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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain

Reg No/Nr 1955/000003/08

Part I Examination for the Fellowship of theCollege of Anaesthetists of South Africa

24 August 2010

PhysiologyPaper I (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more thanone is required for the one answer)

Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig is

vir n vraag) geskryf word

1 A patient who underwent a laparotomy is severely nauseous postoperativelyand vomits. Describe the physiology of nausea and vomiting under the followingheadingsa) Discuss the central pathways and physiological triggers of vomiting. (10)b) List the neurotransmitters involved in nausea. (5)c) Discuss the anatomy and physiology of the lower oesophageal sphincter that

allows it to contract and relax. (10)d) Describe the motor changes that occur in the gastrointestinal tract and

respiratory muscles with nausea and vomiting. (6)e) Discuss the hormonal control of gastric acid production. Additionally also

discuss the process of hydrochloric acid production with the aid of a parietalcell diagram. (18)

f) What is the alkaline tide? (1)[50]

1 n Pasint wat n laparotomie ondergaan het ondervind erge naarheid postoperatiefen braak. Beskryf die fisiologie van naarheid en braking onder die volgende hoofdea) Bespreek die sentrale bane en fisiologiese snellers van braking. (10)b) Lys die neurotransmitters betrokke in naarheid. (5)c) Bespreek die anatomie en fisiologie van die laer-esofageale sfinkter wat

dit toelaat om saam te trek en te ontspan. (10)d) Bespreek die motoriese veranderinge wat plaasvind in die

gastrointestinale en respiratoriese spiere tydens naarheid en braking. (6)e) Bepsreek die hormonale beheer van maagsapproduksie. Bespreek

addisioneel ook die proses van soutsuurproduksie met behulp van nparitaalseldiagram. (18)

f) Wat is die "alkaliese gety"? (1)[50]

PTO/ Page 2 Question 2


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2 Thermoregulation is the ability to maintain a core body temperaturewithin a narrow range for optimal physiological function.a) Discuss the process of thermoregulation under the following headings

i) Afferent thermal sensing. (5)ii) Central regulation. (5)iii) Efferent responses. (7)

b) Briefly describe the four mechanisms by which heat can be lost from the body. (8)

c) Explain how the normal thermoregulatory responses are affected underi) General anaesthesia. (8)ii) Neuraxial anaesthesia. (3)

d) Discuss the physiological consequences of inadvertent perioperativehypothermia. (14)

[50]

2 Termoregulering verwys na die vermo om kernliggaamstemperatuur tehandhaaf binne n nou reikwydte vir optimale fisiologiese funksionering.a) Bespreek die proses van termoregulering onder die volgende hoofde

i) Afferente temperatuurseine. (5)ii) Sentrale regulering. (5)iii) Efferente response. (7)

b) Beskryf kortliks die vier meganismes hoe hitte verloor kan word deur dieliggaam. (8)

c) Verduidelik hoe die normale termoregulatoriese response benvloed word deuri) Algemene narkose. (8)ii) Neuraksiale narkose. (3)

d) Bespreek die fisiologiese gevolge van toevallige perioperatiewe hipotermie.(14)[50]

3 Discuss fluid homoeostasis in terms of the followinga) The body fluid compartments with their respective sizes and approximate

electrolyte composition in terms of the major electrolytes involved. (10)b) The role of plasma oncotic pressure in the maintenance of intravascular volume

with specific reference to the Starling equation. (10)c) Briefly describe the endothelial glycocalyx and its importance in terms of capillary

integrity and the maintenance of the Starling forces. (5)d) Describe the physiological responses to trauma aimed at the maintenance of

circulating blood volume with specific reference to the mechanisms for thepreservation of sodium and water and the subsequent physiological

consequences. (15)e) Describe the physiological adaptation of the circulation to volume loss in order tomaintain the "fight or flight" response. (10)

[50]

PTO/ Page 3 Qustion 3


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3 Bespreek vloeistofhomeostase aan die hand van die volgendea) Die liggaamsvloeistofkompartemente met hul respektiewelike groottes en

benaderde elektrolietsamestelling in terme van die belangrikste elektrolietebetrokke. (10)

b) Die rol van plasma onkotiese druk in die handhawing van intravaskulre volumemet spesifieke verwysing na die Starlingvergelyking. (10)

c) Beskryf kortliks die endoteliale glikokaliks en die belang daarvan interme van kapillre integriteit en handhawing van die Starlingkragte. (5)

d) Bespreek die fisiologiese respons tot trouma gemik op die handhawingvan die sirkulerende bloedvolume met spesifieke verwysing na diemeganismes vir die preservering van natrium en water en die daaropvolgendefisiologiese gevolge. (15)

e) Beskryf die fisiologiese aanpassing van die sirkulasie tot volumeverliesten einde die "veg-of-vlugreaksie" te handhaaf. (10)

[50]

4 A patient presents with critically raised intracranial pressure. In the acute

management of this patient one has to remember that the Monro-Kellie doctrineregards the scull as a closed container encapsulating three intracranial components.Various aspects have to be considered in the acute management of this patient. Writesuccinct notes under the mentioned headings on the following related conceptsa) Cerebral blood flow and cerebral metabolism

i) Total cerebral blood flow (CBF) and selective distribution to white and graymatter. (4)

ii) Critical cerebral blood flow. (2)iii) Anatomical structure of the circle of Willis. (5)iv) Cerebral metabolic rate for oxygen (CMRO2). (4)v) CBF/CMRO2ratio. (2)vi) Normal cerebral autoregulation curve. (5)

vii) Cerebral autoregulatory meganisms. (5)b) Cerebrospinal fluid

i) Sources of production and reabsorption. (4)ii) Rate of production and total volume. (2)iii) Composition (differences with plasma). (4)iv) Functions. (4)

c) Blood-brain barrieri) Structural formation of the blood-brain barrier and blood-cerebrospinal

fluid barrier. (5)ii) Structures outside the barrier. (2)iii) Insults disrupting the barrier. (2)

[50]

4 n Pasint presenteer met kritiekverhoogde intrakraniale druk. In die hanteringvan hierdie pasint moet onthou word dat die Monro-Kellie-doktrine die skedelbeskou as n geslote houer wat drie intrakraniale komponenete bevat. Verskeieaspekte moet oorweeg word in die akute hantering van die pasint. Skryf bondigeaantekeninge onder die genoemde hoofde oor die volgende verwante konseptea) Serebrale bloedvloei en serebrale metabolisme

PTO/ Page 4 Question 4 a) i)


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i) Totale serebrale bloedvloei (CBF) en selektiewe distribusie na die wit- engrysstof. (4)

ii) Kritiese serebrale bloedvloei. (2)iii) Anatomiese struktuur van die sirkel van Willis. (5)iv) Serebraal-metaboliese tempo vir suurstof (CMRO2). (4)v) CBF/CMRO2-verhouding. (2)

vi) Normale serebrale outoregulasiekurwe. (5)vii) Serebrale outoregulasiemeganismes. (5)

b) Serebrospinaalvogi) Bronne van produksie en herabsorpsie. (4)ii) Produksietempo en totale volume. (2)iii) Samestelling (verskille met plasma). (4)iv) Funksies. (4)

c) Bloed-breinskansi) Strukturele samstelling van die bloed-breinskans en bloed-

serebrospinaalvogskans. (5)ii) Strukture buite die skans. (2)iii) Aanslagte wat skansversteuring meebring. (2)

