2017.1 : SAQ 15

Outline the clinical laboratory assessment of liver function

BT_PO 1.106

Many of our drugs are metabolised by the liver, and many of our procedures rely on normal coagulation status.

An elevation in AST is related to zone 1 damage   TRUE/FALSE

Hypoalbuminaemia is seen within 48 hours of a hepatic insult  TRUE/FALSE

There will be hyperglycaemia in severe hepatic insufficiency  TRUE/FALSE

Urea will be low in severe hepatic insufficiency  TRUE/FALSE

Biliary obstruction can cause a high INR  TRUE/FALSE

 

2017.1 : SAQ 14

Outline the physiological effects of the adrenal hormones aldosterone and cortisol. (Do NOT describe synthesis or metabolism).

BT_PO 1.87

Sometimes we administer steroids… Sometimes we withhold them…

Aldosterone works on the distal tubules and collecting ducts  TRUE/FALSE

Aldosterone increases the reabsorption of potassium  TRUE/FALSE

Cortisol increases blood glucose  TRUE/FALSE

Cortisol has mineralocorticoid activity  TRUE/FALSE

Both have slow onsets of action  TRUE/FALSE

2017.1 : SAQ 13

Describe how the large daily volume of glomerular filtrate is altered by the kidney to form a relatively low volume of concentrated urine.

BT_PO 1.64    BT_PO 1.67

This question just asks for some basic functions of the kidney

Approximately 80% of the glomerular filtrate is absorbed  TRUE/FALSE

The medulla is hyperosmotic due to salt and urea  TRUE/FALSE

ADH plays an important role  TRUE/FALSE

Urea is actively secreted  TRUE/FALSE

The counter-current mechanism creates a hypo-osmotic medulla  TRUE/FALSE

2017.1 : SAQ 12

Discuss the physiological consequences of total spinal anaesthesia caused by intrathecal administration of 20ml of  2% lignocaine at the L3/4 level. (Do not include management)

BT_RA 1.2

A great question to demonstrate understanding of the physiological consequences of neuraxial blockade. The effects can all be deduced from your knowledge of physiology and pharmacology. However there is a most excellent article in AIC(1974) in which TI Evans, a Victorian anaesthetist, administered 30-40ml of 1% lignocaine intrathecally at the lumbar level in 100 patients. He proceeded to tilt the table 10 to 15 degrees head down and administer oxygen until vocal cord paralysis and unconsciousness developed and he intubated them. There were excellent conditions for abdominal surgery. The curious can access this work online through the college library, as a bonus the same issue (2) has quite a nice article on electrical safety as well.

This will cause bradycardia TRUE/FALSE

The patient will have dilated gut TRUE/FALSE

The patient will become hyperthermic TRUE/FALSE

The patient will have dilated pupils TRUE/FALSE

The patient will be unconscious TRUE/FALSE

So you’re sitting the primary in August…

Submitting an exam application on the closing date demonstrates commitment to a career in anaesthesia   TRUE/FALSE

 

The above is facetious but many candidates do apply on the final day that applications are open. One of my candidates missed the application date once, it was heartbreaking, not only did she have to study for another 6 months she also lost her spot on the training program and had to find a new job for a year.

It is now a month until applications close, if you are studying as if you will sit in August, then you should apply as if you will sit in August. The college does not deduct the funds from your credit card until after the closing date. Don’t take the risk of missing the application closing date because of personal circumstances or equipment failure.

2017.1 : SAQ 11

Draw an expiratory flow volume curve obtained from a maximal expiratory effort after a vital capacity breath, for a person with:

A.  normal lungs

B.  restrictive lung disease

C.  obstructive lung disease

(10 marks)

Explain how and why these curves (and the derived parameters) are different in each disease state (15 marks)

We see a lot of patients with pulmonary function tests, their associated curves and parameters. Understanding the physiology, aids interpretation of the results.

BT_PO 1.20

A vital capacity breath is from expiratory reserve volume (ERV) to total lung capacity (TLC)  TRUE/FALSE

The effort independent component is due to dynamic airways closure TRUE/FALSE

The TLC is increased in obstructive lung disease TRUE/FALSE

The effort independent component is steeper in restrictive lung disease TRUE/FALSE

A normal peak expiratory flow rate would be 10 L/min TRUE/FALSE

 

 

2017.1 : SAQ 10

I’m skipping over SAQ 9 as I covered it on December 5 last year.

Draw both aortic root and a radial artery pressure wave forms on the same axes.  Explain the differences between them.

It’s important to realise that the vessels of the circulation are not just a passive conduit – systemic pressure waveforms are produced by an interaction of the left ventricle, arterial physical properties and characteristics of the blood

Tapering contributes to the higher peak pressure seen in the radial artery   TRUE/FALSE

Reflection contributes to the diastolic hump seen in the radial artery  TRUE/FALSE

Stiff vessels will transmit reflected pressure waves faster  TRUE/FALSE

Mean pressure is higher in the radial artery  TRUE/FALSE

The Bernoulli effect created by a slower flow rate when the aortic valve closes creates the incisura  TRUE/FALSE

 

 

 

2017.1 : SAQ 8

Compare and contrast low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH).

BT_PO 1.118

These are drugs that are commonly administered to our patients pre-operatively and can impact upon our procedural decisions.

LMWH only inhibits factor XI  TRUE/FALSE

High dose UFH can inhibit platelet aggregation  TRUE/FALSE

Only UFH can be administered IV  TRUE/FALSE

Only UFH prolongs APTT  TRUE/FALSE

LMWH has less predictable pharmacokinetics  TRUE/FALSE

2017.1 : SAQ 7

Discuss the factors affecting duration of action of a local anaesthetic block to a major peripheral nerve.

BT_RA 1.3

Lot of patient interest out there in you knowing this.

Less lipid soluble drugs have a longer duration of action  TRUE/FALSE

Low protein binding causes a longer duration of action  TRUE/FALSE

Large molecules have a longer duration of action  TRUE/FALSE

Less vascular areas have a longer duration of action  TRUE/FALSE

In an elderly patient there will be a longer duration of action  TRUE/FALSE