4d 10 101 u Ma 2 13 4 15 16 7 FANZCA Pt 1 PHYSIOLOGY QUESTIONS RENAL PHYSIOLOGY Dr. Peter Kam Define Glomerular filtration rate ‘What are the determinants of GFR ? How is GFR measured ? Summarise the fanctions of; 2) Proximal convoluted tubules b) Loop of Henle ¢) Thick ascending limb of the Loop of Henle 4) Distal convoluted Tubule 8) Collecting Ducts Describe the reabsorption of Na in the kidney. ‘What are the mechanisms responsible for reabsorption ? Describe the handling of potassium by the renal tubules. 2) Proximal convoluted tubule ) Distal convoluted tubule ©) Loop of Henle Indicate the mechanisms of the processes involved i.e., active, passive and mediators involved. ‘How much potassium is filtered atthe glomerulus and how is it excreted by the kidney each day? How much fixed acid is excreted by the kidney each day ? Describe the mechanisms involved. Define Renal Clearance. Discuss the uses of renal clearance in Physiology. ‘What do you understand by “Glomerulotubular balan: ‘What are the differences ? Describe the reabsorption of Glucose in the kidney. Discuss the role of the kidney in Acid-base regulation ‘What is titrable acidity ? ‘What is the Juxta-Glomerular Apparatus ? Outline its functions, What isthe value of PAH clearance? ‘What are the effects of ADH and aldosterone om the kidney ? Discuss the role of the kidney in Body Fluid Regulation What isthe role of the kidney in'the regulation of Blood Volume ? Discuss the Renal Function Tests used clinically and what are their significance ? Write short answer essay on : 2) —_Reabsorption of water in renal tubules ») Characteristics of Renal efferent arteriole ©) Renin-Angiotensin system 4) Area exeretion ¢) Renal Transport Maxima f) Oxygen extraction rate inthe kidney18 181 19 20 2a 211 28 28.1 29 30 31 ‘Write an account on the counter-curent mechanisms of the kidney. Explain the physiological role of the Counter-Curent Multiolier and Counter-Current Exchanger Systems. Discuss the factors that control the inter-relationship between GFR, Renal blood flow and urine flow/output inthe kidney . ‘What are the characteristics ofthe renal afferent arterioles ? Write an account on the factors controlling Renal Blood Flow. How do you measure Renal Blood Flow ? What do you understand by the therm “Free HO clearance” ? ‘What is the clinical significance of measuring urinary urea, electrolytes and osmolality ? What is the role of Carbonic Anhydrase in the kidneys ? Briefly outline the hormones produced by the kidney ? Explain their effects Briefly outline the effects of hormones/autacoids on renal function. What is “Osmolar clearance”? Define creatinine clearance. Discuss the value in clinical practice and how does it compare with urea clearance as an index of renal function. What do you understand by the pressure — diuresis concept. Cutline the physiological consequences of chronic renal fatture. How does haemodialysis remove the metabolic waste products ? Outline the physics involved.10 101 u Ma n2 12 13 4 141 142 15 15.1 16 RESPIRATORY PHYSIOLOGY QUESTIONS Dr, Peter Kam Define compliance with reference to the Respiratory System. What is static, dynamic and specific compliance? List the factors that determine compliance. ‘What are the components of total respiratory compliance? (give their inter-rlationship) How would you measure Static and Dynamic in an awake and anaesthetised patient? ‘What is Surfactant ? List the functions of Surfactant. Discuss the formation and factors that influence the production of surfactant. Define FRC. ‘What are the factors that define FR.C ? Describe the techniques of measuring FRC. Compare and contrast the physiological features of respiratory system of a neonate with that of an adult ‘What is “Work of Breathing” ? . ‘How does the work of breathing alter with respiratory rate (differentiate elastic work and resistance work) ? Explain the differences in the nature of Respiration of a patient