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The Colleges of Medicine of South AfricaIncorporated Association not for gain (Reg. No. 1955/000003/08)

Nonprofit Organisation (Reg No 009-874 NPO)

27 Rhodes Ave, PARKTOWN WEST 2193Private Bag X23, BRAAMFONTEIN 2017

Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036

General: [email protected] Registrar: [email protected]

Website: http://www.collegemedsa.ac.za

FCA(SA) PART I

Physiology

PAPER II(a)

Question 1 - 5

24 August 2010

14:00 16:00

Marks: 50

Examination Number:

1 Answer the questions on this questionnaire.2 This questionnaire must be handed in to the invigilator.3 The candidates examination number must appear on the questionnaire.


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Question 1 / Vraag 1

The oxygen affinity of haemoglobin can change perioperatively. Answer the followingquestions regarding the oxygen-haemoglobin dissociation curve (OHDC)Die hemoglobien-suurstofaffiniteit kan perioperatief verander. Antwoord die volgende vraerakende die suurstof-hemoglobienekwilibrasiekurwe (OHEK)

a) List three factors which shift the OHDC. (3)

a) Lys drie faktore wat die OHEK skuif. (3)

b) How is 2,3-diphosphoglycerate formed (2,3-DPG)? (1)b) Hoe word 2,3-difosfogluteraat (2,3-DPG) gevorm? (1)

c) How does 2,3-diphosphoglycerate affect oxygen delivery? (1)c) Hoe benvloed 2,3-difosfogluteraat suurstoflewering? (1)

d) Describe the importance of the following on 2,3-DPGd) Beskryf die belang van die volgende op 2,3-DPG

i) Haemoglobin chains (2)i) Hemoglobienkettings (2)

ii) Intracellular pH. (3)ii) Intrasellulre pH. (3)

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An essential function of the anaesthesiologist is to monitor and ensure cardiac output andoxygen delivery. Answer the following questions regarding these conceptsn Belangrike funksie van die narkotiseur is om kardiale omset en suurstoflewering temoniteer en te verseker. Antwoord die volgende vrae rakende hierdie konsepte

a) Define the Fick principle. (2)

a) Definieer die Fick-beginsel. (2)

b) Name two clinical applications of the Fick principle. (2)b) Noem twee kliniese toepassings vir die Fick-beginsel. (2)

c) What are the determinants of arterial oxygen content? (3)c) Wat is die bepalers van arterile suurstofinhoud? (3)

d) Give the oxygen flux equation. (3)d) Gee die suurstoffluksvergelyking. (3)

[10]


Perioperative hypoxia can present due to various causes and mechanisms. Answer thefollowing questions regarding hypoxiaPerioperatiewe hipoksie kan presenteer as gevolg van verskeie oorsake en meganismes.Antwoord die volgende vrae rakende hipoksie


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a) Classify hypoxia. (4)a) Klassifiseer hipoksie. (4)

b) Illustrate the effect of hypoventilation on the partial pressure of oxygen byutilising the alveolar gas equation. (2)

b) Gebruik die alveolre gasvergelyking om die effek van hipoventilasie op dieparsile druk van suurstof te illustreer. (2)

c) Define venous admixture. (2)c) Definieer veneuse vermenging. (2)

d) Name the two main sources of blood that contribute to normal venousadmixture. (2)

d) Noem die twee hoof bronne van bloed wat bydra tot normale veneusevermenging. (2)

[10]


You have conducted a cardiopulmonary exercise test on a patient preoperatively.U het preoperatief n kardiopulmonale oefeningstoets uitgevoer op n pasint.


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i) Discuss the stimulation of ventilation during exercise. (5)i) Bepsreek die stimulasie van asemhaling gedurende fisiese oefening. (5)

ii) Discuss the changes at tissue level allowing improved diffusion of oxygeninduced by physical exercise. (5)

ii) Bepsreek die veranderinge op weefselvlak wat verbeterde diffusie van suurstofbewerkstellig tydens fisiese oefening. (5)

[10]


Gas diffusion in the lungs is essential to life.Gasdiffusie in die longe is essensieel vir lewe.

a) Give Ficks law of diffusion. (4)

a) Skryf Fick se diffusiewet neer. (4)


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b) Draw a diagram to illustrate perfusion and diffusion limitations to gas transferbetween the alveolus and the alveolar capillary. (6)

b) Teken n diagram om perfusie- en diffusiebeperkings tot gasoordrag tussen diealveolus en die alveolre kapillr te illustreer. (6)

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FCA(SA) PART I

Physiology

PAPER II(b)

Question 6 - 10

24 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Make a detailed annotated drawing of the normal neuromuscular junction to indicate all theessential structures and mechanisms involved in impulse conduction. (10)Maak n gedetailleerde benoemde skets van die normale neuromuskulre aansluiting om aldie essensile strukture en meganismes betrokke by impulsoordrag aan te toon.

(10)

[10]


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The adrenal cortex produces hormones that are essential for lifeDie adrenale korteks produseer hormone wat essensieel is vir lewe

a) List the 3 cortex zones in the adrenal gland. (3)a) Lys die drie kortikale sones van die bynier. (3)

b) Complete the missing steps (a-g) in the following pathway describing the synthesisof hormones in the adrenal gland cortex (7)

b) Voltooi die uitstaande stappe (a-g) in die volgende sintesepad van hormone in diebynierkorteks (7)

[10]


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You are tasked to anaesthetise a newborn baby. Answer the following question regardingyour patientU word getaak om narkose toe te dien vir n pasgeborene. Antwoord die volgende vraerakende u pasint

a) List 3 vascular bypass channels in the neonate that close after birth. (3)

a) Lys 3 vaskulre kortsluitings in die neonaat wat na geboorte sluit. (3)

b) Write short notes on the salient features of foetal haemoglobin. (4)b) Skryf kort notas oor die belangrikste aspekte van fetale hemoglobien. (4)

c) Complete the following normal values with regards to neonates

i) Normal Heart Rate = __________ beats per minute.ii) Blood Volume = ___________ ml/kg.iii) Stroke Volume = __________ ml/kg. (3)

c) Voltooi die volgende normale waardes met betrekking tot neonatei) Normale harttempo = __________ slae per minuut.ii) Bloedvolume = ___________ ml/kg.iii) Slagvolume = __________ ml/kg. (3)

[10]


