Fluid & electrolytes

FE08 Hartmann's solution contains

A. Sodium 151 mmol/L

B. Potassium 2 mmol/L

C. Calcium 3 mmol/L

D. Magnesium 5 mmol/L

E. Chloride 151 mmol/L

FE04 ECG change with hyperkalaemia:

A. Long PR

B. Wide QRS

C. Long QT

D. ST elevation

E. ST depression

[edit]

Respiratory Physiology

RE25 The partial pressure of oxygen in dry air (in mmHg) at atmospheric pressure.

A. 149

B. 153

C. 159

D. 163

RE70 The anatomical dead space is increased by:

A. Intubation

B. Chin tuck position

C. Moving from supine to erect

D. Moving from sitting to semi-recumbent

E. Bronchospasm

What gives with the phasic response question to 8 hours of hypoxia without any CO2 correction? (It refers

to the Ventilatory Response to Isocapnoeic Hypoxia)

A. monophasic

B. biphasic

C. triphasic early>late

D. triphasic early<late

E. triphasic early=late

Chemoreceptors.

A. Aortic bodies are principally responsible for the changes in respiratory drive

B. Type 1 cells are in contact with the glossopharyngeal nerve

C. Type 2 cells are responsible for respiratory changes

D.

E. ?

RE71The VO2 max for a sedentary 40 year old male is about?

A. 3ml/kg/min

B. 11ml/kg/min

C. 40ml/kg/min

D. 90ml/kg/min

E. 250ml/kg/min

[edit]

Acid-base physiology

AD19 Which of the following is a 'strong ion'?

A. PO4

B. SO4

C. Cl

D. Albumin

E. Propyl geline

AD20 During infusion of hydrochloric acid (HCl), which contributes most to buffering? (repeated MCQ)

A. Phosphate buffer

B. Bicarbonate buffer

C. Intracellular buffers

D. Proteins (?intracellular proteins)

E. None of the above

AD21 Which of the following sets of values are measured directly by ABG machine

A. pCO2, paO2, pH

B. paCO2, HCO3, pH

C. paCO2, base excess, paO2

D. Something with base excess

E. Something with HCO3

[edit]

CVS physiology

Which one about ECG is correct?

A. The standard limb leads are bipolar

B. Lead 1 negative electrode to R arm

C Lead 2 negative electrode to R arm

D. Lead 3 negative electrode to R arm

E. When lead 1, 2 and 3 are connected correctly potential is zero

I: is a leadobtained between a negative electrode placed on the right arm and a positive electrode placed on

the left arm

II: is a lead obtained between a negative electrode placed on the right arm and a positive electrode placed

on the left foot

III: is a lead obtained between a negative electrode placed on the left arm and a positive electrode placed on

the left foot

Regarding the ECG leads, which is not true?

A. The standard limb leads are bipolar

B. Lead 1 negative electrode to R arm

C Lead 2 negative electrode to R arm

D. Lead 3 negative electrode to R arm

E. When lead 1, 2 and 3 are connected correctly potential is zero

(I'm sure I misread this question as there was only one stem like that) (This is also how I remember the

question - the first stem should have NOT in the question)

CV82Which of the following is not a cardiac channel/current

A. voltage gated Na channel

B. voltage gated Ca channel

C. Inward rectifying current

D. Delayed rectifier

E. Transient inward K+ current

Peripheral baroreceptors

A.

B. 8-10 seconds for response

C.

D.

E. Glomus cells have direct neural input to glossopharyngeal nerve

KD43Renal physiology===

Which of the following results in decreased K+ excretion?

A. prolonged vomiting

B. metabolic acidosis

C. normal saline infusion

D. Aldosterone

E. Renal failure

[edit]

GI physiology

[edit]

Blood & immunology

BL35 HLA is expressed

A. on antigen presenting cells

B. T-cells

C. B-cells

D. Red cells

E. All nucleated cells.

Option E was almost all nucleated cells - slight alteration from previous similar question.

Bilirubin

A. is only produced from the breakdown of haemoglobin

B. free bilirubin is bound to albumin for transport to liver

C. is produced in the reticuloendothelial system

D. is conjugated in the liver and then secreted into the bloodstream

E. ?

answer: B see http://en.wikipedia.org/wiki/Bilirubin

[edit]

Endocrine & metabolic physiology

??

[edit]

Neurophysiology

Which is not an effect of stimulation at Beta-2 receptors

A. tachycardia

B. lipolysis

C. glycolysos

D. bronchodilatation

E. something obvious - i think it was bladder wall relaxation

F. uterine relaxation

Answer: A Sympathetic effects on the heart are mediated by B1 receptors

Unsure if B2 receptors effect glycolysis B2 stimulation does increase glycogenolysis and lipolysis

Bronchodilation, bladder wall relaxation and uterine relation are all effects of B2 stimulation

answer: B. see Ganong p227-228 b: via beta1/beta3. A is right. c: should be glycogenolysis then is right.

The answer is C - Glycolysis is NOT an effect of stimulation at beta-2 receptors. (Glycolysis is the breakdown

of glucose to pyruvate or lactate --> occurs in all cells independent of sympathetic or parasympathetic stimu-

lation). B1 and B2 both cause tachycardia is according to both Ganong and Goodman and Gilman (though

G&G clarify further by stating it is B1>B2) Table 6-1 in G&G as well as table 13-2 in ganong have a good

summary. Lipolysis is mediated by a1, b1,2,3 and inhibited by a2.

NU11Which of the following is an excitatory neurotransmitter

A. Glycine

B. Glutamate

C. Gamma amino butyric acid

D. Serotonin

E. Dopamine

[edit]

Physiology of muscle & NMJ

[edit]

Maternal, foetal & neonatal physiology

Apnoea in neonates caused by 100% O2 indicates

A. Some retinal protective reflex

B. Immature central oxygen chemoreceptors (it said this)

C. Tonic drive by peripheral chemo receptors

D.

E.

C Tonic drive page 234 Nunn 6th Ed

[edit]

Clinical measurement

CM36 Which of the following is NOT a base SI unit

A. metre

B. ampere

C. candela (A unit for luminosity - how bright! or NOT!)

D. kelvin

E. Newton

Regarding humidity

A. Ratio of water vapour present to total water vapour required to fully saturate air

B. Absolute humidity is vapour volume per unit volume of air

C. Relative humidity is volume of water vapour divided by/over volume of water vapour capacity

D. Absolutely humidity is 44gm3 at 20 degrees C

E. Relative humidity is ratio of water vapour present to water vapour required to fully saturate the same vol-

ume of air at the same temperature

■ A - Definition of relative humidity (Davis)

■ B - no it isn't

■ C - Water vapour capacity is a little dodgy

■ D - 100% saturated air at 20oC is 17gm3, 37oC is 44gm3

■ E - Relative humidity = mass of water in given volume : mass required to saturate at given volume

(Davis pg 127 fifth ed)

Which is true regarding the Clarke electrode?

A. Has a Ag/AgCl cathode and a platinum anode

B. Can measure pO2 in both gas and blood sample

C. Uses a 0.6V polarising current

B correct page 205 davis 5th edition

What best describes relative humidity (two different but similar questions)

A. vapour content over vapour capacity

B. saturated vapour pressure

C. can't remember the other options

D. All questions started with "Ratio" of this and that

E. ?

Basic Physiology

BP08 [July-07] Giant Squid Axons are used to study action potentials because:

A. They are large

B. They only contain sodium channels

C. ?

D. ?

E. ?

[edit]

Fluid & Electrolyte Physiology

FE30 Infusion of 40ml/kg of 0.9% saline solution will cause: *new*

A. Hypochloraemic metabolic acidosis.

B. Hypochloraemic metabolic alkalosis.

C. Hyperchloraemic metabolic acidosis.

D. Hyperchloraemic metabolic alkalosis.

E. No acid base disturbance.

FE32 Post-thoracotomy the drain is leaking fluid with protein, fat, lymphocytes etc. What could be the cause?

A. Bleeding

B. Thoracic duct injury

C. sympathectomy

D. Pleural fluid

E.

Alt version- A fluid that has protein, free fatty acids, lymphocytes, and clotting factors would be:

A. thoracic lymph

B. plasma

C. CSF

D. Ascitic fluid

E. serum

FE31 Lymph flow:

A. greatest when skeletal muscle contracting

B. when interstitial pressure 1-2mmHg above atmospheric

C. approx. 1000ml per hour via thoracic duct

D. ?

The following electrolytes Na 120mmol/L, K6.2mmol/L, CL 80mmol/L are consistent with "*New*"

A. Dehydration

B. Hypoadrenalism

C. Primary Hyperaldosteronism

D. Water intoxication

E. Na Loss

answer: B see: http://en.wikipedia.org/wiki/Addison%27s_disease

[edit]

Acid-Base Physiology

Which of the following is a 'strong ion'? *repeat*

A. PO4

B. SO4

C. Cl

D. Albumin

E. Propyl geline

Answer C - Chloride

Stewarts Strong Ion theory states that the difference between strong cations and anions, independently influ-

ences the pH of a solution.

SID = { [Na+] + [K+] + [Ca++] + [Mg++] } - { [Cl-] + [Other strong anions-] }

and in human ECF is in the range 40-44. However Millers Anaesthesia also lists SO4 as a strong cation and

(think sulfuric acid) so this could also be correct, but based on the formula above, chloride is the most cor-

rect.

i think SID = { [Na+] + [K+] + 2[Ca++] + 2[Mg++] } - { [Cl-] + [Other strong anions-] }

[edit]

Respiratory Physiology

With constant oxygen consumption and constant (I think it was) alveolar ventilation, mixed venous oxygen

tension will increase with: *new*

A. alkalaemia.

B. hypothermia.

C. decreased 2,3 DPG.

D. hypercarbia.

E. none of the above.

(I thought it might have "Keeping CO, O2 carrying capacity and consumption constant a change/increase in

mixed oxygen tension will occur with"...this may have been a repeat question)

answer: B see http://books.google.com/books?

id=Z8BFSS9tsgwC&pg=PA499&lpg=PA499&dq=mixed+venous+oxygen+tension+will+increase+with&sourc

e=web&ots=7gsQYy6s0H&sig=nuSV7WmGByE9oH-d16CDkwJlEiA --- i think answer is D (hypercarbia).