with Obstructive Airway Disease and that with Restrictive Lung Disease. Explain what you understand by the term “Ventilation — Perfusion inequality”. How dies V/Q inequality arise ? List the methods of assessing V/Q inequality in a patient. List the Gas Laws. ‘What is the Alveolar Air Equation ? Demonstrate its application. Derive the Bohr Equation . ‘Why is there a “correction factor” ? ‘What is the clinical application of this equation? Discuss the factors that influence that alveolar-arterial O; difference. Discuss the effects of breathing 100% O2 on V/Q mismatch. What is “Dead-space” ? How would you measure: a) Anatomical dead space ») —_ Physiological dead space ‘What are the factors that affect dead-space ? Define Oxygen Flux. ‘What factors alter Oxygen Flux ? Describe the pressure changes in the Alveoli and the pleural space during; 2) Normal breathing LPR CRAB7 11 172 18 19 20 2 ail 2B 24 26 26.1 27 21 28 29 30 31 31d 33 34 34.1 342 343 ®) PEEP breathing Define closing capacity. ‘What are the factors that affect closing capacity ? How do you measure closing volume ? Describe the measurement of Lung Volumes and Capabilities Draw Pressure-Volume Curve for the ung. Describe the Humidification of inspired ai, Classify the types of Hypoxia ‘What are the causes and the differences between the types ? How is Airflow measured ? Draw and discuss the Oxygen Cascade. ‘Write an account on the Physiological mechanisms producing hypoxaemia. ‘What are the cardiovascular effects of LP. a) right heart b) —_leftheart Discuss the control of breathing. Compare the control of respiratory rate in adults and neonates, ‘What is the central and peripheral chemoreceptor ? Compare and contrast the central and peripheral chemoreceptor with respect to their role in respiratory control Discuss the role of muscle spindle in the control of respiration. What is the role of the Vagus Nerve in the control of respiration ? Describe the effects of gravity on pulmonary blood flow and distribution of gas. Describe the reaction between haemoglobin and Oxygen ‘What is the structure of haemoglobin ? Describe the change in alveolar Oxygen when inspired gas is changed from air to 100% On ; ice, Pre-oxygenation. Describe the carriage of Op in blood. Describe the oxyhaemoglobin Curve. ‘What are the factors that shift it to th right or let ? Discuss the mechanisms. Superimposed the dissociation curves of myoglobin, carboxyhaemoglobin and Hb. Why are they different ? How is inspired Oxygen measured ? Describe the carriage of CO: in blood. Draw the CO; dissociation curve, What is the Bohr effect ?39 40 41 41d 2 B 4 45 45.1 46 What is the Haldane effect ? Discuss the body stores of ; a) Oxygen ») Carbon Dioxide What is 2-3 DP.G? What factors alter its concentrations in blood ? Discuss the Alveolar size distribution in a vertical lung in relation to Laplace's Law and Surfactant . ‘What is the composition of 2) Alveolar Gas, ‘What forces operate across the Alveolar-capillary membrane ? ‘What is diffusion ? Discuss the factors that influence diffusion of gases across the alveolar-capillary membrane. ‘What are the differences between the Arterial and Venous Blood ? 46.1 What is Chloride Shift ? 47 48 49 What is Fick's Law of Diffusion ? How does shock or hypotension alter blood gas tensions What isa Shunt ? 49.1Derive the Shunt equation. 49.2How is the magnitude of right to left shunt estimated ? 