-084 CryoprecipitateA. Is approved for use in Jehovah's WitnessB. Contains Fibringen Factor VII and Antithrombin-IIIC. Effective in the reversal of warfarinD. Contains Fibrinogen Factor VIII and Von WIllebrand FactorE. Is effective in resuscitation of hypovolaemia

Answer: D - Contains Fibrinogen, Factor VIII and Von WIllebrand FactorA: Cryoprecipitate is a blood product. Not suitable for JWB: Cryoprecipitate does not contain Factor VIIC: FFP is used for the reversal of warfarinD: Contents of cryoprecipitateFactor VIII, Fibrinogen, Factor XIII, von Willebrand Factor Fibronectin E: Used primarily for Fibrinogen replacement, not volume resuscitationMiller's Patient blood management: Transfusion therapy, Derived from whole blood or collected via apheresis, is prepared by thawing fresh frozen plasma between 1-6C and recovering the precipitate. The cold-insoluble precipitate is refrozen.One unit of cryoprecipitate apheresis is approximately equivalent to 2 units of cryoprecipitate derived from whole blood

[Identical] 18B-103 Pulmonary vascular resistance decreased by: A. Decreasing lung volume below FRC B. Increasing lung volumes C. Decreased PaO2 D. Decreased PaCO2 E. Hypovolaemia

Answer: D - Decreased PaCO2 A: PVR is lowest at FRC.PVR will increase above and below FRC. B: PVR is increased with increasing lung volumes C: HPV increases with decreased pvO2 and pAO2. This leads to increased PVR D: Elevated paCO2 -> increased HPV -> increased PVRDecreased paCO2 -> decreased HPV -> decreased PVRNunn's 8th Ed p101 E: Increased RV output causes distension and recruitment. This is decreased with hypovolaemia. Nunn's 8th Ed p92-94

[Identical] 14B-025 In the normal term neonate liver which of the following is trueA. Produces concentrations of clotting factors similar to adults B. Normal bilirubin conjugation compared with infantC. Increased protein production compared with infantD. Decreased ability to utilise amino acids for protein synthesis E. Due to poor glucose handling fat is the main energy source immediately after birth

Answer: D - Decreased ability to utilise amino acids for protein synthesisA: There is a deficiency of vitamin K-dependent factors (II, VII, IX and X) as synthesis by the liver is suboptimal.B: The ability of the neonate to conjugate bilirubin and drugs with glucuronide is less because of the low activity of hepatic uridine diphosphoglucuronyl transferase. The activity of this enzyme system increases to adult levels about 70 days after birthC: Albumin synthesis in the liver starts at 3 to 4 months' gestation and increases towards term.D: Albumin synthesis in the liver starts at 3 to 4 months' gestation and increases towards termE: Glucose is the main energy source in the first few hours after delivery. The blood sugar level in a normal neonate at term is 2.7-3.3 mmol/L, and it is 2.2 mmol/L in the premature.Power and Kam - Maternal and neonatal physiology

[Identical] 17A-057 Pulmonary vascular resistance A. Decreased with increasing lung volumes B. Decreases with increasing lung volume C. Below FRCPVR is increased due to reduced radial traction on alveolar capillaries D. Decreases with increased Pulmonary artery pressure E. Calculated by multiplying pressure drop x blood flow

Answer: D - Decreases with increased PAPA: PVR is lowest at FRC. Increasing or decreasing lung volume -> increased PVRNunn's p94B: PVR is lowest at FRC. Increasing or decreasing lung volume -> increased PVRNunn's p94C: PVR increases above and below FRC.Below FRC - compression of corner capillaries or extra-alveolar vesselsAbove FRC - compression of alveolar blood vessels.Nunn's p94 fig 6.4D: Increased PAP leads to distension and recruitment -> reducing PVRNunn's p93E: Resistance = dP / QNunn's p92

[Identical] 18A-046 20% blood loss causes A. Irreversible shock and CO cant go back to normal B. Once 20% lost linear decrease in BP C. ADH secreation increased D. Diastolic pressure decreases E. Increased urinary sodium excretion

Answer: D - Diastolic pressure decreases A: Irreversible hypotension can occur with a blood loss greater than 30% of the blood volume. B: Changes in blood pressure are non-linear C: A 5%-10% decrease in blood volume is required before ADH secretion is stimulated. D: When the blood loss is greater than 20%, both arterial blood pressure and cardiac output decrease rapidly because the compensatory mechanisms become inadequate. E: Urinary sodium excretion will decrease with ADH and aldosterone secretion Power and Kam p175

[Identical] 14B-083 Dabigatran etexilateA. Has oral bioavailability of 80%B. Has a half life of 8 hoursC. Requires a 75% dose reduction in renal failure D. Does not exert any anticoagulant activityE. All of the above

Answer: D - Does not exert any anticoagulant activityA: The absolute bioavailability of dabigatran following oral administration of dabigatran etexilate was approximately 6.5 %.B: Half life ~13 hoursC: Dabigatran is contraindicated in patients with CrCl <30mL/minD: Dabigratran etexilate is a prodrug for dabigatranE: D is correctProduct information sheet

[Identical] 15A-127 With respect to Midazolam:A. Less lipophilic than lorazepamB. Has an Alkaline pH in the ampouleC. Metabolised by demethylation (etc etc)D. Has significant first pass metabolismE. Is water soluble at physiological pH

Answer: D - Has significant first pass metabolismA: Midazolam is the most lipiphilic of the benzodiazapinesB: Has an acidic pH in the ampule (maintains water solubility)C: Metabolised by hydroxylationD: Has significant first pass metabolismE: Is lipid soluble at physiological pHMiller's Intravenous anaesthetics

[Identical] 15B-125 Midazolam:A. Less lipid soluble than lorazepamB. Ampoule pH alkalineC. Metabolism by demethylationD. Significant first pass metabolismE. Water soluble at physiological pH

[Identical] 15B-027 In the foetal circulationA. Blood from the SVC flows into the LA via the foramen ovaleB. Blood in the umbilical vein is 40% saturated with oxygenC. Blood from the IVC flows to the head vessels via the ductus arteriosusD. Ductus venosus drains directly into the IVCE. All haemoglobin is foetal haemoglobin

Answer: D - Ductus venosus drains directly into the IVCA: Blood from the SVC flows into the RA then directly into the RVB: Blood from the umbilical vein is >70% saturated (When mixed with portal venous blood the IVC blood is 67% saturated)(blood from the head entering the heart via the SVC is 40% saturated)C: Blood from the IVC traverses the RA and enters the LA via the Foramen Ovale. The Ductus Arteriosus directs blood from the RV away from the pulmonary circulation and into the aortaD: Ductus venosus connects the umbilical vein to the IVCE: Before birth, HbF accounts for 90% of all hae- moglobin productionPower and Kam Maternal and neonatal physiology, Reason: - Ductus venosus shunts well-oxygenated blood returning from Umbilical vein away from the portal venous circulation, directly into the IVC note that the umbilical vein does NOT directly drain into the IVC- Poorly oxygenated blood from the SVC (head/neck; SpO2 32%) flows into RA -> RV -> pulmonary circulation (10% goes through lungs) of which 90% is shunted across ductus arteriosus into descending aorta It does NOT flow through the foramen ovale- Ductus arteriosus is a wide muscular arterial channel b/t pulmonary artery and aorta - Shunts poorly deoxygenated blood from pulmonary artery into descending aorta -> return to placenta (bypasses the lungs) - Umbilical (foetal) vein (PO2 28 mmHg; SpO2 70%) - Umbilical (foetal) artery (PO2 18 mmHg; SpO2 45%)- In utero, HbF (2a2y) accounts for 90% of total Hb inc this dec to 75% at birth inc then dec gradually until it is replaced by HbA at 6/12 post-birth

[Identical] 17A-039 Best matched reversal and anticholinergicA. Edrophonium and neostigmineB. Neostigmine and glycopyrrolateC. Neostigmine and atropineD. Edrophonium and atropineE. Edrophonium and gylocpyrrolate

Answer: D - Edrophonium and atropineEdrophonium + Atropine are best matchedNeostigmine + Glycopyrolate are well matchedMiller's Reversal of neuromuscular blockade

[Identical] 14A-015 Large Elastic Arteries A. Act as hydraulic conductors to increase flow during diastole B. Compliance increases with advancing age C. Larger increases in diameter with increase age D. Equal flow in the pulmonary and systemic circulation E. Compliance is lowest with intermediate pressures

Answer: D - Equal flow in the pulmonary and systemic circulation A: Large elastic arteries act as hydraulic filters, not conductors. This in analogous to resistance-capacitance filters of electrical circuits, maintains a steady flow through the capillaries B: Compliance decreases with increasing age (increased pressure required to dilate) C: The increase in the diameter of the aorta produced by each cardiac contraction is much less in elderly persons than in young persons D: Flow is equal to the pulmonary and systemic circulation, resistance and pressures are different E: In young individuals, the aortic compliance is least at very high and low pressures and greatest at intermediate pressures Pappano and Wier - The arterial system

[Identical] 18A-086 First order kineticsA. Clearance is proportional to the plasma concentrationB. Fixed amount eliminated per unit timeC. Variable proportion eliminated per unit timeD. Fixed proportion eliminated per unit timeE. Half life is proportional to clearance

Answer: D - Fixed proportion eliminated per unit timeA: Clearance is inversely proportional to plasma concentration B: The amount eliminated per unit time is not fixedC: The proportion eliminated per unit time is fixedD: The proportion eliminated per unit time is fixedE: Half life is inversely proportional to clearance

[Identical] 16B-114 During labour the following decreases;A. Epidural pressureB. CSF pressureC. Endorphin levelsD. Gastric emptyingE. Heart rate

Answer: D - Gastric emptyingA: Epidural pressure will increase with increased intraabdominal pressureB: CSF pressure will increaseC: Endorphins and enkephalins will increaseD: Gastric motility is reduced, and there is delayed gastric emptying at 12-14 weeks of gestation. Further prolongtion of gastric emptying occurs during labour as a result of anxiety and pain.E: Heart rate increases during labourPower and Kam Demands of pregnancy, During laborIncreased- Epidural pressure- CSF pressure- Endorphins- HR

[Identical] 15A-077 Dexamethasone: A. Short actingB. Naturally occurringC. Mineralocorticoid activity D. Glucocorticoid agonistE. All of the above

Answer: D - Glucocorticoid agonistA: Long acting - half life 36-54 hoursB: SyntheticC: Minimal mineralocorticoid activityD: Synthetic glucocorticoidE: See DProduct monographDexamethasone- Glucocorticoid- Mechanism unclear- Synthetic

[Identical] 18B-136 Central chemoreceptors most sensitive to: A. CO2 B. Oxygen partial pressure C. Oxygen content D. H ions E. HCO3-

Answer: D - H ions A: CO2 diffuses across the BBB and causes H2O + CO2 -> H+ + HCO3- B: Not responsive to PaO2 in central chemoreceptors. Peripheral chemoreceptors are sensitive to paO2 C: Neither central nor peripheral chemoreceptors are sensitive to caO2 D: H+ ions in the ECF around the central chemoreceptor will increase MV E: HCO3 buffers H+Nunn's p59 Control of Breathing

[Identical] 15B-149 A substance above its critical temperature;A. May exist in either its liquid or solid stateB. May exist in either liquid or gas stateC. May exist in either liquid or vapour stateD. Has a latent heat of vaporisation of zeroE. The pressure within a container is not dependent on the volume of the container

Answer: D - Has latent heat of vaporisation of zeroA: Above a critical temperature a gas cannot be liquified regardless of the pressure appliedB: Above a critical temperature a gas cannot be liquified regardless of the pressure appliedC: Above a critical temperature a gas cannot be liquified regardless of the pressure appliedD: The gas cannot change state to a liquid. Therefore there is no latent heat of condensation or vaporisationE: Presure is proportional to volume (irrespective of temperature)Reference??

[Identical] 14B-126 Midazolam: A. Less lipophilic than lorazepam B. Has an Alkaline pH in the ampule C. Metabolism by demethylation D. Has significant first pass metabolism E. Is water soluble at physiological pH

Answer: D - Has significant first pass metabolism A: Midazolam is more lipophilic than lorazepam (at physiological pH) B: Ampule is acidic - to improve the water solubility of midazolam C: Metabolism is by hydroxylation D: <50% oral bioavailabilityE: Is highly lipid soluble at physiological pHMiller's Intravenous anaesthetics

[Identical] 18A-028 Gabapentin side effectA. Drowsyness same as antiepilepticsB. Can cause suicidal ideationsC. Ataxia may lead to discontinuation of treatmentD. Decreases appetiteE. All of the above

Answer: E - All of the aboveA: Gabapentin is an antiepilepticB: Can cause suicidal ideationsC: Ataxia may lead to discontinuation of treatmentD: Decreases appetiteE: See above

[Identical] 14B-040 Which is not true for 32g O2 and CO2 44g A. Occupy the same volumeB. Have the same number of particles in 1 mole C. Have different densityD. Have the same viscosity E. Have a different mass

Answer: D - Have the same viscosityOxygen molecular weight = 16 g/molCarbon molecular weight = 12 g/mol1 Mole O2 = 32g1 Mole CO2 = 44g1 mole of any gas = 22.4L at STPA: Volume - Avagadro's hypothesis. The same number of molecules at a constant temp/pressure occupy the same volume. At STP 1 mole occupies 22.4L B: 1 Mole - the quantity of substance containing the same amount of particles or molecules as there are in 12g of carbon. 32g O2 = 1 mole44g CO2 = 1 mole Therefore they have the same number of particles1 mole of atoms contains 6 x 10^23 atoms - Avogadro's number.This is 12g of carbon.C. CO2 = 44g/22.4LO2 = 32g/22.4LTherefore they have a different density (from above the volume is the same)D. The others are true.E: 1 Mole O2 = 32g1 Mole CO2 = 44gMass is differentReference??, Molar weight Oxygen: O =16 --> O2 16 + 16 = 32 MW1 mole of O2 --> mass = no of moles x relative formula mass --> 1 x 32 = 32gCarbon Dioxide: C = 12 O = 16 --> 12 + 16 + 16 = 44 MW --> 1 mole CO2 = 44g

[Identical] 18A-095 Nitrous oxideA. Manufactured from ammonium sulfateB. Synergism with volatile agentsC. Boiling point 36 degreesD. Higher blood gas coefficient than xenonE. Higher oil gas coefficient than sevoflurane

Answer: D - Higher blood gas coefficient than xenonA: Manufactured from ammonium nitrate (not sulfate)B: Additive with volatiles agents (not synergistic)C: Boiling point -88cD: Higher blood gas coefficient than xenon (0.47 vs 0.14)E: Lower oil gas coefficient than sevoflurane (1.3 vs 47)Miller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity

[Identical] 16B-108 Which are physiological antagonists?A. Calcium and verapamilB. Dimercaprol And heavy metalsC. Morphine and naloxoneD. Histamine and adrenalineE. Warfarin and phenobarbitone

Answer: D - Histamine and AdrenalineA - CPhysiological antagonism is a form of functional antagonism. Occurs when antagonist acts at a a different receptor to the agonist and opposes the action of the agonistKatzung Basic and Clinical PharmacologyExamplesProtamine + HeparinGlucocorticoids + InsulinAcetylcholine + IsoproterenolTXA + Serotonin E. Phenobarbitone reduces the metabolism of warfarin. It does not antagonise warfarin

[Identical] 18B-028 DantroleneA. Can cause complete paralysis at high doseB. t1/2 is 5 hoursC. Should be combined with CCB verapamil in refractory MHD. Hydantoin derivativeE. Excreted renally unchanged

Answer: D - Hydantoin derivativeA: Can cause weakness, but not paralysisB: t1/2 is 8 hoursC: Should not be combined with verapamilD: Hydantoin derivativeE: 20-25% renal elimination metabolised, rest is hepatic/bilary Product information sheet

[Identical] 14A-065 With constant O2 consumption PvO2 increases with A. Alkalosis B. Decreased 2 3 DPG C. Decreased temperature D. Hypercapnoea E. None of the above,

Answer: D - HypercapnoeaCvO2 = CaO2 - VO2/QPvO2 is related to CvO2 via the CvO2 : PvO2 curve(similar to SO2 vs PO2 in that saturation makes up a large part of content)A, B, C - Shift the curve left (A, B, C) decreases the PvO2 for the same CvO2 (increased Hb binding -> decreased PvO2)D - Shift the curve right (D) will increase the PvO2 for the same CvO2 (as CO2 will cause O2 to bind less to Hb) Nunn's - Oxygen p192 - 200