The above reference mentions hypothermia will increase oxygen tension only if Bold textoxygen consump-

tion decreasesBold text but stem says constant consumption. ODC will right shift (increasing pO2) with in-

crease PCO2 vs left shifting with options A,B and C. And of course Henry's Law, decrease temp, increases

gas solubility decreasing partial pressure/tension. Anyone else agree/disagree?? - I'm not so sure... the

question is referring to mixed venous oxygen tension. A hypercarbia would cause a decreased paO2 (can be

estimated using the alveolar gas equation given that there is no great A-a gradient), and at a constant oxy-

gen consumption, this would mean the pvO2 would be even lower. I'm going with "none of the above"

For a normal oxygen-Hb dissociation curve (Temp 37, pH 7.4, pCO2 40), which of the following paired values

are most accurate? *repeat*

A. SaO2 99%, PaO2 350 mmHg

B. SaO2 98%, PaO2 150 mmHg

C. SaO2 97%, PaO2 ?

D. SaO2 94%, PaO2 65mmHg

E. SaO2 91%, PaO2 60mmHg

Increases in respiratory rate cause changes in lung compliance because of "*New*"

A. Gas trapping in apical alveoli

B. Alveoli with long time constants

C. ??somthing with airways resistance

D. ??something with hypercarbia

answer: ?C see:http://books.google.com/books?

id=Ne3Jholg4SMC&pg=PA101&lpg=PA101&dq=increases+in+respiratory+rate+cause+changes+in+lung+co

mpliance&source=web&ots=9_Rn4jR3vv&sig=fgrwFn9TYw9qPrU9nkJs5VJejuk#PPA103,M1 answer: see

P&K p80

[edit]

Cardiovascular Physiology

CV80A prolonged PR interval, ST segment flattening, and the appearance of a U-wave is consistent with:

*new*

A. Hyperkalaemia.

B. Hypokalaemia.

C. Hypomagneseamia.

D. Hypocalcaemia.

E. None of the above.

Also had hypermagnesaemia as an option

CV81 Question about conductance of blood flow *new*

A. is directly related to resistance

B. directly related to the diameter squared

C. same as pressure difference between arterial and venous system

D.

E. ??addition in parallel circuits to get total conductance??

Question about coronary blood flow, which is wrong? *new*

A. drains via anterior coronary vein into right atrium

B. oxygen extraction is maximal, no oxygen reserve

C.

D.

E.

answer: A see: http://books.google.com/books?

id=GMnCtsxIdj4C&pg=PA88&lpg=PA88&dq=coronary+blood+flow+drains+via&source=web&ots=Vtvl_4pZh

4&sig=jk8gS0uRgliLfmHs806fh7EcKlE

Question about ECG recording *new*

A. Isoelectric because right ventricle depolaristion is opposited to ?left ventricle

B. QT interval is proportional to HR

C

D.

E.

QT is inversely proportional to HR (as Action potenial duration is inversely proportional to HR)

In a normal, healthy 70 kg male what is the end-systolic volume of the left ventricle?

A. 10-20 ml

B. 20-30 ml

C. 50-70 ml

D. 90-100 ml

E. 100-120ml

Answer: c 50 - 70 mL Guyton and Hall states that the end-systolic volume is equal to 40 - 50 mL.

Cardiac cells *new*:

A. RMP -60mV

B. RMP changes with changes in extracellular K+ concentration

C. Action potential magnitude?/amplitude? changes with changes in extracellular potassium concentration

answer: B see:EK = -61 log [K+]i / [K+]o

I agree, however, isn't C also possibly correct? A change in RMP, changes the potential closer or further

away from threshold - and this effects AP amplitude and conduction velocity

C is wrong. AP amplitude is changed if ECF Na conc changes

[edit]

Renal Physiology

KD7Regarding the renal effects of intermittent positive pressure ventilation: *new*

A. Na+ retention due to increased ANP release.

B. Decreased cardiac output causes oliguria.

C. ???increased venous pressure and ??increase/decreases in renal blood blow

D.

E.

Juxtamedullary nephrons *new*

A. Have long loops of henle

B. ? have no glomeruli in the cortex

C.

D.

E.

(Note, the stem for this question actually included the term "Juxtaglomerular nephrons")

answer: A see http://en.wikipedia.org/wiki/Juxtamedullary_nephron

KD40 Increased tubular reabsorption with increased GFR is related to "*New*"

A.

B. Autoregulation

C. Tubuloglomerular Balance

D. Tubuloglomerular Feedback

E.

[edit]

GIT Physiology

[edit]

Blood & Immunology

I think it's a repeat about FFP and what it contains..

MCQ-30 Following breakdown of haemoglobin

A. free iron transported in plasma and excreted in urine

B. free bilirubin transported in plasma bound to albumen

C. globin chains reused in formation of new haemoglobin

D. Heme broken down in liver to biliverdin

E. none of above

answer: B

A wrong, iron+ plasma transferrin > marrow erythroblasts

B Correct: The globin chains are broken down to amino acids and reenter the amino acid pool. The iron is re-

utilized by the bone marrow for the synthesis of haemoglobin. The protoporphyrin ring is opened to form

biliverdin. Biliverdin is metabolised to bilirubin which is bound to albumin and carried to the liver. (P&K p.238)

C wrong, globins>amino acids>general protein synthesis

D wrong, maily bone marrow + liver + spleen

[edit]

Endocrine & Metabolic Physiology

[edit]

Neurophysiology

NU10 The sharp initial pain associated with injury is transmitted by: *new*

A. Unmyelinated C fibres

B. Unmyelinated Aδ fibres

C. Nerve fibres with a conduction velocity of approximately 15 m/sec

D. Nerve fibres which project to the anterior horn and the spinothalamic tract

E. Nerve fibres with a diameter of less than 2 µm

Some horrific question about dull pain transmission and paleospinothalamic vs neospinothalamic tracts...

Yes, a stem like "the spinothalamic tract consists of paleothalamic and neothalamic tracts..."

The neospinothalamic tracts:

A. synapse in the substantia gelatinosa of the dorsal horn.

B. ? second order neurons projecting to ventro basal part of the thalamus.

C. neo/paleo carries deep/superficial pain

D.

E.

answer B

Neospinothalamic tract

Fast pain(mechanical and thermal stimulation)> type Aδ fibers >/ dorsal horn of the spinal cord >synapse

with the dendrites of the neospinothalamic tract>cross the midline through the anterior white commissure>

contralateral anterolateral columns>/ventrobasal complex of the thalamus > synapse with the dendrites of

the somatosensory cortex.

Paleospinothalamic tract

Slow pain (chemical stimulation poorly localized)>slower type C fibers > laminae II and III of the dorsal

horns(substantia gelatinosa)>/lamina V> join fibers from the fast pathway>crossing to the opposite side via

the anterior white commissure>anterolateral pathway>/ brain stem(1/10 stopping in the thalamus,9/10 stop-

ping in the medulla, pons and periaqueductal grey of the midbrain tectum.

"Some question about the functions of brain cells" "new"

A. microglia have large dendritic networks

B. glia cells are only found in the cortex

C. oligodendrocytes are the only cells to form many connections in the brain

D. astrocytes are scavenger cells

E. ?Schwann cells are involved in the BBB

page 63 Ganong 22nd

■ Oligodendrocytes produce mylin

■ Schwann cells are Glia (and not in CNS so B is wrong)

■ Microglia are like macrophages with short branching processes (Ross, Romrell, Kaye HISTOLOGY 3rd

Ed)

■ Astrocytes induce blood vessels to form BBB

[edit]

Physiology of Muscle & Neuromuscular Junction

[edit]

Maternal, Foetal & Neonatal Physiology

Apnoea in neonates caused by 100% O2 indicates: *repeat*

A. Some retinal protective reflex.

B. Immature central oxygen chemoreceptors.

C. Tonic drive by peripheral chemo receptors.

D. Central hypercarbic depression

E.

- I did find something about peripheral chemoreceptors being more important for reflex control of ventilation

in premature neonates as opposed to term babies - but now I can't find the page I was looking at...

Answer C - look up neonates in Nunn - hmmm

From A foundation for neonatal care: a multi-disciplinary guide By Michael Hall, Alan Noble, Susan

Smith (relax, despite the title they are doctors; neonatologists from Southampton, UK): Essentially the

neonate is used to relative hypoxia and relative hypercarbia in utero and require time (4-6 weeks) to adjust to

lashings of oxygen and less CO2 at birth. Giving a neonate 100% FiO2 essentially silences the peripheral

chemoreceptors because they have a low set point. After this adjustment period, they begin to respond to

higher po2 levels as per the adult. I agree with (C)

Increased cardiac output, reduced systemic vascular resistance, alkalosis and tachypnoea would be caused

by ? *new*

A. pregnancy.

B. exercise.

C. altitude adaptation

D. overdose

E.

- I'm going for altitude adaptation (decreased SVR due to the extra capillaries formed in muscles, which in-

creases the CSA, which decreases the SVR). I was thinking pregnancy, but isn't that the only time where pH

is virtually perfectly compensated (I guess if the question said respiratory alkalosis, it could still be correct,

because it is compensated, but if it said alkalaemia, I think altitude).

[edit]

Clinical Measurement

What best describes relative humidity? *repeat*

A. vapour content over vapour capacity.

B. saturated vapour pressure.

C. a bunch of other ratios of this and that, all of which were wrong.

D.

E.

(A) - Relative humidity = Actual vapour pressure / saturated vapour pressure (B) - incorrect because SVP is

just that, SVP

CM37 Which is true regarding the Clarke electrode?

A. Has a Ag/AgCl cathode and a platinum anode

B. Can measure pO2 in both gas and blood sample

C. Uses a 0.6 amp polarising current

D. Is accurate despite changing temperature

E. Is calibrated using a special electrical device

Which has the highest specific heat capacity

A. Whole Blood

B. Skeletal muscle

C. Water

D.

E.

answer: C a: heat capacity = 3.594 J/gK b: c: Water (liquid): heat capacity = 4.1813J/gK

what about muscle? shouldn't solid have a higher heat capacity?

