FCA (SA) Part I Past Papers

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 the
College of Anaesthetists of South Africa
27 August 2012
Physiology
Paper 1
(3 hours)
All questions are to be answered. Each question to be answered in a separate book (or books if more than
one 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.
Question1/Vraag1
a)
Describe how myocardial contraction and relaxation occurs.
(20)
b)
Discuss the factors that increase myocardial contractility.
(10)
c)
With the aid of a diagram explain the Frank-Starling law of the heart. Discuss
the proposed underlying mechanism and include the effect of inotropy and
afterload on the relationship.
(10)
d)
Draw a fully annotated normal left ventricular pressure-volume loop.
(8)
i)
Indicate on your diagram what effect an increase in preload would have
on stroke volume.
(2)
[50]
a)
b)
c)
d)
Beskryf hoe miokardiale kontraksie en ontspanning plaasvind.

(20)
Bespreek die faktore wat miokardiale kontraksie verhoog.
(10)
Verduidelik die Frank-Starlingwet van die hart met behulp van n diagram.
Bespreek die voorgestelde onderliggende meganisme en sluit in die effek van
inotropie en nalading op die verwantskap.
(10)
Teken n volledig benoemde linkerventrikel druk-volumekurwe.
(8)
i)
Dui aan op u grafiek wat die effek van verhoogde voorlading op die
slagvolume sal wees.
(2)
[50]
Question2/Vraag2
a)
Describe the foetal circulation.
(20)
b)
Describe the mechanisms of transition to adult circulation.
(20)
c)
A one-month-old baby presents with central and peripheral cyanosis. On
investigation the baby is shown to have a large ventricular septal defect,
pulmonary artery stenosis, an overriding aorta and right ventricular
hypertrophy.
d)
Define physiologically
i)
Central cyanosis.
(1)
ii)
Peripheral cyanosis.
(1)
PTO/Page 2 Question 2e)
-2e)
With the aid of an annotated diagram explain why the child is cyanosed.
a)
b)
c)
Beskryf die fetale sirkulasie.

(20)
Beskryf die meganisme van oorgang na volwasse sirkulasie.
(20)
n Een-maand-oue baba presenteer met sentrale en perifere sianose. Met
ondersoek het die baba n groot venrtikuloseptale defek, pulmonale
arteriestenose, n oorrydende aorta en regter ventrikelhipertrofie.
Definieer fisiologies
i)
Sentrale sianose.
(1)
ii)
Perifere sianose.
(1)
Verduidelik met behulp van n benoemde diagram hoekom die kind sianoties
is.
(8)
[50]
d)
e)
(8)
[50]
Question3/Vraag3
a)
You administer an anaesthetic an altitude of approximately 1700m, with a
barometric pressure of 630mmHg (84kPa). The arterial PCO2 is 36mmHg
(4.8 kPa)
i)
What is the difference in the inspired room air oxygen concentration
between sea-level and 1700m?
(5)
ii)
Assuming the patient is breathing room air calculate this patients
alveolar PO2 using the alveolar gas equation
(3)
iii)
Describe the physiology of the ventilatory response to increasing
altitude.
(4)
iv)
What are the beneficial and harmful physiological changes that occur
secondary to hypoxia from living at high altitude?
(6)
b)
You pre-oxygenate this healthy adult patient for surgery with 100% oxygen for
3 minutes
i)
What is the main objective of pre-oxygenation?
(1)
ii)
Based on a FRC of 30ml/kg in a 70kg male, calculate the increase in
oxygen in the lung using the alveolar gas equation at sea level. .
Assume that the FRC had an oxygen concentration of 13% prior to preoxygenation and therefore contained 270mls of oxygen.
(5)
iii)
What is an expected basal metabolic rate of oxygen consumption for
an adult and how much longer would the patient therefore tolerate
apnoea?
(3)
iv)
How is oxygen carried in the body?
(3)
v)
How much does dissolved oxygen increase in the presence of
breathing 100% oxygen?
(2)
c)
During the procedure a large volume of CO2 is insufflated into the abdominal
compartment
i)
What are the factors that determine blood flow through the lungs and
briefly describe (with appropriate diagrams) how this varies from apex
to base in a normal standing patient?
(10)
d)
What effect would abdominal CO2 insufflation have on
i)
PaCO2.
(3)
ii)
PaO2.
(3)
[50]
PTO/Page 3 Question 3a)
-3-
a)
b)
c)
d)
U dien narkose toe op n hoogte van ongeveer 1700m, met n

barometriese druk van 630mmHg (84kPa). Die arterile PCO2 is
36mmHg (4.8kPa).
i)
Wat is die verskil in die ingeasemde kamersuurstofkonsentrasie
by seevlak en 1700m?
(5)
ii)
Neem aan die pasint asem kamerlug en bereken dan sy
alveolre PO2 deur die alveolre gasvergelyking te gebruik. (3)
iii)
Beskryf die fisiologie van die ventilatoriese respons tot
toenemde hoogte.
(4)
iv)
Wat is die voordelige en nadelige fisiologiese veranderinge wat
voorkom sekondr tot n verblyf op n ho hoogte.
(6)
U preoksigeneer hierdie gesonde volwassene met 100% suurstof vir 3
minute
i)
Wat is die hoof oogmerk van preoksigensaie?
(1)
ii)
Met n FRK van 30ml/kg in n 70kg man, bereken die toename in
suurstof in die longe deur gebruik te maak van die alveolre
gasvergelyking by seevlak. Neem aan dat die FRK n
suurstofkonsentrasie van 13% het voor preoksigenasie en dus
270ml suurstof bevat het.
(5)
iii)
Wat is die verwagte basale metaboliese tempo vir
suurstofverbruik in n volwassene, en hoeveel langer sal die
pasint apnee kan verdra?
(3)
iv)
Hoe word suurstof vervoer in die liggaam?
(3)
v)
Hoeveel neem opgeloste suurstof toe in die teenwoordigheid
van 100% suurstofinaseming?
(2)
Gedurende die prosedure word n groot volume CO2 in die abdominal
kompartement ingeblaas
i)
Wat is die faktore wat bloedvloei deur die longe bepaal en
beskryf kortliks (met toepaslike diagramme) hoe dit verander
van apeks tot basis in n normale, staande persoon.
(10)
Watter effek sal CO2 insufflasie h op
i)
PaCO2.
(3)
ii)
PaO2.
(3)
[50]
Question4/Vraag4
a)
List the divisions of the renal artery that supply the kidney.
(5)
b)
Describe how the arterial divisions are adapted to perform their role in
filtration and water conservation.
(15)
c)
Draw and label a juxtamedullary nephron.
(8)
d)
Briefly describe how the nephron is adapted to perform its role in
reabsorbtion and secretion.
(6)
e)
How are the nephron and collecting duct adapted to regulate water
homeostasis?
(9)
f)
What is the function of the juxtaglomerular apparatus.
(4)
g)
What anatomical and physiological adaptations allow the JGA to
function efficiently?
(3)
[50]
-44
a)
b)
c)
d)
e)
f)
g)
Lys die divisies van die renale arterie wat die nier voorsien.
(5)
Beskryf hoe die arterile divisies aangepas is om hul rol te vervul in
filtrasie en waterkonservering.
(15)
Teken en benoem n jukstaglomerulre nefron.
(8)
Beskryf kortliks hoe die nefron aangepas is vir die funksie van
herabsorpsie en sekresie.
(6)
Hoe is die nefron en versamelbuise aangepas vir waterhomeostase?
(9)
Wat is die funksie van die jukstaglomerulre apparaat?
(4)
Watter anatomiese en fisiolopgiese aanpassings laat die JGA toe om
doeltreffend te funksioneer?
(3)
[50]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