[Identical] 14B-016 Hypokalaemia will result inA. Prolonged QRS durationB. Prolonged QT interval ('apparent' prolongation with U wave)* C. Peaked T waveD. Hyperpolarisation of cell membraneE. Shortened PR interval

Answer: D - Hyperpolarisation of cell membrane- HYPO K+ causes cardiac membrane hyperpolarisation - decreased ability of atrial myocardium to create action potentials. Decreases conduction velocity- typical ECG changes:o (1) Prolonged PR intervalo (2) ST segment depressiono (3) Prominent U waveso (4) Late T-wave inversiono (5) Ventricular extrasystolesMiller's Perioperative fluid and electrolyte therapy

[Identical] 16A-010 Electrolyte disturbance associated with long PR / ST depression / T-wave inversion and U waves:A. HypermagnesaemiaB. HyperkalaemiaC. HyponatraemiaD. HypokalaemiaE. Hypomagnesaemia

Answer: D - HypokalaemiaA: Hypermagnesaemia - 5 to 10 mg/dL: Impaired cardiac conduction (widened QRS, long PR) 24 to 48 mg/dL: Diffuse vasodilation with hypotension, bradycardiaB: Hyperkalaemia - 5.5 to 6.5 mEq/L: tall, peaked T-waves6.5 to 7.5 mEq/L: prolonged PR intervalGreater than 7.5 mEq/L: widened QRSGreater than 9.0 mEq/L: sine wave pattern, bradycardia, ventricular tachycardia, increased risk for cardiac arrestD: Hypokalaemia - electrocardiogram (ECG) abnormalities (ST segment depression, T wave depression, U wave elevation), and arrhythmias (atrial fibrillation and ventricular extrasystoles)E: Hypomagnesaemia - Wide QRS, prolonged PR, T-wave inversion, ventricular arrhythmias- HYPO K+ causes cardiac membrane hyperpolarisation ntially - decreased ability of atrial myocardium to create action potentials. Decreases conduction velocity- typical ECG changes:o (1) Prolonged PR intervalo (2) ST segment depressiono (3) Prominent U waveso (4) Late T-wave inversiono (5) Ventricular extrasystolesMiller's Perioperative fluid and electrolyte therapy

[Identical] 14A-017 The following are cardiovascular changes in the elderly. A. Increased compliance of ventricles B. Fibrosis of AV node C. Unchanged stroke volume D. Impaired baroreceptors E. Decreased resting heart rate

Answer: D - Impaired baroreceptors A: There is an age-related increase in cardiac connective tissue that, when combined with ventricular hypertrophy, increases wall stiffness and reduces diastolic compliance B: The sinoatrial node, atrioventricular node, and conduction bundles also become infiltrated with fibrous and fatty tissue C: Stoke volume can decrease in the elderly D: Impaired baroreceptor reflexes and attenuated peripheral vasoconstriction E: Resting heart rate may increase Stoeltings - Physiology and pharmacology of the elderly

[Identical] 14B-061 Hypoxic pulmonary vasoconstriction A. Is solely mediated by alveolar pO2 B. Requires neural connections to the lung C. Is not affected by NO and PGI2 D. In prolonged hypoxia shows a biphasic response at 40 minutes E. Is due to smooth muscle contraction in pulmonary veins

Answer: D - In prolonged hypoxia shows a biphasic response at 40 minutesA: Mediated by both mixed venous O2 + alveolar O2B: Still functional in excised lung, does not require neural connections to the lungC: Inhibitors of HPV include NO and PGI2D: Time course of pulmonary vasoconstriction - Nunn's fig 6.8 p99E: Contraction of pulmonary arteries, not veinsNunn's 8th Ed p98-100

[Identical] 15A-130 Acetyl-salycylic acid (aspirin): A. Causes a reversible inhibition of cyclo-oxygenase (COX-1) B. Has a duration of action which is directly related to plasma half-life C. Acts on gastric mucosa COX but not platelet COX D. In toxic doses uncouples oxidative phosphorylation in skeletal muscle E. Is poorly absorbed by the stomach

Answer: D - In toxic doses uncouple oxidative phosphorylation in skeletal muscleA: Aspirin irreversibly acetylates cyclooxygenase and thereby prevents formation of thromboxane A2B: Half life is 15 minutes. Duration is for the life of the platelet - 7-10 daysC: Acts on both gastric mucosal COX and platelet COXD: In toxic doses uncouple oxidative phosphorylation in skeletal muscleE: Aspirin is acidic and is unionised at low pH -> readily absorbed in the stomachStoelting's AnticoagulantsMiller's Acute postoperative painProduct information sheet

[Identical] 15A-146 Disinfection:A. Removal of micro-organisms and unwanted matter from contaminated materials B. Prevention of microbial contaminationC. Complete destruction of all microorganisms including sporesD. Inactivation of non-sporing organisms using thermal or chemical meansE. Occurs before decontamination and sterilisation

Answer: D - Inactivation of non-sporing organisms using thermal or chemical means- Asepsis: the prevention of microbial contamination of living tissues or sterile materials.- Disinfection: the inactivation of non-sporing organisms using either thermal or chemical means.- Sterilisation: complete destruction of all micro-organisms, including spores.ANZCA PS28 - Guidelines on Infection Control in Anaesthesia

[Identical] 15B-150 Disinfection:A. Removal of micro-organisms and unwanted matter from contaminated materialsB. Prevention of microbial contaminationC. Complete destruction of all microorganisms including sporesD. Inactivation of non-sporing organisms using thermal or chemical meansE. Occurs before decontamination and sterilisation

[Identical] 14A-038 With regards to Cerebral Blood FlowA. Inversely proportional to temperature B. Depends on MAP and ICPC. Increased blood flow with increased plasma glucose levelD. Increased blood flow with increased neuronal activityE. Permenantly increases with an increase in PaCO2

Answer: D - Increased blood flow with increased neuronal activityA: CBF is proportional to temperatureB: Depends on the driving pressure (MAP - ICP) and the resistance to flowC: CBF increases with anaerobic metabolism -> hypoglycaemia will increase CBFD: Flow-metabolism coupling - an increase in neuronal activity -> an increase in CBFE: Changes in CBF with increased PaCO2 are not sustainedHemmings and Egan 2nd ed - Central nervous system physiology - Cerebrovascular

[Identical] 18B-100 Milrinone and amrinone: A. PDE ii inhibitors B. Cause vasodilation via nitric oxide release C. Increase dysrythmias due to beta 1 stimulation D. Increased contractility due to inhibition of cAMP breakdown E. Cause thrombocytopenia

Answer: D - Increased contractility due to inhibition of cAMP breakdown A: Phosphodiesterase III inhibitors B: Cause vasodilation due to MLCK not nitric oxide C: No beta1 stimulation. Can cause AF and PVCs D: PDE inhibition -> increase cAMP E: Amrinone causes thrombocytopenia, milrinone does note Hemmings and Egan Vasopressors and Inotropes

[Identical] 15A-091 With regards to volatile agents and nephrotoxicity:A. Increased risk with enflurane onlyB. Increased risk with SevofluraneC. Increased risk with DesfluraneD. Increased risk with MethoxyfluraneE. None of the above

Answer: D - Increased risk with MethoxyfluraneA: Enflurane can cause renal failure (not the only one)B: Theoretical nephrotoxicity with Sevo and Compound A, unlikely in humansC: Nil nephrotoxicity with DesfluraneD: Methoxyflurane causes high output renal failureE: See aboveMiller's Inhaled anaesthetic uptake, distribution, metabolism and toxicity

[Identical] 15A-052 In a patient with significant hypovolaemia and decreased osmolality: A. Decreased sodium reabsorption at distal tubule & collecting duct B. Increased water reabsorption at proximal tubuleC. Increased water reabsorption at ascending loop of HenleyD. Increased water permeability of collecting duct E. None of the above

Answer: D - Increased water permeability of collecting ductIncreased ADH -> Increased H2O permeability of the collecting ductWhat happens when baroreceptor and osmoreceptor inputs oppose each other (eg, if plasma volume and osmolality are both decreased)? In general, because of the high sensitivity of the osmoreceptors, the osmoreceptor influence predominates over that of the baroreceptor when changes in osmolality and plasma volume are small to moderate. However, a very large change in plasma volume will take precedence over decreased body fluid osmolality in influencing ADH secretion; under such conditions, water is retained in excess of solute, and the body fluids become hypoosmotic (for the same reason, plasma sodium concentration decreases). In essence, it is more important for the body to preserve vascular volume and thus ensure an adequate CO than it is to preserve normal osmolality.Vander's 7th ed Ch 7 Control of Sodium and Water Excretion

[Identical] 18B-061 The right vagus nerveA. Cannot be damaged by jugular cannulationB. Decreases gastric acid secretionC. Enters the thorax between the left carotid and left subclavian arteriesD. Is asymetrical with the left vagus nerveE. Crosses the aortic arch more lateral and posterior to the phrenic nerve

Answer: D - Is asymetrical with the left vagus nerveA: Travels in the carotid sheath and can be damaged by jugular cannulationB: Increases gastric acid secretionC: Right vagus nerve enters between the internal jugular vein and the common carotid sheath, then crosses the subclavian arteryD: Is asymetrical with the left vagus nerveE: The left vagus nerve crosses the aortic arch more lateral and posterior to the phrenic nerveAnatomy for the Anaesthetists - The vagus nerve

[Identical] 15B-011 Peripheral vascular resistance: A. Can be calculated from mean arterial pressure pulmonary wedge pressure B. Units are dynes.s.cm^5 C. Equals driving pressure multiplied by CO D. Is proportional to viscosity E. Is higher in parallel than series

Answer: D - Is proportional to viscosity A: Peripheral resistance = (MAP - RAP) / QPulmonary wedge pressure = Left atrial pressure not RAPAlso need cardiac outputPulmonary vascular resistance = (Mean PAP - PCWP)/Q x 80 dyn/sec/cm^5 B. Units are dyn.sec/cm^5. Normal value 700-1600 dyn.s/cm^5 or dyn.s.cm^-5(mmHg /L /min = woods units normal = 9-20 woods units)Power and Kam p141 C: Peripheral resistance = dP / QWhere dP = MAP - RAP D: R=8ηl/πr4. High viscosity will increase resistance to flow E: Resistance is higher in series compared to parallel. Total resistance in parallel is less than the sum of each of the resistances Pappano and Wier p129 Hemodynamics

[Identical] 17A-047 MicroshockA. Higher risk with direct current vs alternating currentB. Prevented by use of LIOMC. Higher risk with higher frequencyD. Isolating capacitor is used to protect patient from mains power frequencyE. 0.01 mA direct to heart

Answer: D - Isolating capacitor is used to protect patient from mains power frequencyA: The DC required to cause VF is very much higher than the AC -> lower risk with DCB: LIM will protect against macroshock, but will not cease the currentC: Higher frequency current reduces the risk of microshockD: Isolating capacitor is used to protect patient from mains power frequencyE: >0.05 - 0.1 mA is required to cause microshock Al-Shaikh- Electrical safety

[Identical] 15A-147 Oxygen flush on Anaesthetic machine:A. It has the flow of 15-30 L/ min and the same rate of volatile agent adjusted for B. It has the flow of 15-30 L/ min with no volatile agentC. It has the flow of 45-60 L/min and the same rate of volatile agent adjusted for D. It has the flow of 45-60 L/ min with no volatile agentE. None of the above

Answer: D - It has the flow of 45-60L/min with no volatile agentD: When pressed, pure oxygen is supplied from the outlet of the anaesthetic machine. The flow bypasses the flowmeters and the vaporizers. A flow of about 35-75 L/min at a pressure of about 400 kPa is expected. The emergency oxygen flush is usually activated by a non-locking button and using a self-closing valve. It is designed to minimize unintended and accidental operation by staff or other equipment. The button is recessed in a housing to prevent accidental depression.Al-Sheikh - The Anaesthetic Machine

[Identical] 14B-046. Regarding the juxtaglomerular apparatus: A. Has both sympathetic and parasympathetic supplyB. Macula densa cells sense pressureC. Angiotensin II increases renin production on the granular cellsD. Juxtaglomerular cells lie in the afferent arteriolesE. Macula densa cells are in the thick ascending loop of Henle

Answer: D - Juxtaglomerular cells lie in the afferent arteriolesA: The JGA has only sympathetic stimulus - neural signals originating in the vasomotor center (generated in response to vascular baroreceptors) reach the granular cells via the renal sympathetic nerveB: Macula densa senses NaCl concentration, not pressureC: Angiotensin II acts in a negative feedback manner to inhibit renin production by acting directly on granular cells (by inter- acting with AT1 receptors on granular cells to increase intracellular Ca concentra- tion, which inhibits renin production).D: Specializations of the cells of the afferent arteriole: granular cells (also called juxtaglomerular cells) that form part of the juxtaglomerular apparatusE: At this location, which marks the start of the distal convolution, there is a modified region of tubular epithelium called the macula densa. Vander's 7th Ed Ch 7 p108-111 Control of Sodium and Water excretionGanong 26e Ch38 Regulation of renin secretion

[Identical] 18B-122 Metformin commonly held 24-48 hours pre-op due to risk of:A. Cardiovascular morbidityB. Renal failureC. HypoglycaemiaD. Lactic acidosisE. All of the above

Answer: D - Lactic acidosisA: Should be given with caution to patients with increased CVS risk due to risk of lactic acidosisB: Short half life - excreted unchanged within 12 hoursC: Metformin does not cause renal failureD: Metformin may cause lactic acidosisE: See DStoelting's Drugs that alter glucose regulation

[Identical] 17B-057 Reason for speed of onset for alfentanilA. Low potencyB. Low protein bindingC. Low volume of distributionD. Low pKaE. High efficacy

Answer: D - Low pKaA: 10-20x more potent than morphineB: High protein binding 90%C: Very low Vd 0.6L/kg, this does not affect onsetD: Low pKa 6.5 = 90% unionised at physiological pH 7.4E: Efficacy has no impact on onsetStoelting's Opioid agonists and antagonists

[Identical] 18B-044 Which receptor type is not involved in PONV?A. 5-HT3B. D2 receptorsC. NK1 receptorsD. M2 receptorsE. H1 receptors

Answer: D - M2 receptorsD: M2 receptors are cardiac (M1 receptors are involved in PONV)CTZ has 5HT3, D2, M1, H1, Opioid, NK1 receptorsVestibular centre has H1, M1 receptorsVomiting centre has 5HT3, D2, NK1 receptorsVagal stimulation acts on vomiting centre (not CTZ)Hemmings and Egan Physiology of post operative nausea and vomiting

[Identical] 14A-147 The coaxial Bain circuit is a modification of the Mapleson: A. A B. B C. C D. D E. E

Answer: D - Mapleson DBain is a modified Mapleson D- Bag + APL are at the far end to the patient. - FGF is at the patient endBain - puts the FGF at the patient end via a coaxial tubingUsed for moving the inspiratory limb and reducing the FGFFGF 3x MV to prevent rebreathing --> expiration flows dwn the outer tube fills the reservoir and then opens APL.Mapleson circuitsThe systems are classified according to the relative positions of 3 components:FGF, APL and gas reservoirMapleson A + B have all componentsMapleson E + F do not have APL valvesMapleson E has no bagMapleson F has an open ended bag. Manual PEEP (for pediatrics)Mapleson A: FGF at operator endFGF --> reservoir --> tubing --> APL --> patient: the volume of the tubing must be > 1 VT and flows must be greater than MV to ensure no rebreathing - expiration the reservoir bag will fill until the pressure opens the APL.Lack system (Coaxial Mapleson A / Magill modification): FGF then reservoir and APL at the same point but attached to an inner tube: outer tube 30mm diam / inner tube 14mm diamMapleson B (distal to proximal): reservoir bag --> tubing --> FGF --> APL --> patient:requires FGF 2 - 3x MV. BAD for spontaneous ventilation.Mapleson C: distal to proximalreservoir bag --> short tube --> FGF --> APL --> patientrequires FGF 2 - 3x MV --> CO2 accumulates over timeMapleson D: distal to proximalreservoir bag --> APL --> tubing --> FGF --> patientMapleson E aka Ayre's T-piece:Tubing --> FGF --> patient. --> the tubing is the reservoir.Mapleson F Jackson Rees: distal to proximalbit of tube --> reservoir bag --> tubing --> FGF --> patientFGF 2 - 3x FGF required.Al-Shaikh - Breathing circuits