General physiology

BP08 In regards to voltage gated Na+ channels:

A. Giant squid axons used to study as they only contain Na+ channels

B. Blocked from the inside by tetrodotoxin

C. ?

D. ?

E. ?

BP09 Which is incorrect regarding the Kreb’s cycle:

A. Acetyl-coA is metabolized to CO2 & H+

B. ?

C. Oxaloacetate is recycled

D. 12 ATP is generated

E. Cycle is continous during anaerobic metabolism but at slower rate

BP10 Cytochrome c oxidase catalyses *new*

A. O2 + 2H+ -> H2O

B. ?

C. ?

D. H+ + HCO3- -> H2CO3

E. None of the above

(Think this may have actually been asking about cytochrome a3)

BP11 In regards to the Na+/K+ ATPase *new*

A. Three K+ out for every two Na+ pumped in

B. Stimulated by Ouabain

C.3ATP broken down to ADP and P for every 3Na+ pumped in

D.is inhibited by high extracellular concentrations of Na+

E. an electrogenic pump

[edit]

Fluid & electrolytes

FE33 Hyponatraemia is usually due to:

A. Excess lipids

B. Excess glucose

C. Free water deficit

D. Excess protein

E. Free water excess

FE30 [Jul07] [Feb08] Infusion of 40ml/kg of 0.9% saline solution will cause:

A. Hypochloraemic metabolic acidosis.

B. Hypochloraemic metabolic alkalosis.

C. Hyperchloraemic metabolic acidosis.

D. Hyperchloraemic metabolic alkalosis.

E. No acid base disturbance.

Feb08: Remembered as:

An infusion of 40mls/kg of Normal Saline would cause

A. Metabolic alkalosis

B. Mixed repiratory and metabolic acidosis

C. Metabolic acidosis

D. No change

E. ?

[edit]

Acid-base physiology

AD10 [Apr01] [Jul04] [Feb08] A patient is draining 1 litre of fluid per day from a pancreatic fistula while main-

taining normal volume status. The most likely acid-base disorder is:

A. Hyperchloraemic metabolic acidosis

B. Hypochloraemic metabolic acidosis

C. Metabolic acidosis with normal chloride

D. Hyperchloraemic metabolic alkalosis

E. Hypochloraemic metabolic alkalosis

AD18 [Feb06] [Feb08] Calculation of Base Excess

A. ? related to Henderson Hasselbalch equation

B. Assumes a PCO2 of 40mmHg

C. ?

D. ?

E. ?

AD22 [Feb08] Person with these blood gas results: pH 7.33 CO2 58 HCO3 33

A. Acclimitization after several weeks at altitude

B. Person with chronic pulmonary disease

C. Diabetic ketoacidosis

D. Hyperventilation

E. Prolonged vomiting

AD23 [Feb08] Person with these blood gas results: pH 7.53 pCO2 27 HCO3 22

A. Acclimitization after several weeks at altitude

B. Person with chronic pulmonary disease

C. Diabetic ketoacidosis

D. Hyperventilation

E. Prolonged vomiting

[edit]

Respiratory Physiology

■ new*

RE Hypoxic Pulmonary Vasoconstriction follows a biphasic response. The time taken to maximal vasocon-

striction in the Initial phase of HPV is:

A. 1-2 minutes

B. 5-10 minutes

C. 30-40 minutes

D. 1-2 hours

E. (hours?)

Answer: A

Actaully Nunn states is rapid in ONSET with maximal response after 5-10 mins, then rapid decrease to previ-

ous level- followed by slow sustained rise to plateau after 40 mins pg 101-102 Nunn 5th

■ new*

RE In regards to CO2

A.

B.

C. The exchange of Cl for the inwards movt of HCO3 results from the buffering of CO2 in the red blood cell.

D.

E. CO2 uptake in the peripheries results in an increased haematocrit

Answer: C I think E is correct- Brandis page 6

■ new*

RE If breathing air, what is PAO2 at 8,828m (atm pr = 248mmHg) when PACO2 is 20mmHg?

a) 10

b) 17

c) 27

d) 32

e) 42

ANSWER:21%*(248-47)=44 PAO2= 44-20/0.8-2=17 answer: B

■ new

RE In normal patient, which has the highest PCO2 value?

a) dead space gas

b) ideal alveolar gas

c) end tidal

d) mixed expiratory

e) ? CO2 come from blood, the most CO2 close to blood level is the highest. Answer: C Hmmmm Doesn't

the CO2 in the alveoli have a higher PO2 than the end tidal which is always going to be a bit less than the

ideal? (the ideal gas is still mixed with some well ventilated but underperfused alveoli) (page 157 Nunn 5th

ed) I think answer is B

I Agree the answer is B. See Nunn Ed 6 pg 156 Fig 10.7 for some useful numbers.

■ new*

RE Which of the following would occur within 30mins of ascent to extremely high altitude

A.Increased respiratory rate to completely restore PaO2 to normal

B. Decreased cardiac output

C. Respiratory acidosis

D. increased levels of 2,3 DPG

E. pulmonary edema

Answer: E can try it yourself, take some Dex with you.And a oxygen bottle. How fast does 2,3 DPG rise??

■ new

RE During normal tidal ventilation

a) Intrapleural pressures between -5 & -8mmHg

b) Alveolar pressures between -2 & +2 cmH2O

c) Tracheal flow is sinusoidal

d) Peak flow is 5L/s

e)?intrapleural pressure curve is sinusoidal

a) correct pg 109 west, but isn't tracheal flow sinusoidal. Peak flow is 0.5L/s. and technically alveolar pres-

sures are between those values (-1 to +1). intrapleural pressure curve is not sinusoidal.

■ New

Respiratory rate affects compliance due to:

a)

b)

c)alveoli having different time constants

d)Compression of airways

e) Answer: c

[edit]

CVS physiology

■ new

CV All are ion channels in the cardiac muscle except

a) Voltage gated Ca-Channel

b) Delayed rectifying K-channel

c) Inwardly rectifying K-channel

d) Transient inward K-Channel

e) Voltage gated Na-Channel

■ repeat*

ANSWER: D

CV In regards to ECG calibration and speed.

A. 1mV/cm at speed 50mm/sec

B. 1mV/1cm at speed 25mm/sec

C. 1mV/0.5cm at speed 25mm/sec

other options were mixes of the above

■ REPEAT*

ANSWER B

CV Which organs have the highest O2 extraction per unit weight?

A. Heart>liver>kidney>skin

B. Liver>skin>kidney>heart

C. Kidney>Liver>Heart>Skin

D. Heart>liver>kidney>skin

E. Heart>Liver>Skin>Kidney

(There were actually two answers exactly the same!)

■ REPEAT*

answer:E

I can't see a correct answer. From Ganong Ed21 Table 32-1: O2 consumption in ml/100g/min: Heart 9.7,

Kidneys 6.0, Liver 2.0, Skin 0.3

It's not asking about O2 consumption, it's asking about extraction ratio. Kidneys have blood flow far in excess

of their O2 requirements. Heart has highest extraction ration of all organs (55-65% (Brandis)). Therefore E

is the correct answer

CV Which is the least likely to show autorhythmicity? (comment: I think stem was saying slowest autoryth-

micity)

a) AV node

b) HIS bundle

c) SA node

d) Atrial muscle

e) Ventricular muscle

■ repeat*

ANSWER: E

CV Which CVS change is not true regarding normal aging process

a) Decreasing HR

b) Increasing diastolic pressure

c) ?Increased heart compliance

d) ?increased peripheral resistance

e) ?

■ REPAET*

ANSWER: BEST ANSWER: C B also wrong, the question ask about normal aging process,which diastolic

BP can be decrease. not talking about diastolic hypertension.

[edit]

Renal physiology

■ new

KD Which is an action of aldosterone on principal cells?

a) K resorption

b) H+ secretion

c) Na resorption

d) Bicarbonate secretion?

e) Chloride resorption?

Answer C: Aldosterone causes K+ secretion and Na+ absorption from principal cells. Also H+ secretion from

intercalated cells (from Peter Watt's notes)

[edit]

GI physiology

■ new*

GI Functions of Liver DOES NOT include

a) synthesis of immunogloubins

b) Synthesis of clotting factors

c) Conjugation of bilirubin

d) ?cholesterol

e) Inactivations of steroids

Answer A: The immunoglobulins are produced by plasma cells of the bone marrow, spleen, lymph nodes and

gut. (Power and Kam p 258)

■ new*

GI The following CHO is absorbed in the small intestine:

a) glucose

b) sucrose

c) hexose

d) trehalose

e) lactose

Answer A: The three monosaccharide products of carbohydrate digestion - glucose, galactose and fructose

are absorbed by the small intestine. (Boron p 952)

[edit]

Blood & immunology

■ new*

BL Plasmin cleaves all the following except

a) II

b) V

c) VII

d) VIII

e) XII

Plasmin cleaves F2,5,8,10,12 fib, activated by t-PA, u-PA AND F12a , inactivated by PAI-1 and alfa 2 -AP.

answer: c

■ new*

BL Regarding the complement system

a) aids innate immunity

b) aids ?cellular/humoral/acquired immunity

c) bacterial mannose triggers alternate pathway

d) requires b-cells for activation

e) answer: B

■ new

BL Regarding Fe and haemoglobin:

a)

b) 69% stored in Hb

c) Hb has 4heme groups each containing porphyrin and ferric iron

d)

e)

answer: B. 65-70% in Hb, 25-30% in liver as ferritin, total 3-4 g (Brandis table p 199)

C is also correct

[edit]

Endocrine & metabolic physiology

■ new*

ED Patient with following results: Na 122, K 6.7 Cl 80. Which is correct?

a) hyperaldosteronism

b) adrenal insufficiency

c) DKA

d) Diabetes insipidus

e) Water Toxicity

B http://en.wikipedia.org/wiki/Addison%27s_disease#Addisonian_crisis

Why is this not DKA? I suspect that DKA and Addison's disease may have similar Na, K and Cl with glucose

being the major difference (high in DKA, low in Addison's)

■ new

ED Patient with core temperature of 33C under anaesthesia

a) decreased metabolic rate by 15%

b) Decreased HR

c) Decreased CO2 and Increased O2?

d)

e) Platelet function preserved

[edit]

Neurophysiology

■ new*

NU In Cerebrospinal Fluid there is:

A. higher concentration of sodium

B. higer concentration of protein

C. lower concentration of potassium

D. lower concentration of chloride

E. higher osmolarity

Answer: C. K is lower, Cl is higher, protein is lower. (Brandis p 224). Not sure about Na and osmolality. I am

assuming they are the same as plasma as they are not mentioned as differences in Brandis

■ new

NU Regarding the (?sympathetic) autonomic system, which is true?

a)

b) Postganglionic sympathetic fibres secrete noradrenaline to sweat glands

c) Sympathetic preganglionic fibres originate from T1 to L2/3

d) Some preganglgionic sympathetic fibres enter the gray communicans to enter spinal & visceral nerves

e) The adrenal glands are similar to modified preganglionic nerve cells

Some POSTganglgionic sympathetic fibres enter the gray communicans to enter spinal & visceral nerves.

The adrenal glands are similar to modified POSTganglionic nerve cells C is correct I think, but Ganong states

that B is as well pg 228 22nd ed so???