27 August 2012
Physiology
Paper 2
(2 hours)
Candidate Number:....................................................
Question 1 5 / Vraag 1 - 5
PTO/ Page 2 Question 1...
-2Question 1 / Vraag 1
a)
List the digestive enzymes secreted by the exocrine pancreas.
(2)
a)
Lys die spysverteringsensieme wat afgeskei word deur die eksokriene pankreas. (2)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
b)
Describe the mechanisms that are responsible for preventing auto-digestion of the
pancreas.
(3)
b)
Beskryf die meganismes verantwoordelik vir die voorkoming van outo-vertering van
diepankreas.
(3)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
c)
c)
Discuss the regulation of pancreatic secretion under the headings

Bespreek die regulering van pankreas-sekresie onder die volgende hoofed
(5)
(5)
i)
Cephalic phase.
i)
Kefaliese fase.
_________________________________________________________________________
_________________________________________________________________________
ii)
Gastric phase.
ii)
Gastriese fase
_________________________________________________________________________
_________________________________________________________________________
iii)
Intestinal phase.
iii)
Intestinale fase.
_________________________________________________________________________
_________________________________________________________________________
[10]
PTO/ Page 3 Question 2

a)
List the normal functions of the liver.
(6)
a)
Lys die normale funksies van die lewer.
(6)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
b)
Briefly discuss the hepatic arterial buffer response.
(4)
b)
Bespreek kortliks die hepatiese arterile bufferrespons.
(4)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]

a)
a)
b)
b)
c)
c)
What are the normal values for mean pulmonary artery pressure and pulmonary
vascular resistance?
(1)
Wat is die normale waardes vir gemiddelde pulmonale arteridruk en pulmonale
vaskulre weerstand?
(1)
Discuss the effects that the following factors have on pulmonary vascular resistance
Bespreek die effekte wat die volgende faktore het op pulmonale vaskulre
weerstand
i)
i)
Pulmonary blood flow.

Pulmonale bloedvloei.
(2)
(2)
ii)
ii)
Lung volume.
Longvolume.
(3)
(3)
Briefly discuss hypoxic pulmonary vasoconstriction.

Bespreek kortliks hipoksiese pulmonale vasokonstriksie.
(4)
(4)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]

PP = pulse pressure
PP = polsdruk
a)
A patient is rushed back to theatre for a post-operative bleed. Explain the respiratory
variations in pulse pressure as seen in this diagram.
(6)
a)
n Pasint word teruggehaas na die teater vir postoperatiewe bloeding. Verduidelik
die respiratoriese variasies in polsdruk soos gesien op die diagram.
(6)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
b)
How is pulse pressure variation calculated?
(1)
b)
Hoe word polsdrukvariasie bereken?
(1)
_________________________________________________________________________
_________________________________________________________________________
c)
What are the limitations to monitoring pulse pressure variation?
(3)
c)
Wat is die beperkinge van polsdrukvariasie-monitering?
(3)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]
Cholesterol
17OH pregnenolone
Progesterone
Corticosterone
17OH progesterone
Dehydroepiandrosterone
androstenedione
androstenediol
11 deoxycortisol
18OH corticosterone
Aldosterone
a)
a)
Fill in the missing steroids 1,2,3,4.

Gee die afwesige steroede 1,2,3,4.
(4)
(4)
b)
What enzyme converts progesterone to 2, and 17OH progesterone to

deoxycortisol?
Watter ensiem skakel progesteroon om na 2, en 17OH progesteroon
deoksikortisol?
11
(1)
na
(1)
b)
c)
c)
d)
d)
e)
e)
Which two steroids in the above diagram are glucocorticoids and which two have
mineralocoticoid action?
(2)
Watter twee steroede in bostaande diagram is glukokortikoede en watter twee het
mineralokortikoedaksie?
(2)
Which induction agent can cause adrenal suppression and where does it act?
Watter induksiemiddel kan adrenale onderdrukking veroorsaak en waar vind dit
plaas?
(2)
Which enzyme is most commonly deficient in congenital adrenal hypoplasia?

Watter ensiem is mees algemeen tekort in kongenitale adrenale hipoplasie?
(1)
(1)
(2)
[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

27 August 2012
Physiology
Paper 2
(2 hours)
a)
a)
Draw the cardiac action potential. Fully annotate your drawing. Indicate which
direction the different electrolytes flow in each cycle. Indicate the different refractory
periods on your drawing. What is the difference between the refractory periods. (10)
Teken die kardiale aksiepotensiaal. Benoem jou skets volledig. Dui aan in watter
rigting die verskillende elektroliete beweeg tydens elke siklus. Dui die verskillende
refraktre periodes aan op u skets. Wat is die verskil tussen die refraktre periods.
(10)
[10]
-3Question 7/ Vraag 7
a)
a)
What is facilitated diffusion?

Wat is gefasiliteerde diffusie?
(2)
(2)
b)
b)
List one substance that crosses cell membranes by facilitated diffusion.

Lys een substans wat die selmembraan kruis met gefasiliteerede diffusie.
(1)
(1)
c)
c)
What is the difference between primary and secondary active transport?

Wat is die verskil tussen primre en sekondre aktiewe transport?
(2)
(2)
d)
Describe the process of primary active transport of hydrogen ions during the
formation of hydrochloric acid in the stomach.
(5)
Beskryf die proses van primre aktiewe transport van waterstofione gedurende die
vorming van soutsuur in die maag.
(5)
d)
[10]
List the autonomic receptors found in the following tissues and describe the effect of
sympathetic stimulation on each of them
Lys die outonome reseptore gevind in die volgende weefsel en beskryf die effekte van
simpatiese stimulasie op elk
a)
a)
Heart.
Hart.
(3)
(3)
b)
b)
Arteries.
Arteries.
(2)
(2)
c)
c)
Lung.
Long.
(1)
(1)
d)
d)
Liver.
Lewer.
(3)
(3)
e)
e)
Submanibular and parotid glands.