[Identical] 14B-028 In thromboelastography (TEG):A. α angle represents lysis timeB. Beta angle represents clot formationC. R value represents the rate of clot formationD. Maximum Amplitude reflects the strength of the clot which is dependent on platelet number and functionE. Measures all aspects of clot formation from initial thrombin activation to thrombolysis

Answer: D - Maximum Amplitude reflects the strength of the clot which is dependent on platelet number and functionA: The α angle values measure rate of clot formation and may be prolonged by any variable slowing clot generation such as a plasma coagulation factor deficiency or heparin anticoagulation. Modification of clotting activators may be incorporated to assess platelet or fibrin contributions to clot strength.B: There is no beta angleC: The R value (reaction time) measures time to initial clot formationD: Maximum amplitude provides a measure of clot strength and may be decreased by either qualitative or quantitative platelet dysfunction or decreased fibrinogen concentration.E: Does not measure all aspects of clot formation and lacks specificityMiller's Patient blood management - coagulation

[Identical] 17A-071 TEG A. α angle represents lysis timeB. Beta angle represents clot formationC. R value gives a more accurate platelet countD. Maximum Amplitude reflects the strength of the clot which is dependent on platelet number and functionE. Measures all aspects of clot formation from initial thrombin activation to thrombolysis

[Identical] 14B-120b Atracurium:A. has active metabolitesB. metabolism is affected by pseudocholinesterase deficiencyC. metabolism is only affected by temperatureD. metabolism is largely via ester hydrolysisE. is organ dependent

Answer: D - Metabolism largely via ester hydrolysisA: Has no active metabolites (Laudanosine is mostly inactive in humans)B: Metabolism is independentof pseudocholinesteraseC: Metabolism affected by temperature and pHD: 60% metabolised via non-specific plasma esterasesE: Is organ independentMiller's Pharmacology of Neuromuscular blocking drugsStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 17B-013 Pulse oximetry A. Low reading with carbon monoxide poisoningB. Low reading with bilirubinaemiaC. Inaccurate with dark skinD. Methaemoglobinaemia causes reading of 85%E. Reading not affected by use of indocyanine green

Answer: D - Methaemoglobinaemia causes reading of 85%A: High reading with COHbB: Normal reading with bilirubinaemiaC: Skin colours don't alter the SpO2 due to the Lambert Law accommodating for non pulsatile absorptionD: Methaemoglobin - absorbs red and infrared light at a ratio of 1:1, which is interpreted by the algorithm as a saturation of 85%, resulting in falsely low readings above 85% and falsely high reading below 85%E: Indocyanine green - falsely low readings

[Identical] 16A-137 Inhalation analgesiaA. Don't use methoxyflurane for burnsB. N2O good for bowel obstructionC. Vit B6 supplement needed for N2OD. Methoxyflurane use limited by nephrotoxicityE. Pernicious anaemia not an issue with N2O

Answer: D - Methoxyflurane use is limited by nephrotoxicityA: Methoxyflurane is used frequently for burn dressing changesB: N2O expands in air filled spaces. Not for use with bowel obstructionC: B12 supplementation may be useful for use with N2OD: Methoxyflurane use is limited by nephrotoxicityE: Pernicious anaemia (B12) is exacerbated with N2OMiller's Inhaled anaesthetic uptake, distribution, metabolism, and toxicity

[Identical] 18B-030 Methaemoglobinaemia is not caused byA. prilocaineB. GTNC. SNPD. methylene blueE. paracetamol

Answer: D - Methylene blueMethylene blue is the treatment for methaemoglobinaemia. The others are causes.

[Identical] 19B-021 What has highest CO2? A. Ideal alveolar gas B. Mixed expired C. End tidal D. Mixed venous blood E. Arterial blood

Answer: D - Mixed venous bloodA: Ideal alveolar wil have an equal pCO2 to arterial (after equilibration of venous blood and the alveolusB: Mixed expired gas will have deadspace gas + alveolar gas -> less CO2C: End tidal CO2 will be almost all alveolar gas. However CO2 will continue to be added to alveolar gas during early inspiration -> alveolar CO2 higher than end tidalD: Mixed venous blood has the highest pCO2 (46mmHg) E: Arterial blood has the same CO2 as ideal alveolar gasNunn's 8th Ed p159 Alveolar PCO2

[Identical] 14B-113 Local anaesthetic solutions are prepared with dilute hydrochloric acid because:A. More stable in solutionB. Shows tautomerismC. Make solution isotonicD. More water soluble at acidic pHE. Bacteriostatic

Answer: D - More water soluble at acidic pHA: Acidic solution is important if adrenaline is added because it is unstable at alkaline pHB: Local anaesthetics do not show tautomerism (see Midazolam)C: Local anaesthetics are isotonic and require no tonicitiy agentD: Local anaesthetics are more soluble in water when prepared as hydrochloride salts (basic drugs that ionise in acidic solution)E: Preservatives are weak acids with pKAs of 4-5. They are most effective in acidic environments. Not all local anaesthetics come with preservative. Stoeltings Local anaesthetics

[Identical] 18B-023 Intrathecal morphine vs fentanyl:A. 12hr peak resp depression for fentanylB. morphine-induced delayed resp depression with morphine peaks at 18-14 hrsC. fewer spinal segments blocked with morphineD. morphine doses 10x that of fentanylE. fentanyl lasts longer than morphine due to lipid solubility

Answer: D - Morphine given in 10x the concentration of fentanylA: Morphine causes respiratory depression 6-12 hours post administration, fentanyl doesn't last that longB: Morphine causes respiratory depression 6-12 hours post administrationC: Morphine has a higher segmental block than fentanylD: Mophine given as 100-150mcg vs fentanyl 10-15mcgE: Duration of action is longer with morphine than fentanyl (morphine remains in the CSF)Stoelting's Opioid agonists and antagonists

[Identical] 15B-001 Axillary nerve block. On incision patient complains of pain at antero-lateral aspect of forearm. What nerve has been missed?A. MedianB. UlnarC. AxillaryD. MusculocutaneousE. Radial

Answer: D - Musculocutaneous nerveA: Median n. only to the palm of hand and tips of fingersB: Ulna n. only to lateral hand, little finger and half ring fingerC: Axillary n. only to bottom part of deltoidD: Musculocutaneous n. to radial aspect of forearmE: Radial n. to lateral upper arm and posterior forearmAnatomy for Anaesthetists - Brachial plexus

[Identical] 17A-054 Prostaglandins and COX2 inhibitors: choose incorrectA. Decrease GIT symptomsB. No effect on platelet functionC. Safe in asthmaD. No effect on renal functionE. Increased cardiovascular side effects

Answer: D - No effect on renal functionA: COX 2 inhibitors have less GIT effects than COX 1 inhibitorsB: There is no COX2 in plateletsC: COX 2 inhibitors may reduce the risk of aspirin exacerbated respiratory disease, although they are not "safe" in asthmaD: COX 1 and COX 2 inhibitors will impact renal functionE: Valdecoxib cause 4x increase incidence of myocardial infarctionStoelting's Peripherally acting analgesics

[Identical] 18B-119 Regarding volatiles:A. Same concentration is needed for amnesia and hypnosisB. Same concentration needed for amnesia and immobilityC. Mechanism of action due to disolving in lipid layersD. Immobility mediated at supraspinal levelsE. None of the above

Answer: D - None of the aboveA: Volatile anaesthetics have a dose dependent response for amnesia and hypnosisB: Volatile anaesthetics have a dose dependent response for amnesia and immobilityC: Previous believed MOAD: Immobility is mediated at the spinal levelE: None of the above are trueMiller's inhaled anaesthetics: mechanisms of action

[Identical] 15A-064 Peripheral chemoreceptors A. Respond to decreased O2 saturation B. Respond to increased arterial pH C. Respond to decreased arterial CO2 tension D. Nonlinear increase with arterial oxygen tension E. Slow response to changes in arterial carbon dioxide tension

Answer: D - Nonlinear increase with arterial oxygen tension A: Respond to decreased paO2 (not saturation) B: Respond to decreased pH C: Respond to increased paCO2 D: Exponential increase below paO2 60mmHg E: Fast response to changes in paO2, pH and paCO2 Nunn's p66 Nunn's p66 Peripheral chemoreceptors

[Identical] 15B-126 Phenytoin:A. Low protein bindingB. Increases Sodium ConductanceC. Can not be used as an antiarrhythmicD. Nystagmus sign of toxicityE. All of the above

Answer: D - Nystagmus is a sign of toxicityA: Phenytoin is highly protein bound 90-93% B: Phenytoin reduces the influx of sodium into neuronsC: Can has been used in the treatment of cardiac arrhythmiasD: Nystagmus is the most common clinical sign of toxicityE: See DProduct information sheet

[Identical] 18B-042 Ventricular myocyte diagram A. Phase 4 matches Q wave on ECG B. Phase 3 due to calcium efflux C. Phase 3 due to inward potassium flow D. Phase 3 corresponds to the T wave E. Phase 0 is due to outward Na flux

Answer: D - Phase 3 corresponds to the T wave A: Phase 4 corresponds to the isoelectric period between end of T wave and the beginning of the QRS B: Phase 3 is due to closure of Ca ch and continued outwards K+ flow C: Phase 3 is due to closure of Ca ch and continued outwards K+ flow D: Phase 3 corresponds to the T wave E: Phase 0 is due to inward Na flux Power and Kam

[Identical] 18B-077 Which of the following is not a catecholamine? A. Adrenaline B. Noradrenaline C. Dobutamine D. phenylephrine E. isoprenaline

Answer: D - Phenylephrine is not a catecholamineNaturally occurring catecholamine - Adrenaline, NAd, Dopamine, Isoprenaline Naturally occurring catecholamine with significant beta activity (large group on terminal amine) - Isoprenaline Synthetic catecholamine - Dobutamine Synthetic non-catecholamine - Phenylephrine, EphedrineSteolting Sympathomimetic drugs

[Identical] 15B-139 What one of these is NOT a catecholamine: A. Isoprenaline B. Dobutamine C. Dopamine D. Phenylephrine E. Noradrenaline

Answer: D - PhenylephrineSynthetic non-catecholamine - Phenylephrine, EphedrineNaturally occurring catecholamine - Adrenaline, NAd, Dopamine, IsoprenalineNaturally occurring catecholamine with significant beta activity (large group on terminal amine) - IsoprenalineSynthetic catecholamine - DobutamineHemmings and Egan Vasopressors and InotropesStoeltings Sympathomimetic drugs

[Identical] 14A-119 Seizures after BupivicaineA. ProlongedB. Treated with lignocaineC. Treated with phenytoinD. Preceded by drowsinessE. Associated with hyperventilation

Answer: D - Preceded by drowsinessA - Seizures will vary in length. Increased dose of LA -> CNS depression.B - It is not recommended to treat bupivacaine-induced ventricular arrhythmias with lidocaine or amiodarone. MillersC - Treat LAST with benzodiazepines and lipid emulsionsD - Lidocaine and other amide local anesthetics may cause drowsiness before the onset of seizures StoeltingE - Seizures are classically followed by CNS depression, which may be accompanied by hypotension and apnea. StoeltingStoelting Local anaestheticsMiller's Local anaesthetics

[Identical] 14B-074 Which statement is true regarding the following beta-blockers:A. Esmolol and carvedilol are B1 selectiveB. Sotalol and metoprolol are class III anti-arrhythmicC. Esmolol and metoprolol have membrane stabilising propertiesD. Propranolol and metoprolol have half-lives of 4-6 hoursE. Carvedilol and atenolol have intrinsic sympathomimetic activity

Answer: D - Propranolol and metoprolol have half-lives of 4-6 hoursBeta1 selective (amino-oxypropanol) Atenolol, Bisoprolol, Esmolol, Metoprolol Beta1 + 2 (Hydroxyaminoethyl) Prolpranolol, Sotolol Beta and alpha Carvedilol, Labetalol Membrane stabilising properties Carvedilol, Propranolol Intrinsic sympathomimetic activity Acebutolol, Prctolol, Oxprenolol, Alprenolol, Pindolol Labetalol (some at B2) Low oral bioavailability Atenolol + Sotalol (more polar) Hemmings and Egan Table 14.4 b-adrenergic blocking drugs "Autonomic Nervous system pharmacology"

[Identical] 18B-007 Systemic toxicity of local anaesthetics:A. Less likely with bupivacaineB. Seizures will occure at lignocaine plasma concentrations of 5ug/mLC. Less likely to occur in hypoalbuminaemiaD. Rarely will CVS effects occur before CNS effectsE. Symptomatic bradycardia will be followed by ventricular fibrillation

Answer: D - Rarely will CVS effects occur before CNS effectsA - Bupivacaine is most likely to cause toxicityB - Siezures with lignocaine occur >10ug/mLC - More likely with lower plasma proteins (more unbound drug)D - CNS symptoms usually preceed CVS symptomsE - Common arrhythmias are prolonged PR -> PVCs -> Heart block, Ventricular tachycardias.Stoeltings Local anaesthetics

[Identical] 15A-060 Which respiratory parameter cannot be obtained using spirometry? A. Tidal volume B. Vital capacity C. Inspiratory capacity D. Residual volume E. Expiratory reserve capacity

Answer: D - Residual volumeResidual volume, TLC and FRC cannot be obtained with spirometry West's 9th Ed p14 - Ventilation

[Identical] 14A-012 During normal inspiration A. Increased CVP B. Increased RAP C. Increased Intrathoracic Pressure D. SVC blood flow doubles E. Decreased pulmonary vascular resistance

Answer: D - SVC blood flow doubles A: Central venous pressure is reduced during inspiration, increasing the pressure gradient between extrathoracic and intrathoracic veins. B: During normal inspiration RAP decreases due to reduced extramural forces C: During normal inspiration Intrathoracic pressure decreases (negative pressure inspiration) D: During normal inspiration flow in the SVC increases from 5.2-11 mL/s E: Increasing lung volume -> increasing pulmonary vascular resistance (alveolar vessel compression) Pappano and Wier - Contrl of Cardiac Output: Coupling of Heart and Blood vessels

[Identical] 19B-074 During normal inspiration A. Increased CVP B. Increased RAP C. Increased Intrathoracic Pressure D. SVC blood flow doubles E. Decreased pulmonary vascular resistance

Answer: D - SVC blood flow doubles A: Central venous pressure is reduced during inspiration, increasing the pressure gradient between extrathoracic and intrathoracic veins. B: During normal inspiration RAP decreases due to reduced extramural forces C: During normal inspiration Intrathoracic pressure decreases (negative pressure inspiration) D: During normal inspiration flow in the SVC increases from 5.2-11 mL/s E: Increasing lung volume -> increasing pulmonary vascular resistance (alveolar vessel compression) Pappano and Wier - Control of Cardiac Output: Coupling of Heart and Blood vessels

[Identical] 17A-009 Zero order kineticsA. Same proportion removed per unit timeB. Half life is independent of doseC. Cant measure clearanceD. Same amount removed per unit timeE. Is an exponential process

Answer: D - Same amount removed per unit timeA: Zero order kinetics = an increasing proportion of drug is removed per unit time B: Half life is not fixed and is dependent on dose and plasma concentration.C: Clearance is decreased with zero order kinetics and it is not possible to measure D: The amount of drug removed per unit time is constant in zero order kinetics E: Is a linear process Rang andDales Pharmacology - PharmacokineticsGoodmann and Gilman's - Pharmacokinetics: The dynamics of drug absorption, distribution, metabolism, and elimination

[Identical] 15B-083 Which of the following is MOST likely to cause anti-cholinergic syndrome?A. GlycopyrrolateB. MetoclopramideC. AtropineD. ScopolamineE. Muscarine

Answer: D - ScopolamineA: Glycopyrolate does not cross the blood brain barrierB: Metoclopramide can cause tardive dyskinesiaC: Atropine is less likely to cause central anti-cholinergic syndrome than scopolamineD: Scopolamine and to a lesser extent atropine produces symptoms characterised as the central anticholinergic sydnromeE: Muscarine Muscarine is a nonselective agonist of the muscarinic acetylcholine receptors. Stoelting's Intravenous sedatives and hypnoticsHemmings and Egan Autonomic Nervous system pharmacology

[Identical] 18B-011 Ropivacaine:A. Pure R-isomerB. Isomer of bupivacaineC. More cardiotoxic than bupivacaineD. Similar physicochemical properties to bupivacaineE. Causes more motor blockade than bupivacaine