50 BT 32 53 37 58 59 60 6 Define “Partial Pressure” as used to describe oxygen contained in blood. Discuss the physiological adaptation to attitude. Discuss the respiratory changes with exercise How do you use a body pletysmograph ? Describe the lung function tests. ‘What tests would you use to differentiate obstructive and restrictive lung disease ? Describe the non-respiratory functions of the lung. ‘Draw the flow/volume relationship of ; ) Normal forced Expiration and Inspiration >) Seen in Intra-thoracic airway obstruction ©) _ In obstructive and restrictive lung disease é) —_Extra-thoracie obstruction List 5 differences in the alveoli at the Apex and the base of the lung. How 0, consumption and CO; production measured ? How do you measure diffusion capacity in a patient ? Explain the physiological changes in the respiratory system during general anaesthesia. How is arterial O; saturation measured by a pulse oximeter ?7 or 68 68.1 68.2 6 70.1 a n 4 14.1 5 16 ” 8 9 79.1 80 80.1 2 3 ‘what are the Physiological mechanisms responsible for Dyspnoea ? ‘What is maximal breathing capacity ? ‘What factors influence it ? What is Peak Expiratory flow Rate ? How do you measure it ? ‘What factors affect it ? What is Dalton’s Law ? Discuss the physiological principles that promote the resorption of air in a closed pneumothorax ? What is the effect of breathing 100% Os ‘What is the arterial and mixed venous blood gases in a normal person breathing: a air ») 1000, What are the physiological effects of hyperbaric O2 ? ‘What isthe value of measuring ; 2) mixed venous 0; tension ? b) ——_endetidal CO, ? Describe how you measure End-tidal CO> . Discuss the possible changes of End-tidal CO, and their mechanisms. Discuss laminar and turbulent flow in relation to the respiratory system, Describe a Wright's Spirometer. Describe a Vitalograph ‘How does a Pneumotachograph work ? What factors cause pulmonary vasoconstriction ? Discuss the mechanisms. Describe the responses to airway obstruction. How are they mediated ? Discuss the physiological responses to ; a) Hypocarbia b) —Hyperearbia Discuss the physiological responses to 2) Hypoxaemia >) —Hyperoxia Outline the physiological effects of breath holding, What i the break point ?41 42 10 101 u Ma 2 3B 4 141 142 15 16 16.1 7 19 19.1 192 193 NEUROPHYSIOLOGY Dr. Peter Kam Describe the composition of CSF. How does it differ from plasma ? (Ontline the production, circulation and absorption of CSF. How do you measure CSF pressure ? What are the determinants of Intra-cranial pressure ? How do you measure ICP ? ‘What is the Monro-Kellie Doctrine ? ‘What are the physiological features of cerebral blood flow ? Draw a nerve action potential. What is the Ionic basis of a nerve action potential ? Discuss the refractory period. Outline the propagation of a nerve impulse along a nerve fibre. a) Myelinated Fibre 1b) —_Non-Myelinated Fibre ‘What is the electrophysiological basis of nerve conduction ? ‘What ar the cable properties of a nerve ? How does an action potential at a nerve differ from that at a muscle ? ‘What is a Synapse ? ‘What are the functions of a Synapse ? Outline what you understand by convergence and divergence at the synapse. ‘What are the physiological implications ? ‘What do you know about positive and negative feed-back loop at Synapses ? ‘What is a Renshaw Cell ? Define a “Reflex”, Give an example What are the physiological importance and properties ? Give examples of mono-synaptic and poly-synaptic reflexes. ‘What is the blood-brain barrier ? ‘Ontline the basis and importance of the blood-brain barrier. ‘What are the neurotransmitters found in ; a) the brain? ») Spinal cord ? ©) Syapses? ‘Ontline the stimulus strength vs minimum stimulus duration characteristics of a nerve. Define sleep. What is REM sleep ? How does REM sleep differ ftom normal sleep ? ‘What are the different levels of sleep ?20 2a 2 23 24 25 What are the physiological changes during sleep ? ‘What makes person conscious ? What are the fonctions ofthe hypothalamus ? Draw the Eye reflexes. ‘What are the fimetions of a) the limbic system ? >) the cerebellum ? ‘What are the factions of the Vagus Nerve ? What do you know about sensory receptors ? What ae the functions of the Extra-pyramidal system ? ‘What is the physiological basis of nystagmus 2: Outline the physiological basis of cerebral function test. ‘What is the basis of EEG ? What are the different types of EEG waves ? ‘What is the gate control therapy of pain ? ‘What are the neurotransmitters involved in pain ? how can you modulate it ? ‘What isthe role of the substantia gelatinosa in the perception of pain ? Outline the physiology of balance or equilibrium.10 un 2 B “4 15 15. 