Opinion: Kam Pg 58 Preganglionic sympathetic fibers originate from T1-L2/3 Kam 328 Sweat glands are in-

nervated by cholinergic sympathetic fibers

■ New

NU EEG waves of a person moving from a hyperexcitable state to sleep would be

A theta -> alpha -> beta -> delta

B

C

D

E

B-E different order of the same four http://en.wikipedia.org/wiki/Sleep#Stages_of_sleep

[edit]

Physiology of muscle & NMJ

■ new

MU Smooth muscle differs from skeletal muscle

a) they have a longer latency

b) cannot produce as high a peak force

c) cannot sustain as long a contraction

d) ? have longer sarcomeres

e)none of the above

REPEAT: ANSWER E

■ new

MU Microscopy of a striated (?skeletal) muscle

a)

b)

c) Z-discs intersect fibrils?

d)

e) http://en.wikipedia.org/wiki/Sarcomere

[edit]

Maternal, foetal & neonatal physiology

■ new*

MF During pregnancy, O2 consumption increases by 16-20%. This is due to

A. effects of progesterone

B. evident by 20 weeks gestation

C. due to fetoplacental unit

D. unrelated to muscle work

E. ? hypercarbia

■ new*

MF Pregnant woman at term has a spinal block to T4 on sensory testing. She is unable to generate an effec-

tive cough because:

A. laryngeal edema

B. cephalad movement of uterus after 20 weeks gestation causes a decrease in ERV (?)

C. phrenic nerve block

D. Block of lower intercostal muscles

E.

MF Breathing 100% O2 may cause apnoea in the neonate. This is due to (I’m unsure of exact options)

a) optic nerve protective reflex

b) immature peripheral chemoreceptors

c) immature central O2 receptors.

d) Tonic discharge of peripheral receptors

[edit]

Clinical measurement

■ new

CM Which of these is LEAST likely to affect CO measurement by thermodilution?

a) ...rapid injection?

b) Injection during inspiratory phase

c) Incorrect volume of injectate

d) Temperature of injectate very close to body temperature

e) ?

■ repeat*

CM In regards to clarke electrode

A. has a platinum annode and Ag/AgCl cathode

B.

C. measures O2 content of both gas and blood samples

D. requires 0.6 amp current

Fluid & electrolytes

Osmotic pressure of ECF is

a. 300 mosmol/L

b. 20 mmHg ???

c. 5900 mmHg

d. ?

e. ??

Acid-base physiology

■ NEW*

pH 6.96 pCO2 23 HCO3 5

ABG is consistent with

a. ?

b. ?

c. diabetic coma

d. ?

e. prolonged vomiting

■ Repeat* Pancreatic fistula with output of 1L per day and normovolaemia

a. ?

b. ?

c. hyperchloraemic metabolic acidosis

d. hypochloraemic metabolic alkalosis

e. ?

Respiratory Physiology

Resp01 Functional residual capacity

a. decreases with age

b. increases in pregnancy

c. decreases in obesity

d. ?

e. ?

Resp02 New* Rate of PaCO2 rise in breath-holding

A. 1 mmHg/min

B. 2 mmHg/min

C. 4 mmHg/min

D. 8 mmHg/min

E. 16 mmHg/min

Nunn's Ed 6 pg 160 ....pC02 rises at 3-6 mmHg/min. Hence C best answer

In asthmatics (? poorly remembered? something about dead space)

... anatomical deadspace is reduced

Transmural pressure

a. is greater at the apex

b. ?

c. ?

d. ?

e. ?

Nunn's Ed 6 pg 29 .... A is correct

■ New* Rate of PaCO2 rise in breath-holding

A. 1 mmHg/min

B. 2 mmHg/min

C. 4 mmHg/min

D. 8 mmHg/min

E. 16 mmHg/min

CVS physiology

ECG

a.

b.

c. QT interval proportional to HR

d. PR interval is atrial depolarisation to ventricular depolarisation

e.

■ Repeat* Hyperkalaemia causes

a. increased QT interval

b. absence of P waves

c. ST depression

d. inverted T waves

e. ?

Endothelin

a. is produced by vascular smooth muscle

b. is not found in the brain

c. cause vasodilation

d. released with vascular stretch

e. ?

■ REPEAT* Reynold's number is not affected by

a. velocity

b. diameter

c. density

d. length

e. viscosity

Renal physiology

RP01 Maximal urine pH

A. 3.0

B. 3.5

C. 4.0

D. 4.5

E. 5.0

■ new* Renal oxygen consumption

a. Is greater in the medulla than the cortex

b. ?

c. is greater than the brain per unit weight

d. ?

e. is 25ml/100g/min (whatever the correct units were)

Both A and C are correct. Reference for A, Ganong Ed 21 pg 708 and for C, Ganong Ed 21 pg 615

■ Repeat* Glycosuria is most likely to occur with

a. increase GFR and increase blood glucose concentration

b. increase GFR and decrease blood glucose concentration

c. ?

d. ?

e. ?

GI physiology

Blood & immunology

■ Repeat* Haemoglobin

a. is a large metalloprotein with a molecular weight of 169500 daltons (? can't remember if it was kDa or Da)

b. ?

c. accounts for 65-70% of total iron body stores

d. is always bound to 2,3 DPG

e. contains 4 protoporphyrin rings with 1 ferrous ion

FFP

a. does not contain factors V and VIII

b. Must be crossmatched

c. does not contain albumin

d. Contains an anticoagulant

e. does not contribute to colloid osmotic pressure

Actcois of complement (it said 'ACTCOIS' i'm guessing it meant actions)

a. phagocytosis

b. ?vasodilation

c. ?

d.

e.

Endocrine & metabolic physiology

■ NEW* The citric acid cycle does NOT produce

a. CO2

b. H+

c. NADH

d. FADH2

e. NAD

The last reaction in the electron transport chain is

a. ?

b. ?

c. 1/2 O2 + 2H+ --> H2O

d. ?

e. ?

■ Repeat* Basal metabolic rate is measured how many hours after the last meal?

a. 1 hour

b. 6 hours

c. 8 hours

d. 12 hours

e. 24 hours

■ New* Initial temperature drop under anaethesia is due to:

a. Opening of AV shunts in the skin (or something like that)

b. radiation to the theatre

c. conduction to the operating table

d. evaporation from the skin

e. ???

Neurophysiology

■ NEW* The EEG in a person with eyes closed and mind wandering would be

a. beta waves

b. theta waves

c. delta waves

d. alpha waves

e. beta and alpha waves

■ NEW* CSF

a. is reabsorbed by the choroid plexus

b. turnover rate of 6 times per day

c. is produced at 4ml/hr

d. is actively secreted

e. reabsorption is inversely proportional to CSF pressure

■ NEW* In woman in active labour

a. epidural pressure is decreased

b. CSF volume increased (??? not sure but it was something to do with CSF)

c. Gastric emptying is decreased

d. ?

e. ?

■ REPEAT* EEG changes with sleep

a. ?

b. ?

c. ?

d. beta > alpha > theta > delta

e. ?

■ New* Itch is transmitted via

a. Aalpha

b. ?Abeta

c. Adelta

d. B fibers

e. C fibers

■ Repeat* Sharp pain due to injury is transmitted by

a. Myelinated Aalpha

b. Unmyelinated Adelta

c. Fibers which carry impulses at the rate of 15m/s

d. Fibres which synapsy in the anterior horn and travel via spinothalamic tract

e. ?

Physiology of muscle & NMJ

■ NEW* Question on smooth muscle

a. ?

b. ?

c. ? No troponin in smooth muscle. contraction is mediated by calcium binding to calmodulin

d. ?

e. Something about the Fenn effect?

Maternal, foetal & neonatal physiology

Clinical measurement

■ NEW* Regarding invasive pressure monitoring

a. Systems with natural frequency of 5Hz will have a decrease in MAP

b. Overdamped will have decrease in MAP

c. Underdamped will have decrease in MAP

d. Underdamped will have decrease in diastolic BP

e. overdamped will have increase in systolic BP

General physiology

■ New*

Sodium/potassium/ATPase:

A. Is a dimer

B. Transports 3 potassium in and 2 sodium out

C. Activated by cellular dehydration

D. ?

E. Digoxin binds to the potassium binding portion

■ New*

Regarding protein synthesis and DNA

A. Introns are the DNA transcription sites

B. Promoter region

C. Something about DNA gyrase

D. Something about RNA translation (wrong)

E. DNA replication arises from a single mRNA strand

Fluid & electrolytes

■ new*

17. In the resting state, the cell membrane permeability to Na:K is

A. 100:1

B. 10:1

C. 1:1

D. 1:10

E. 1:100

Significant hypovolaemia in the presence of decreased plasma osmolality results in:

A. increased urine output

B. increased permeability of collecting duct to water

C. decreased aldosterone secretion

D. decreased renin secretion

E. none of the above

Acid-base physiology

Respiratory Physiology

■ New*

Carbon dioxide tension is highest in which gas sample?

A. Alveolar dead space

B. End tidal

C. Ideal alveolar

D. Mixed expiratory

E. Anatomical dead space

■ New*

Carbon dioxide is carried most in the body in the form of

A. Dissolved in blood

B. Carbamino compounds in RBC

C. Carbamino compounds in plasma

D Bicarbonate in RBC

E. Bicarbonate in plasma

Answer E. West Ed 7 pg 81

■ New*

Most likely physiological cause of hypoxaemia after intra-abdominal surgery:

A.