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Write short notes under the following headings on the physiological effects ofpregnancy on the cardiovascular systemSkryf kort notas onder die volgende hoofed oor die fisiologiese effekte vanswangerskap op die kardiovaskulre sisteem

a) Cardiac output. (2)

a) Kardiale omset. (2)

b) Blood volume. (2)b) Bloedvolume (2)

c) Uterine size and vascularity. (2)c) Uterine grootte en vaskulariteit. (2)

d) Vascular tone. (2)d) Vaskulre tonus. (2)

e) Blood coagulation. (2)e) Bloedstolling. (2)

[10]


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With reference to cytokines produced in the human body, complete the following table byindicating the sources / activities (a) to (j):Voltooi die volgende tabel met verwysing na sitokiene wat in die menslike liggaamgeproduseer word deur die bronne / aktiwiteite (a) tot (j) aan te dui

CYTOKINESITOKIEN

CELLULAR SOURCESELLULERE BRON

MAJOR ACTIVITYMAJOR AKTIWITEIT

Tumor Necrosis Factor Tumor Nekrose-faktor

(a) Promotion of InflammationBevorder Inflammasie

Transforming Factor Transformerende Faktor

T cells, Macrophages, B cellsand mast cellsT-selle, Makrofage,B-selle and mastselle

(b)

Interferon Interferon

(c)Induction of Resistance ofcells to viral infectionInduksie van selweerstand tot

virale infeksie


Virally infected cellsVirus-genfekteerde selle

(d)


Type 1 (TH1) helper T cellsand natural killer cellsTipe 1 (TH1) helper T-selle en"natural killer cells"

(e)

Interleukin 1Interleukien 1

(f)Activation of T cells andmacrophagesPromotion of InflammationAktivering van T-selle en

makrofagePromoveer inflammasie


(g)Activation of lymphocytes,natural killer cells andmacrophagesAktivering van lymfosiete,"natural killer cells" enmakrofage


Type 2 (TH2) helper T cellsand macrophagesTipe 2 (TH2) helper T-selle enmakrofage

(h)


(i) Chemotaxis of NeurtophilsChemotakse van Neutrofiele


(j)Stimulation of the productionof Acute phase proteinsStimulasie van Akute-faseproteene

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FCA(SA) PART I

Physiology

PAPER II(c)

Question 11 - 15

24 August 2010

14:00 16:00

Marks: 50

Examination Number:



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a) Draw a diagram of the action potential of cardiac ventricular muscle with time onthe x-axis and mV on the y-axis. (2)

a) Teken n diagram van die aksiepotensiaal van kardiale ventrikulre spier mettyd op die x-as en mV op die y-as. (2)

On the above diagram

Op bogenoemde diagram

i) Indicate the ionic fluxes involved in each phase of the action potential. (3)i) Dui die betrokke ioonbewegings aan in elke fase van die aksiepotensiaal.(3)

ii) Indicate the absolute and relative refractory periods of the cardiac muscle.(1)

ii) Dui die absolute en relatiewe refraktre periodes van die kardiale spier aan.(1)

b) Draw a diagram of the action potential in the sino-atrial node indicating the ionicfluxes involved. (2)

b) Teken n diagram van die aksiepotensiaal in die sino-atriale node en dui diebetrokke ioonbewegings aan. (2)


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c) List the differences in ionic flux between the action potentials in pacemaker tissueand cardiac muscular tissue. (2)

c) Lys die verskille in ioonbewegings tussen die aksiepotensiale in pasaangerweefselen kardiale spierweefsel. (2)

[10]


Draw a diagram illustrating the pressure-volume relationships in the left ventricle of theheart. (4)Teken n diagram om die druk-volumeverhouding in die linker ventrikel van die hart aan tedui. (4)

i) Label the 4 phases of this diagram. (1)i) Benoem die 4 fases van hierdie diagram. (1)


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ii) What does the included area of this diagram represent? (1)ii) Wat verteenwoordig die ingeslote oppervlak van die diagram? (1)

iii) Add a loop to your original diagram to illustrate the changes that occur in thisrelationship with increasing afterload. (2)

iii) Voeg n lus by u oorspronklike diagram om die veranderinge in hierdie verhoudingaan te toon met n toename in nalading. (2)

iv) Add a further loop to illustrate the changes that occur in this relationship withincreasing contractility. (2)

iv) Voeg n verder lus by om die veranderinge in hierdie verhouding mettoenemende kotraktiliteit aan te toon. (2)

[10]


i) Draw a diagram of the changes seen in blood pressure and heart rate with aValsalva manoeuvre over time. (4)

i) Teken n diagram van die veranderinge gevind oor tyd in bloeddruk enharttempo met die uitvoer van n Valsalvamaneuver. (4)

ii) Briefly explain the reason for these changes. (4)

ii) Verduidelik kortliks die redes vir hierdie veranderinge. (4)


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ii) How does diabetic autonomic neuropathy alter this pattern? (2)ii) Hoe verander diabetiese outonome neuropatie hierdie patroon? (2)

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Fibrinolysis is a critical component of blood homeostasis.Fibrinolise is n kritiese komponent van homeostase.

i) What is the principle circulating fibrinolytic factor? (1)i) Wat is die hoof sirkulerende fibrinolitiese faktor? (1)

ii) Outline the pathway for the activation of fibrinolysis. (3)ii) Omskryf die fibrinolise-aktiveringspad. (3)

iii) How do thrombin and activated protein C interact with the fibrinolytic system?(2)

iii) Hoe skakel trombien en geaktiveerde proteen C met die fibrinolitiese sisteem?(2)


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iv) List the inhibitors of fibrinolysis. (2)iv) Lys die inhibeerders van fibrinolise. (2)

v) Give two of the effects of fibrin degradation products on coagulation. (2)v) Gee twee van die effekte van fibrienafbraakprodukte op stolling. (2)

[10]


In immunologyIn immunologie

i) Define an antigen. (1)i) Definieer n antigeen. (1)

ii) Define a hapten. (1)ii) Defieer n hapteen. (1)

iii) List 4 types of thymus-derived T-cells. (4)iii) Lys 4 tipes timus-afkomstige T-selle. (4)


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iv) Which of the T-cell types is predominantly affected by the HumanImunodeficiency Virus (HIV)? (1)

iv) Watter T-seltipes is oorwegend aangetas deur die MenslikeImmuungebreksvirus (MIV)? (3)

v) List the cellular and major humoral elements involved in Type I (immediate)hypersensitivity reactions. (3)

v) Lys die sellulre en major humorale elemente betrokke by Tipe I (onmiddelike)hipersensitiwiteitsreaksies. (3)

[10]


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FCA(SA) PART I

Physiology

PAPER II(d)

Question 16 - 20

24 August 2010

14:00 16:00

Marks: 50

Examination Number:



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i) Bicarbonate is buffered inside the red blood cell. Indicate the substancesenzymes represented by the symbols A to E (5)

i) Bikarbonaat word gebuffer in die rooibloedsel. Dui die substrate / ensieme aan watverteenwoordig word deur simbole A tot E (5)

A.

B.

C.

D.