16 v7 18 18.1 19 19.1 20 21 211 212 213 2 2.1 23 231 MUSCLE PYSIOLOGY Dr. Peter Kam Outline the structure of skeletal muscles. Describe the events occurring during contraction of skeletal muscles. Describe the energy changes and sources during muscle contraction. ‘What is the heat of contraction ? ‘What is Oxygen dept ? ‘Draw a simple diagram of the sarcomere What is myoglobin ? ‘Why is it important to the muscle. ‘Compare and contrast isometric and isotonic contraction, ‘What is the series elastic ? Parallel elastic ? Contractile elements model for a muscle unit ‘How does this apply to isometric and isotonic contraction Outline the kinetic and potential energy generated during a muscle contraction. Outline the interactions of tension, velocity and length of a muscle, ‘Compare and contrast skeletal, cardiac and intestinal smooth muscles. Classify smooth muscles and outline its features. ‘What are the types of smooth muscles ? Draw the resting membrane potentials and action potentials of smooth muscle. Describe a muscle spindle. ‘What are the functions of a muscle spindle ? Describe the changes in a muscle spindle during a muscle contraction, Discuss the control or regulation of muscle spindle activity. Draw a neuromuscular junction Describe the events that occur at the NMJ to produce a contraction of the skeletal muscle. ‘What is Tetanic Stimulation ? Describe the physiological events. Outline the receptors and neurotransmitters at the NMJ and explain their physiological role . What is “Tetany” ? What isthe physiology mechanism responsible for Tetany ? ‘Why do you see “Tetany” with hypocalcaemia? ‘What i the Postulated mechanism ? What is a “Golgi Tendon body” ? ‘What is its fanction ? Define or explain “Muscle Tone” How is it produced ?232 ‘How does the body control muscle tone ? 1010 u 2 13 13 13.2 4 METABOLISM Dr. Peter Kam Define Basal Metabolic Rate. ‘What factors effect BMR ? ‘How do you measure BMR ? How is O; consumption measured ? Describe the physiological response to a patient. 2) Fasting for 12 hours preoperatively >) Fasting for 24 hours ©) Fasting for 507 days, Outline Embden-Meyerhof Pathway and the Kreb's Cycle, How much ATP is produced at each pathway ? Where is Glycogen stored ? ‘How much Glycogen isin the liver ? Inthe muscle ? Discuss how long and when these stores can provide energy substrates, What are essatial fatty acids ? ‘What is their function ? ‘What is ATP ? How is Energy derived form ATP ? ‘What are the sources of ATP ? ‘What are ketone bodies ? How are they produced ? Describe the central role of acetyl COA. in inter-relationships between the metabolism of carbohydrates, fats and proteins. ‘What are the minimal requirements in a 70kg male of; 2) protein? b) fat? ©) carbohydrates ? ‘What are the physiological principles of parenteral nutrition ? What is the caloric value of ; a) protein? fit? ©) carbohydrates ? Define respiratory quotient. What is the RQ relationship with different foods ? How do you measure RQ? Describe the pathway in anaerobic metabolism . Mtul Ma 12 124 3 4 141 1s 16 Wy qa 18 18.1 19 20 a 2d 2 MATERNAL & FOETAL, NEONATAL PHYSIOLOGY Dr. Peter Kam Describe the changes in the maternal cardiopulmonary fiction durig pregnancy. ‘What is a typical arterial blood gas result in a pregnant lady ? ‘What are the physiological changes in the mother during the third trimester of pregnancy ? ‘What are the physiological effects during labour ? ‘A mother in the third trimester of pregnancy has a sudden blood loss of 1000ml due to placenta praevia. Discuss the physiological consequences of this blood loss. ‘What are the Endocrine changes during pregnancy ? What is the pysiological significance of