Submandibulre and parotiskliere.
(1)
(1)
[10]
PTO/Page 5 Question 9
-5Question 9 Vraag 9
a)
a)
Draw a cross section of the adult nicotinic acethylcholine receptor. Indicate

active domains on your diagram.
Teken n dwarsdeursnit van die volwasse nikotiene asetielcholienreseptor. Dui
aktiewe domeine aan op u diagram.
the
(6)
die
(6)
b)
b)
How does the fetal nicotinic acethylcholine receptor differ from the adult receptor?(1)
Hoe verskil die fetale asetielcholienreseptor van die volwasse reseptor?
(1)
c)
c)
What are prejunctional acetylcholine receptors and state their function?
(3)
Wat is prejunksionale asetielcholienreseptore en gee hul funksies?
(3)
[10]
-6Question 10/Vraag 10
List the anaesthetically important effects of hypercalcaemia on the following organ systems
Lys die faktore wat die miokardiale suurstofvoorsiening-aanvraagbalans benvloed.
a)
a)
Cardiovascular.
Kardiovaskulr.
(2)
(2)
b)
b)
Renal.
Renaal.
(3)
(3)
c)
c)
Gastrointestinal.
Gastrontestinaal.
(2)
(2)
d)
d)
Musculoskeletal.
Muskuloskeletaal.
(2)
(2)
e)
e)
Central nervous system.

Sentraalsenustelsel.
(1)
(1)
[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

27 August 2012
Physiology
Paper 2
(2 hours)
-2Question 11/ Vraag11

In blood plasma.
In bloedplasma.
a)
a)
Is the cation in highest concentration.

Is die katioon in hoogste konsentrasie.
(1)
(1)
b)
b)
Is the anion in highest concentration.

Is die anioon in hoogste konsentrasie.
(1)
(1)
c)
c)
The total plasma osmotic pressure is usually.

Die totale plasma-osmotiese druk is gewoonlik.
(1)
(1)
Answer True or False to questions d to j

Antwoord Waar of Vals op vrae d tot j
d)
d)
The colloid osmotic pressure of the plasma falls as blood passes through skeletal
capillaries.
(1)
Die kolloedosmotiese druk van plasma daal wanneer bloed deur skeletale kapillres
beweeg.
(1)
e)
e)
The molecular weight of albumin is greater than globulin.

Die molekulre massa van albumien is groter dan di van globulien.
f)
f)
The albumin is responsible for the majority of the colloid osmotic pressure.
(1)
Albumien is verantwoordelik vir die grootste deel van die kolloedosmotiese druk. (1)
g)
g)
The packed cell volume increases as blood passes through systemic capillaries. (1)
Die gepakte selvolume verhoog as bloed deur die sistemies kapillres vloei.
(1)
h)
As blood descends in the vasa recta to the medullary region of the kidney, the colloid
osmotic pressure of the plasma rises.
(1)
Die kolloedosmotiese druk van die plasma styg wanneer bloed afdaal deur die vasa
recta na die medullre deel van die nier.
(1)
h)
i)
i)
j)
j)
(1)
(1)
Non-polar molecules diffuse across the endothelial cell membranes more easily than
polar molecules.
(1)
Nie-polre molekules diffundeer makliker oor die endoteliale membraan dan polre
molekules.
(1)
Small polar molecules pass through the channels between endothelial cells.
Klein polre molekules beweeg deur die kanale tussen endoteliale selle.
(1)
(1)
[10]
Concerning saliva
Betreffende speeksel
a)
a)
Salivary amylase is secreted by the

Speekselamilase word gesekreteer deur die
(1)
(1)
b)
b)
The mucus content is increased by .. nervous stimulation.

Die mukusinhoud word verhoog deur
senustimulsie.
(1)
(1)
c.
c)
Saliva has a pH of ..
Speeksel pH is.
(1)
(1)
d.
d)
Salivary amylase acts mainly in which organ

In watter orgaan werk speekselamilase hoofsaaklik.
(1)
(1)
Answer True or False to questions e to j

Antwoord Waar of Vals op vrae e tot j
e)
e)
The concentration of sodium ions is more than in plasma.

Die konsentrasie natriumione is hor dan in plasma.
(1)
(1)
f)
f)
Saliva has the same osmolarity as plasma.

Speeksel het dieselfde osmolaliteit as plasma.
(1)
(1)
g)
Parasympathetic nervous stimulation of the parotid gland, causes vasoconstriction

within the gland.
(1)
Parasimpatiese senustimulasie van die parotisklier veroorsaak vasokonstriksie in die
klier.
(1)
g)
h)
h)
Salivary amylase is a protein.

Speekselamilase is n proteen.
(1)
(1)
i)
i)
Salivary amylase is necessary for carbohydrate digestion.

Speekselamilase is nodig vir koolhidraatvertering.
(1)
(1)
j)
j)
The average salivary flow rate is 100ml per 24 hours.

Die gemiddelde speekselvloeitempo is 100ml per 24-uur.
(1)
(1)
[10]
-5Question 13 / Vraag13
Concerning metabolism
Betreffende metabolisme
a)
a)
A man who has been eating nothing for 6 hours typically has a respiratory quotient
approaching .
(1)
n Man wat niks geet het vir 6-ure nie, het tipies n respiratoriese kofisint van
(1)
b)
b)
In a healthy person most of the glycogen is stored in the ..

In n gesonde persoon word die meeste glikogeen gestoor in die
c)
c)
How many kcal are yielded by complete oxidative metabolism of

Hoeveel kcal word verkry met die volledige oksidatiewe metabolisme van
(1)
(1)
i)
i)
1g of glucose.
1g glucose.
(1)
(1)
ii)
ii)
1g of fat.
1g vet.
(1)
(1)
iii)
iii)
1g of protein.
1g proteen.
(1)
(1)
d)
d)
List 4 hormones that promote glycogenolysis.

Lys 4 hormone wat glikogenolise bevorder.
(4)
(4)
e)
e)
List the hormone that promotes glycogen synthesis.

Lys die hormone wat glikogeensintese bevorder.
(1)
(1)
[10]
a)
a)
State the formula whereby cerebral perfusion pressure is calculated.

Gee die formule om serebrale perfusiedruk te bereken.
(3)
(3)
b)
b)
What is the normal upper limit of supratentorial intracranial pressure?

Wat is die normale bogrens van supratentoriale intrakraniale druk?
(1)
(1)
c)
c)
Using a graph, illustrate what is meant by cerebral autoregulation.