Answer: D - Similar physicochemical properties to bupivacaineA: Ropivacaine is presented as a pure S enantiomerB: Not an isomer of bupivacaineC: Bupivacaine has a higher risk of cardiac and central nervous system toxicity than RopivacaineD: Bupivacaine has a butyl group (C5H9) Ropivavaine has a Propyl group (C3H7). They have similar physico-chemical propertiesE: Motor blockade is less intense and of shorter duration than BupivacaineStoeltings Local anaestheticDrug information sheets

[Identical] 18B-072 Amiodarone:A. treatment for Torsades de PointesB. mainly renally excretedC. alpha agonist effectsD. Similar to thyroxineE. shortens the QTc

Answer: D - Similar to thyroxineA: Can precipitate TDPB: Mainly hepatic and biliary excretionC: Noncompetitive alpha and beta adrenergic inhibitionD: Structurally similar to thyroxineE: Polongs the QTcProduct information sheet

[Identical] 17A-011 What is the PR interval A. Start of the P wave to start of R wave B. End of the P wave to the start of R wave C. Start of P wave to the end of QRS complex D. Start of P wave to start of QRS complex E. Normal value < 120ms

Answer: D - Start of the P wave to the start of the QRS complexD: PR interval represents the time between the onset of atrial depolarization and the onset of ventricular depolarization.Onset of P wave to onset of QRS complex 120-200ms. Power and Kam

[Identical] 15A-085 Regarding adverse/side effects of ClonidineA. Hypotensive side effect is exacerbated by tricyclic antidepressants (TCAs)B. TachycardiaC. Excess salivationD. Sudden cessation causes hypertensive crisisE. Increase MAC

Answer: D - Sudden cessation causes hypertensive crisisA: TCAs interfere with the action of clonidineB: Clonidine causes bradycardiaC: Clonidine causes decreased salivationD: Sudden cessation causes hypertensive crisisE: Clonidine and dexmedetomidine decrease anaesthetic requirementsMiller's - Anaesthetic implications of concurrent diseases (Antihypertnsive drugs)

[Identical] 14A-142 A substance above critical temperature: A. Exists as a solid liquid and gas B. Exists as a liquid and gas C. Exists as a liquid and vapour D. The latent heat of vapourisation will be zero E. Pressure does not relate to volume

Answer: D - The latent heat of vapourisation will be zeroCritical temperature - The temperature above which a substance cannot be liquified no matter how much pressure is applied. A: Will only exist as a gasB: Will only exist as a gasC: Will only exist as a gasD: It is not possible for the gas to become a liquid. Only one phase exists Thus the latent heat of vaporisation will be zero. E: Pressure will still relate to volume. Boyles law at a constant temperature a given mass of a gas is inversely proportional to its pressure. Pressure can still be applied above the critical temperature. Reference (Wiki), Critical temperature is the temperature above which a substance cannot be liquefied no matter how much pressure is applied. The critical temperatures for nitrous oxide and oxygen are 36.5°C and − 118°C, respectively.Reason: Critical temperature - the temperature above which a substance CANNOT be liquefied, no matter how much pressure is applied. Is all a gas. Therefore no vaporisation =? No latent heat of vaporisation- Latent heat of vaporization is the thermal energy is that is used by a substance to change from the liquid to the gaseous phase, without resulting in any change in its temperature.

[Identical] 14A-149 The SVC is formed by the formation of: A. The R brachiocephalic and L subclavian veinsB. The R brachiocephalic and L internal jugular veinC. The L brachiocephalic and azygos vein D. The R brachiocephalic and L brachiocephalic veinsE. The R brachiocephalic and the L common carrotid

Answer: D - The right brachiocephalic and left brachiocephalic veinsVenous drainage is the same bilaterally- Internal Jugular and the Subclavian join to form Brachiocephalic veins- Bilateral brachiocephalic veins into the SVCArterial supply variesLeft- Left Carotid + Left SubclavianRight- Right brachiocephalic artery - Splits into the right Carotid and Subclavian arteriesAnatomy for Anaesthetists - The Great vessels of the neck

[Identical] 18B-131 Respiratory changes in aging include: A. Decreased lung compliance B. Increased PaCO2 C. Decreased closing capacity D. Wider scatter of V/Q ratios E. Decreased FRC

Answer: D - Wider scatter of V/Q ratios A: Compliance increases with age B: paCO2 does not change with agepaO2 decreases with age in anaesthesia due to increasing closing capacity and increasing shunt C: Closing capacity increases with age D: V/Q scatter increases with age E: FRC increases with age Nunn's 8th Ed - p121, 147, 27, 25, 307

[Identical] 18B-005 Specific heat capacity:A. total thermal energy of a substanceB. Is a poor conductorC. Is a poor insulator D. amount of energy to heat substance by 1 Kelvin/kgE. Can be used as a heat sink

Answer: D - amount of energy to heat substance by 1 Kelvin/kgA: A substance with a high heat capacity will have a low thermal energy for its temperature. B: Conductivity is the ability of a substance to transmit heat energy, often used as heat sinksMetals are good conductors (after they're heat capacity has been filled)C: A substance with a high heat capacity will store heat energy, within a range they are good insulators, outside that range they are good conductorsD: Heat capacity - the amount of energy (joules) required to increase the temperature of an object by 1degree. E: A heat sink is a conductor of heat energy away from one substance towards anotherReference??

[Identical] 16A-122 Plasma cholinesterase/ pseudocholinesteraseA. patients with Ea:Eu have a dibucaine number of 80B. Is increased in neonate compared to adultC. increases in concentration in third trimester pregnancyD. metabolises mivacuriumE. metabolises lignocaine

Answer: D - metabolises mivacuriumA: Ea:Eu have a dibucaine number of 50-60B: Dibucaine number is normal in neonates (quantity of plasmacholinesterase may be lower)C: Concentration of plasmacholinesterase decreases in pregnancyD: Metabolises mivacuriumE: Lignocaine metabolised in the liverMiller's Pharmacology of neuromuscular blockers

[Identical] 18A-018 Suggamadex choose correctA. no allergyB. >affinity for Pancuronium vs vecuroniumC. light reversal use 4mgD. no dose adjustment in mild / mod renal impairmentE. does not bind fluclox

Answer: D - no dose adjustment in mild/mod renal impairmentA: Anaphylaxis is noted as a possible warningB: Affinity for Rocuronium > Vecuronium > PancuroniumC: 4mg/kg for PTC 1-9 and TOF 0D: No dose adjustment for mild/moderate renal impairement. Not recommended in severe renal impairment. E: High doses of flucloxacillin may cause some displacement of rocuronium from sugammadexProduct information sheet

[Identical] 18B-040 Atropine and glycopyrrolate:A. quaternary aminesB. both cause significant CNS side effectsC. naturally occurringD. comes from belladonnaE. None of the above

Answer: D - none of the aboveatropine = naturally occurring (from belladonna) tertiary amineglyco = synthetic Quaternary amine thus CNS penetrationProduct information sheets

[Identical] 14B-122 Post-tetanic facilitation:A. is used to assess residual paralysisB. 50Hz stimulation followed by 2Hz twitchesC. can be used every 2 minutesD. used to assess a deep level of neuromuscular blockadeE. 20Hz stimulation followed by 5Hz twitches

Answer: D - used to assess a deep level of neuromuscular blockadeA: Residual paralysis is measured with TOF ratio after reversal agent is givenB: PTC = 50Hz for 5 seconds followed by 1Hz x 20 starting 3 seconds after the end of tetanic stimulationC: Should not be performed more often than every 6 minutesD: Used to evaluate blockade that does not respond to TOFE: PTC = 50Hz for 5 seconds followed by 1Hz x 20 starting 3 seconds after the end of tetanic stimulationMiller's Neuromuscular Monitoring

[Identical] 15A-058 Severe hypercapnia is most likely to be associated with A. Increased MAP B. Increased urine output C. Increased myocardial contractility D. Increased catecholamines E. Hypokalaemia

Answer: D Increased catecholaminesA: Elevated PaCO2 may cause a small increase in blood pressure, however the response is variableB: SNS flow -> decreased urine outputC: CO2 -> causes constriction of the gloerular afferent arterioles, leading to anuriaD: Hypercapnia increases SNS outflowE: The acidosis that accompanies hypercapnia causes leakage of potassium ions from the cells into the plasmaOther effects of hypercapniaQT prolongationSmall increase in BPConstriction of glomerular afferent arterioles + inc resorption of HCO3Acidosis - hyperkalemia -> hyperexcitability of nervesInc CBFPulm vasoconstrictionNarcosisNunn's p322 Changes in the carbon dioxide partial pressure

[Identical] 14B-092 2 opioids X and Y in graph: 2 Sigmoid curves with: x axis plasma conc in mcg/L / y axis % effect. What is the relative potency of Y compared to X?A. 2xB. 4xC. 0.5xD. 0.125xE. 1x

Answer: D. 8x more drug Y is needed for the same effect as drug X.Drug Y is 0.125x as potent as drug X

[Identical] 17A-052 Drugs that increase LOS tone A. N2OB. Sodium citrateC. RanitidineD. MetoclopramideE. Ketamine

Answer: DA - Side effect of nitrous oxide - nausea and vomiting (requires antiemetics)B - Sodium citrate - particulate antacid. Nil effect on LOS tone C - Ranitidine - non particulate antacid. Nil effect on LOS tone. D - Metoclopramide - Stimulates gastric motility without stimulating gastric, pancreatic or biliary secretions. It also increases LOS toneE - Ketamine - All the anaesthetic induction agents decreased the tone of the lower oesophageal sphincter but the reduction was least with ketamine.Product information sheets

[Identical] 14A-049 Regarding control of Renal blood flow A. Is predominantly SNS to the kidney B. Is predominately PNS to the kidney C. PNS from the Vagus via the hypogastric nerve D. Noradrenaline acts on the JG and tubular cells E. Autoregulation between 40 - 140mmHg

Answer: DA: Renal blood flow is controled by many factors, not only SNSB: There is minimal, if any PNS supply to the kidneysC: There is minimal, if any PNS supply to the kidneysD: Stimulation of the renal nerves increases renin secretion by a direct action of released norepinephrine on β1-adrenergic receptors on the juxtaglomerular cells and it increases Na+ reabsorption, probably by a direct action of norepinephrine on renal tubular cells.E: Autoregulation between 80-170mmHgGanong's Review of medical physiology - 26ed ch37 Renal Function and Micturition

[Identical] 18B-071 PhenytoinA. Enhances sodium conductivityB. Minimally protein boundC. Predictable bioavailabilityD. Nystagmus is a sign of toxicityE. Is effective for absence seizures

Answer: DA: Stabilises Na channels in inactive state - inhibits further APsB: Highly protein bound, unreliable plasma levelsC: Highly protein bound, unreliable plasma levelsD: Nystagmus is the most common sign of toxicityE: Is ineffective for absence seizures and may increase frequency of these seizuresProduct information sheet

[Identical] 16A-104 Volatiles anaesthetics act at which anatomic site?A. HippocampusB. ThalamusC. Spinal Motor NeuronesD. Cerebral CortexE. All of the above

Answer: E - All of the aboveA: Amnesia probably involves the hippocampus, amygdala, mediotemporal lobe and other cortical structuresB: Suppression of consciousness is caused by action in the thalamusC: The immobilising effect of inhaled anaesthetics involves actions in the spinal cord. D: Amnesia probably involves the hippocampus, amygdala, mediotemporal lobe and other cortical structuresE: All of the above are trueMiller's Inhaled Anesthetics: Mechanisms of Action

[Identical] 18B-075 von Willbrand FactorA. Binds collagen via glycoprotein IbB. Production stimulated by desmopressinC. Synthesised in megakaryocytes and vascular endotheliumD. Prolongs half life of VIIIE. All of the above

Answer: DA: vWF - binds to Gp Ib on plateletsB: Production of vWF is promoted by desmopressinC: vWF is released from platelets and vascular endothelium. Platelets are derived from megakaryocytes.D: Under normal conditions, vWF plays a critical role in platelet adhesion to the ECM and prevents degradation of factor VIII by serving as a carrier molecule.E: See abovePower and Kam - Physiology of bloodMiller's - Patient blood management: coagulation, Like haemophilia A, DDAVP can be used to boost the body's own factor VIII and vWF production, and is commonly used prior to surgery or dental extractionChambersDDAVP is the V2 analog of arginine vasopressin that stimulates the release of ultra large vWF multimers from endothelial cells.vWF mediates platelet adherence to vascular subendothelium by functioning as a protein bridge between glycoprotein Ib receptors on platelets and subendothelial vascular basement membrane proteins. DDAVP shortens the bleeding time of patients with mild forms of hemophilia A or von Willebrand's disease (VWD).DDAVP can treat VWD (mild type 1 and 3)DDAVP should be administered by slow intravenous infusion to avoid hypotension because it stimulates endothelial cells releasing vasoactive mediators in addition to vWF.vWF binds FVIII and increases half life

[Identical] 19B-052 CSL contains mmol/La. Na 140b. Ca 5c. Mg 2d. K 5e. Cl 120

Answer: DCSLNa 129K 4Cl 109lactate 29Ca 2Miller's Perioperative fluid and electrolyte therapyProduct information sheet

[Identical] 15A-142 The following are complications of oxygen therapy EXCEPT: A. CO2 narcosisB. Seizures with partial pressures administered over 1000 mmHgC. Haemorrhagic pulmonary interstitial oedema D. Retrolental hypoplasia E. Absorption atelectasis

Answer: DReason: A: CO2 narcosis - this could occur with a variable performance device - facemask even a so-called non-rebreather if the flow is lower than the minute ventilation --> at risk population COPD patients.B. Seizures occur at PAO2 >1.6bar ~1200mmHg (close enough to 1000mmHg?)C. Occurs in neonates with oxygen toxicityD. O2 therapy causes Retrolental Fibroplasia in newborns (not hypoplasia)E. True

[Identical] 18B-056 10 ml of 2% lignocaine with adrenaline 1: 200 000 contains:A. 20mg lignocaine + 25 microg adrenalineB. 200mg lignocaine + 200 microg adrenalineC. 20mg lignocaine + 50 microg adrenalineD. 200mg lignocaine + 25 microg adrenalineE. 200mg lignocaine + 50 microg adrenaline

Answer: E - 200mg lignocaine + 50 microg adrenaline10mL x 2% Lignocaine =10mL x 20mg/mL = 200mg10mL x 1:200,000 Adrenaline = 10mL x 5mcg/mL = 50mcg

[Identical] 14B-003 The H+ production by body metabolism that has to be excreted by the kidney to prevent acidosis is?A. 32nmolB. 32mmol C. 0.68mmolD. 6.8mmol E. 68mmol

Answer: E - 68mmol20 to 70 mEq of hydrogen ion-promoting anions are excreted daily thru the kidney.68mmol of H+ produced daily1mmol = 1mEqMiller's 9th Ed - Perioperative acid-base balance

[Identical] 18A-041 Question about Mast CellsA. Activated by plasma IgEB. Activated by a single IgEC. Activated by histamineD. Activated by complement 2 / 3 / 4E. Activated by IgE on mast cells

Answer: E - Activated by IgE on mast cellsA: IgE on the surface of the sensitized mast cells triggers mast cell degranulationB: Cross linking of 2 IgE is required to trigger mast cell degranulationC: Histamine is released from mast cellsD: Compliment 3a, C4a and C5a can activate mast cellsE: IgE on the surface of the sensitized mast cells triggers mast cell degranulationPower and Kam - Physiology of the immune system

[Identical] 15A-017 Peripheral chemoreceptors respond to: A. pH B. pO2 C. pCO2 D. Reduced perfusion E. All of the above

Answer: E - All of the above All of these Nunn's p66 Peripheral chemoreceptors: - Carotid bodies respond to pH, paCO2, paO2 - Aortic bodies respond to paCO2, paO2

[Identical] 18A-017 Severe hepatic impairment no dose adjustment needed for:A. cis atricuriumB. suxamethoniumC. rocuroniumD. EsmololE. All of the above

Answer: E - All of the aboveA - Cisatracurium - 2/3 ester hydrolysis by non specific tissue and plasma esterases, 1/3 Hoffmann elimination. Non specific tissue and plasma esterases have little inter-individual variability amongst individuals, except in severe liver disease when production is decreased.B - Sux - metabolised by plasma and liver cholinesterases, therefore reduced metab in severe liver dsease. But initial dose required does not change. Duration of action may be prolonged.C - Rocuronium - very minimal metabolism, majority excreted unchanged in bile (70%) > urine. But initial dose required does not change. Duration of action may be prolongedD - Esmolol - metabolised by the esterases in the cytosol of erythrocytes. No dose adjustment in hepatic diseaseProduct information sheets