these changes ? (Outline the functions of the placenta, ‘What is the Double-Bobr and Double Haldane effects ? Discuss their physiological importance. Outline the transfer of gases and substances across the placenta; indicating the mechanism What isthe immunological role ofthe placenta ? Briefly describe the endocrine role ofthe placenta. Outline the foetal circulation. ‘What is blood gas picture in the umbilical artery and umbilical vein ? ‘What is HF ? How is it different from HbA ? How is Oxygen supplied to the brain ofa foetus-in-utero ? Describe the changes in the foetal circulation at birth, Indicate the time scales for the changes. What are the changes in the respiratory system occurring with the first few breaths in the neonate after delivery ? Draw P-V Loop and explain the changes. Compare and contrast the respiratory physiology of a neonate with that of an adult . What is the arterial blood gas result you would obtain in ; 2) fall term neonate b) _ premature neonate ‘What is the normal blood Glucose level ? Describe the changes in haemoglobin from @ neonate at delivery to 1 year of life. Explain the changes . ‘What ae the differences in the thermo-regulation ofa neonate compared to an adult ? Describe the neonate response to Hypothermia . Outline the principles controlling the passage of drugs across the placenta and the factors influencing it. What is “Iron Trapping” and give examples. Outtine the pharmacological differences between a neonate and an adult. 122B 23.1 (Outline the production of Surfactant in the foetus. How can we assess and improve its production ? 1B2 21 10 n 2 B BA LIVER PHYSIOLOGY Dr. Peter Kam List the fictions of the liver. Outline the urea cycle, ‘What is the significance of the formation of urea ? ‘What are the Physiological effects of uraemia ? Outline the formation of Bilirubin and how the liver handles bilirubin, Describe the metabolic functions of the liver. (Carbohydrate, fat, protein, nucleic Acid), How does the liver handle drugs? Outline the physiological effects of obstructive jaundice Discuss the physiological consequences of liver failure, ‘What are the storage functions of the liver ? Discuss the blood supply to the liver. ‘How do you measure liver blood flow ? Describe the physiological effects on the iver physiology due to anaesthetic drugs. ‘What are the physiological effects of cirshosis of the liver ? Describe the physiology ofthe hepato-portal circulation. Outline liver function tests. Indicate what aspect of liver fiction they assess. 410 10.1 u 12 IMMUNOLOGY Dr. Peter Kam ‘Discuss the various body defence mechanisms against micro-organism present in the body. (Classify the tests used to assess the body's protective mechanisms. Define antibody and antigen, ‘What is the nature of antibody and antigen ‘What do you know of anti-body-antigen reactions ? ‘What are the consequences of such reactions and give examples. What is a Hapten and give examples. What are immunoglobulins ? Briefly outline their properties and functions. What is a complement ? ‘What is their importance in immune reactions and give examples. Classify hypersensitivity reactions Briefly compare and contrast the different types giving examples. (use a table). ‘What is the difference between an anaphylactic and Anaphylactoid reactions ? List the In-vivo tests and In-vitro tests used to assess a person’s immune status and classify ‘them. Write an account ofthe hypersensitivity reactions to drugs used in anaesthesia, How would you investigate a patient who is thought to have a hypersensitive reaction during ‘an anaesthetic. ‘What isthe value ofthe Tryptase Test in assessing drug reactions during anaesthesia ? How do you manage an anaphylactic reaction ?3 32 33 3a 35 10 10.1 ul ud 12 12 3 BA 4 41 BODY FLUIDS AND ELECTROLYTES Dr. Peter Kam Discuss the composition and distribution of body fluid compartment. Describe the methods of measuring body fluid compartment. Write