B. Diffusion hypoxia

C. Metabolic acidosis

D. Increased physiological dead space

E. Increased shunt

■ New*

Most likely changes in a previously healthy 60 year old male who has morphine overdose in room air

A. pO2 pCO2 60 pH 7.51 HCO3 25 BE -1

B. pO2 60 pCO2 50 pH 7.26 HCO3 26 BE-1

C. pO2 pCO2 25 pH HCO3 BE-1

D. pO2 pCO2 25 pH HCO3 BE+8

E. pO2 pCO2 15 pH 7.35 HCO3 BE -12

■ New*

Static lung compliance

A. Is change in pressure per unit volume

B. Affected by airway resistance

C. Is equal to pulmonary elastance

D. Depends upon surface tension forces

E. Combination of lung and chest wall compliance

■ New*

Application of 10cmH20 of pressure at the upper airway of a spontaneously breathing person will cause

A. Decreased airway resistance

B. Increased V/Q mismatch

C. ?

D. ?

Answer A. Nunn's Ed 6 pg 44

■ New*

When breathing 100% oxygen, the mixed venous oxygen saturation is

A. 25%

B. 50%

C. 75%

D. 85%

E. 100%

Nunn's Ed 6 table 26.1 ... 100% O2 causes a rise in venous O2 content from 14.3 to 16.3 ml/dL. No figure for

sats but would expect a small rise from 75% to maybe 85%. Hence I feel D is the best answer

■ New*

Hypoxic pulmonary vasoconstriction

A. Is due to decreased oxygen saturation in arterial blood

B. Is due to decreased oxygen tension in bronchial circulation

C. Inhibited by metabolic alkalosis

D. Inhibited by respiratory alkalosis

E. Is associated with increased V/Q mismatch

Answer D. Nunn's Ed 6 pg 102..... Alkalosis, whether respiratory or metabolic in origin, causes pulmonary

vasodilatation and reduces or even abolishes HPV Which is why I thought C and D are correct or one of

them should read Acidosis

■ New*

The following is true for true for mixed venous carbon dioxide

A. CO2 content is 42mls/100ml blood

B. Most carried in dissolve form

C. Most carried in carbamino form.

D.

E. Causes increased haematocrit

CO2 content = ~54ml/dL in mixed venous blood (Nunns 5th Ed pg 227) B and C obviously wrong E is correct

albeit poorly worded

CVS physiology

■ New*

With regard to the connection between the heart and the circulation:

A. When arteriolar resistance increases, total systemic blood pressure decreases.

B. With constant cardiac output, decrease in systemic vascular resistance is associated with increase in CVP

C. With transfusion of volume, the vascular curve will shift left and the cardiac output curve will shift right

D. With sympathetic stimulation the cardiac output curve will shift right.

E. Hypervolaemia is the treatment for cardiac failure

Answer B

REPEAT

Pulse pressure increases all except

A. Increased aortic compliance

B. Decreased diastolic pressure

C. Increasing heart rate

D. Increased systolic pressure

E. Decreased systemic resistance

Answer A

■ New*

Normal pulmonary artery pressure

A. 10/0 mmHg

B. 15/5 mmHg

C. 25/10 mmHg

D. 45/15 mmHg

E. 120/80mmHg

■ New*

True about carotid sinus:

A. Located at the origin of the external carotid artery

B. Increased firing in response to increased blood pressure

C. Decreases central sympathetic outflow by inhibiting medullary vasomotor centre

D. Do not respond to something

E. Responds to pressure rather than stretch

■ New*

True about regular exercise

A. Maximal heart rate is increased

B. ?

C. During moderate exercise, total systemic vascular resistance increases

D. During moderate exercise, systemic blood pressure increases

E.

■ New*

Cardiac action potential in SA node

A. Vagal stimulation causes depolarisation

B. Something about potassium channels being responsible for phase 0

C. Long term calcium channels cause depolarizing potential

D. Calcium channels are cause of action potention, no role of sodium channels

E. Long term calcium channels cause action potential

■ New*

T-tubules in cardiac cells located in:

A. Z line

B. M line

C. A-I band junction

D. A-H band junction

E. I line

Answer A : see http://en.wikipedia.org/wiki/T-tubule

■ new*

Mild to moderate blood loss in a healthy 70kg 30 year-old male:

A. Decreased renin and aldosterone

B.

C. Does not cause decrease in systemic blood pressure

D. Does not cause cardiac and cerebral vasoconstriction

E.

■ New*

Isometric contraction

A. Force of contraction independent of the initial fibre length

B. Force of contractionis independent of initial load

C. Velocity of contraction is independent of load

D. Not associated with decreased fibre length? Z-Z length?

E.

■ New*

Left ventricular compliance

A.

B. Is directly proportional to elastance

■ New*

Left coronary perfusion is least during

A. Tachycardia

B. Ventricular systole

C. Hypotension

D.

E.

Renal physiology

■ New*

Renal circulation

A.

B Renal O2 consumption is higher than cardiac by mls/100g/min

C. Renal circulation has the highest resistance in the body

D. Renal medulla has higher oxygen supply than cortex

E. Renal oxygen consumption is proportional to sodium transport

■ New*

Osmotic diuresis

A. Causes sodium loss

B. Washes out medullary concentration gradient

C. Increases afferent arteriole pressure

D. Increases blood flow to the cortex

E. All of the above

The ascending limb of the Loop of Henle:

A. is permeable to water

B. Active transport of K+ into the lumen

C. Active transport of water into the lumen

D. Active transport of Cl- out of the lumen

E. Active transport of Na+ into the lumen

Glomerulotubular balance refers to:

A. the proportionate reabsorption of filtered load

B. the maintenace of iso-osmolality between glomerular filtrate and fluid in the proximal tubule.

C. The proprtionate urine output relative to GFR

D. the maintenace of equal Na+ concentration in glomerular filtrate and proximal tubule

E. None of the above.

GI physiology

■ New*

Liver synthesizes all but

A. vWF

B. Prothrombin

C. Antithrombin III

D. Fibrinogen

E. Albumin

Answer A. Reference Brandis pg 197, vWF synthesised by endothelial cells and megakaryocytes

Blood & immunology

■ new*

Macrophages

A. Derived from circulating lymphocytes

B. Half life of less than 24 hours

C. First line of defence against bacterial infection

D. Not present in CNS

E. Called histiocytes in liver

Endocrine & metabolic physiology

Repeat How many hours post eating to measure BMR?

Neurophysiology

As a person moves from hyperalert state to sleep, EEG waves change:

A. alpha -> delta -> beta -> theta

B. a -> b -> d -> t

C. b -> t -> d -> a

D. b -> a -> t -> d

E. t -> d -> b -> a

Comparison of EEG bands

■ Beta (12–30 Hz)

2. symmetrical distribution, most evident frontally; low amplitude waves

3. alert/working

4. active, busy or anxious thinking, active concentration

5. benzodiazepines

■ Delta (<4Hz)

6. frontally in adults

7. posteriorly in children

8. high amplitude waves

9. adults slow wave sleep

■ Theta (4-7Hz)

10.Found in locations not related to task at hand

11.drowsiness or arousal in older children and adults

12.idling

■ Alpha (8-12Hz)

13.posterior regions of head, both sides, higher in amplitude on dominant side

14.Relaxed/reflecting with eyes closed

Hence beta -> alpha -> theta -> Delta = ANSWER (C)

Physiology of muscle & NMJ

■ New*

Isometric contraction

A. Force of contraction independent of the initial fibre length

B. Force of contractionis independent of initial load

C. Velocity of contraction is independent of load

D. Not associated with decreased fibre length? Z-Z length?

E.

Maternal, foetal & neonatal physiology

Clinical measurement

■ new*

Laminar flow is directly proportional to

A. Length

B. Viscosity

C. Radius4

D. Density

E. Velocity

■ New*

Pulse oximeter underestimates saturation with

A. Carboxyhaemoglobinameia

B. Fluorescin dye

C. Hyperbilirubinaemia

D. Fetal Hb

E. Sickle cell Hb

■ A) Falsely elevates SpO2 (i.e. it reads high but is really lower - COHb of up to 48% can still read SpO2

of 91% - Dorsch and Drosch)

■ B) Fluorescin dye is NOT one of the dydes which interfere with SpO2 [1]

■ C) Hyperbilibubinaemia < 440 does NOT interfere with SpO2 (does interfere with co-oximetry)

■ D) No effect

■ E) Controversial - so say it does, some say it doesn't. Not sure if trick question

Unclassified Physiology

Add to this section if don't have time to classify & organise your remembered MCQs

Vasomotor centre:

a. Depressed by hypoxia

b. has afferents from skeletal muscle

c. decrease sympathetic output with increased BP (i thought it was increased sns output, which made the

question harder)

d. located at C1 area of medulla

e.

Answer C presuming wording is correct. If C reads.... increased SNS output with increased BP .... then B

next best answer. Reference Ganong Ed 21 pg 608 Table 31-4

■ I disagree. I think the question may have read "increased SNS output" which makes C incorrect.

■ The RVLM is the vasomotor centre = C1 region of medulla -> D correct (from"the rostral ventrolateral

medulla (RVLM) is the dominant source of excitatory drive to the barosensitive class of sympathetic

efferent under anaesthesia. Its role is assumed, but not proved, to be equally dominant in the awake

state. The RVLM input originates from a neurochemically heterogeneous collection of glutamatergic

neurons, a large subset (70%) of which also synthesize adrenaline. These are called C1 neurons" -

Guyenet in Nature Reviews Neuroscience 7, 335-346 (May 2006)

General physiology

Regarding NaKATPase:

a. stimulated by high extracellular sodium levels

b. stimulated by ouabain

c. electrogenic pump

Mineral essential for function of lactate dehydrogenase and all other peptidases is

a. Magnesium

b. manganese

c. copper

d. zinc

e. ?selenium

Gibbs-donnan (can't remember wording):

a. membrane potential

b. intravascular and extravascular ions

c. intracellular and extracellular ions

d.

e.

Gibbs-Donan equilibrium

a. explains the distribution of diffusable ions between intravascular and extravascular space

b. effects distribution of plasma proteins across capillary membrane

c. effects distribution of proteins across cell membrane

d. explains the distribution intracellular and extracellular ions

e. explains the distribution of non-diffusable ions across cell membrane

■ I don't remember the options quite being like this

■ I agree - was definitely only one option with the word 'diffusible' in it, option e was not there

■ Repeat*

In the presence of hyposmolarity and significant hypovolaemia

a.

b. water permeability of collecting ducts in increased

c. aldosterone decreased

d.

e. none of the above

Fluid & electrolytes

Hypokalaemia (2.5 mM/l):

a. shorten PR interval leading to tachyarrhythmias

b. lengthen QT interval

c. no effect on T wave

d. depresses ST segment

e. widen QRS complex

Laminar Flow of Newtonian fluid is inversely proportionate to

a. pressure gradient

b. ?radius or ?diameter

c. density

d. length

e.