E.

ii) H+ secretion and HCO3- absorption by the renal tubules is an important

mechanism in acid-base homeostasis. List five factors that will promote thereabsorption of HCO3-and the accompanying secretion of H+ (5)

ii) H+-sekresie en HCO3absorpsie deur die renale tubules is n belangrike

meganisme in suur-basishomeostase. Lys vyf faktore wat herabsorpsie van HCO3-

en meegaande H+-sekresie sal bevorder. (5)

1.

2.

3.

4.

5.

[10]


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You are tasked with the preoperative optimisation and anaesthesia of a patient with anadrenal pheochromocytoma. List the substances and enzymes found in the normalsynthetic pathway of the catecholaminesU word getaak met die preoperatiewe optimalisering en narkose vir n pasint met nadrenale feochromositoom. Lys die substanse en ensieme wat gevind word in dienormale sintetiese pad van die katekolamiene

[10]


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A patient with haemorrhagic shock is brought to theater. The arterial blood gas reveals amarked high anion gap metabolic acidosis. List the various consequences of a severemetabolic acidosis on the various organ systemsn Pasint met hemoragiese skok word na die teater gebring. Die arterile bloegas wys nerge ho-anioongaping metaboliese asidose. Lys die verskeie gevolge van n ergemetaboliese asidose op die verskeie orgaansisteme

Organ SystemOrgaansisteem

Effects of Metabolic AcidosisEffekte van Metaboliese Asidose

CardiacKardiaal

SystemicVasculature

SistemieseVaskulatuur

PulmonaryVasculaturePulmonaleVaskulatuur

RespiratoryRespiratories

Central NervousSystemSentraalSenustelsel

EndocrineEndokrien

MetabolicMetabolies

ElectrolytesElektroliete

[10]


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You initiate a successful epidural block. The block spreads to a high thoracic level (T1). Listthe physiological effects of this block on the various organ system listed. Give a succinctexplanation for each effect mentioned.U doen n suksesvolle epiduraalblok. Die blok versprei na n ho torakale vlak (T1). Lys diefisiologiese effekte van hierdie blok op die verskeie orgaansisteme genoem. Gee n kortverduideliking vir elke effek genoem.

SystemSisteem

Effect & ExplanationEffek & Verduideliking

Blood pressureBloeddruk

Heart rateHarttempo

BreathingAsemhaling

IntestinalIntestinaal

Urine bladderUrienblaas

ThermoregulationTermoregulering

NeuroendocrineNeuroendokrien

[10]


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Cranial nerve pathology can have major implications in the administration of anaesthesia tosuch an individual. List the functions of the mentioned cranial nerves in the table belowKraniaalsenuweepatologie kan groot implikasies inhou met die toediening van narkose aanso n persoon. Lys die funksies van die genoemde kraniaalsenuwee in die tabel hieronder

Cranial NerveKraniaalSenuwee

Motor functionMotorfunksie

Sensory functionSensoriese Funksie

Autonomic functionOutonome Funksie

N V

TrigeminalTrigeminaal

N VII

FacialFasiaal

N X

VagalVagus

N XII

HypoglossalHipoglossus

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FCA(SA) Part I


Incorporated Association not for gain

Reg No/Nr 1955/000003/08


25 August 2010

PharmacologyPaper III (3 hours)


Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig isvir n vraag) geskryf word

1 You are requested to give anaesthesia to a young healthy man for an open reductionof a forearm fracture after failure of a closed reduction under a Biers block. Discussthe drug lignocaine (lidocaine) with regard to the following aspectsa) Chemical structure and mechanism of action. (5)b) Indications and routes of administration. (5)c) Side effects and precautions. (10)d) Important drug interactions. (10)e) Important differences from bupivacaine. (10)f) Important differences from benzocaine. (10)

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1 U word gevra om narkose te gee aan n jong man oop reduksie en internefiksasie

van n voorarm fraktuur na onsuksesvolle geslote reduksie onder n Biersblok.

Bespreek lignokain (lidocaine) kortliks onder die volgende hoofdea) Chemiese struktuur en meganisme van werking. (5)b) Indikasies en roetes van toediening. (5)c) Newe effekte en voorsorgmaatrels. (10)d) Belangrike geneesmiddel interaksies . (10)e) Belangrike verskille met bupivakain. (10)f) Belangrike verskille met bensokain. (10)

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2 a) The guidelines for bacterial endocarditis prophylaxis during dental surgery havechanged over the last few years.i) Name the antibiotics of choice, dosage, and routes of administration. (4)ii) Name alternative drugs, with dosages, if a patient is unable to tolerate the

choice in i) above. (4)iii) Describe the cardiac conditions deemed necessary for antibiotic prophylaxis

during dental procedures. (7)PTO/ Page 2 Question 2 b)


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b) You are requested to give an initial dose of Vancomycin during a generalanaesthetic. Write notes oni) Dosage.ii) Administration.iii) Possible Complications. (5)

c) While seeing a patient pre-operatively prior to a major GIT procedure, you note

that he has been on gentamycin for the last 5 days. Write notes on how this mayaffect your anaesthetic. (5)

d) You are required to anesthetise a 50-year-old lady with Myastenia Gravis forthymectomyi) Write short notes on your choice of drugs, with dosages, used pre-operatively

and intra-operatively to provide adequate muscle relaxation for both thesurgery and ventilation. (10)

ii) Describe briefly how you would attempt to achieve post-operativespontaneous ventilation for this patient. (5)

iii) List drugs that may hinder your attempt in (ii) and briefly describe their effecton the patient with myasthenia gravis (10)

[50]

2 a) Die riglyne vir bakterile endokarditis profilakse gedurende tandheelkundigechirurgie het onlangs verander.i) Lys die antibiotika van keuse, dosis en roete van toediening. (4)ii) Lys alternatiewe middels, met dosisse, vir gebruik wanneer n pasint nie

genomde keuse in i) mag ontvang nie. (4)iii) Lys die kardiale toestande wat tans antibiotiese profilakse bvehoort te ontvang

voor tandheelkundige prosedure. (7)b) U word gevra om n inisile dosis Vankomisien gedurende algemene narkose te

gee. Skryf bondige notas oor diei) Dosering.ii) Voorsorg met toediening.iii) Moontlike komplikasies. (5)

c) Tydens n preoperatiewe besoek aan n pasint vir major buik prosedure, merk uop dat hy gentamisien vir die afgelope 5 dae ontvang het. Maak kortaantekeninge oor hoe dit u narkose mag benvloed. (5)

d) U word gevra om n 50-jarige-dame met Myastenia Gravis narkose te gee virtimektomie:i) Maak n kort opsomming oor u keuse van middels, met dosisse, wat pre en

intraoperatief gebruik kan word om voldoende spierverslapping tebewerkstellig vir chirurgie en ventilasie. (10)

ii) Verduidelik hoe u spontane ventilasie post-operatief te weeg sal bring. (5)iii) Lys middels wat hierdie poging (in ii) mag verhinder, en beskryf hulle effek in

Myastenia. (10)[50]

3 a) Corticosteroids are widely used in anaesthesia and intensive care. Discussthis under the following headingsi) Classification (you may tabulate your answer if you wish) . (5)ii) Mechanisms of action. (5)iii) Structure activity relationships . (5)

PTO/ Page 3 Question 3a) iv)...