an account of the mechanisms that control the movement of water and electrolytes across the body compartments of the patient. What is “Total body Water” in a normal 70kg male ? What is its distribution in a male adult ? Female adult ? Neonate ? Premature neonate ? Discuss the factors responsible for the differences. Define the following term; a) Osmotic Pressure >) Osmotarity ©) Osmolality @) Colloid Oncotie Pressure ©) Osmole ‘Compare and contrast the composition of intra-cellular, interstitial and extracellular fluid. ‘What is the Osmolality of Serum ? ‘What isthe total osmotic Pressure it can exert ? Discuss the regulation of Plasma Osmolality in a normal adult, What is “Osmolar Gap”? How do you measure plasma Osmolality ? ‘What do you understand by the term “Colliquative properties” of a fluid ? ‘What is Gibbs-Donnan Equilibrium ? Explain the mechanisms of thirst . Discuss Water balance in the body. ‘What are the effects of an intravenous infusion of 1 litre of normal saline ? How is it distributed ? How do you measure ECF Volume ? Compare and contrast the physiological effects of a rapid infusion of I lite ofthe following fluids in a normal 70kg male. a) ‘Normal Saline b) Distilled Water ©) Hartmana’s Solution @ 8% Dextrose Solution °) Haemaccel or Gelatine solutions 1) NaBicarbonate sotution 2% 2) _0.3M Sodium Citrate Solution +h) ‘NH4 Cl Solution j) — spps 3) 10% ATbumin Solution Discuss the regulation of body water ‘What happens ina person who abstains form drinking for 24 hours ? ‘What is Plasma Oncotie Pressure how much Osmotic Pressure does it exert ? 1615 15.1 16 16.1 7 1A 172 18 181 19 191 192 20 20.1 21 21 212 2B 24.1 25 26 ‘What is the physiological significance of plasma oncotic pressure ? What are the fictions of calcium in the body ? How i it regulated ? How is Serum Cai+ controlled ? ‘What is composition of Serum Ca++ ? ‘What are the functions of Na inthe Body ? How isit distributed ? Discuss the regulation of Na and Na balance in the body. ‘What is the functions of K+ in the body . Discuss K+ haemostasis and distribution in the body. Discuss the regulation of K+ ‘What are the effects of a) Hyperkalemia ? ») —_Hypokalaemia ? Discuss the principles of treating hyperkalaemia. ‘What is Normal Serum Albumin ? What are the functions of plasma albumin 2 Outline the normal physiology of plasma albumin. ‘What is the function of magnesium in the body ? How is it regulated ? Describe the physiological effects of hyper and laypo magnesiumaemia, Postoperatively, a 70kg patient produces approximately 200-300 mls of urine per hour, discuss the physiological mechanism involved, Postoperatively, a 70kg patient produces $-10mls of urine per hour, discuss the physiological ‘mechanisms, . ‘What i the composition ofthe following ; 2) Normal Saline b) Hartman's solution ©) Dextrose 5% @ — Haemaccell ) Dextran 40% ) —SPPS Ringer’s Solution 2 Discuss the difference in the distribution of these fluids when administered to a patient. ‘What are the physiological consequences of Congenital Pyloric Stenosis ? Discuss the physiological effects of diarthoea seen with cholera. 710 u 114 12 B 4 15 16 ” 18 19 21 214 PHYSIOLOGY OF THE GASTRO-INTESTINAL TRACT Dr. Peter Kam Deseribe the physiological Events during vomiting. Outline the factors that influence vomiting. ‘What are the afferent and efferent pathways. ‘What is the composition of gastric juice ? Discuss the physiology of gastric acid production ? ‘What are the functions of the stomach ? ‘What is the significance of Gastric Discuss the physiology of gastric emptying. Cutline the factors that influence the rate of gastric emptying. ‘How do you measure gastric emptying? What is Gastrin ? Discuss the effects of Gastrin. Outline the physiological control of the release and production of Gastrin ‘What are the function of Iron ? Describe the Absorption of Fe. Describe the formation and function of ble salts. What isthe function