[Identical] 16A-050 Regarding the loop of Henle in the kidney:A. Tubular fluid is hypotonic to plasma at the top of the ascending limbB. Chloride is actively reabsorbed in the ascending loop of HenleC. The descending limb of the loop of Henle is permeable to waterD. At the end of the loop of Henle 25% of the filtered water remainsE. All of the above

Answer: E - All of the aboveA: "The net of the loop as a whole is reabsorption of more salt than water. The ascending limb is called a diluting segment, because the fluid leaving the loop to enter the distal convoluted tubule is hypo-osmotic (more dilute) compared with plasma."B: Sodium, potassium and chloride are actively reabsorbed from the ascending thick limb by a co-transport mechanism. C: The descending limb of the loop of Henle is permeable to waterD: At the end of the loop of Henle 25% of the filtered water remainsPower and Kam 3rd edition - Loop of Henle and production of concentrated urineVander's 7th edition p87 Henle's Loop- In the ascending limb of Henle, passive chloride reabsorption occurs (due to favourable osmotic gradient produced by the water reabsorption in the descending limb). The thin ascending limb cells express chloride channels in both luminal and basolateral membranes through which passive chloride reabsorption occurs. However, in the thick ascending limb, active processes again become dominant. Vander

[Identical] 19B-018 Therapeutic indexa.Broad index = curves don't overlapb.Derived from quantal dose-response curvec.LD50 is the numeratord.Based on the median dose for those expressing a responsee.All of the above

Answer: E - All of the aboveA: A broad index means the curves have less overlap (although they will overlap at 0 and 100%)B, C, D: It is derived from the 'quantal dose-response curve' as the ratio of the median lethal dose (LD50) to the median effective dose (ED50):TI = LD50 / ED50 Stoeltings Basic principles of pharmacology Millers Basic principles of pharmacology

[Identical] 18B-035 Gentamicin:A. Concentration dependent killingB. Cmax/MIC best predicts killingC. Causes muscle weaknessD. Toxicity is worsened with furosemideE. All of the above

Answer: E - All of the aboveA: Gentamicin exhibits concentration killingB: Cmax/MIC best predicts killing (concentration dependent killing)C: Gentamicin can cause muscle weakness and prolong NMBD: Toxicity is worsened with furosemideE: All of the above are trueKatzung Antibiotics (best book for antibiotics) Stoelting's Antimicrobials, Antiseptics, Disinfectants, and Management of Perioperative Infection

[Identical] 18B-016 Frusemide:A. Inhibits Na/K/ClB. VasodilationC. OtotoxicityD. Decreased medullary concentrationE. All of the above

Answer: E - All of the aboveA: Inhibits NaK2Cl transport proteins in thick ascending limb of the loop of Henle B: Loop diuretics induce renal synthesis of vasodilatory prostaglandinsC: Ototoxicity, either transient or permanent, is a rare, dose-dependent complication associated with the use of loop diuretics.D: Loop diuretics reduce the medullary concentration gradient, preventing H2O reabsorptionE: All of the aboveStoelting's Diuretics

[Identical] 18B-081 Following 6 hours of fasting:A. Osmoreceptors will cause an increase in release of ADHB. Osmoreceptors will cause thirstC. Increased renin releaseD. Increased reabsorption of fluid in peritubular capillariesE. All of the above

Answer: E - All of the aboveA: Osmoreceptors cause an increased release in ADHB: Hypothalamic osmoreceptors will increase the sensation of thirstC: Renin release will increase in response to decreased intravascular blood volumeD: ADH secretion will increase the reabsorption of fluid into the peritubular capillariesE: See abovePower and Kam, ,

[Identical] 16A-097 Regarding transdermal drug deliveryA. Useful for drugs with high first pass metabolismB. Dependant on molecular weight of the drugC. Dependant on lipid solubility of the drugD. Dependant on keratin and drug hydro/lipophiliaE. All of the above

Answer: E - All of the aboveDependent of Fick's Law of diffusionJ = Diffusion coefficient * (C1-C2) * Surface area / ThicknessDiffusion coefficient depends on- Molecular weight- Solubility of the agent in the barrierStoeltings Basic principles of pharmacology

[Identical] 14A-125 Side effects of suxamethonium:A. Hypotension is secondary to histamine releaseB. BradycardiaC. HypertensionD. TachycardiaE. All of the above

Answer: E - All of the aboveSide effects of SuxBradycardia, arrhythmiasAnaphylaxisMasseter spasmMyalgiasMHInc intragastric, intraocular, intracranial pressuresTransient inc in KSux apnoeaInc salivation + gastric secretionsStoeltings

[Identical] 17A-017 Pulse oximetry A. Affected by skin colourB. Bilirubin artefactually reduces SpO2C. Anaemia causes spurious reduction in SpO2D. Carbon monoxide poisoning -> SpO2 approaching 85%E. Artefactually low SpO2 in severe tricuspid regurgitation

Answer: E - Artefactually low SpO2 in severe tricuspid regurgitationA: Skin colours don't alter the SpO2 due to the Lambert Law accommodating for non pulsatile absorption B: Bilirubin has no effect on oximetryC: Anaemia - at low saturations poorer accuracy but not a lower SpO2D: CarboxyHb - similar spectral absorption to Hb. Gives falsely high readings. (MetHb approximates 85%)E: Venous congestion in TR may give falsely low readings. Al Shaikh Non-invasive monitoring

[Identical] 14A-063 Most CO2 in the blood is carried: A. Dissolved in plasma B. As carbamino compounds in RBCs C. As carbamino compounds in plasma D. As HCO3 in RBCs E. As HCO3 in plasma

Answer: E - As HCO3 in plasma Carriage of CO2 Carbamino - 5%HCO3- - 90%Dissolved - 5%The AV difference is mostly HCO3-Carbamino - 30%HCO3- - 60%Dissolved - 10%Bicarbonate is formed inside the red cell (due presence of carbonic anhydrase) but then exchanges for Cl- across the cell membrane to enter the plasma. West 9th Ed p83

[Identical] 15A-059 In which form is the majority of CO2 carried in blood? A. Carbamino groups bound to proteins B. Carbamino groups bound to haemoglobin C. Dissolved in plasma D. Bicarbonate in red blood cells E. Bicarbonate in plasma

Answer: E - Bicarbonate in plasmaCarriage of CO2Carbamino - 5%HCO3- - 90%Dissolved - 5%The AV difference is mostly HCO3-Carbamino - 30%HCO3- - 60%Dissolved - 10%Bicarbonate is formed inside the red cell (due presence of carbonic anhydrase) but then exchanges for Cl- across the cell membrane to enter the plasma. West 9th Ed p83

[Identical] 18B-134 According the Stewart approach which of the following is not a strong ion?A. MgB. CaC. ClD. lactateE. bicarbonate

Answer: E - BicarbonateHCO3 is the dependent variable in the Stewart approachStrong ion difference, total [ ] weac acids, pCO2 in solution- Strong cations include Na+, K+, Mg2+ and Ca2+- Strong anions include Cl-, lactate and ketone bodiesStrong ions are defined by being completely dissociated. pKa is when 50% is dissociated. They can be anions or cations.Miller's Perioperative acid base balance

[Identical] 15B-021 Lowest intracellular concentrationA. NaB. HCO3C. ClD. MgE. Ca

Answer: E - CalciumIntracellular concentrationsNa+ 10 mmol/LHCO3- 7 mmol/LCl- 10 mmol/LMg2+ 20 mmol/LCa2+ 0.5 mmol/LMiller's Perioperative fluid and electrolyte therapy

[Identical] 19B-048 Nitrous oxide causesA. Cardiac morbidityB. Peripheral vasodilationC. Decreased homocysteineD. Increased methionineE: Can cause megaloblastic bone marrow changes

Answer: E - Can cause megaloblastic bone marrow changesA: N2O has no increased risk of cardiac morbidity (ENIGMA II)B: In contrast to volatile anesthetics, nitrous oxide may produce constriction of cutaneous blood vesselsC: N2O causes an increase in blood homocysteineD: Inhibition of methionine synthase causes an decrease in methionineE: N2O can cause megaloblastic bone marrow changesMiller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity Stoelting's Inhaled anaesthetics

[Identical] 16A-54 With regard to renal oxygen consumptionA. Kidney has the highest AV difference of any organB. Has a higher oxygen extraction ratio than myocardiumC. Is greater in the cortex than the medullaD. Can be measured using inulinE. Directly proportional to active sodium reabsorption

Answer: E - Directly proportional to active sodium reabsorptionA: AV difference is 1/5mL/dL (very low)B: Myocardium has the highest AV difference (114mL/L) Renal AV difference (14mL/L)C: The medulla performs most of the metabolic work of the kidney and has the greater oxygen consumptionD: Renal clearance can be measured with inulin (not oxygen consumption). Renal plasma flow can be measured with p-aminohippuric acidE: Oxygen consumption is directly proportional to sodium reabsorptionGuyton and Hall 14th ed - Glomerular filtration, renal blood flow, and their controlGanong's Review of Medical Physiology, 26ed - Renal function and micturition

[Identical] 18B-076 Metabolic rate changes minimally withA. Skeletal muscle activityB. Increased T3/T4C. Cold environmentD. Hot environmentE. Cerebral metabolic activity

Answer: E - Cerebral metabolic activityA: The resting metabolic rate of skeletal muscle is 1.5-2 mL O2 per minute per kilogram. During maximal muscle exercise, the skeletal muscle metabolic rate can exceed 150 mL O2 per minute per kilogram.B: Excessive amounts of T3 and T4 can increase the basal metabolic rate (BMR) by 60%-100%. T3 is three to five times more active than T4. This increase in BMR (oxygen consumption) is due to stimulation of the cell membrane Na+/K+-ATPase enzyme by thyroid hormones.C + D: Below the critical temperature (27°C), the metabolic rate rises linearly as the temperature decreases. As the ambient temperature rises above the critical tem- perature, the metabolic rate remains constant until an upper limit is reached and the metabolic rate rises again. E: Although the brain comprises only 2% of the body weight, it uses 20% of the total body's resting oxygen consumption. There is an excess of glucose delivered to the brain (At rest, the brain extracts about 10% of the glucose delivered to it.) Thus an increase in CMRO2 will have little effect on the BMRPower and Kam - various

[Identical] 16A-003 ABG shows pH 7.34 / HCO3- 33 / PCO2 64. Most likely scenario:A. Hypoventilation for 5 minutesB. VomitingC. Mountain climber after several weeks of acclimatizationD. Aspirin overdoseE. Chronic pulmonary disease

Answer: E - Chronic pulmonary diseaseA: Hyperventilating causes a respiratory acidosis with minimal metabolic compensationB: Prolonged vomiting causes a metabolic alkalosis with respiratory acidosis compensationC: Altitude causes a Respiratory alkalosis with metabolic compensationD: Aspirin overdose causes various acid base disturbances depending on the phaseE: COPD causes a respiratory acidosis with metabolic compensation

[Identical] 15B-097 Drugs with high hepatic clearance:A. Express Capacity limited metabolismB. Clearance does not change with high hepatic blood flowC. More sensitive to alterations in drug binding D. Will have low first pass metabolism with oral administrationE. Clearance is decreased with low hepatic blood flow

Answer: E - Clearance is decreased with low hepatic blood flowA - Drugs with high hepatic clearance are sensitive to blood flow "Flow limited clearance". Drugs with low hepatic clearance express "Capacity limited clearance)B - Clearance increases with blood flowC - Drugs with high hepatic clearance are less sensitive to alterations in drug bindingD - Drugs with high hepatic clearance will have high first pass metabolismE - Clearance is decreased with decreased hepatic blood flowStoelting Basic Principles of PharmacologyHemmings and Egan Drug Metabolsim and Pharmacogenetics

[Identical] 18B-124 Stored red cells as whole blood:A. HypercalcaemiaB. Metabolic alkalosisC. HypokalaemiaD. Decreased Hb affinity for O2E. Coagulopathy

Answer: E - CoagulopathyNote - Storage of red cells as whole blood = CPDA (citrate, phosphate, dextrose, adenine)Storage of packed red cells = SAGM (Saline, adenine, glucose, manitol)A: Hypocalcaemia - due to citrate toxicityB: Metabolic acidosis - b/c stored blood becomes acidotic (pH 6.5)C: Hyperkalaemia - b/c stored blood has increased plasma K+ (up to 30 mmol/L at 30 days) due to leakage from RBCD: Increased Hb affinity for O2 - b/c stored blood has decreased 2,3-DPG levelsE: Coagulopathy - due to dilutional thrombocytopaenia (which occurs first) and dilution of clotting factorss, and NOT specifically due to Ca2+ reduction from citratePower and Kam - Blood transfusion

[Identical] 17A-030 Minimum safety requirements of anaesthetic machine as per Professional Document PS54 include all of the following exceptA. Minimum battery supply as reserve for >30minsB. A high priority alarm must be activated when the airway pressure falls 10 cm H2O below atmospheric pressure for more than one secondC. The emergency oxygen flush control must be protected from accidental activationD. A fresh gas outlet if provided must be 22 mm outer diameter and 15 mm inner diameterE. Connections for medical gas cylinders / yokes or regulators must be diameter indexed

Answer: E - Connections for medical gas cylinders, yokes or regulators must be diameter indexedA: If the anaesthetic machine requires electrical power for normal operation, a backup power supply must be a part of the machine and permit normal operation for at least 30 minutes after a mains power supply failure. An alarm must be activated at the time of the mains failure and the state of the reserve power supply must be indicated while it is in useB: A high priority alarm must be activated when the airway pressure falls 10 cm H2O below atmospheric pressure for more than one second.C: The emergency oxygen flush control must be protected from accidental activation.D: A fresh gas outlet, if provided, must be 22 mm outer diameter and 15 mm inner diameter, visible to the operator and should be capable of being connected to the breathing system in such a way as to prevent accidental disconnectionE: Connections for medical gas cylinders, yokes or regulators must be pin indexed. ANZCA Statement on the Minimum Safety Requirements for Anaesthetic Machines and Workstations for Clinical Practice - PS54

[Identical] 14B-097 When calculating a loading dose prior to infusion of a drug what factors are NOT considered:A. VdB. Ke0C. Toxicity and side effectsD. Plasma concentrationE. Context sensitive half time

Answer: E - Context sensitive half timeLoading Dose = target plasma concentration x Volume of Distribution (of central compartment V1)Mg = mg/mL x mLLoading dose should take into account effect site, therefore should include Ke0CSHT is not considered in loading doseStoeltings Basic Principles of Pharmacology

[Identical] 17A-023 Effect of anaesthesia on FRCA. Less effect in obese patientsB. Decreases by 24-34%C. Blood pooling in chestD. Caused by a reduced closing capacityE. Decreased in thoracic cross sectional area

Answer: E - Decreased in thoracic cross sectional areaA: FRC is decreased to a greater extent in obese patients under anaesthesiaB: FRC is reduced during anaesthesia with all anaesthetic drugs that have been investigated, by a mean value of about 15% to 20% of the awake FRC in the supine positionC: A shift of blood from the peripheral circulation into the chest during anaesthesia has been postulated. However, this observation has not been confirmedD: The reduction in FRC following the induction of anaesthesia will bring the lung volume close to residual volume. The reduction in FRC is not caused by a change in closing capacityE: Anaesthesia decreases the thoracic cross sectional area.Nunn's 8th Ed Anaesthesia

[Identical] 18B-132 Most sensitive sign to detect opioid-induced ventilatory impairment?A. Decreased peak inspiratory flowB. SpO2C. MiosisD. Respiratory rateE. Sedation score

Answer: E - Sedation scoreANZCA STATEMENT ON OIVISignificant OIVI is almost always accompanied by excessive sedation. Therefore, regular assessment of a patient's level of sedation in all patients receiving any opioid for management of their acute pain, using a sedation score, is a more reliable clinical indicator of early OIVI than a decrease in respiratory rate.