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iv) Indications for use. (10)v) Adverse effects. (10)

b) A patient on chronic steroid therapy is scheduled for major surgeryi) What is your approach to steroid replacement therapy for major surgery?

(5)ii) What is the rationale behind steroid replacement therapy? (5)

iii) What is the latest replacement regimen? (5)[50]

3 a) Kortikosteroide word wyd in narkose en intensiewe sorg gebruik. Bespreekdit kortliks onder die volgende hoofdei) Klassifikasie (tabuleer u antwoord as u wil). (5)ii) Meganisme van werking. (5)iii) Struktuur-aktiwiteits verwantskap. (5)iv) Indikasies vir gebruik. (10)v) Newe effekte. (10)

b) n Pasint op choniese steroid terapie is geskeduleervir major chirurgie.i) Wat is u benadering tot steroid vervanings terapie tydens major

chirurgie? (5)ii) Wat is die rasionaal agter steroied vervanging? (5)iii) Wat is die nuutste vervanging regimen? (5)

[50]

4 a) Complete the table

Isoflurane Sevoflurane Desflurane N2O Xenon

MAC

BGPC

% liver

metabolism (8)b) For each of Isoflurane, Sevoflurane , Desflurane, N2O , and Xenon, list the

effects on each of the following systemsi) Central Nervous System.

(7)ii) Cardiovascular system. (15)

iii) Respiratory system and upper airway. (5)iv) Side effects. (5)v) Toxic metabolites or breakdown products. (5)vi) Contra indications and special precautions. (5)

[50]

4 a) Voltooi die tabel

Isofluraan Sevofluraan Desfluraan N2O Xenon

MAK

BGSK

%lewermetabolisme

(8)

PTO/ Page 3 Question 4 b)...


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b) Lys kortliks elk van Isofluraan, Sevofluraan, Desfluraan, N2O en Xenon seeffekte op die volgende sistemei) Sentraal senuwee stelsel. (7)ii) Kardiovaskulre stelsel.

(15)

iii) Respiratoriese sisteem en boonste lugweg. (5)

iv) Newe effekte. (5)v) Toksiese metaboliete of afbraak produkte. (5)vi) Kontra indikasies en voorsorg maatrels. (5)

[50]


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FCA(SA) PART I

Pharmacology

PAPER IV(a)

Question 1 - 5

25 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Concerning dantroleneMet betrekking tot dantroleen

a) List the indications for usage. (5)a) Lys die indikasies vir gebruik. (5)

b) Briefly explain its mechanism of action. (3)b) Verduidelik kortliks die meganisme van werking. (3)

c) Mention the recommended dosages. (2)c) Noem die voorgestelde doserings. (2)

[10]


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Briefly list all the pharmacological methods used to obtund the sympathetic response tointubation. (10)Lys al die farmakologiese metodes wat gebruik kan word om die simpatiese respons opintubasie te demp. (10)

[10]


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A patient is scheduled for laparoscopic cholecystectomy. Briefly outline a strategy for postoperative analgesia. Include dosages for relevant drugs mentioned. (10)n Pasint is geskeduleer vir laparoskopiese cholesistektomie. Maak n bondige opsommingvan u strategie vir post operatiewe analgesie. Meld dosisse vir alle relevante middels watgenoem word. (10)

[10]


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a) Define the term Volume of distribution. (2)a) Defineer die begrip volume van distibusie. (2)

b) List the factors that may influence the volume of distribution of drugs. (8)b) Lys die faktore wat die volume van distribusie van middels benvloed. (8)

[10]


a) Give the recommended maximum dosages of lignocaine, bupivacaine and

ropivaicaine when used for infiltration. (3)a) Gee die voorgestelde maksimum doserings vir lignokaen, bupivakaen en

ropivakaen wanneer dit gebruik word vir infiltrasie. (3)


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b) How would toxic effects occurring from super-wet infiltration for liposuction present?(3)

b) Hoe sal toksiese effekte wat volg op super-nat infiltrasie vir liposuiging presenteer? (3)

c) Describe the treatment of bupivicaine toxicity. (4)c) Beskryf die hantering van bupivaikaen toksisiteit. (4)

[10]


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FCA(SA) PART I

Pharmacology

PAPER IV(b)

Question 6 - 10

25 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Explain the mechanism of action of each of the following drugs relevant to the specificindicationVerduidelik die meganisme van werking van elk van die volgende middels relevant tot diespesifieke indikasie

a) Selegiline in Parkinsons disease. (2)

a) Selegilien in Parkinson se siekte. (2)

b) Neostigmine in Myasthenia gravis. (2)b) Neostigmien in Myastenia gravis. (2)

c) Carvedilol in heart failure. (2)c) Karvedilol in hartversaking. (2)

d) Vasopressin in bleeding esophageal varices. (2)d) Vasopressien in bloeiende esofageale varices. (2)


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e) Lamotrigine in grand mal epilepsy. (2)e) Lamotrigien in grand mal epilepsie. (2)

[10]


Select an appropriate antihypertensive drug for each of the following circumstances / co-morbid conditions and motivate your choiceSelekteer n geskikte antihipertensiewe middel in elk van die volgende omstandighede /ko-morbiede toestande en motiveer u keuse

a) Elderly patient. (2)

a) Bejaarde pasint. (2)

b) Chronic renal disease. (2)b) Croniese niersiekte. (2)

c) Diabetes Mellitus. (2)c) Diabetes Mellitus. (2)


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d) Post-myocardial infarction. (2)d) Post-miokardiale infarksie. (2)

e) Ischemic heart disease. (2)e) Isgemiese hartsiekte. (2)

[10]


Serotonin syndrome is associated with overdose of SSRI, but may also be precipitated bycertain important drug interactions.Serotonien sindroom word geassosier met SSRI oordosis, maar kan ook deur sekeremiddelinteraksies gepresipiteer word.

a) What are the clinical manifestations of serotonin syndrome? (4)a) Wat is die kliniese manifestasies van serotonien sindroom? (4)

b) What commonly used anaesthetic agents may precipitate it? (4)b) Watter algemeen gebruikte narkosemiddels mag dit uilok? (4)


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c) What is the treatment of serotonin syndrome? (2)c) Wat is die behandelikng van serotonien sindroom? (2)

[10]


Concerning amiodaroneMet betrekking tot amiodaroon

a) List indications for its use. (3)a) Lys indikasies vir die gebruik daarvan . (3)

b) List the side effects associated with its use. (7)b) Lys die newe effekte geassosierd met die gebruik daarvan. (7)

[10]


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Concerning metforminMet betrekking tot metformin

a) Briefly discuss the mechanism of action. (4)a) Bespreek kortliks die meganisme van werking. (4)

b) List the side effects of metformin. (6)b) Lys die newe effekte van metformin. (6)