(3)
Gebruik n grafiek om te illustreer wat bedoel word met serebrale outoregulasie. (3)
d)
d)
What is the main site of cerebrospinal fluid absorption?

Wat is die hoofsetel van serebrospinaalvogabsorpsie?
(1)
(1)
e)
e)
What is the total volume of cerebrospinal fluid in normal adults?

Wat is die totale volume serebrospinaalvog in volwassenes?
(1)
(1)
f)
f)
How does PaCO2 influence cerebral blood flow?

Hoe benvloed PaCO2 serebrale bloedvloei?
(1)
(1)
[10]
-7Question 15/ Vraag15

With reference to the Wiggers diagram, what event occurs at the following points?
Met betrekking tot die Wiggers diagram, watter gebeurtenis vind plaas by die volgende
punte?
U________________________________
o'________________________________1
c ________________________________1
c ________________________________1
o ________________________________1
Shaded area in LV pressure curve

Skadu-area in LV-drukkurwe
________
Point no 2 / Punt nr 2 ________________________

Phase 1 / Fase 1 __________________________
1
1
Phase 2 / Fase 2 _________________________

Phase 4 / Fase 4 _________________________
1
1
[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

27 August 2012
Physiology
Paper 2
(2 hours)
Fill in the average normal electrolyte concentrations (in mmol/l)
Gee die normale, gemiddelde elektrolietkonsentrasies (in mmol/l)
In plasma
In cytosol (within a cell)
In plasma
In sitoplasma (in sel)
Na+
K+
Ca2+
ClPO4-
[10]

a)
a)
What is Pain?
Wat is pyn?
b)
b)
Define the following and give an example of each

Definieer die volgende en gee n voorbeeld van elk
(2)
(2)
i)
i)
Nociceptive pain.
Nosiseptiewe pyn.
(2)
(2)
ii)
ii)
Neuropathic pain.
Neuropatiese pyn.
(2)
(2)
iii)
iii)
Hyperalgesia
Hiperalgesie.
(2)
(2)
iv)
iv)
Allodynia.
Allodinia.
(2)
(2)
[10]
a)
a)
What is innate immunity?

Wat is aangebore immuniteit?
(2)
(2)
b)
b)
What is aquired immunity?

Wat is verworwe immuniteit?
(3)
(3)
c)
c)
What are cytokines?

Wat is sitokiene?
(1)
(1)
d)
d)
What is the complement system?

Wat is die komplimentsisteem?
(2)
(2)
e)
e)
What is meant by CD4 count?

Wat word bedoel met CD4-telling?
(2)
(2)
[10]
A 24-year-old woman was admitted to a high care unit following a caesarian section. She
was diagnosed with a 'fatty liver of pregnancy' preoperatively. A morphine infusion at 4
mg/hr was started for analgesia. The next day she was noted to be drowsy. She had an
anion gap of 22 and her arterial blood gas revealed the following
n 24-Jarige vrou is opgeneem in hosorg na n keisersnit. Sy is preoperatief gediagnoseer
met lewervervetting van swangerskap. n Morfieninfuus teen 4mg/uur is begin vir
analgesie. Die volgende dag word opgemerk dat sy slaperig is. Sy het n anioongaping van
22 en haar arterile bloedgas wys die volgende
pH 7.12
pCO2 60 mmHg (8 kPa)
pO2 110 mmHg (14.7 kPa)
HCO3- 21 mmol/l
Comment on the
Lewer kommentaar op die
a)
pH
(1)
b)
pCO2
(2)
c)
c)
Acid base disturbace.
(5)
Suur-basisversteuring.
(5)
d)
PO2.
(2)
[10]
A 20-year-old healthy man sustains an isolated femur fracture during a biking accident. He
acutely loses 1.5 litres of blood. What is the bodys physiological response to restore
circulating blood volume within 24hours?
(10)
n 20-Jarige, gesonde man, doen n gesoleerde femurfraktuur op in n fietsongeluk. Hy
verloor 1.5 liter bloed. Wat is die liggaam se fisiologiese respons in die volgende 24-uur om
die sirkulerende volume te herstel.
(10)
[10]
FCA(SA) Part I
Reg No/Nr 1955/000003/08
28 August 2012
Pharmacology
Paper 3
(3 hours)
Question 1/Vraag 1
a)
Describe the mechanisms of
i)
Normal neuromuscular transmission
ii)
Depolarising neuromuscular blockade
iii)
Non-depolarisingneuromuscular blockade
b)
With reference to scoline apnoea describe its
i)
Pharmacogenetics
ii)
Time course
iii)
Suggested agonist-receptor interactions
iv)
Management
a)
b)
(10)
(6)
(8)
(7)
(6)
(7)
(6)
[50]
Bespreek die meganismes van

i)
Normale neuromuskulre oordrag
ii)
n Depolariserende neuromuskulre blokkade
iii)
n Nie-depolariserende neuromuskulre blokkade
Met verwysing na scoline apnee beskryf die:
i)
Farmakogenetika
ii)
Tydsverloop
iii)
Voorgestelde agonis-reseptor interaksies
iv)
Hantering
Question 2/Vraag 2
a)
Briefly discuss the pharmacokinetics of ketamine.
b)
Write short notes on the mechanism of actions of ketamine.
c)
Describe the potential benefits of S-(+) isomer of ketamine.
d)
Discuss the effects of ketamine on the following organs
i)
Central nervous system
ii)
Respiratory system
iii)
Cardiovascular system
e)
Ketamine enjoys recreational popularity. Discuss.
(10)
(6)
(8)
(7)
(6)
(7)
(6)
[50]
(10)
(10)
(10)
(8)
(4)
(4)
(4)
[50]
-2a)
b)
c)
Beskryf kortliks die farmakokinetika van ketamien.

Skryf kort notas oor die werkingsmeganisme van ketamien.
Bespreek die potensile voordele van die S-(+) isomeer van ketamien.
d)
Bespreek die effekte van ketamien op die volgende organe

i)
Sentraalsenuweestelsel
ii)
Respiratoriese stelsel
iii)
Kardiovaskulre stelsel
Ketamien geniet gewildheid as rekreasiemiddel. Bespreek.
e)
(10)
(10)
(10)
(8)
(4)
(4)
(4)
[50]
Question 3/Vraag 3
a)
b)
c)
d)
e)
f)
g)
a)
b)
c)
d)
e)
f)
g)
Briefly discuss the mechanism of action of the opioids.