[Identical] 15A-149 ScavengingA. Downstream pressures are limited between -2 and -10 cmH2O B. Tubing is 22mm in diameterC. Must have high- and low-pressure relieving devices on the interfaceD. Decreases the risk of intra-operative fires E. Disposal system can be active or passive

Answer: E - Disposal system can be active or passiveA: Passive system has -0.5 - +5cmH2O relief valves in the collecting system. Other resources say the scavenging interface limits downstream pressures from -0.5 - +10cmH2O B: Collecting system is 30mm in diameter to prevent it from being cross connected with the breathing systemC: A well-designed scavenging system should consist of ... a method for limiting both positive and negative pressure variations in the breathing system.D: Reducting of fire risk not specifically stated in texts E: Disposal system is either passive or activeAl-Shaikh - Pollution in theatre and scavengingMiller's - Inhaled anaesthetics: Delivery systems

[Identical] 16A-078 Sodium Nitroprusside is an unstable compound which undergoes degradation under which conditions:A. Exposure to highly acidic plasmaB. Exposure to highly alkaline solutionsC. Exposure to plastic syringesD. Admixture with dextroseE. Exposure to sunlight

Answer: E - Exposure to sunlightSNP breaks down in sunlightProduct information sheet

[Identical] 14A-019 ECG changes with digoxin toxicity:A. Shortened PRB. Prolonged QRSC. ST depressionD. Prolonged QT E. Heart block

Answer: E - Heart BlockA: Digoxin will prolong PR intervalB: Digoxin has little effect on QRSC: ST depression occurs at therapeutic levels of digoxinD: QTc is shortened in therapeutic levels of digoxinE: Heart block may occur with toxic doses of digoxin Stoelting Ch18 -> Cardiac glycosides

[Identical] 18B-111 When imaging superficial structures: ultrasound A. Low frequency to improve penetrationB. Low frequency to improve spatial resolutionC. Low frequency to improve contrastD. High frequency to improve penetrationE. High frequency to improve spatial resolution

Answer: E - High frequency to improve spatial resolutionA: Lower frequencies (longer wavelengths) penetrate more deeply at the expense of axial resolution. True, but not required for superficial structures. B: Higher frequency (shorter wavelength) transducers provide superior axial resolution, but limited penetration depth due to attenuation.C: Contrast is improved by harmonic imaging, use of contrast agents, B-color maps, and post-processing controlsD: Higher frequency (shorter wavelength) transducers provide superior axial resolution, but limited penetration depth due to attenuation. Lower frequencies (longer wavelengths) penetrate more deeply at the expense of axial resolution.E: Higher frequency (shorter wavelength) transducers provide superior axial resolution, but limited penetration depth due to attenuation. Higher frequencies are better for imaging superficial structures; lower frequencies are better for deeper structures.Miller's - Perioperative echocardiography

[Identical] 17B-036 Outlet wall gas supply in theatre:A. 760mmHg gauge pressureB. 15 000kPa gauge pressureC. Uses pin index system connectionsD. 400kPa absolute pressureE. Higher pressure than is supplied from reserve cylinders

Answer: E - Higher pressure than is supplied from reserve cylindersA: 760mmHg is atmospheric pressure. B: Tank pressure when full is ~13700 kPaC: Wall outlets accept matching quick connect/disconnect Schrader probes and sockets with an indexing collar specific for each gas (or gas mixture).D: Pipeline gas supplied at 400kPa gauge pressure. Absolute pressure is calibrated to a vacuum. Gauge pressure is calibrated to atmospheric. E: Standard oxygen cylinder pressure is ~13700 kPa. Wall oxygen pressure is 400kPaAl-Shaikh - Medical Gas supply

[Identical] 17A-059b CO change in pregnancyA. Due to an increase in afterloadB. Aortocaval compression can occur from 10/40 gestationC. Uterine blood flow increases 5 foldD. Blood volume increases by 20%E. Increase 40% by 2nd trimester

Answer: E - Increase 40% by 2nd trimesterA: Total peripheral vascular resistance decreases by 30% at the 12th week and 35% by the 20th week and then remains at 30% below non-pregnant valuesB: Aortocaval compression can occur after 20/40 weeks.C: Uteroplacental flow increases 10 fold to 750ml/minD: HR increases 20%Stroke volume increases 40%Blood volume increases by 35-40%. Due to increased venous return and increased vascular volume caused by oestrogensE: Cardiac output increases 40% at termPower and Kam Maternal and neonatal physiology

[Identical] 18B-047 IPPV and renal effects: A. Decreased renal venous pressure B. Decreased angiotensin C. Decreased ADH secretion D. Decreased renin secretion E. Increased SNS tone to kidneys

Answer: E - Increased SNS tone to kidneysIPPV will increase sympathetic outflow A: Increased Renal venous pressure due to increased intrathoracic pressure B: Increased angiotensin due to increased renin from increased SNS outflow to kidneys C: Increased ADH secretion due to increased renin-aldosterone release D: Increased renin secretion due to increased SNS outflow to the kidneys E: Increased SNS tone to kidneys -> increased reninPower and Kam - Renal Physiology

[Identical] 17A-066 Oxygen can be measured by all except:A. Fuel cellB. Paramagnetic analyserC. Raman analyserD. Mass spectrometryE. Infrared

Answer: E - InfraredA: A fuel cell measures the electrochemical change relative the partial pressure of oxygenB: Paramagnetic analyser measures the pressure change from the magnetic movement of gases (oxygen relative to a known gas)C: Raman analyser measures the changes in wavelengths in argon laser when scattered by different particles. all molecules in the gas/volatile phase can be identified by their charateristic spectrum of scatteringD: Mass spectrometry is used on a breath to breath basis by charge particles of the sample with an electron beam, then separate the components into a spectrum according to their specific massE: Infrared analysis can only be used on non-monatomic molecules (this does not include oxygenAl-Shaikh - Non-invasive monitoring

[Identical] 14A-072 The effects of digoxin includeA. Centrally mediated vagotonic activityB. ↓pacemaker ectopic activityC. ↑myocardial KD. ↓myocardial Ca E. Inhibit Ca/Na exchanger

Answer: E - Inhibit Ca/Na exchangerA: Peripherally mediated increase in parasympathetic activityB: Increased automaticity of ventricular pacemaker ectopics in digoxin toxicityC: Increased intracellular Na and decreased intracellular KD: Increased myocardial Ca due to inhibition of Na/Ca exchangerE: Ca/Na exchanger is inhibited by the increase in intracellular NaStoeltings Cardiac Glycosides

[Identical] 18A-092 Picture of larynx at laryngosopy - what is posterior midline structureA. Aryepiglottic foldB. CricoidC. ThyroidD. Corniculate tubercleE. Interarytenoid notch

Answer: E - Interarytenoud notchInterarytenoid notch is midline posterior of glottisNext to that is Corniculate tubercleThen cuneiform tubercleAnatomy for the Anaesthetist

[Identical] 14A-144 With respect to ventricular Phase 1 repolarisation: A. It is not as pronounced in purkinje fibers B. It is due to intracellular potassium current C. It is due to opening inward ion current D. It is not as pronounced in epicardial fibers E. Is due to transient outward rectifying current

Answer: E - Is due to transient outward rectifying current A: Phase 1 is prominent in Purkinje fibers B: Phase 1 reflects the activation of a transient outward current , i to , mostly carried by K + C: Phase 1 reflects the activation of a transient outward current , i to , mostly carried by K + D: Phase 1 is prominent in Purkinje fibers and in epicardial fibers from the ventricular myocardium; it is much less developed in endocardial fibersE: Phase 1 reflects the activation of a transient outward current , i to , mostly carried by K + Pappano and Wier - Excitation: The cardiac action potential

[Identical] 16A-046 In regards to the effect of ANP on the kidney:A. It acts on the proximal tubule to prevent sodium reabsorptionB. It acts on the proximal tubule to increase sodium reabsorptionC. It acts on the distal tubule to prevent sodium reabsorptionD. It acts on the loop of henle to prevent sodium reabsorptionE. It relaxes the afferent arteriole to increase GFR

Answer: E - It relaxes the afferent arteriole to increase GFRA: ANP acts in the medullary collecting duct to inhibit sodium absorptionB: ANP acts in the medullary collecting duct to inhibit sodium absorptionC: ANP acts in the medullary collecting duct to inhibit sodium absorptionD: ANP acts in the medullary collecting duct to inhibit sodium absorptionE: ANP relaxes the afferent arteriole, thereby promoting increased filtrationThe main source of both natriuretic peptides is the heart. The natriuretic peptides have both vascular and tubular actions. They relax the afferent arteriole, thereby promoting increased filtration, and act at several sites in the tubule. They inhibit the release of renin, inhibit the actions of angiotensin II that normally promote reabsorption of sodium, and act in the medullary collecting duct to inhibit sodium absorption.Directly inhibits sodium reabsorption in collecting ducts Also inhibits renin and aldosterone; so would indirectly inhibit Na reabsorption in DCDVander's 7th Ed - p128 Ch7 Control of sodium and water

[Identical] 19B-016 2mL 2% Lignocaine + 1:80000 Adrenaline =a. Lignocaine 4mg + Adrenaline 8 mcgb. Lignocaine 4mg + Adrenaline 16 mcgc. Lignocaine 40mg + Adrenaline 8 mcgd. Lignocaine 40mg + Adrenaline 16 mcge. Lignocaine 40mg + Adrenaline 25 mcg

Answer: E - Lignocaine 40mg + Adrenaline 25 mcgStandard 2% Lignocaine with adrenaline ampule used for epidural top up2% = 20mg/mL2mL x 20mg/mL = 40mg1:80,000 = 12.5mcg/mL2mL = 25mcg

[Identical] 15A-136 Pharmacokinetics of fentanyl is most affected by:A. Variability in ageB. Renal diseaseC. Type of surgeryD. Albumin levelsE. Liver blood flow/disease

Answer: E - Liver blood flow/diseaseA: Age will affect the pharmacodynamic effects of fentanylB: For the fentanyl congeners, the clinical importance of kidney failure is much less marked, but nonetheless measurable.C: Type of surgery (unless hepatic) has minimal effect on fentanyl pharmacokineticsD: Fentanyl is ~80% protein bound (40% albumin, 40% RBC)E: Fentanyl has high hepatic extraction ratio -> dependent on renal blood flowProduct information sheetMiller's opioidsHemmings and Egan Intravenous opioids and antagonists

[Identical] 16A-063 Minute ventilation response to CO2 is NOT affected by: A. High PO2 B. Work of breathing C. Sleep D. Opioids E. Low dose volatile (0.1 MAC)

Answer: E - Low dose volatile (0.1 MAC) A: High paO2 will decrease the magnitude (gain) of MV response to paCO2 (Nunn's p60)(West p152) B: The ventilatory response to CO2 is also reduced if the work of breathing is increased. This can be demon- strated by having normal subjects breathe through a narrow tube. (West p136) C: Respones to hypoxia and hypercapnia are reduced during sleep - 30% in non-REM, further in REM.(Nunn's p230) D: u and s opioid receptors are in the respiratory centre. In pre-Botzinger complex. Dose dependent reduction in ventilatory responses to hypoxia and hypercapnia.(Nunn's p68) E: With low doses of inhaled anaesthetic (MAC 0.2) there is almost no depression of the hypercapnic ventilatory response.However 0.1 MAC will blunt the response to paO2(Nunn's p292) Nunn's 8th Ed various West's 9th Ed various

[Identical] 15B-146 What sort of Mapleson circuit is an Ayre's T-piece?A. AB. BC. CD. DE. E

Answer: E - Mapleson E (and F)Mapleson E aka Ayre's T-piece:Tubing --> FGF --> patient. --> the tubing is the reservoir.Mapleson F Jackson Rees: distal to proximalbit of tube --> reservoir bag --> tubing --> FGF --> patientFGF 2 - 3x FGF required.Mapleson circuitsThe systems are classified according to the relative positions of 3 components:FGF, APL and gas reservoirMapleson A + B have all componentsMapleson E + F do not have APL valvesMapleson E has no bagMapleson F has an open ended bag. Manual PEEP (for pediatrics)Mapleson A: FGF at operator endFGF --> reservoir --> tubing --> APL --> patient: the volume of the tubing must be > 1 VT and flows must be greater than MV to ensure no rebreathing - expiration the reservoir bag will fill until the pressure opens the APL.Lack system (Coaxial Mapleson A / Magill modification): FGF then reservoir and APL at the same point but attached to an inner tube: outer tube 30mm diam / inner tube 14mm diamMapleson B (distal to proximal): reservoir bag --> tubing --> FGF --> APL --> patient:requires FGF 2 - 3x MV. BAD for spontaneous ventilation.Mapleson C: distal to proximalreservoir bag --> short tube --> FGF --> APL --> patientrequires FGF 2 - 3x MV --> CO2 accumulates over timeMapleson D: distal to proximalreservoir bag --> APL --> tubing --> FGF --> patientMapleson E aka Ayre's T-piece:Tubing --> FGF --> patient. --> the tubing is the reservoir.Mapleson F Jackson Rees: distal to proximalbit of tube --> reservoir bag --> tubing --> FGF --> patientFGF 2 - 3x FGF required.Al-Shaikh - Breathing circuits

[Identical] 18A-065 Temperature measurementA. Thermister in PA not affected by ventilationB. Rectal bacteria does not affectC. Big toe does not reflect perfusion and cardiac outputD. Ear is 0.5 degrees greater than core temperatureE. Oesophageal nasopharyngeal reflects brain temp

Answer: E - Oesophageal nasopharyngeal reflects brain tempA: Ganz wrote "The temperature of the pulmonary artery ... related in frequency and magnitude to respiration. The variation ranged up to 0.05 deg"B: Heat-producing bacteria in the gastrointestinal tract, cold blood returning from the lower limbs, and insulation of the probe by feces, can all influence rectal temperature.C: Skin temperature gives no information other than the temperature of that area of the skin. Skin temperature, when measured with the core temperature, can be useful in determining the volaemic status of the patientD: Tympanic membrane and aural canal temperatures provide a rapidly responsive and accurate estimate of hypothalamic temperature and correlate well with esophageal temperature.E: Measuring the temperature of the lower 25% of the esophagus gives a reliable approximation of blood and cerebral temperatureStoelting's Ch3 Neurophysiology

[Identical] 18A-010 Ayre T piece is Mapleson classificationA. AB. BC. CD. DE. E

[Identical] 16A-076 Antiemetic actions of dexamethasone:A. Oedema in cells of CTZB. Antagonism of opioid and 5HT3 receptorsC. Partial antagonism of D2 receptorsD. Should be given at the end of surgeryE. Mechanism is not known or not yet elucidated

Answer: E - Mechanism not yet knownA: Mechanism not yet knownB: Mechanism not yet knownC: Mechanism not yet knownD: Should be given early in the operationE: Mechanism not yet knownStoelting's Antiemetics

[Identical] 15B-045 The greatest effect of ADH on water reabsorption in the kidney occurs in the:A. Proximal tubuleB. Loop of henleC. Distal TubuleD. Cortical collecting ductE. Medullary collecting duct

Answer: E - Medullary collecting ductE: Greatest effect of ADH occurs in the medullary collecting ductsNote - greatest H2O reabsorption, even in the presence of ADH, is in the proximal tubuleVander's 7th Ed

[Identical] 18B-025 Phenylephrine A. Indirect acting B. Tachyphylaxis seen after 6 -18 hrs use C. Catecholamine D. Decreases coronary blood flow E. Metabolised by MAO

Answer: E - Metabolised by MAO A: Primary direct a1 stimulation (very minor indirect) B: No tachyphylaxis due to minimal indirect action C: Synthetic non-catecholamine (no hydroxyl on the C4) D: Increases/maintains coronary blood flow E: Metabolised by MAO Not by COMT (non-catecholamine) Stoeltings Sympathomimetic drugs

[Identical] 18B-096 Adenosine:A. metabolism inhibited by beta blockersB. half life in plasma 2-3 minC. potentiated by caffeineD. causes bronchodilation in non-asthmaticsE. metabolised in RBCs

Answer: E - Metabolised in RBCsA: Beta blockers have no impact on metabolism of adenosineB: Half life in plasma is 10secC: Inhibited by methylxanthines (caffeine)D: Causes bronchoconstriction in non-asthmaticsE: Metabolised by RBCsMiller's - Pediatric neonatal critical careStoeltings - Antiarrythmic drugs

[Identical] 17A-033 Which opioid does not have active metabolitesA. ketamineB. tramadolC. codeineD. morphineE. methadone

Answer: E - MethadoneA: Ketamine - Norketamine 1/6 potency of ketamineB: Tramadol - ODM Tramadol - active (CYP2D6)C: Codeine - morphine (CYP2D6)D: Morphine - M6G (CYP3A4)E: Methadone has no active metabolitesProduct information sheets

[Identical] 18B-066 Lower oesophageal sphincter tone is increased byA. SwallowingB. SecretinC. GlucagonD. VIPE. Metoclopramide