■ viscosity is not in the options*

The therapeutic Magnesium levels for management of pre-eclampsia is

a. 1-1.5mmol/L

b. 2-3 mmol/L

c. 4-6 mmol/L

d. 6-8 mmol/L

e. 8-10 mmol/L

[According to the Royal Women's Hospital protocol plasma levels of 1.7 to 3.5 should be aimed for] [Ref:

http://www.thewomens.org.au/MagnesiumSulphate]

Acid-base physiology

pH 7.4. H+ concentration is

a. 40 ummol/L

b. 40 mmol/L

c. 40 nmol/L

d. 40 mg/L

e. 40 ng/L

PO4 is a good intracellular buffer and tubular buffer because

a. PKa is similar to intracellular pH

b. intracellular concentration of PO4 higher

c. tubular fluid concentration of PO4 higher

d. Urine usually more acidic

e. all of above

Addition of H+ to the following

H+ + (HPO4)2- = H2PO4-

a.

b. increase in conjugate base

c.

d.

e. decrease [HPO4 2-]

Respiratory Physiology

Intra-alveolar pressure at mid-inspiration in normal healthy person (I don't remember this question being

asked)

a. -1 cmH2O

b. 0 cm H2O

■ I don't remember this question either!

■ Answer A - J.B.West 7th Edition page 109

Differences between the apex and the base of the lung

a Transmural pressure is greater

b less negative intrathoracic pressure at the apex

c V/Q ratio is lower at apex

d alveoli are smaller at apex

Answer (A)

A-a gradient of 50mmHg in person breathing room air could be

a normal

b due to venous admixture

c Due to hypoventilation

d Low cardiac output

e None of above

Answer (B)

CO (Carbon Monoxide) is diffusion limited because

a.CO rapidly equilibrates

b.CO is so small that only a defect in diffusion could hinder it

c.CO is so soluble that only a defect in diffusion could hinder it

d. is a large molecule and has ?trouble crossing membrane

e PaCO can be assumed as zero

Answer (C)

Arterial-venous difference in CO2 content

a.2ml/100ml

b.4ml/100ml

c.8ml/100ml or 16ml/100ml

d. 48ml/100ml

e. 52ml/100ml

Answer (C) - PaCO2 = 35-45mmHg, PvCO2 - 42-52mmHg (typical A-V difference = 6-8mmHg)

I think its B = referring to CO2 content not pCO2 - CO2 content arterial blood = 48 ml CO2/100 ml blood -

CO2 content venous blood = 52 ml CO2/100 ml blood

Partial pressure of oxygen in mixed venous blood of a person breathing 100% oxygen

a 50 mmHg

b 80 mmHg

c number higher than 80

d number higher than c

e number higher than d

answer a, nunn's 6th edition p349

Vasoactive substance inactivated through passage in lung:

a. Angiotensin 1

b.

c. bradykinin

d. adrenaline

e.

Oxygen toxicity:

a. CNS effects if 100% O2 for 24 hrs

b. Resp effects if FiO2>30% O2 for 24 hrs

c. both pulmonary and CNS toxicity at 760 mmHg

d.

e. CNS effects only if PO2 significantly higher than 760 mmHg

nunn's 6th edition p357

Oxygen toxicity:

a. due to lung absorption atelectasis

b. CNS effects

c.

d. lipid peroxidation

e.

Increased parasympathetic stimulation of the respiratory tract causes

a. change in the static compliance

b.

Static compliance is affected by (i think this was roughly the wording):

a.

b. airway resistance

c. surface tension

d.

e.

CVS physiology

■ repeat*

Which one of following causes an increase in heart rate?

a. Bainbridge reflex

b. Carotid chemoreflex

c. Bezold-Jarisch reflex

d. Cushing reflex

■ Repeat*

Relating heart to circulation

a. sympathetic stimulation shifts cardiac function curve to the right

b. arteriolar dilatation will increase CVP when all other variables are fixed

c. increased blood volume shift cardiac function curve to right

d. hypervolaemia can correct heart failure

e. Vasoconstriction shift vascular function curve to left

Answer (B) - (A), (C) shifts curve to left, (E) shifts curve to right, (D) is strange because whilst the body aims

to conserve volume to increase preload and therefore SV, hypervolaemia is NOT a treatment per se of heart

failure (in fact we use diuresis as a management to correct pulmonary and peripheral oedema) - so I don't

know what they mean be 'correct' in this context.

CV Effect of isometric contraction of skeletal muscle

A. systolic BP decreases

B. pulsepressure widens

C diastolic BP decreases

D. diastolic pressure increases

E. steady decrease in stroke volume

Which one of the following caused arteriolar vasoconstriction

a. nitric oxide

b. neuropeptide Y

c. substance P

d.

e. alkalosis

Most important determinant of long term BP control is

a.

b. blood volume

c. total peripheral resistant

d. stroke volume

e. total body water

Action potential in myelinated axon

A. absolute refractory period less than one millisecond

B. Na channels close when membrane potential becomes zero

C. duration is 5-10 seconds

D.

E.

Fastest propagation of action potential occurs in:

a. Atrial muscle

b. AV node

c. bundle of His

d. purkinje fibres

e. ventricular muscle

The immediate effect of moving from supine to erect

a.increase in cardiac output

b.

c.increase in CVP

d.increase in pulmonary vascular resistance

e. increase in systemic vascular resistance

Isovolumetric contraction relates best to which part of atrial pressure wave: *repeat*

a. a wave

b. c wave

c. x descent

d. v wave

e. y descent

Renal physiology

Glomerular-tubular balance relates to:

a. reabsorption is proportional to filtered load

b.

c.

d.

e. none of the above

Glycosuria is most likely to occur if:

a. both GFR and plasma glucose level increase

b. GFR increases but plasma glucose remains same

c. plasma glucose increased but GFR remains same

d. both GFR and plasma glucose decrease

e.

Which one of the following increase tubular reaborption of salt and water

a.

b.

c. increase oncotic pressure of peritubular capillaries

d. increase hydrostatic pressure of peritubular capillaries

Response to significant hypovolaemia and decreased plasma osmolality:

a. increased urine output

b. decreased urine output

c.

d.

e.

GI physiology

Regarding bilirubin:

a. all bilirubin produced from haemoglobin

b. bilirubin produced in reticuloendothelial system

c. stercobilinogen excreted in kidneys

d. bilirubin is conjugated in the liver and secreted into the blood

e. conjugated bilirubin is responsible for total blirubin measured in blood

Ganong 22nd pg 502

■ (A) "Most"

■ (B) "formed in the tissues"

■ (C) "urobilinogens enter the general circulation and are excreted in the urine"

■ (D) Some is but the majority into bile canaliculi by active transport

■ (E) Total = conjugated + free bilirubin

So once again straight out of Ganong. D is most correct

An alternative view of the above - correct answer (B). Power and Kam (2Ed, Pg. 211) notes that haem is bro-

ken down in the reticuloendothelial system, particularly the spleen. 85% of this is derived from the haem

moeity of haemoglobin, whilst the remainder comes from haem containing compounds (cytochrome P450,

respiratory chain transporters, etc.). No mention is made in this text of bilirubin secretion into the blood-

stream.

Blood & immunology

1 unit fresh frozen plasma:

a. contains anticoagulant

b. contains all coag factors except V and VIII

c. needs to be crossmatched

d. does not contain albumin

e. does not contribute to oncotic pressure once transfused

■ Repeat* Erythropoietin

a. stimulates production of both red and white cells

b. plasma concentration is inversely proportionate to haematocrit

c. something wrong

d. inactivated in kidney

e. half life several minutes

■ Repeat* Concerning fixed tissue macrophages

a.

b. activated by lymphokines from T cells

c. engulf and kill bacteria with lymhokines

d. absent in lungs and liver

e.

Endocrine & metabolic physiology

Which is NOT produced in citric acid cycle:

a. CO2

b. H+

c. NADH

d. NAD

e. FADH2

Per cycle of CAC-> 2 x CO2, 3 x H+, 3 x NADH, 1 x FADH2 -> No NAD (this is a high energy molecule) AN-

SWER (D) Source Mr Kreb

Catecholamines:

a.are produced in the mitochondria

b.action ceased by both enzyme and non-enzyme actions

c.are released at the synapse by the release of Acetylcholine in both sympathetic and parasympathetic

nerves.

d.half life of 50-60 seconds.

e.10% conjugated and renal excretion

Neurophysiology

The C fibers that enter the dorsal root terminate

A Laminae I & II

B I & IV

C III & IV

D IV & V

E V& VI

Answer A. Reference Ganong Ed 21 pg 139

■ repeat*

Regarding glial cells

a.

b. Something about Schwann cells

c. Oligodendrocytes form myelin in CNS neurons

d. Something about astrocytes

e.

Answer C. Reference Ganong Ed 21 pg 51. Oligodendrocytes produce myelin in CNS, Schwann cells pro-

duce myelin in peripheral nervous system

Regarding cerebrospinal fluid:

a. Produced at a rate of 150ml/day

b. absorption is fixed amount daily

c. produced by choroid plexus and ependymal surfaces of all ventricles

d. total volume 350mL

e.

Answer C. Reference Ganong Ed 21 pg 615

Physiology of muscle & NMJ

In the Resting State the permeability of the cell membrane to ions is

Na:K

a.100:1

b.10:1

c.1:1

d.1:10

e.1:100

Immediate source of energy in muscles:

a. ATP in all muscles

b. creatine phosphate in smooth, ATP in cardiac and skeletal

c. creatine phosphate in smooth and skeletal, ATP in cardiac

d. creatine phosphate in skeletal, ATP in smooth, cardiac

e. creatine phosphate in all

T tubules in cardiac muscle enter at:

a. m line

b. Z line

c. h band

d. i band

e. a band

see [1] - cardiac has one t tubule per sarcomere (at z disc), skeletal has 2 (at A-I band) - put in comments

once MCQ code assigned

Maternal, foetal & neonatal physiology

Increase in maternal ventilation

a. to do with oestrogen

b. to do with progesterone

c. Present by second trimester

d. mostly due to increased respiratory rate

e.

Foetal circulation all true except:

a. systemic venous blood saturation is 26%

b. Oygen saturation of umbilical vein is 67%

c. ductus venosus drains into IVC

d. 75% of foetal cardiac output goes to placenta

e. pressure is higher in pulmonary artery than aorta

■ (A) Ganong 22nd Ed pg 628 - 26%

■ (B) Same reference -> 80%

■ (C) Obviously true

■ (D) Same reference -> 55% of foetal cardiac output goes through placenta

■ (E) Also obvious: Ppul.art. > Paorta and therefore blood is shunted through ductus arteriosus

So (as remembered), all are true except (B) and (D)

Clinical measurement

CM38 Raman Scattering is

a. the wavelength remains unchanged

b. is a type of mass spectroscopy

c.

d. measures type of gas only

e. measures the concentration of a gas

Which one of the following is a linear change

A. oxygen tension vs alveolar ventilation

B. CO2 tension vs alveolar ventilation

C. partial pressure of oxygen along tissue capillary

D. partial pressure of carbon dioxide along tissue capillary

E. malignant growth

Answer B. Reference Nunns Ed 6 pg 465

■ Repeat*

When measuring cardiac output by thermodilution technique, which of the following affect least on accuracy

a. rapid injection of cold saline

b. injection during inspiration

c.

d.

e.