(5)
Briefly list side effects of the opioids as a group.
(8)
List the opioid receptors, as well as the clinical effect stimulation of each of
these receptors may have.
(15)
Briefly discuss each of morphine, fentanyl, and remifentanil under the
following headings
i)
Potency
ii)
Metabolism
iii)
Analgesic dose and route of administration
(9)
Briefly discuss the pharmacological difference between morphine and fentanyl
during intrathecal use. What is the significance of this for the
anaesthesiologist?
(6)
How does nalbuphine differ from other opioids? What is the significance of
this difference?
(3)
How does tramadol differ from other opioids? What is the significance of this
difference?
(4)
[50]
Verduidelik kortliks die meganisme van werking van die opioede.
(5)
Maak n lys van die newe-effekte van die opioede as groep.
(8)
Lys die opioedreseptore, asook die kliniese effek wat stimulasie van elk tot
gevolg sal h.
(15)
Bespreek kortliks die middels morfien, fentaniel, en remifentanil onder die
volgende hoofde
i)
Potensie
ii)
Metabolisme
iii)
Analgetiese dosis en roete van toediening
(9)
Bespreek kortliks die farmakologiese verskil tussen morfien en fentanyl
gedurende intratekale gebruik. Wat is die belang hiervan vir die narkotiseur?
(6)
Hoe verskil nalbufien van ander opioede? Wat is die belang van hierdie
verskil?
(3)
Hoe verskil tramadol van ander opioede? Wat is die belang van hierdie
verskil?
(4)
[50]
a)
b)
c)
d)
e)
f)
g)
Define bioavailability.
(2)
What determines bioavailability of an orally administered drug?
(2)
How is bioavailability calculated for an orally administered drug?
(3)
Discuss the bioavailability of a rectally administered drug (iesuppository). (4)
Define the term volume of distribution.
(2)
List the factors that affect drug distribution within the body.
(5)
Discuss factors affecting drug distribution in the following patient groups. Give
relevant examples, and discuss the relevant clinical implications
i)
an elderly patient
(18)
ii)
a neonate
(8)
iii)
a patient with chronic renal failure
(6)
[50]
a)
b)
c)
Definieer biobeskikbaarheid.
(2)
Wat bepaal die biobeskikbaarheid van n oraaltoegediende middel?
(2)
Hoe word die biobeskikbaarheid van n oraaltoegediende middel bereken?
(3)
Bespreek die biobeskikbaarheid van n rektaaltoegediende middel (setpil). (4)
Definieer die term volume van distribusie.
(2)
Lys die faktore wat middeldistribusie in die liggaam bepaal.
(5)
Bespreek faktore wat middeldistribusie benvloed in die volgende
pasintgroepe. Gee relevante voorbeelde en bespreek die toepaslike kliniese
implikasies
i)
n bejaarde pasint
(18)
ii)
n neonaat
(8)
iii)
n pasint met chroniese nierversaking
(6)
[50]
d)
e)
f)
g)
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 August 2012
Pharmacology
Paper 4
(2 hours)
Question 1 5 / Vraag 1-5
Discuss the possible advantages and disadvantages of using pethidine in neuraxial blockade, in
terms of
Bespreek die moontlike voordele en nadele van die gebruik van petidien in neuraksiale blokkade in
terme van
a)
Its solubility compared to other opioids.

Die oplosbaarheid daarvan teenoor di van ander opioede.
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
______________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Its mechanisms of action.

Die werkingsmeganisme daarvan.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Its metabolites.
Die metaboliete.
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
PTO/Page 3 Question 2...
Write short notes on the perioperative use of anticholinergic drugs in
Skryf kort notas oor die perioperatiewe gebruik van anticholinerge middels met
a)
Premedication.
Premedikasie.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Prophylaxis.
Profilakse.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Emergency management.
Noodhantering.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________ [10]
Briefly discuss the factors that influence local anaesthetic
Bespreek kortliks die faktore wat bepalend is by lokaalverdowers se
a)
Onset times.
Aanvangstyd van werking.
(6)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Offset times.
Werkingsduur.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
__________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________ [10]
Describe briefly the structure-function relationships of the volatile anaesthetic molecules as a group
with regard to their
Bespreek kortliks die struktuur-funksieverwantskap van narkosedampmolekules as n groep met
betrekking tot hul
a)
Pharmacological efficacy.
Farmakologiese effektiwiteit.
(6)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Safety.
Veiligheid.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
Write short notes on the position of nitrous oxide in modern anaesthetic practice, bearing in mind its
Skryf kort notas oor die posisie van laggas in moderne narkosepraktyk met betrekking tot die
a)
Physical properties.
Fisiese eienskappe.
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Chemical properties.
Chemiese eieskappe.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Pharmacological properties.
Farmakologiese eienskappe.
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 August 2012
Pharmacology
Paper 4
(2 hours)
Discuss the pharmacological actions of magnesium sulphate in terms of
Bespreek die farmakologiese werking van magnesiumsulfaat in terme van
a)
Its relationship to other cations.

Die verhouding daarvan tot ander katione.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Its effects on various organ-systems in the body.

Die effek daarvan op veskeie orgaansisteme in die liggaam.
(8)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
-3Question 7 /Vraag 7
With respect to methylene blue describe its
Met betrekking tot metileenblou beskryf die
a)
Mechanism of action.
Werkingsmeganisme.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Physicochemical properties.
Fisies-chemiese eieskappe.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Surgical uses.
Chirurgiese aspekte.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
Toxicity.
Toksisiteit.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
Absolute contraindications.
Absolute kontra-indikasies.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
List the antidotes to the following drugs
Lys die teenmiddels vir die volgende middels
a)
Methanol.
Metanol.
_______________________________________________________________________________
_______________________________________________________________________________
b)
Cyanide.
Sianied.
_______________________________________________________________________________
_______________________________________________________________________________
c)
Beta blockers and Quinidine.

Betablokkers and kinidien.
_______________________________________________________________________________
_______________________________________________________________________________
d)
Sulfonylurea-induced hypoglycaemia.
Sulfonielurea-genduseerde hipoglukemie.
_______________________________________________________________________________
_______________________________________________________________________________
e)
Anticholinergic agitated delirium.

Anticholinerge geaggiteerde delirium.
_______________________________________________________________________________
_______________________________________________________________________________
f)
Acetaminophen.
Parasetamol.
_______________________________________________________________________________
_______________________________________________________________________________
g)
Carbon monoxide.
Koolstofmonoksied.
_______________________________________________________________________________
_______________________________________________________________________________
h)
Iron.
Yster.
_______________________________________________________________________________
_______________________________________________________________________________
i)
Isoniazid.
Isoniasied.
_______________________________________________________________________________
_______________________________________________________________________________
j)
Methaemoglobinaemia.
Methemoglobienemie.
_______________________________________________________________________________
_______________________________________________________________________________
[10]
Regarding digoxin
Betrefende digoksien
a)
Write short notes on the mechanism of action.

Skryf kort notas oor die werkingsmeganisme.
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Briefly describe the management of toxicity.