Answer: E - MetoclopramideA: The LOS relaxes 1-2s after swallowing is initiated and remains relaxed for 8-9sMediated by NO and VIPIncrease in LOS tone Raised IGP, gastrin, motilin, alpha adrenergic stimulation, metoclopramide, sux, anticholinesterases, histamine, alpha adrenergic agentsDecrease in LOS toneSecretin, Glucagon, VIP, GIP, antimuscarinics, dopamine, ethanol, opioids,beta adrenergic agentsPower and Kam 3rd ed

[Identical] 18B-118 Most likely mechanism of volatile anaesthetics is:A. Direct action at the thalamusB. Lipid membrane expansionC. LuciferaseD. Disolving in cell membranesE. Multiple receptor and molecular sites of action in CNS

Answer: E - Multiple receptor and molecular sites of action in CNSA: Unconsciousness occurs in the thalamus. Volatiles have effects elsewhere as wellB: A previous theory was that of lipid membrane expansionC: Anaesthetics bind to luciferase, but this is not relevant to anaesthesiaD: A previous theory was that of lipid membrane expansionE: Volatile anaesthetics have multiple receptor and molecular sites of action in CNSMiller's inhaled anaesthetics: mechanisms of action

[Identical] 19B-025 Dantrolenea. Constitute in normal salineb. Dilute in 1000mL before administrationc. Max dose 10mg/kgd. Bolus 0.5mg/kg and titratee. Must be mixed in 60ml of water

Answer: E - Must be mixed in 60ml of waterA: Constituted in 60mL sterile water per 20mgB: Constituted in 60mL sterile water per 20mgC: Initial dose 1mg/kg, continue infusion until maximum 10mg/kg or symptoms subside. (if symptoms reappear may be repeated)D: Bolus 1mg/kgE: Mix in 60mL sterile waterProduct information sheet

[Identical] 15B-143 Left recurrent laryngeal nerve:A. Motor nerve root from accessory nerveB. Hook around aorta anterior to arteriosus ligamentumC. Supply cricothyroid muscleD. Sensory supply to left pharyngeal mucosaE. None of the above

Answer: E - None of the aboveA: Recurrent laryngeal nerve originates from the vagus nerveB: The recurrent laryngeal nerve runs posterior to ligamentum arteriosumC: The cricothyroid muscle is supplied by the superior laryngeal nerveD: The recurrent laryngeal n. only supplies the laryngeal mucosa inferior to vocal cordsE: None of the above are trueAnatomy for the Anaesthetist

[Identical] 18B-086 Oral bioavailability of which is highest:A. KetamineB. BuprenorphineC. MorphineD. OxycodoneE. Paracetamol

Answer: E - ParacetamolParacetamol 63-89% (1st pass)Oxyxodone 60-87%morhpine 15-50% (sig 1st pass)ketamine 20-25%buprenorphine 0-10% Miller's Various

[Identical] 15B-023 Pulmonary capillary pressure trace has: A. a but not c or v waves B. c but not a or v waves C. v but not a or c waves D. a and v waves but not c E. a c and v waves

Answer: E - a, c and v waves E: Pulmonary artery wedge pressure has a similar morphology to right atrial pressure, although the a-c and v waves appear later in the cardiac cycle relative to the electrocardiogram. A wave C wave X descent V wave Y descent Millers - Cardiovascular monitoring

[Identical] 14A-014 In response to exercises. A. AV oxygen difference increases to 20mls/dl B. MAP increases from 90-140mmhg C. O2 consumption increases up to a maximum of 500% D. Stroke volume increases linearly up to 120mls E. Peripheral vascular resistance falls by greater than half.

Answer: E - Peripheral vascular resistance falls by greater than half A: Av oxygen difference increases from 5mL/dL -> 15mL/dL B: MAP increases from 90-120mmHg C: O2 consumption increases up to 1600mL/minOxygen consumption may increase as much as sixtyfold, with only a fifteenfold increase in muscle blood flow D: SV increases non linearly to 100mL then decreases as HR increases E: SVR decreases from 0.014 to 0.006. This is greater than half Pappano and Wier - Interplay of central and peripheral factors that control the circulation

[Identical] 15A-139: Which is not a catecholamine? A. Adrenaline B. Dopamine C. Isoprenaline D. Dobutamine E. Phenylephrine

Answer: E - Phenylephrine Synthetic non-catecholamine - Phenylephrine, Ephedrine Naturally occurring catecholamine - Adrenaline, NAd, Dopamine, Isoprenaline - Naturally occurring catecholamine with significant beta activity (large group on terminal amine) - Isoprenaline Synthetic catecholamine - Dobutamine Hemmings and Egan Vasopressors and Inotropes Stoeltings Sympathomimetic drugs

[Identical] 14B-123 Which drug does NOT potentiate the action of non-depolarising neuromuscular blockers by inhibiting the action of acetylcholinesterase?A. CyclophosphamideB. MagnesiumC. MetoclopramideD. FrusemideE. Phenytoin

Answer: E - Phenytoin will reduce the duration of NMBA: Cyclophosphamide may decrease the plasmacholinesterase activity and prolong blockade (esp sux)B: Magnesium will prolong the duration of NMB - pre and post synaptic Ca Ch blockadeC: Metoclopramide will prolong the duration of NMB (esp sux) by lowering plasmacholinesterase activityD: Frusomide will prolong the duration of NMB - inhibits cAMPE: Phenytoin will reduce the duration of NMB - increased clearance, increased PPB, upregulation of ACh receptorsMiller's Pharmacology of Neuromuscular blocking drugsStoeltings Neuromuscular blocking drugs and reversal agents

[Identical] 15B-037 Increased sympathetic activity causes A. Increased gastrointestinal peristalsis B. Pulmonary vasodilation C. Splanchnic vasodilatation D. Miosis E. Piloerection

Answer: E - Piloerection A, B, C, D - PNS or decreased SNS tone for increased peristalsis, pulmonary vasodilation, splanchnic vasodilation and miosisE - SNS - PiloerectionGuyton and Hall - Body Temperature Regulation and Fever

[Identical] 17B-061 C size cylinderA. 400L capacityB. Uses diameter index systemC. Full tank will last 45min at 15L/minD. O2 cylinder coded with black and white shoulderE. Pressure will increase with temperature

Answer: E - Pressure will increase with temperatureA: C size cylinder has 490L capacityB: Uses a pin index systemC: Full tank 490L / 15L/min = 32 minutesD: O2 cylinder white with white shoulderE: P=kT for a constant volumeBOC gas -> medical gas cylinders

[Identical] 14B-006 ECG changes with digoxin toxicity:A. shortened PR intervalB. prolonged QRS durationC. ST depressionD. Prolonged QT intervalE. Prolonged PR

Answer: E - Prolonged PRA: Digoxin will prolong PR intervalB: Digoxin has little effect on QRSC: ST depression occurs at therapeutic levels of digoxinD: QTc is shortened in therapeutic levels of digoxinE: Digoxin will prolong PR interval Stoelting Ch18 -> Cardiac glycosides

[Identical] 14B-024 Thirst is stimulated by A. Antidiuretic hormoneB. ANPC. Increased osmolarity sensed by posterior pituitary D. Angiotensin II inhibiting the subfornical organE. Reduction in volume

Answer: E - Reduction in volumeA: ADH is release in conjunction with thirst. It does not stimulate thirstB: ANP - reduces thirstC: The subjective feeling of thirst, which drives one to obtain and ingest water, is stimulated both by reduced plasma volume and by increased body fluid osmolality (sensed in the hypothalamus, not the posterior pituitary)D: The subfornical organ senses osmolality and will lead to release of ADH. Ang II will stimulate, rather than inhibit, the SFOE: The subjective feeling of thirst, which drives one to obtain and ingest water, is stimulated both by reduced plasma volume and by increased body fluid osmolalityVander's 7th ed Ch 7 p134, The centers that mediate thirst are located in the hypothalamus (very close to those areas that produce ADH). The subjective feeling of thirst, which drives one to obtain and ingest water, is stimulated both by reduced plasma volume and by increased body fluid osmolality. The adaptive significance of both are self-evident. Note that these are precisely the same changes that stimulate ADH production, and the receptors—osmoreceptors and the nerve cells that respond to the cardio- vascular baroreceptors—that initiate the ADH-controlling reflexes are near those that initiate thirst. The thirst response, however, is significantly less sensitive than the ADH response.

[Identical] 18B-141 Why is plasma creatinine used to measure GFR?A. Filtered but not secreted or reabsorbedB. It is the gold standardC. Does not need to be adjusted for age and weightD. Has a linear relationship between plasma creatinine and GFRE. Relatively constant production by muscles

Answer: E - Relatively constant production by musclesA: Creatinine is filtered and secretedB: Inulin is the gold standard for measuring GFRC: CrCl uses formula based on age and weight to correct for plasma creatinineD: The relationship between plasma creatinine and GFR is non-linearE: Produced at a constant rate from muscles -> the secretion is constant. The filtration estimates GFRVander's 7th Ed - p42 Clearance

[Identical] 15B-047 Atrial natriuretic peptide (ANP):A. Decreases Na reabsorption in PTB. Increases Na reabsorption somewhereC. Decreases Na reabsorption PT and distal tubulesD. Decreases reabsorption in ascending loop of henleE. Relaxes afferent arteriole

Answer: E - Relaxes afferent arterioleThe natriuretic peptides have both vascular and tubular actions. They relax the afferent arteriole, thereby promoting increased filtration, and act at several sites in the tubule. They inhibit the release of renin, inhibit the actions of angiotensin II that normally promote reabsorption of sodium, and act in the medullary collecting duct to inhibit sodium absorption.ANP dilates afferent arteriole Directly inhibits sodium reabsorption in collecting ducts Also inhibits renin and aldosterone; so would indirectly inhibit Na reabsorption in DCTVander's 7th ed Control of Sodium and Water excretion p128

[Identical] 16A-073 Which of the following about amiodarone is incorrect?A. Torsades de Pointes risk is increased with hypokalaemiaB. Structure similar to thyroxineC. Increased refractory periodD. Non-competitive antagonist at alpha and beta adrenoceptorsE. Renal elimination major pathway

Answer: E - Renal elimination major pathwayAll are true exceptE - Elimination primarily via hepatic and biliary excretionProduct information sheetStoeltingsMiller's

[Identical] 14A-116 RopivacaineA. Pure R isomerB. Isomer of bupivacaineC. Causes more motor blockade than BupivacaineD. More cardiotoxic than BupivacaineE. Similar physicochemical properties to Bupivacaine

Answer: E - Similar physicochemical properties to BupivacaineA: Ropivacaine is presented as a pure S enantiomerB: Not an isomer of bupivacaineC: Motor blockade is less intense and of shorter duration than BupivacaineD: Bupivacaine has a higher risk of cardiac and central nervous system toxicity than RopivacaineE: Bupivacaine has a butyl group (C5H9) Ropivavaine has a Propyl group (C3H7). They have similar physico-chemical propertiesStoeltings Local anaestheticDrug information sheets

[Identical] 19B-001 Which of the following is a non-particulate antacid?a. Magnesium hydroxideb. Omeprazolec. Ranitidine d. Scopalaminee. Sodium citrate

Answer: E - Sodium CitrateA - Magnesium Hydroxide - (MgAl) - Buffer H+, ParticulateB - Omeprezole - PPIC - Ranitidine - H2 blockerD - Scopalamine - ACh receptor antagonistE - NaCitrate + NaHCO3 - Buffer H+, Non-particulateParticulate antacids - MgHydroxide, AlHydroxide, CaCarbonateNon-particulate - NaHCO3, NaCitrateProduct information sheets

[Identical] 17B-001 What is the PR interval A. Start of the P wave to start of R wave B. End of P wave to end of R wave C. End of P wave to start of R wave D. Start of P wave to end of R wave E. Start of P wave to start of QRS complex

Answer: E - Start of the P wave to the start of the QRS complex E: PR interval represents the time between the onset of atrial depolarisation and the onset of ventricular depolarisation. Onset of P wave to onset of QRS complex 120-200ms. Power and Kam

[Identical] 16A-025 Which of the following is INCORRECT regarding entropy monitoring?A. Uses Shannon entropyB. Used Fourier analysisC. State entropy uses frequencies in range of 0-32 HzD. Response entropy uses frequencies in range of 0-47HzE. State entropy is given as a value between 0-100

Answer: E - State entropy A: The concept of Shannon entropy is applied to normalize the entropy values to between zero (total regularity) and 1 (total irregularity).B: The device uses Fourier transformation to calculate the frequencies of voltages for each given time sample (epoch). C: State entropy (SE) index is calculated from a low-frequency range (under 32 Hz) corresponding predominantly to EEG activity.D: Response entropy (RE) index uses a higher frequency range (up to 47 Hz) and includes electromyographic activity from frontalis muscle.E: State entropy (SE) index is calculated from a low-frequency range (under 32 Hz) corresponding predominantly to EEG activity.Al-Shaikh - Non-invasive monitoring

[Identical] 18B-070 Capsaicin acts on:A. TRPA1B. TRPM8C. TRPV3D. TRPV2E. TRPV1

Answer: E - TRPV1A: TRPA1 - Icilin, Mustard oilB: TRPM8 - Menthol, EucalytolC: TRPV3 - Caphor, MentholD: TRPV2 - THCE: TRPV1 - Capsaicin, Protons, CamphorRang and Dale 9th Ed - TRP channels - thermal sensation and pain(See Chambers for a table)

[Identical] 15A-143 The following are all found in the epidural space EXCEPT: A. Anterior venous plexusB. Posterior venous plexusC. Fat D. Connective tissue E. Anterior vertebral artery

Answer: E - The anterior vertebral arteryA: Venous drainage is from anterior and posterior venous plexiB: Venous drainage is from anterior and posterior venous plexiC: Epidural space contains fat, nerve roots, blood vessels and lymphatics.D: Epidural space contains fat, nerve roots, blood vessels and lymphatics.E: The arteries of the epidural space are relatively insignificant and originate from the arteries corresponding to the named veins enumerated aboveMargins of the epidural spaceSuperiorly: Fusion of the spinal and periosteal layers of dura mater at the foramen magnumInferiorly: Sacrococcygeal membraneAnteriorly: Posterior longitudinal ligament, vertebral bodies and discsLaterally: Pedicles and intervertebral foraminaePosteriorly: Ligamentum flavum, capsule of facet joints, and laminaeAnatomy for anaesthetists - The spinal meninges

[Identical] 14A-141 The epidural space does NOT contain: A. Fat B. Connective tissue C. The anterior venous plexus D. The posterior venous plexus E. The posterior spinal artery

Answer: E - The posterior spinal arteryA: Epidural space contains fat, nerve roots, blood vessels and lymphatics.B: Epidural space contains fat, nerve roots, blood vessels and lymphatics.C: Venous drainage is from anterior and posterior venous plexiD: Venous drainage is from anterior and posterior venous plexiE: The arteries of the epidural space are relatively insignificant and originate from the arteries corresponding to the named veins enumerated aboveAnatomy for anaesthetists - The spinal meninges

[Identical] 15A-002 Spinal arteries A. There are two anterior arteriesB. Originate from the carotid arteriesC. Have anterior radicular arteries in the upper thoracic regionD. Anterior spinal artery travels on the right side E. There is no anastomosis between the anterior and posterior spinal arteries

Answer: E - There is no anastomosis between the anterior and posterior spinal arteriesA: Dual posterior arteries, single anterior arteryB: Originate from the union of a branch from each vertebral arteryC: The anterior radicular arteries are situated in the lower cervical, lower thoracic and upper lumbar regionsD: Anterior spinal artery is supplied via the artery of Adamkiewicz that originates on the left hand sideE: There are no anastomoses between the anterior and posterior spinal arteriesAnatomy for Anaesthestists - Vertebral canal and its contents

[Identical] 18B-037 Which drug is excreted mostly via kidneys?A. rocuroniumB. amiodaroneC. enoxaparinD. midazolamE. vancomycin

Answer: E - VancomycinA: Rocuronium 70% biliary 30% renal eliminationB: Amiodarone primarily hepatic, some lacrimal glandsC: Enoxaparin is excreted unchanged via the kidneys. Needs dose adjustment in renal failure. 10% unchanged 40% total renally excretedD: Midazolam primarily hepatic E: 75% of a dose of vancomycin is excreted in urine in first 24 hrsProduct information for each drug

[Identical] 15A-120 Which combination is correct with regards to chemotherapeutic agents and their effects?A. Doxorubicon - pulmonary fibrosisB. Bleomycin - cardiomyopathy C. Cisplatin - pseudocholinesterase deficiencyD. Cyclophosphamide - monamine oxidase inhibition E. Vincristine - peripheral neuropathy