Unclassified Physiology

Which is represented by linear equation? (repeat)

A) malignant growth

B) minute ventilation with O2

C) minute ventilation with CO2

D) uptake of O2 along capillary

E) uptake of CO2 along capillary

Which is assocaited with the ?sarcolemmal or ?sarcoplasmic reticulur Ca2+ channel?

A) ryanodine receptor

B) dihydropyridine receptor

C) voltage-gated Ca2+ channel

D) IP3 receptor

E) Ca/Mg ATPase

(Don't know if this was deliberate or not but A) was definitely RYANDINE receptor - ? typo ?? examiners be-

ing mean)

General physiology

Regarding voltage clamping (new):

A) giant squid axon is used because it contains only Na+ channels

B) you apply a current to stop flow through the Na+ chanel and the current applied is equal in magnitude but

opposite in polarity to the channel being studies

C) ?

D) ?

E) ?

Bilirubin (repeat)?

A) formed in reticuloendothelial system

B) is formed only from RBC breakdown

C) transported to liver, conjugated then secreted into blood

D) stercobilin ends up in the urine

E) ?

Steady laminar flow is inversly related to:

A) radius4

B) pressure difference

C) length

D) density

E) velocity

The Na/K-ATPase pump (repeat):

A. is stimulated by ouabain

B. 3ATP is hydrolysed for every 3Na+ pumped

C. it is electrogenic

D. pumps 3K+ out for 2Na+ in

E. ?

Regarding nitric oxide:

A. diffuses across the membrane to bind to intracellular receptors

B. binds to extracellular receptors that stimulates ...

C. ?

D. ?

E. ?

Fluid & electrolytes

Which is true regarding a normal 70kg adult on a normal day (repeat?):

A) 300mL water lost in faeces

B) 700mL water lost as insensibles from lung and skin and ?

C) 500mL water lost in urine

D) 200mL water lost from metabolic processes

E) none of the above

Aldosterone causes which of the following?

A) Na+ and water retention but K+ secretion

B) Na+, water and K+ absorption

C) Na+, water and H+ absorption

D) Na+ and water excretion

E) ?

Regarding sweat osmolality during exercise (repeat):

A. greater than plasma

B. less than plasma

C. ?

D. ?

E. ?

Acid-base physiology

In plasma, a 'strong ion':

A. is usually a cation

B. is usually an anion

C. has its pKa close to 7.40

D. almost completely dissociates

E. ?

Base excess is

A) measured at a (? standard) pCO2 of 40mmHg

B) is EQUAL to the difference between the measured bicarb and standard bicarb

C) is always negative when pH > 7.40

D) increases inversely with the bicarbonate level

E) something wrong

Why is phosphate such a good buffer in ICF and urine? (repeat)

A. ICF has lower pH than ECF (I'm pretty sure this was ICF has higher conc of phosphate than ECF actually)

B. tubular pH is low

C. pKa is close to pH

D. concentration is high in urien and ICF (don't remember them asking about conc in the urine)

E. all of above

At pH 7.4, [H+] is (repeat)?

A. 40nmol/L

B. 40mmol/L

C. 40mOsmol/L

D. ?

E. ?

Respiratory Physiology

ANATOMICAL dead space is increased with

A) supine to erect

B) erect to sitting

C) intubating the patient

D) flexing the patient's head and putting their chin down

E) ? breathing out from TLC to RV

NB: I remember option B as going from "erect to semi-recumbent position"

Probably best answer A. Reference Nunn's Ed 6 pg 119

PHYSIOLOGICAL dead space:

A) may contribute to the etCO2 being lower than the ideal alveolar gas

B) can be measured using the Bohr equation with end-TIDAL CO2

C) isn't influenced by alveolar dead space

D) ?

E) ?

At altitude of 8,800m the atmospheric pressuere is 248mmHg. What is the alveolar pO2 assuming PaCO2 is

20mmHg?

A. 0mmHg

B. 17mmHg

C. 27mmHg

D. 30mmHg

E. ?

Which is true (repeat regarding dissolved O2 in plasma)?

A) 6mL/100mL with 3atm of air

B) 6mL/100mL with 3atm of 100% O2

C) ?

D) ?

E) ?

When would the pulmonary capillary (didn't say end-capillary) pO2 be substantially different to the alveolar

pO2?

A) increased alveolar wall thickness

B) perfusion limitation

C) increased venous admixture

D) ?

E) ?

The respiratory exchange ratio [Mar03] [July03]:

A. is the same as the respiratory quotient

B. is always measured at rest

C. decreases during severe exercise

D. increases when repaying an oxygen debt

E. ?

Ganong

■ (A) - Incorrect => "Not to be confused"

■ (B) - Incorrect - This is metabolic rate - R can be measured at any instant in time and does not require

equilibrium to have been reached

■ (C) - Incorrect - Increases during severe exercise as CO2 increases - can rise to 2

■ (D) - Increases - Decreases whilst repaying oxygen debt - can fall to 0.5

Hence E must have been something correct or others remembered differently

A normal person breathing room air has a A-a gradient of 50mmHg (repeat), what could this be due to?

A. hypoventilation

B. venous admixture

C. ?

D. ?

E. ?

Oxygen toxicity (i'm pretty sure there were 2 questions)?

A. CNS affected only if significantly above 760mmHg of PiO2

B. CNS and RS affected at 760mmHg PiO2 for 24 hours

C. RS affected at FiO2 30% and 1atm for 48hours

D. mediated by superoxide dismutase

E. involves lipid peroxidation

CO2 is highest in which sample (repeat):

A. alveolar dead space

B. mixed expired gas

C. ideal alveolar gas

D. pulmonary end-capillary blood

E. mixed venous blood

Someone with a PaCO2 of 200mmHg (two hundred!), which of the following would you expect:

A. ?

B. ?

C. Hypercalcemia

D. Hyperkalaemia

E. Bradycardia

Answer D. Reference Nunns Ed 6 pg 331.....The acidosis that accompanies hypercapnia causes leakage of

potassium from the cells into the plasma

CVS physiology

Mixed venous oxygen tension when breathing 100% oxygen

A) 50mmHg

B) 70mmHg

C) 85mmHg

D) 100mmHg

E) 650mmHg

Answer A. Reference Nunn's Ed 6 pg 349

The kidney has

A) less blood flow per 100g than the heart

B) greater AV extraction than the heart

C) flow is related to sodium reabsorption

D) renal blood flow is measured by inulin

The vasomotor centre in the medulla is (new)

A. Depressed by local hypoxia

B. Stimulated by afferents from skeletal muscle

C. Stimulated by carotid sinus baroreceptors

D. Inhibited by aortic body stimulation

E. Stimulated by cardiopulmonary baroreceptors

The A-V difference in terms of mLO2/100g/min from greatest to smallest:

A. ??

B. ??

C. ??

D. heart muscle > liver > skin > kidney

E. heart muscle > liver > kidney > skin

The vasomotor centre (? repeat):

A. is depressed by local hypoxia

B. is stimulated by stimulation of the carotid sinus

C. is stimulated by stimulation of cardiopulmonary baroreceptors

D. ?

E. ?

Arterial baroreceptors:

A. located at the beginning of the external carotid artery

B. respond to pressure rather than stretch

C. stimulate GABA-ergic inhibitory interneurons

D. send afferents to the C1 area of the medula

E. ?

What happens directly after moving from supine to erect?

A. increased SVR

B. ?

C. ?

D. ?

E. ?

When does the c wave occur in the JVP/CVP?

A. during atrial systole

B. just prior to atrial systole

C. during inspiration

D. during ventricular systole

E. ?

Which of the following would NOT cause an increase in pulse pressure?

A. decreased diastolic pressure

B. increased aortic compliance

C. increased SV

D. decreased TPR

E. decreased rate of ventricular ejection (pretty sure this was the exact wording)

Stimulation of carotid sinus sometimes ceases an SVT because:

A. decreases sympathetic output to SA node

B. increases vagal output to SA node

C. decreases sympathetic output to AV node

D. increases vagal output to AV node

E. ?

In a normal adult standing still, the pressure in the ankle vein would be:

A. 20mmHg

B. 30mmHg

C. 60mmHg

D. 90mmHg

E. 150mmHg

Answer D. Reference Ganong Ed 21 pg 633

Venous return:

A. Dependant on MSFP

B. Increased/decreased by inspiration

Renal physiology

The following is associated with a decrease in renin secretion

A. vasopressin

B. angiotensin II

C. oxytocin

D. SNS activity on kidney

Why can't urea be used to measure GFR?

A) it is actively reabsorbed in PCT

B) it is actively secreted in LoH

C) its concentration (didn't say where) is under control of ADH

D) ?

E) ?

Tubuloglomerular balance means:

A) proportionate reabsorption of filtered load

B) osmolality of filtrate and plasma is the same

C) ?

D) ?

E) none of the above

Renal oxygen consumption:

A. best correlates with Na/K-ATPase activity

B. is greater than the ??heart

C. ?

D. ?

E. ?

GI physiology

The following cause an increase in pH in the duodenum

A. gastrin releasing peptide

B. secretin

C. CCK

D. gastrin

E. histamine

Repeat question from GI09 [Jul99] [Feb00] [Apr01]:

■ Firstly (D) and (E) are obviously wrong

■ (A) GRP releases gastrin which stimulates HCl release from parietal cells -> decrease in duodenal pH

■ (C) Potentiates (B)

■ (B) Secretin is probably the best answer

Blood & immunology

Cross-matching involves comparing donor's

A) red cells with recipient's red cells

B) red cells with recipient's serum

C) serum with recipient's red cells

D) serum with recipient's serum

E) whole blood with recipient's whole blood

Adult Hb has which of the following?

A) 1 porphyrin ring and 1 FERROUS ion

B) 4 and 1

C) 4 and 4

D) 1 and 4

E) none of the above

Which would increase carbamino-Hb formation?

A) decreased pH

B) increased carbonic anhydrase

C) decreased carbonic anhydrase

D) decreased pO2

E) ?

Tissue macrophages (repeat):

A. absent in the liver and the lungs

B. activated by lymphocytes to kill bacteria

C. engluf bacteria and kill them with lymphokines

D. made in bone marrow and the circulate as megakaryocytes

E. ?

Endocrine & metabolic physiology

Posterior pituitary secretes arginine, vasopressin (this was the punctuation used!) and :

A) oxytocin

B) FSH

C) LH

D) Prolactin

E)

■ Answer (A)

What is the main reason why heat production can't increase during a general anaesthetic?