Beskryf kortliks die hantering van toksisiteit.
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
Discuss diazepam under the following headings
Bespreek diasepam onder die volgende hoofde
a)
Physicochemical properties.
Fisies-chemiese eienskappe.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Absorption.
Absorpsie.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Metabolism.
Metabolisme.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
Drug interactions.
Middelinteraksies.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
Context sensitive half-time.

Konsteks-sensitiewe halfleeftyd.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 August 2012
Pharmacology
Paper 4
(2 hours)
a)
Explain the mechanism of action of the following anticoagulants

Verduidelik die maganisme van werking van die volgende antistolmiddels
i)
Heparin.
Heparien.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
ii)
Warfarin.
Warfarien.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
iii) Dabigatran.
Dabigatran.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
iv) Rivaroxiban.
Rivaroxiban.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
b)
What is protamine sulphate?

Wat is protamiensulfaat?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
What are the problems associated in its use?

Watter probleme is geassosieerd met die gebruik daarvan?
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
___________________________________________________________________________ [10]
Briefly discuss oxytocin under the following headings
Bespreek oksitosien kortliks onder die volgende hoofde
a)
Chemical constitution.
Chemiese samestelling.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
b)
Clinical use.
Kliniese gebruik.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Side effects.
Newe-effekte.
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
Current dosing recommendation to augment uterine contraction post caesarean section.

Huidige doseringsaanbeveling om uteriene kontraksie te versterk na keisersnit.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
____________________________________________________________________________[10]
List 5 groups of drugs effective in prevention and/or treatment of PONV, and briefly explain the
mechanism of action of each
Lys 5 groepe van middels wat effektief is in die vookoming en behandeling van PONB en
verduikelik kortliks die meganisme van elk
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
-5Question14/Vraag 14
a)
What is the mechanism of action of amiodarone?

Wat is die meganisme van werking van amiodaroon?
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
List the side effects that may manifest in a patient taking amiodarone.
Lys die newe-effekte wat manifesteer in n pasint wat amiodaroon gebruik.
(7)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____________________________________________________________________[10]
-6-
Question 15/Vraag 15
Briefly explain how the interaction of the following drugs with specific receptors cause their clinical
effect
Verduidelik kortliks hoe die volgende middels se interaksie met spesifieke reseptore hul kliniese
effek bepaal
a)
Propofol.
Propofol.
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Ketamine.
Ketamien.
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Midazolam.
Midasolam.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 August 2012
Pharmacology
Paper 4
(2 hours)
a)
Give the mode of action of cyclophosphamide.

Gee die werkingswyse van siklofosfamied.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
List three major side effects of cyclophosphamide treatment that are relevant to anaesthesia.
Mention the anaesthetic implications of each.

Lys drie major newe-effekte van siklofosfamiedbehandeling wat relevant is tot narkose. Noem
die
narkose-implikasies van elk.
(3X3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
-3-
Question 17/Vraag 17
What are the effects of 1 MAC isoflurane on
Wat is die effekte van 1 MAK isofluraan op
a)
Blood pressure.
Bloeddruk.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Systemic vascular resistance.

Sistemies-vaskulre weerstand.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Cardiac output.
Kardiale uitwerp.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
Cerebral metabolic rate of oxygen.

Serebraalmetaboliese tempo vir suurstof.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
Cerebral blood flow.

Serebrale bloedvloei.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
f)
Coronary blood flow and the steal phenomenon.

Koronre bloedvloei en die steelverskynsel.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
g)
Hepatic blood flow.

Hepatiese bloedvloei.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
Regarding nonsteroidal anti-inflammatory drugs: Rofecoxib (Vioxx) was withdrawn from the market
in 2004 following reports of an increased risk of adverse cardiovascular events with chronic use.
Betreffende nie-steroed anti-inflammatoriese middels: Rofecoxib (Vioxx) is onttrek van die mark in
2004 na verslae van n verhoogde risiko vir kardiovaskulre insidente met chroniese gebruik
a)
What is the mechanism behind this complication?

Wat is meganisme van hierdie komplikasie?
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
What is the mechanism of renal damage caused by NSAIDs?

Wat is meganisme van nierskade veroorsaak deu NSAIMs?
(3)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
What patient factors may predispose patients to NSAID-related renal damage?

Watter pasint faktore mag predisponeer tot NSAIM-geassosieerde nierskade?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
Regarding hypertonic saline
Betreffende hipertoniese saline
a)
List indications for its use.

Lys die indikasies vir gebruik.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
What is its mechanism of action?

Wat is die werkingsmeganisme?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
How does this mechanism of action differ from that of commonly used colloids (e.g. a
tetrastarch) to provide volume expansion?

Hoe verskil hierdie meganisme van werking van die algemeen gebruikte kolloiede (bv. n
tetrastysel)
vir volumeverruiming?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
d)
How many mmol/l of sodium ions are present in 3% hypertonic saline? Show your calculation.
Hoeveel mmol/l natriumione is in 3% hipertoniese saline? Wys u berekeninge.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
What is the osmolality of hypertonic saline?

Wat is die osmolaliteit van hipertoniese saline?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
f)
What is the initial dose of hypertonic saline used for small volume resuscitation?
Wat is die aanvangsdosering van hipertoniese saline vir kleinvolume-resussitasie?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
g)
Why might hypertonic saline offer advantages over an isotonic crystalloid (e.g. Ringers
lactate) in the resuscitation setting?
Hoekom mag hipertoniese saline voordele inhou bo n isotoniese kristalloied (bv.

Ringerslaktaat) met
resussitasie?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
a)
Give an example of the following

Gee n voorbeeld van die volgende
i)
A drug with combined and antagonism.

n Middel met beide - en antagonisme.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
ii)
A nonselective blocker.
n Non-selektiewe -blokker.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
__________________
iii) A cardioselective blocker.
n Kardioselektiewe -blokker.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
What does it mean if a blocker is cardioselective?

Wat beteken dit wanneer n -blokker kardioselektief is?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
What are the clinical effects of blockade?

Wat is die kliniese effekte van -blokkade?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
What is the mechanism of action of a blocker at the myocyte?

Wat is die meganisme van werking van n -blokker op die miosiete?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
List 2 side effects of blockers.