[10]


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FCA(SA) PART I

Pharmacology

PAPER IV(a)

Question 11 - 15

25 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Classify colloidal solutions that may be used for fluid resuscitation. Give an example ofeach class that you mention. (10)Klassifiseer koloed oplossings wat vir vog resussitasie gebruik word. Gee n voorbeeld vanelk wat genoem word. (10)

[10]


Define the following terms giving examplesDefinier die volgende begrippe en gee voorbeelde van

a) Agonist. (2)a) Agonis. (2)


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b) Partial agonist. (2)b) Gedeeltelike agonis. (2)

c) Antagonist. (2)c) Antagonis. (2)

d) Use a graph to illustrate your answers (4)d) Gebruik n grafiek om u antwoord te illustreer (4)

[10]


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A patient has an anaphylactic reaction to penicillin. List in a sequential manner thepharmacological management. (10)n Pasint kry anafilakse teen penisillien. Lys, in volgorde, die farmakologiese hanteringhiervan. (10)

[10]


a) What do you understand by the term off label use of drug? (2)a) Wat verstaan u met die begrip ongeregistreerde gebruik van n middel? (2)


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b) List 4 drugs and their off label use. (8)b) Lys 4 middels en hulle ongeregistreerde gebruik. (8)

[10]


Concerning the statinsMet betrekking tot statiene

a) List indications for their use. (3)a) Lys indikasies vir die gebruik daarvan. (3)

b) List side effects. (3)b) Lys newe effekte. (3)


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c) Define the term pleotropic effects. (1)c) Definier die begrip pleotropiese effekte. (1)

d) List the pleotropic effects of these drugs. (3)

d) Lys die pleotropiese effekte van die middles. (3)

[10]


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FCA(SA) PART I

Pharmacology

PAPER IV(d)

Question 16 - 20

25 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Benzodiazepines are often prescribed as premedication.Bensodiasepiene word dikwels as premdikasie voorgeskryf.

a) What is the mechanism of action of the benzodiazepines? (1)a) Wat is die meganisme van werking van bensodiasepiene? (1)

b) Why is there a difference in the anxiolysis potential between thedifferent benzodiazepines? (2)

b) Waarom is daar n verskil in die angsiolise potensiaal tussen verskillendebensodiasepiene? (2)

c) What is unique about the pharmacology of midazolam? (3)c) Wat is uniek aan die farmakologie van midasolam? (3)

d) Why is diazepam a poor choice for premedication? (3)d) Waarom is diasepam n swak keuse vir premedikasie? (3)

e) How can you reverse the effects of benzodiazepines? (1)e) Hoe kan die effek van bensodiasepiene omgekeer word? (1)

[10]


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Describe the effect of stereo isomerism on the pharmacokinetics of the following drugsBeskryf die effek van stereo-isomerism op die farmakokinetika van die volgende middels

a) Atracurium and Cis-atracurium. (4)a) Atrakurium and Cis-atrakurium. (4)

b) Bupivacaine and levobupivacaine . (3)b) Bupivakaen and levobupivakaen . (3)

c) Ketamine and S-ketamine. (3)c) Ketamien and S-ketamien. (3)

[10]


Post operative nausea and vomiting (PONV) may be a complication of general anaesthesia.List 5 groups of drugs that is effective in either the prevention or treatment of this condition,as well as the receptors they occupy. (10)

Post operatiewe naarheid en braking (PONB) is n komplikasie van algemene narkose. Lys5 groepe middles wat effektief in die voorkoming of behandeling van PONB gebruik kanword, en meld ook die reseptors wat elk van die middels beset. (10)


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[10]


a) What is protamine sulphate? (1)a) Wat is protamiensulfaat? (1)

b) What are the complications associated in its use? (4)b) Wat is die komplikasies geassosierd met gebruik van die middle? (4)


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c) What is droperidol? (1)c) Wat is droperidol? (1)

d) What are the side effects seen in the use of this drug? (4)

d) Wat is die newe effekte by gebruik van die middle? (4)

[10]


The administration of opioids into the intrathecal space is commonly practiced.Die toediening van opioiede in die intratekale spasie is algemene gebruik.

a) What are the advantages of opioids in the epidural space? (2)a) Wat is die voordele van opioiede in die epidurale spasie? (2)

b) What are the disadvantages of opioids in the epidural space? (2)b) Wat is die nadele van opioiede in die epidurale spasie? (2)

c) How does the pharmacokinetics of intrathecal morphine and sufentanil differ? Whatis the cause of this difference? (4)c) Hoe verskil die farmakokinetika van intratekale morfien van die van sufentanil? Wat

is die oorsaak van die verskil? (4)


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d) Why is the intrathecal use of remifentanil contra-indicated? (2)d) Hoekom is die gebruik van remifentanil intratekaal gekontra-indikeerd? (2)

[10]


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FCA(SA) Part I


Incorporated Association not for gainReg No/Nr 1955/000003/08


26 August 2010

PhysicsPaper V (3 hours)


Al die vrae moet beantwoord word. Elke vraag moet in n aparte boek (of boeke indien meer as een nodig isvir n vraag) geskryf word

1 A 51-year-old patient presents for elective surgery. A pacing device with automaticcardioversion / defribrillating capability was placed 18 months previouslya) List your pre-anaesthetic considerations and investigations that would be

appropriate and justify your reasons. (15)b) Which adverse intraoperative events should be anticipated and how could these

be prevented? (10)c) Explain the NASPE / BPEG codes for pacemakers. (10)d) What are the characteristics of a DDD pacemaker? (5)e) When would the placement of a biventricular pacemaker be appropriate? (10)

[50]

1 51-Jarige pasint word vir elektiewe chirurgie aangebied. Pasaanger met

outomatiese kardioversie / defibrillasievermo is 18 maande gelede ingeplaas.a) Lys u toepaslike pre-operatiewe narkose-oorwegings en ondersoeke en motiveeru besluite. (15)

b) Op watter ongunstige gebeurtenisse moet u intraoperatief bedag wees en hoekan dit voorkom word? (10)

c) Verduidelik die "NASPE / BPEG"-kodes vir pasaanger. (10)d) Wat is die eienskappe van DDD-pasaanger? (5)e) Wanneer sal die plasing van dubbelventrikel-pasaanger aangedui wees? (10)

[50]

2 When considering Bi-Spectral Index monitoringa) Describe how frequency analysis of an EEG is done to calculate a bi-spectral

index. (20)b) How is this used to represent the level of consciousness during anaesthesia?(30)[50]

2 Met verwysing na Bispektrale Indeksmoniteringa) Beskryf hoe frekwensie-analise van die EEG plaasvind om die bispektrale

indeks te bereken. (20)b) Hoe sal dit gebruik word gedurende narkose om die vlak van bewussyn

voor te stel? (30)[50]

PTO/ Page 2 Question 3a)