A. decreased skeletal muscle tone

B. decreased Na/K-ATPase activity

C. vasodilation

D. decreased ?hypothalamic ?pituitary responsiveness

E. ?

Which is not produced in the TCA cycle (repeat)?

A. NADH

B. NAD

C. FADH2

D. H+

E. CO2

■ Answer (B) - this high energy molecule is used in the CAC and produces NADH

Neurophysiology

Repeat regarding CSF:

A) produced at 150mL/day

B) produced by choroid plexus and all the ventricles

C) ?

D) ?

E) total volume 350mL

Which has the greatest difference between plasma concentration and CSF concentration?

A) glucose

B) Na+

C) proteins

D) K+

E) Cl-

C fibres terminate in (repeat):

A. lamina I and II

B. lamina I and IV

C. lamina I and V

D. lamina II and III

E. lamina ??

Resting state permeability of Na:K in large axon is:

A. 100:1

B. 10:1

C. 1:1

D. 1:10

E. 1:100

Physiology of muscle & NMJ

What is the reason why net flow of fluid out of the intravascular space is so low in muscle?

A) increased lymphatic drainage with muscular contractions

B) interstitial protein concentration is high

C) Kf is low

D) ?

E) ?

Maternal, foetal & neonatal physiology

A foetus has lungs full of amniotic fluid in utero - what is the most important mechanism responsible for get-

ting rid of it?

A) compression of foetal thorax going through birth canal

B) suctioning of airway after birth

C) it is reabsorbed into the lymphatics within 24 hours

D) it is coughed up within 72 hours

E) it is reabsorbed into the pulmonary circulation

? E . Reference Nunn's Ed 6 pg 232

I agree

■ Production of foetal lung fluid is reduced to 65% of maximal levels as labour approaches (cortisol and

catecholamine-mediated)

■ 30% by compression during labout

■ 35% transported by amiloride-sensitive Na channels into pulmonary circulation

■ "Overall 20% is cleared by the pulmonary lymphatics" - this last bit doesn't add up but the wording im-

plies it is the smallest proportion

http://books.google.com.au/books?

id=ioyvuitdXHcC&pg=PA213&lpg=PA213&dq=fate+of+foetal+lung+fluid&source=bl&ots=L99xtuwbs5&sig=U

C16fTImZCEB9wPc469VbCjHtkg&hl=en&ei=8-

UqTP7wFc2HkQXsqZzrAw&sa=X&oi=book_result&ct=result&resnum=7&ved=0CDIQ6AEwBg#v=onepage&

q&f=false

In pregnancy, liver function changes such that:

A) serum cholesterol decreases

B) ALP increases

C) liver blood flow increases/decreases

D) ?

E) ?

Answer B. Reference Power and Kam Ed 2 pg 406

Clinical measurement

CM38 Raman scattering (repeat):

A) only occurs with ? monoatomic molecule

B) is a form of mass spectroscopy

C) ... the emitted photon has the same wavelength

D) can be used to measure the concentration of a gas

E) can only be used to measure one gas at a time

Clarke electrode (repeat):

A) requires 0.6amp current

B) uses platinum anode and Ag/AgCl cathode

C) can measure gas or blood samples

The PR interval in lead II is measured from:

A) start of P wave to start of R wave

B) start of P wave to end of R wave

C) start of P wave to start of Q wave

D) start of P wave to end of Q wave

E) end of P wave to start of Q wave

Which is true regarding the T wave?

A) it occurs 0.08seconds after the QRS

B) it is a depolarization currend heading towards the base of the heart

C) it occurs due to early repolarization of the ventricular SYSTEM

D) it is caused by ventricular depolarization

E) it occurs due to early repolarization of the ventricualr SURFACE

Answer (C) - although it is actually LATE repolarisation (the ST segment from the J point to T is the early re-

polarisation) Reference: Hlaing T, DiMino T, Kowey PR, Yan GX. ECG repolarization waves: their genesis

and clinical implications. Ann Noninvasive Electrocardiol. 2005 Apr;10(2):211-23.

Regarding ECG normal calibration: (repeat)

A) 1mV per cm and 25mm per second

B) 0.5mV/cm and 25mm/s

C) 10mV/cm and 25mm/s

D) 1mV/cm and 50mm/s

E) ? and 50mm/s

Fluid & electrolytes

FE01 ECG Changes in hypokalaemia:

A. Prolonged QT

B. Depressed ST

C. Shortened QT

D. ?

E. ?

[edit]

Acid-base physiology

AD08 During the infusion of a hydrochloric acid (HCl) infusion wich of the following contributes most to

buffering?

A. Phosphate buffer

B. Intracellular buffers

C. Bicarbonate buffer

D. Proteins

E. ?

AD10 A patient is draining 1,5l from a pancreatic fistula per day whilst remaining of at a normal volume sta-

tus. The most likely acid-base disorder is:

A. Metabolic acidosis with a normal chloride

B. Hypochloraemic metabolic acidosis

C. Hyperchloraemic metabolic alkalosis

D. Hyperchloraemic metabolic acidosis

E. Hypochloraemic metabolic alkalosis

AD12 For the following blood gas results, which clinical scenario fits best?

ABGs: pH 7.53, PCO2 26, HCO3 22

A. Mountain climber after several weeks at altitude

B. Chronic respiratory disease

C. ?

D. Hyperventilation for 5 minutes

E. Prolonged vomiting

REPEAT question Base excess A. Calculated from PaCO2 40mmHg

[edit]

Respiratory Physiology

■ New*

What percentage of total blood volume is found in the pulmonary capillaries?

A. 1%

B. 3%

C. 9%

D. 11%

E. 15%

Surfactant

A. Production by Type 1 alveolar cells

B. Synthesis is slow

C. Acts like detergent in water

D Decreases pulmonary interstitial hydrostatic pressure

Hypoxaemia during anaesthesia is best fixed by

A. Increased pressure between breaths

B. Increased respiratory rate

C. Increased tidal volume

D. V/Q matcing

Altitude question (repeat) What would PAO2 be with PC02 40 when atmospheric pressure 248mmHg

A. 17 mmHg

B. 20 mmHg

C. 40 mmHg

Not possible: pAO2 = 0.21(248-47) - 40/0.8 = -7!!

A-a gradient of 50 mmHg due to

A. Hypoventilation

B. Venous admixture

Anatomical dead space (repeat)

A. Increased with moving supine to erect

Can't remember other options

FRC reduced in anaesthesia by

A. Cephalad displacement of diapragm

B. Muscle relaxants

C. Age

[edit]

CVS physiology

Example of autoregulation

A. Increased tissue vascularity

B. Renin angiotensin system

What is 'Cardiac Efficiency'?

A. 20-30%

B. 31-40%

C. 41-50%

D. 51-60%

E. 61-70%

Answer = A

T Tubule in cardiac muscle

A. Z line

B. A band

C. H band

Answer = A

VO2 Max in a sedentary male (repeat)

A. 4

B. 11

C. 40

Repeat question about radial art trace v aorta

A. Peaks earlier

B. Bigger diacrotic notch

Question about MAP A. Determined by area under arterial waveform

B. Determined by arteriolar resistance

Pulmonary wedge pressure

A. a but no c or v wave

B. a and c but no v wave

C. a, c and v wave

[edit]

Renal physiology

KD38 Creatinine/urea is not used for the measurement of GFR because:

A. It is not readily filtered

B. It is secreted in the ascending loop of Henle

C. It is reabsorbed in the proximal tubule

D. ?

E. ?

What is Glomerular capillary hydrostatic pressure?

A. 20 mm Hg

B. 30 mm Hg

C. 40 mm Hg

D. 50 mm Hg

E. 60 mm Hg

Answer = E

Aldosterone

A. Increases Na, K and H20 reabsorption

B. Increases Na and H20 reabsorption

C. ?

D. ?

B

[edit]

GI physiology

What increases gastric pH?

A. CCK

B. Gastrin

C. Secretin

■ Repeat*

Which of the following is NOT produced by the liver:

a)Immunoglobulins

b)Clotting Factors

c)Cholesterol

d)Conjugated Bilirubin

e)?

[edit]

Blood & immunology

FFP contains

A. All pro-coagulants except platelets

B. Is treated to inactivate viruses

[edit]

Endocrine & metabolic physiology

[edit]

Neurophysiology

Which spinal cord (Rexed) laminae do C-fibers synapse in?

A. I and II

B. I and IV

C. I and V

D. II and IV

E. II and V

Answer = A

Biggest concentration difference between plasma and CSF

A. Proteins

B. Potassium

C. Sodium

Answer = A

[edit]

Physiology of muscle & NMJ

Smooth Muscle differs from Skeletal Muscle because:

A. It contains more mitochondria

B. It contains Troponin

C. It has a better developed Sarcoplasmic Reticulum

D. It has a higher ratio of Actin to Myosin

E. It contains fibers in a regular arrangement

Answer = D

[edit]

Maternal, foetal & neonatal physiology

Hb Sats in Foetal IVC are:

A. 67%

B. 50%

C. 80%

D. 23%

(can't remember options correctly)

Power and Kam 2nd ed p.411 diagram - 67% in the IVC

[edit]

Clinical measurement

What is NOT important when measuring Cardiac Output by oesophageal Doppler?

A. Haematocrit

B. Aorta Cross Sectional Area

C. Red Cell Velocity

D. Heart Rate

E. Red Cell Velocity

Answer = A I think, B & C are required to estimate SV, and HR required to calculate cardiac output using es-

timated stroke volume.

Clark electrode question:

A. Ag/Ag Cathode and Platinum anode

B. Can measure concentration in both blood and gas samples

C. Requires 0.6V applied to it (?wording)

D. ?

CM38 [Jul09] [Mar10] [Jul10]

Regarding Raman scattering:

A. The wavelength remains unchanged

B. It is a form of mass spectroscopy

C. ?... the emitted photon has the same wavelength

D. Only occurs with ?monoatomic molecule -OR- Can only be used to measure one gas at a time

E. Can be used to measure the concentration of a gas

ECG R wave in V1 compared to V5

A. Bigger than

B. Smaller than

C. Proportional to

D. Not related

E. ?

Repeated question about pulse oximetry Reading falsely ?high in

A. MetHb

B. Bilirubin

C. Methylene Blue

Answer = A. B should have no effect. C is the cure for A and underestimates SpO2