Lys 2 newe-effekte van -blokkers.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
FCA(SA) Part I
Reg No/Nr 1955/000003/08
29 August 2012
Physics
Paper 5
(3 hours)
Question 1/Vraag 1
a)
Classify LASERs according to the International Electrotechnical Commission
(IEC) risk classification schema.
(5)
b)
Tabulate the different types of LASER used in clinical practice. Make mention
of the application and the specific characteristics of the individual LASERs.
(10)
c)
Write short notes on the production of LASER. Use diagrams to explain your
answer if necessary.
(10)
d)
Explain flammability limits and why adding nitrous oxide to a mixture
increases flammability.
(5)
e)
Write short notes on the prevention of fires in theatre.
(10)
f)
Write short notes on the management of an airway fire.
(5)
g)
Classify fire extinguishers and give examples of fires for which they can be
used.
(5)
[50]
a)
b)
c)
d)
e)
f)
g)
Klassifiseer LASERs volgens die Internasionale Elektrotegniese Kommissie

(IEC) se risikoklassifikasieskema.
(5)
Tabuleer die verskillende tipes LASER wat klinies gebruik word. Noem die
toepassings and spesifieke eienskappe van die individuele LASERs.
(10)
Skryf kort notas oor die vervaardiging van LASER. Gebruik diagramme on u
antwoord te ondersteun, indien nodig.
(10)
Verduidelik vlambaarheidsbeperkinge en waarom die byvoeging van laggas
tot n mengsel die vlambaarheid verhoog.
(5)
Skryf kort notas oor die voorkoming van brande in teater.
(10)
Skryf kort notas oor die hantering van n lugwegbrand.
(5)
Klassifiseer brandblussers en gee voorbeelde van brande waar dit gebruik
kan word.
(5)
[50]
a)
b)
c)
d)
e)
f)
g)
Briefly explain how an arterial blood pressure waveform is reproduced.

(5)
By means of an annotated diagram explain how the following information can
be gained from an arterial pressure waveform
(10)
i)
Myocardial contractility
ii)
Stroke volume
iii)
Systemic vascular resistance
iv)
Mean Arterial Pressure
v)
Status of the circulating volume
Provide brief explanations of the following concepts
(6)
i)
Fundamental frequency
ii)
Natural frequency
iii)
Damping coefficient
List the factors affecting the natural frequency of an arterial line monitoring
system.
(5)
Provide a formula to calculate natural frequency.
(2)
What is an acceptable natural frequency of an arterial line system?
(2)
The following graph is a fast flush high test of an arterial line monitoring
system:
Using the graph, calculate the following

i)
Natural frequency
(5)
ii)
Amplitude ratio
(5)
h)
Describe, with the aid of annotated diagrammes, the differences that would be
observed in arterial pressure traces recorded simultaneously from radial and
dorsalis pedis arterial catheters.
(10)
[50]
a)
Verduidelik kortliks hoe n arterile drukgolf gevorm word.
(5)
PTO/Page 3 Question 2b)
-3b)
Verduidelik deur middel van n benoemde diagram hoe die volgende inligting
van n arterile drukgolf verkry kan word
(10)
i)
Miokardiale kontraktiliteit
ii)
Slagvolume
iii)
Sistemiese vaskulre weerstand
iv)
Gemiddelde arterile druk
v)
Status van die sirkulerende volume
c)
Gee kort verduidelikings vir die volgende konsepte
(6)
i)
Fundamentele frekwensie
ii)
Natuurlike frekwensie
iii)
Dempingskofisint
d)
Lys die faktore wat die natuurlike frekwensie van n arterile lyn
moniteringsisteem benvloed.
(5)
e)
Gee n formule om die naturlike frekwensie te bereken.
(2)
f)
Wat is die aanvaarbare natuurlike frekwensie van n arterile lynsisteem. (2)
g)
Die volgende grafiek is n vinnige spoel-piektoets van n arterile lyn
moniteringsisteem
Gebruik die grafiek en bereken die volgende:
i)
Natuurlike frekwensie
(5)
ii)
Amplitudeverhouding
(5)
h)
Beskryf met behulp van benoemde diagramme die verskille wat waargeneem
sal
word in die arterile drukkurwes wat gelyktydig geneem word van die radialeen
dorsalis pedis arterile kateters.
(10)
[50]
Question 3/Vraag 3
a)
List ten (10) causes of operating theatre pollution or contamination with
gases.
(10)
b)
What is the recommended exposure limit or trace level for nitrous oxide and
halogenated anaesthetic agents?
(2)
c)
Classify scavenging systems.
(3)
d)
Draw and label the component systems of standard scavenging techniques
and briefly describe the function of each system and necessary
specifications.
(20)
e)
What are the potential occupational hazards of operating theatre pollution? (5)
f)
Regarding operating theatre ventilation
i)
What is efficient ventilation?
(1)
ii)
Briefly discuss the effects of other environmental factors on infection
control.
(9)
[50]
a)
b)
c)
d)
e)
f)
Lys tien (10) oorsake van teaterbesoedeling of kontaminasie met gasse. (10)
Wat is die voorgestelde blootstellingslimiet of spoorvlakke vir laggas en
gehalogeneerde narkosemiddels.
(2)
Klassifiseer opruimingsisteme.
(3)
Teken en benoem die komponentsisteme van standaard opruimingtegnieke
en beskryf kortliks die funksie van elke sisteem asook die nodige
spesifikasies.
(20)
Wat is die potensile beroepsgevare van teaterbesoedling?
(5)
Betreffende teaterventilasie
i)
Wat is effektiewe ventilasie?
(1)
ii)
Beskryf kortliks die effekte van ander omgewingsfaktore op infeksiebeheer.
(9)
[50]
PTO/Page 4Question 4
The lack of temperature management in theatre leads to morbidity and mortality.
Discuss temperature management in theatre under the following headings
a)
Different methods of measuring body temperature in theatre (electrical vs.
non- electrical)
(5)
b)
Heat loss in theatre, physical principles.
(15)
c)
Different ways of conserving body temperature in theatre(physical
principles).
(20)
d)
Difference between core and shell temperature.
(4)
e)
Thermal burns in theatre and the causes.
(6)
[50]
Swak temperatuurbeheer in teater lei tot morbiditeit en mortaliteit.
Bespreek temperatuurbeheer in die teater onder die volgende hoofde
a)
Verskillende metodes om liggaamstemperatuur in teater te meet (elektries
teenoor non-elektries).
(5)
b)
Hitteverlies in teater, fisiese beginsels.
(15)
c)
Verskillende metodes om liggaamstemperatuur te behou in teater (fisiese
beginsels).
(20)
d)
Verskil tussen kern- en oppervlakstemperatuur
(4)
e)
Termiese brandwonde in teater en die oorsake daarvan.
(6)
[50]
FCA(SA) Part I

Reg No/Nr 1955/000003/08

29 August 2012
Physics
Paper 6
(2 hours)
Question 1 5 / Vraag 1-5
With respect to the Systme International d'units (SI) units, state the derived SI unit and the SI
base units for
Met betrekking tot die Systme International d'units (SI) eenhede, gee die afgeleide SI-eenhede
asook die basiseenhede vir
a)
Work.
Arbeid.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Electric Charge.
Elektriese lading.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Magnetic field strength.