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3 a) Classify contemporary anaesthetic ventilators according to the followingcriteria, giving examples where possiblei) Power source.ii) Drive mechanism.iii) Cycling mechanism.iv) Bellows classification. (20)

b) Draw the pressure/time andflow/time curves of an anaesthetic machine usingi) Volume control with an inspiratory pause setting.ii) Pressure controlled ventilation mode. (10)

c) Compare a double circuit, bag in the bottle type ventilator with a pistontype ventilator using decoupling technology, with regard toi) Oxygen usage for ventilation.ii) Potential scavenging problems.iii) Risk of using oxygen flush during inspiration.iv) Provision of obligatory PEEP.v) Possible cause of awareness and hypoxia. (20)

[50]

3 a) Klassifiseer moderne narkose-ventilators aan die hand van die volgendekriteria en gee voorbeelde waar moontliki) Kragbron.ii) Aandrywingsmeganisme.iii) Sikliese meganisme ("cycling mechanism").iv) Blaasbalk ("bellows") klassifikasie. (20)

b) Teken die druk/tyd- en vloei/tyd-kurwes van n narkosemasjien met diegebruik vani) Volumebeheer met n inspiratoriese pouse-stelling.ii) Drukbeheerde ventilasiemodus. (10)

c) Vergelyk n dubbelsisteem "bag in bottle"-tipe ventilator met n suiertipe("piston type") ventilator met ontkoppelingstegnologie ("decouplingtechnology") met betrekking toti) Suurstofverbruik vir ventilasie.ii) Potensile opruimingsprobleme ("scavenging").iii) Risiko met gebruik van die hovloeisuurstofmeganisme ("oxygen

flush") tydens inspirasie.iv) Voorsiening van verpligte PEED.v) Moontlike oorsake van bewustheid en hipoksie. (20)

[50]

4 This is the structural formula for Sevoflurane

Given the atomic weights

Carbon = 12

Oxygen = 16

Flourine = 19

Hydrogen = 1

PTO/ Page 3 Question 4 a)


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a) Calculate the molar mass of Sevoflurane and give its units. (5)b) State the volume that 1 mole of sevoflurane will occupy at standard

temperature and pressure (STP) and give the values and units that defineSTP. (5)

c) Whos name is associated to the equation relating moles of gas to volume?(2)

d) The specific gravity of sevoflurane is 1.52i) What does this tell us about its relative density to water? (3)ii) Use this figure together with the information calculated above to determine

what volume of vapour will be generated by one milliliter of sevoflurane atSTP. Show your working. (25)

iii) Correct this volume for a temperature of 20 degrees Celsius (at the samepressure). Explain the basis for your calculation. (10)

Note: Rounding of decimal places is permitted.[50]

4 Hierdie is die struktuurformule van Sevoflurane

Gegee die atoommassas

Koolstof = 12

Suurstof = 16

Floried = 19

Waterstof = 1

a) Bereken die molre massa van Sevofluraan en gee die eenhede. (5)b) Gee die volume wat 1 mol sevofluraan sal beslaan by standaard temperatuur en

druk (STP) en gee die waardes en eenhede wat "STP" definieer. (5)c) Wie se naam word geassosieer met die vergelyking wat die aantal mol gas na

volume herlei? (2)d) Die soortlike gewig ("specific gravity") van sevofluraan is 1.52

i) Wat s dit vir ons omtrent die relatiewe digtheid daarvan tot di van water? (3)ii) Gebruik hierdie waarde saam met die inligting wat hierbo bereken is en

bepaal die volume damp wat geproduseer sal word deur een millilitersevofluraan by STP. Wys u berekeninge. (25)

iii) Korrigeer hierdie volume vir n temperatuur van 20 grade Celsius (by dieselfdedruk). Verduidelik die beginsels toegepas met u berekeninge. (10)

Nota: Afronding van desimale is toelaatbaar.[50]


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FCA(SA) PART I

Physics

PAPER VI(a)

Question 1 - 5

26 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Question 1 / Vraag1

a) Define mickroshock (2)a) Definieer mikroskok. (2)

b) Give practical examples of how it can occur in theatre. (5)b) Gee praktiese voorbeelde hoe dit in die teater kan voorkom. (5)

c) How can it be prevented? (3)c) Hoe kan dit voorkom word? (3)

[10]


Describe clearly what is meant by the following termsBeskryf duidelik wat bedoel word met die volgende terme

a) Critical temperature. (4)a) Kritiese temperatuur. (4)


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b) Pseudocritical temperature. (4)b) Pseudokritiese temperatuur. (4)

c) Standard temperature and pressure. (2)c) Standaard temperatuur en druk. (2)

[10]


Define the following terms with respect to patient monitorsDefinieer die volgende terme met betrekking tot pasintmonitors

a) 'Signal-to-noise ratio'. (4)a) 'Sein-tot-geraasverhouding'. (4)

b) Zero drift.b) "Zero drift'. (2)


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c) Linearity. (2)c) Liniariteit. (2)

d) Calibration. (2)d) Kalibrasie. (2)

[10]


a) Classify vaporisers. (5)

a) Klassifiseer verdampers. (5)

b) What is the function of a bimetallic strip contained in some vaporizers and describethe underlying physical properties to its function in the vaporiser?

b) Wat is die funksie van n bimetaalstrokie wat voorkom in sommige verdampers enbeskryf die onderliggende fisiese beginsels ten opsigte van die funksioneringdaarvan in die verdamper? (5)


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a) One of the hazards of the anaesthesia machine is that a hypoxic mixture can bedelivered to the patient. Shortly name and describe 5 mechanisms of how a patientcan experience hypoxia while being ventilated. (10)

a) Een van die gevare van die narkosemasjien is dat n hipoksiese mengsel aan diepasint gelewer word. Noem en beskryf kortliks 5 meganismes van hoe n pasinthipoksie kan ontwikkel wanneer hy geventileer word. (10)


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FCA(SA) PART I

Physics

PAPER VI(b)

Question 6 - 10

26 August 2010

14:00 16:00

Marks: 50

Examination Number:



67/82


a) Define humidity. (2)a) Definieer humiditeit. (2)

b) What is the difference between relative and absolute humidity? (6)b) Wat is die verskil tussen realtiewe en absolute humiditeit? (6)

c) What physical properties may effect the relative humidity of a gas. (2)c) Watter fisiese eienskappe kan die relatiewe humiditeit van n gas benvloed? (2)


a) Describe all the components required to fully define a sine wave. (6)a) Beskryf al die komponente wat benodig word om n sinusgolf ten volle te definieer.