Answer: E - Vincristine - peripheral neuropathyA: Doxorubicin - CardiotoxicityB: Bleomycin - Pneumonitis (rarely fibrosis)C: Cisplatin - CCF, myocarditisD: Cyclophosphamide - CCF, tachyarrhythmiasE: Vincristine - Peripheral neuropathyRang and Dales Anticancer drugs

[Identical] 14A-108 Which agent undergoes the LEAST metabolism?A. sevofluraneB. desfluraneC. isofluraneD. nitrous oxideE. xenon

Answer: E - XenonA: Sevoflurane - Compound A, 3-5% 2E1 -> fluorideB: Desflurane - 2E1 -> 0.02% Trifluoracetic acidC: Isoflurane - 2E1 -> 0.2% Trifluoracetic acid + fluorideEnflurane - 2E1 -> 2% FluorideD: Nitrous oxide - 0.004% by anaerobes in GITE: Xenon - none

[Identical] 18A-053 SVP of isofluraneA. dec at altitudeB. SVP 157mmHgC. unchanged by change by temperatureD. greater than SVP of sevofluraneE. occurs at the boiling point

Answer: E - occurs below the boiling point at room temperatureA: Altitude and pressure have no influence on SVPB: SVP sevoflurane is 157mmHg. SVP of isoflurane 238mmHgC: Changes with temperatureD: Greater than the SVP of sevofluraneE: Boiling point is when SVP equals atmospheric pressure. SVP changes depending on temperatureMiller's Inhaled Anesthetic Uptake, Distribution, Metabolism, and Toxicity

[Identical] 15B-074 Esmolol A. Non selectiveB. More lipid soluble than propanololC. Intrinsic sympathomimeticD. Broken down by pseudocholinesteraseE. Peak haemodynamic effects in 5 min

Answer: E - peak effects in 5 minutesA: CardioselectiveB: Low lipid solubilityC: Nil intrinsic sympathomimetic activityD: Broken down by plasma/RBC esterasesE: Time to peak effect 5 minutesHemmings and Egan Antihypertensive drugs and vasodilators

[Identical] 14A-007 In the kidney which of the following substances is NOT under hormonal control?A. Calcium B. Potassium C. Phosphate D. Sodium E. Sulphate

Answer: EA: Calcium is under the regulation of vitamin D and PTHB: Potassium is under the control of AldosteroneC: Phosphate is regulated by vitamin D and PTHD: Sodium is regulated by Angiotensin II, Aldosterone, ADH, ANPE: Sulphate is note under hormonal controlVanders 7th Ed - various pagesReason: - Sulphate is NOT regulated by a hormone- Na+ - regulated by AII, aldosterone, SNS, ADH, ANP- K+ - regulated by aldosterone- Ca2+ and PO43- - regulated by PTH and 1,25-dihydroxy-vitamin D

[Identical] 18B-045 Dexamethasone and PONV:A. Causes significant adverse effects when given as a single dose intraoperatively B. Should be used as the sole agent in prevention of chemotherapy nauseaC. Less effective than 1.25 mg droperidolD. Less effective than 4 mg ondansetronE.Mmost effective if given at start of surgery

Answer: EA: Causes minimal adverse effects when given as a single dose intraoperativelyB: Should be combined with 5HT3 antagonist for CINVC + D: Ondansetron 4mg, Droperidol 1.25mg and Dexamethasone 4mg are all equally effective and each independently reduce PONV risk by 25%E: Dexamethasone is recommended at inductionHemmings and Egan

[Identical] 18A-069 Which herbal medicines should be stopped before surgeryA. GarlicB. GingerC. GingkoD. GlucosamineE. All of the above

Answer: EA: Garlic - Inhibits platelet aggregationB: Ginger - potent cyclooxygenase-1 inhibitor and antiplatelet aggregatorC: Gingko - alters vasoregulation, acts as an antioxidant, modulates neurotransmitter and receptor activity, and inhibits platelet-activating factorD: Glucosamine - Concern with diabetes and interaction with warfarin/coagulationE: See above - all should be ceased pre-operativelyMiller's Anesthetic implications of complementary and alternative therapies

[Identical] 18A-066 PneumotachographA. Independent/not affected by humidityB. Does not require temperature compensation / temp independentC. Directly measures flowD. Works with turbulent flowE. Uses the venturi effect

Answer: EA: Humidity will affect a pneumotachograph by blocking the resistance mechanismB: The effects of density and viscosity (which depend on temperature) can alter the accuracy of a pneumotachographC: Directly measures pressure difference. Flow can be calculatedD: Does not work with turbulent flowE: Venturi effect not the principle. Uses the bernouli principleAl-Shaikh Non-invasive monitoring, To maintain constant flow a fluid must increase its velocity as it flows through a constriction. This increase in kinetic energy occurs at the expense of its potential energy. Through a decrease in pressure. Measures flow, calculates volume; condensation can cause turbulent flow, sensitive to changes in temperature, humidity and gas composition

[Identical] 15B-046 The effects of IPPV on the renal systemA. decreased renal peritubular pressure secondary to decreased venous pressureB. decreased sodium reabsorptionC. increased ANP secretionD. decreased aldosterone secretionE. increased SNS activity

Answer: EA: IPPV will increase RAP and increase venous pressure. B: Sodium reabsorption is increased with IPPV due to the reduction in cardiac output and MAP -> increased Aldosterone releaseC: ANP will be decreased due to a decreased venous return and less Right Atrial stretchD: Aldosterone will be increased due to a decreased cardiac output and MAPE: SNS will increase due to decreased baroreceptor stretchAfter induction of general anesthesia, patients are placed on positive pressure ventilation with positive end-expiratory pressure (PEEP), which can reduce cardiac output, RBF, GFR, Na + excretion, and urine flow rate. The extent of this effect depends on mean airway pressure, the degree of reduction in cardiac output, and activation of the renin-angiotensin-aldosterone pathway.Hemmings and Egan 2nd ed Renal physiology- Mechanical ventilation with positive airway pressure leads to a dec in renal H2O + Na excretion. - dec venous return, less RA stretch -> decANP, contributing to inc Na reabsorption - Low pressure baroreceptors discharge -> inc SNS activity, inc ADH concentration -> inc Na reabsorption - dec renal perfusion and inc in renal SNS activity -> incRAS. ATII -> inc aldosterone Inc NA + H2O reabsorption- inc in intrathoracic pressures -> decCO + decMAP. Low pressure baroreceptors - inc SNS activityMiller's

[Identical] 18B-137 Plasma contains:A. Less protein than interstitial compartmentB. More potassium than sodiumC. 10% of total body weightD. Osmotic pressure of 28mmHgE. >90% water

Answer: EA: Plasma has significantly more proteins than the interstitial compartmentB: Na 140mmol/L K 4mmol/LC: 4% of total body weightD: Oncotic pressure of 28mmHg, Osmotic pressure of 5610mmHgE: 93% waterPower and Kam - Physiology of blood

Administration of a large volume of Normal Saline (0.9%) is likely to produce A. no change in acid base status B. hyperchloraemic metabolic acidosis C. hypochloraemic metabolic acidosis D. hyperchloraemic metabolic alkalosis E. hypochloraemic metabolic alkalosis

Healthy young person loses 20% of their blood volume: A. diastolic pressure decreases: B. increased ADH secretion: C. reduced cerebral blood flow: D. increased urinary sodium excretion

Dabigatran: A. Has oral bioavailability of 80% B. Has a half life of 8-12 hours C. Requires a 75% dose reduction in renal failure D. ? .

Frusemide: A. Has 30% (?35%) protein binding B. Has an elimination half-life less than 1 hour C. 90% excreted in bile D. Increases rate of secretion in the renal tubules

Hartmann's solution contains A. 154 mmol/L Na+: B. 2 mmol/L Ca++: C. 2 mmol/L K+: D. 154 mmol/L Cl: E. 3 mmol/L Mg2+

Inability for anaesthetised patients to generate heat due to: A. Insufficient brown fat B. skeletal muscle relaxation C. Dilated peripheral vessels

Na/K ATPase pump: A. ''something about ADP ATP production'' B. is electrogenic C. 3K/ 2Na

Neonatal tidal volume per kg A. 3mls B. 7mls C. 15mls D. 20mls

Peripheral vascular resistance: A. can be calculated from mean arterial pressure/ pulmonary wedge pressure: B. units are dynes∙s∙cm−5 C. equals diving pressure mutiplied by CO

REM sleep: A. Easily rousable state B. Always comes after NREM C. becomes more frequent toward end of sleep cycle

Torsades de Pointes: A. results from SVT B. more likely in bradycardia in susceptible pts C. treated with 150mg of amiodarone over 30 minutes D. results from hypermagnesaemia

What inhibits insulin? A. Glucagon: B. Alpha-2 Agonists

When used for myocardial ischaemia intravenous nitroglycerine: A. Dilates coronary arterioles B. Reduces myocardial oxygen demand by reducing left ventricular enddiasolic pressure and reducing mean arterial pressure C. Is ineffective when used in doses <5 mcg/kg/min D. Is associated with methaemoglobinaemia when infused for prolonged periods E. Can't remember the last option sorry possibly something about coronary arteries (not arterioles as per option A)

Which ONE of the following is TRUE? A. Hartmann's solution contains 150 mmol/L Na B. Osmolality of Normal Saline is 308 mosm/L C. pH of Normal Saline is 7.35 7.45 D. Osmolality of Hartmann's solution is 308 mosm/L E. rapid infusion of Hartmann's solution can cause lactic acidosis

Which of the following is classified as a "strong ion"? A. phosphate B. chloride C. albumin

Which of the following would cause a decrease in fluid movement from a capillary to the interstitium?: A. Closure of pre-capillary sphincters: B. Increased plasma oncotic pressure: C. Decreased MAP: D. Decreased venous pressure: E. Sympathetically mediated increased arteriolar tone

Which of these increases vasopressin (ADH) secretion? A. Increase in arterial BP B. Moving to erect position C. Increased pressure venoatria junction D. Reduced effective oncotic pressure plasma E. Increase ECF volume

How long after commencing a propofol infusion must it be used by: A. 6 hrs B. 12 hrs C. 18 hrs D. 24 hrs E. 30 hrs

B Discard the tubing and vial after 12 hours of an infusion, and 6 hours if you open the vial and don't use it at all (Stoelting, 5th ed, p167)

Gas flow is less likely to be turbulent with A. Decreased viscosity B. Increased temperature C. Increasing the density D. Increasing the radius bifurcation

B Increased temp increases viscosity in a gas

An increase in venous admixture has most effect by an increase in A. Alveolar dead space B. Wests zone 3 C. Aa gradient D. PaCO2 E. Mixed venous PO2

Cardiogenic shock is the result of: A. decreased arterial pressure B. cardiac arrhythmia C. decreased stroke volume D. decreased venous return E. increased venous pressure

Histamine: A. Sequestration in body and bound to platelets B. Bronchodilation via H1 receptors C. Augments nociception via action in central and peripheral nociceptors D. Potent inhibitor of gastric acid secretion E. Severe bradycardia with IV infusion of histamine

Increased tubular reabsorption in response to increased glomerular filtration is: A. Tubuloglomerular feedback B. Autoregulation C. Tubuloglomerular balance D. Pressure diuresis E. Pressure naturesis

Mobile phones are classified as what type of electrical appliance (repeat)? A. class I B. class II C. class III D. type BF E. type CF

Normal CVS physiology in elderly:: A. Increased arterial elasticity: B. Increased DBP: C. Increased pulse pressure: D. Increased ventricular compliance: E. Faster diastolic filling time

Pulmonary Vascular resistance A. Same as Systemic vascular resistance as both sides of the heart receive the same cardiac output B. Influenced only by alveolar oxygen tension C. Increased by increasing airway pressures D. decreased with increasing lung volumes E. Calculated by multiplying pressure drop x blood flow

Regarding rectal administration of drugs A. Rectal indomethacin does not cause gastric symptoms B. Rectal administration is predictable and effective. C. Superior haemorrhoidal vein absorption results in hepatic first pass metabolism D. paracetamol cannot be given rectally

What is the initial response to moving from supine to erect : A. Increased SV: B. Increased CO: C. Increased TPR: D. Increased MAP: E. Increased CVP

What minimum level of shunt cannot reach PaO2 100mmHg A. 15% B. 25% C. 35% D. 45% E. 55%

In pregnancy the increase in ventilation: A. Occurs in 2nd trimester of pregnancy onwards B. Is primarily due to an increase in oestrogen C. Is primarily due to an increase in progesterone D. Represents a 10% increase in ventilation E. Is mainly due to an increase in respiratory rate

C - direct effect on resp centre.

Bicarbonate buffer most important extracellular buffer system because:: A. Because CO2 and HCO3- are present in large concentrations B. Because of carbonic anhydrase C. Because CO2 is dealt with by the lung and HCO3- by the kidneys D. Of the Henderson-Hasselbach equation

C - open ended buffer system

A substance above its critical temperature; A. May exist in either its liquid or solid state B. May exist in either liquid or gas state C. may exist in either liquid or vapour state D. has a latent heat of vaporisation of zero E. the pressure within a container is not dependent on the volume of the container

Adenosine and amiodarone are both A. Class three antiarrhythmics B. Half life 10secs and 10 mins respectively C. Can be used for SVT and VT D. Prolong AV node conduction and PR interval E. Blocks Na channels

An axillary nerve block is performed. On incision the patient complains of pain anterolateral forearm. Which nerve has been missed? A. Median n B. Ulnar n C. Axillary n D. Musculocutaneous n E. Radial n

Ankle venous pressure in adult standing (mmHg): : A. 4.5: B. 9: C. 45 : D. 90 : E. 150

Carotid sinus massage is used in SVT to: A. Decrease sympathetic stimulation of SA node: B. Increase vagal outflow to SA node: C. Decrease sympathetic stimulation to AV node: D. Increase vagal outflow to AV node: E. Decrease conductivity

In the foetal circulation...: A. Blood from the SVC flows into the LA via the foramen ovale: B. Blood in the umbilical vein is 40% saturated with oxygen: C. Blood from the IVC flows to the head vessels via the ductus arteriosus: D. Ductus venosus drains directly into the IVC: E. All haemoglobin is foetal haemoglobin

Pure water at pH 7 has hydrogen ion concentration of A. 0 nanomol/L B. 40 nanomol/L C. 70 nanomol/L D. 100 nanomol/L E. 1000 nanomol/L

What one of these is NOT a catecholamine: A. Isoprenaline B. Dobutamine C. Dopamine D. Phenylephrine

Which is NOT a derived SI unit: A. Joule B. Litre C. Pascal D. Ampere E. Newton

the first two hours of fasting...: A. Glucagon is increased: B. Proteolysis is the main source for glucose: C. Hormone sensitive lipase is activated: D. Increased insulin

D Glucagon - not increased for 6 hours

The effects of IPPV on the renal system A. decreased renal peritubular pressure secondary to decreased venous pressure B. decresed sodium reabsorbtion C. increased ANP secretion D. decreased aldosterone secretion E. increased SNS activity

The greatest effect of ADH on water reabsorption in the kidney occurs in the: A. proximal tubule B. loop of henle C. Distal Tubule D. cortical collecting duct E. medullary collecting duct

[Identical] 15B-33 In pregnancy

the increase in ventilationA. Occurs in 2nd trimester of pregnancy onwardsB. Is primarily due to an increase in oestrogenC. Is primarily due to an increase in progesteroneD. Represents a 10% increase in ventilationE. Is mainly due to an increase in respiratory rate, Answer: C - Is primarily due to an increase in progesteroneA: Increase in ventilation occurs from the onset of pregnancy and plateaus in the second trimesterB: Progesterone stimulates the respiratory centres and shifts the ventilation-carbon dioxide response curves to the left.C: Progesterone stimulates the respiratory centres and shifts the ventilation-carbon dioxide response curves to the left.D: Minute volume increases >50%, Tidal volume increases 40%, Respiratory rate increases 10%E: Tidal volume increases 40% cf respiratory rate increases 10%Power and Kam Maternal and noenatal physiology, Reason: Primarily due to progesterone- inc minute and alveolar ventilation (50-70% at term)occurs early in pregnancy (esp after 10/40)inc gradually during pregnancy inc due to (i) inc TV (by 40% at term) (ii) inc RR (by 15% at term)- Caused by progesterone-mediated stimulation of medullary respiratory centres-> inc sensitivity to PaCO2 (left shift in CO2 response curve)TV increases 40%ERV decreases 20%RV decreases 20%-> FRC decreases 20%TLC decreases 5%VC unchangedPower and Kam

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