Magnetiese veldsterkte.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
d)
Electric potential difference.

Elektriese potensiaalverskil.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
Absorbed dose of ionising radiation.

Geabsorbeerde dosis ioniserende bestraling.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
Regarding Entonox (50:50 nitrous oxide/oxygen)
Betreffende Entenox (50:50 laggas/suurstof)
a)
What is the poynting effect?

Wat is die poynting effek?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Explain why cylinders containing entonox should be stored at room temperature.

Verduidelik waarom entenoxsilinders gestoor moet word by kamertemperatuur.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
Draw a diagram showing the pressure/volume relationship of nitrous oxide.

Indicate the effect of temperature on the graph.
Teken n diagram wat die druk/volume-verhouding van laggas aandui. Dui die effek van
temperatuur aan op die grafiek.
(2)
PTO/Page 4 Question 2d)...
-4d)
You are asked to transport a ventilated patient. Given an oxygen flow rate of 8L/min from a
cylinder
with an empty volume of 5L with a pressure gauge reading of 5000 kPa, calculate
how many minutes
of gas supply are present in the cylinder. Show all calculations.
U moet n geventileerde pasint vervoer. Bereken hoeveel minute se gasvloei oor is vanuit
die silinder, gegewe die suurstofvloeitempo van 8L/min, n silinder met n le volume van 5L en
n drukmeter wat 5000 kPa lees. Wys u berekening.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
e)
What is gauge pressure?

Wat is gauge pressure?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]
a)
Write short notes on the generation of ultrasound images.

Skryf kort notas oor die opwekking van ultraklankbeelde.
(5)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
List potential complications which may arise from the use of a trans-oesophageal echo device.
Lys die potensile komplikasies wat mag voorkom met die gebruik van n transesofageale
eggo-apparaat.
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
For each listed Doppler mode give 2 examples of their clinical application.
Gee 2 voorbeelde vir elke Doppler-modus en die kliniese toepassing.
i)
Pulse Wave Doppler.
Pulse Wave Doppler.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
ii)
Continuous Wave Doppler.

Continuous Wave Doppler.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
iii)
Color Flow Doppler.
Color Flow Doppler.
(1)
_______________________________________________________________________________
_______________________________________________________________________________
[10]
-6-
Question 4/Vraag 4
A Coagulation monitoring device produces the output shown below
n Stollingsmoniteringsapparaat gee die resultaat hieronder
a)
What is indicated by A and what information can be obtained from its value?
Wat word aangedui deur A en watter inligting kan verkry word uit hierdie waarde?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
What is indicated by B and what information can be obtained from its value?
Wat word aangedui deur B en watter inligting kan verkry word uit hierdie waarde?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
using
Briefly describe the physical principles and function of the device which produces this graph,
diagrams if required.
Beskryf kortliks, met behulp van diagramme as nodig, die fisiese eienskappe en funksionering
van die apparaat verantwoordelik vir hierdie grafiek.
(4)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
PTO/Page 7 Question 4d)...
-7-
d)
Draw the curves produced in the following states

Teken die grafieke verkry gedurende die volgende toestande
i)
Fibrinolysis.
(1)
Fibrinolise.
ii)
Dilutional coagulopathy.
Verdunningskoagulopatie.
(1)
[10]
Oxygen concentrators are typically used in situations where Vacuum Insulated Evaporator (VIE) or
bottled oxygen is prohibitively expensive or impractical
Suurstofkonsentreerders word gebruik in situasies waar die Vacuum Insulated Evaporator (VIE) of
gebottelde suurstof te duur of onprakties is
a)
What oxygen concentration is typically produced from an oxygen concentrator?

Watter suurstofkonsentrasie word tipies verskaf deur n suurstofkonsentreerder?
(1)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
b)
Describe in detail the function of the oxygen concentrator.

Beskryf in besonderhede die funksionering van die suurstofkonsentreerder.
(7)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
c)
How may oxygen be generated by chemical means (give formulae)?

Hoe kan suurstof gegenereer word deur chemiese metodes (gee formules)?
(2)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
[10]

FCA (SA) Part I Past Papers

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FCA (SA) Part I Past Papers

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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Beskryf hoe miokardiale kontraksie en ontspanning plaasvind.

Beskryf die fetale sirkulasie.

PTO/Page 3 Question 3a)

U dien narkose toe op n hoogte van ongeveer 1700m, met n

PTO/Page 4 Question 4a)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

PTO/ Page 2 Question 1...

Discuss the regulation of pancreatic secretion under the headings

PTO/ Page 3 Question 2

PTO/ Page 4 Question 3

Pulmonary blood flow.

Briefly discuss hypoxic pulmonary vasoconstriction.

PTO/ Page 5 Question 4

Fill in the missing steroids 1,2,3,4.

What enzyme converts progesterone to 2, and 17OH progesterone to

Which enzyme is most commonly deficient in congenital adrenal hypoplasia?

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

PTO/ Page 2 Question 6...

PTO/ Page 3 Question 7

What is facilitated diffusion?

List one substance that crosses cell membranes by facilitated diffusion.

What is the difference between primary and secondary active transport?

PTO/ Page 4 Question 8

Submanibular and parotid glands.

Draw a cross section of the adult nicotinic acethylcholine receptor. Indicate

What are prejunctional acetylcholine receptors and state their function?

Wat is prejunksionale asetielcholienreseptore en gee hul funksies?

Central nervous system.

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

PTO/ Page 2 Question 11...

-2Question 11/ Vraag11

Is the cation in highest concentration.

Is the anion in highest concentration.

The total plasma osmotic pressure is usually.

Answer True or False to questions d to j

The molecular weight of albumin is greater than globulin.

PTO/ Page 3 Question 12

Salivary amylase is secreted by the

The mucus content is increased by .. nervous stimulation.

Salivary amylase acts mainly in which organ

Answer True or False to questions e to j

The concentration of sodium ions is more than in plasma.

Saliva has the same osmolarity as plasma.

Parasympathetic nervous stimulation of the parotid gland, causes vasoconstriction

Salivary amylase is a protein.

Salivary amylase is necessary for carbohydrate digestion.

The average salivary flow rate is 100ml per 24 hours.

PTO/ Page 5 Question 13

In a healthy person most of the glycogen is stored in the ..

How many kcal are yielded by complete oxidative metabolism of

List 4 hormones that promote glycogenolysis.

List the hormone that promotes glycogen synthesis.

PTO/ Page 6 Question 14

State the formula whereby cerebral perfusion pressure is calculated.

What is the normal upper limit of supratentorial intracranial pressure?

Using a graph, illustrate what is meant by cerebral autoregulation.

What is the main site of cerebrospinal fluid absorption?

What is the total volume of cerebrospinal fluid in normal adults?