(6)


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b) South African domestic electricity supply is 220V rms. Explain what this means. (4)b) Suid Afrika se huishoudelike elektrisiteitvoorsiening is 220V rms. Verduidelik wat dit

beteken. (4)

[10]

Question 8/ Vraag 8

With the help of diagrams indicate how a pneumotachographmeasures gas flow? (10)Dui aan met behulp van diagramme hoe npneumotakograafgasvloei meet? (10)


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Question 9/ Vraag 9

a) Define a nebuliser. (2)a) Definieer n nebuliseerder. (2)

b) Classify nebulisers. (3)b) Klassifiseer nebuliseerders. (3)

c) Explain the mechanism of how a gas driven nebuliserworks. (5)c) Verduidelik die werkingsmeganisme van n gasaangedrewe nebuliseerder. (5)

[10]

Question10 / Vraag 10

a) State the First Gas Law. (5)a) Gee die Eerste Gaswet. (5)


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b) State Daltons Law of Partial pressures. (5)b) Gee Dalton se Wet van Parsile drukke. (5)

[10]


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FCA(SA) PART I

Physics

PAPER VI(c)

Question 11 - 15

26 August 2010

14:00 16:00

Marks: 50

Examination Number:



72/82


i) Briefly describe the specifications you would want met when purchasing a Heat andMoisture Exchange Filter for general use in theatre. (6)

i) Beskryf kortliks die spesifikasies wat u sal versoek met die aankoop van n Hitte- enVoguitruilfilter vir algemene teatergebruik. (6)

ii) Using a diagram, briefly describe how resistance to flow through the Heat andMoisture Exchange Filter could be measured.

ii) Gebruik n diagram om kortliks te beskryf hoe die weerstand tot vloei deur n Hitte-en Voguitruilfilter gemeet kan word. (4)

[10]


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Question 12 / Vraag 12a) Technicians have been working on the hospital gas supply pipeline. Soon after

commencing ventilation in an intubated, otherwise healthy 23-year-old patientundergoing minor surgery, the patient turns blue and the pulse oximeter saturationdrops to less than 75%. The pressure in the oxygen pipeline remains at 400 kPa.

a) Tegnici het gewerk aan die hospitaal se gasvoorsieningspyplyne. Kort nadat daarbegin is om n geintubeerde, 23-jarige gesonde pasint te ventileer vir minor sjirurgieword die pasint blou en die polsoksimetersaturasie val tot onder 75%. Die druk in

die suurstofpyplyn bly 400 kPa.

i) What would be your working diagnosis? (2)i) Wat is u werksdiagnose? (2)

ii) How would you confirm the diagnosis and what steps would you take toalleviate the problem? (4)

ii) Hoe sal u die diagnose bevestig en watter stappe sal u neem om dieprobleem op te los? (4)

b) A paralysed patient is being ventilated during anaesthesia using a bag in bottle typeventilator and a circle system, when the oxygen pipeline pressure suddenly dropsfrom 400 to 200 kPa.

b) n Verslapte pasint word geventileer gedurende narkose met n sak-in-bottel-tipe("bag in bottle") ventilator en sirkelsisteem toe die suurstofpyplyndruk skielik val van400 tot 200 kPa.

i) What steps would you take to conserve oxygen so that the surgery could be

completed safely? (4)i) Watter stappe sal u neem om suurstof te bespaar sodat die sjirurgie veiligvoltooi kan word? (4)

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Question 13 / Vraag 13Draw an annotated scavenging system. Briefly describe safety features that need to beincorporated into the system. (10)Teken n benoemde opruimingsisteem. Beskryf kortliks die eienskappe wat deel van diesisteem moet wees. (10)


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a) Draw a sketch of an ungrounded power supply (isolated electric circuit) providingelectricity to a theatre. (4)

a) Teken n skets van n ondergrondse kragvoorsieningsnetwerk (gesoleerde elektriesestroombaan) wat krag voorsien aan n teater. (4)

b) Explain the function of a line isolation monitor (LIM). (2)b) Verduidelik die funksie van n lyn-isolasiemonitor (LIM). (2)

c) Briefly describe two scenarios which could result in the LIM alarm being activated ina operating theatre with an isolated electrical circuit, but neither which arenecessarily dangerous to the patient. (4)

c) Beskryf kortliks twee senario's wat sal lei tot die aktivering van die LIM-alarm in noperasieteater met n geisoleerde stroombaan, wat beide nie noodwendig gevaarlikis vir die pasint nie. (4)

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The Systme Internationaleunits (SI Units)were introduced by the General Conference onWeights and Measures in 1960, and are based on the metric system. Complete thefollowing table:Die 'Systme Internationale' se eenhede (SI-eenhede) is voorgestel deur die "GeneralConference on Weights and Measures" in 1960 en is gebaseer op die metrieke stelsel.Voltooi die volgende tabel:

Unit of:Eenheid vir:

SI Unit nameSI-Eenheid naam

SI Unit abbreviationSI-Eenheid afkorting

Electric current

Elektriese stroom

TemperatureTemperatuur

Amount of substanceHoeveelheid van 'n substans

ForceKrag

PressureDruk

Energy for electromagnetic radiationEnergie van elektromagnetiese

straling

FrequencyFrekwensie

EnergyEnergie

WorkArbeid

Power

Drywing

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Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036

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Academic Registrar: [email protected]: http://www.collegemedsa.ac.za

FCA(SA) PART I

Physics

PAPER VI(d)

Question 16 - 20

26 August 2010

14:00 16:00

Marks: 50

Examination Number:



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Give a short description of the physical principles that underlie how paramagnetic oxygenanalysers function. (10)Gee n kort beskrywing van die fisiese beginsels wat die funksionering van paramagnetiesesuurstofanaliseerders onderl. (10)


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When considering heatMet hitte as oorweging

a) Give the S.I. units in which heat energy is measured (2)a) Gee die S.I. -eenhede waarin hitte-energie gemeet word. (2)

b) What units are used to measure heat transfer? (2)b) Watter eenhede word gebruik vir hitte-oordrag? (2)

c) Define the term specific heat capacityand give the units in which this is measured.(6)

c) Definieer die term spesifieke hittekapasitieit en gee die eenhede daarvan. (6)

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a) Explain what a Galvanometer is and how it works. (5)a) Verduidelik wat n Galvanometer is en hoe dit werk. (5)

b) Explain the role of the galvanometer in the Wheatstone bridge. (5)b) Verduidelik die rol van die galvanometer in die Wheatstonebrug. (5)


Describe in brief the main principles involved in generating an image using a magneticresonance imaging machine. (10)Beskryf kortliks die hoofbeginsels betrokke in die opwekking van n beeld met diemagnetiese resonansiebeeldmasjien. (10)


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When a sample group is taken for study, it is important that attempts are made to make itas representative of the population being studied as possible.Wanneer n datamonster geneem word vir n studie is dit belangrik dat pogings aangewendword om dit so verteenwoordigend as moontlik te maak van die bevolking wat bestudeerword.

a) Briefly describe what steps can be taken to improve the chances of collecting arepresentative sample. (8)

a) Beskryf kortliks watter stappe geneem kan word om die kans op nverteenwoordigende datamonster te verbeter. (8)


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b) Mention a statistical test that can be used to test the representivity of a sample. (2)b) Noem n statistiese toets wat gebruik kan word om die 'verteenwoordigbaarheid' van

n datamonster te toets. (2)

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fca(sa)_part_i_past_papers 2

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