of Gall Bladder 7 ‘What is Secretin ? ‘What are the effects of Secretin ? Outline the composition and control of biliary secretion ‘What are the functions of “Pancreatic Juice” ? ‘What is its composition ? Outline the digestion and absorption of 2) Carbohydrates ») Protein et ‘What are the functions of the small intestine ? ‘What substances are specifically absorbed in the ileum ? Outline Glucose absorption. Discuss the reabsorption of HO and Electrolytes inthe GIT. ‘What are the physiological effects of Malabsorption syndrome ? ‘What factors determine Gastric Volume and regulatory factors of the various secretions of the Grr? ‘Summarise the composition, volume and regulatory factors of the various secretions of the ar. Outline the physiological role of vitamins. ‘What isthe fuaction of Vitamin B12 How is it absorbed ? 18212 24 24.1 25 26 Where is it absorbed ? ‘Write short notes on ; a) Cholecystokinin b) Substance P ©) Secretin d vw ©) Gastrin ) Intrinsic factor gs) Transferritin Outline the digestion and absorption of starch. ‘What is the function of saliva ? ‘What is its composition ? Describe the physiological evens at swallowing, ‘What are the physiological consequences of; a ilar fistula b) Pancreat fistula ©) Teal conduit in a patient after a radical cystectomy. 1941 42 2 21 122 13 Ba 32 4 15 16 "7 18 181 ENDOCRINE PHYSIOLIOGY Dr. Peter Kam List the hormones produced by the anterior pituitary gland. Outline their actions and control ‘What is Growth hormone ? Classify the actions of growth hormone, What factors influence the release of growth hormone ‘What are the actions off 2) Thyroid stimulating hormone (TSH) ») ACTH Outline iodine metabolism How is it absorbed from the gut ? Describe the fate of iodine on entering the thyroid cell. ‘What are the actions of thyroid hormones ? Classify them, Indicate their half-life and how they are present in blood. List the hormones produced by the posterior pituitary gland. Outline their actions and factors controlling their release. ‘What is insulin ? ‘What are the effects of insulin on the liver ? What are the effects of Insalin on muscle ? ‘What are the effects of insulin on fat ? ‘Summarise the actions of Insulin, ‘What is the structure of insulin ? Its halflife and fate Factors controlling its release ‘What does the insulin receptor look like ? Write an essay on the physiological mechanisms that regulate blood sugar levels. Indicate their mode of action, ‘What are the physiological effects of ; a) —_Hypoglycaemia ? b) ——_Hyperglycaemia ? ‘What are the actions of ADH How is the release of DH controlled ? ‘What are the intracellular mediators of the actions of ADH? ‘What are the functions of aldosterone ? Its halite, How is its secretion regulated ? ‘What hormones are secreted by the hypothalamus ? What is the difference in the physiological effects of primary and secondary aldosteronism ? ‘What are the physiological effects of Vitamin D ? ‘What are the physiological functions of parathyroid hormone ? What is Glucagon ? How is it secreted ? 20182 19 19.1 20 20.1 202 au 2 2B ‘What are the effects of Glucagon ? What is Calcitonin ? What are the effects of calcitonin ? Outline the physiological effects of the glucocorticoids. ‘What is the half-life? ‘What is the molecular mechanism of action ? what are the systemic effects of excessive glucocorticoids ? ‘What are the endocrine response to starvation ? ‘What are the main catecholamines secreted ? Outline the functions of the catecholamines. ‘Compare and contrast the role of adrenaline and noradrenaline in the body. 2110 n 2 1B 4 15 16 16.1 7 Wd 18 18.1 19 20 20.1 CARDIOVASCULAR PHYSIOLOGY QUESTIONS ‘What do you understand by the term “Central Venous Pressure” ? ‘Write an account on the factors controlling CVP. Dr. Peter Kam Discuss the role of the autonomic nervous system in the control of cardiac output. Outline the principles of measurement of cardiac output with respect to; a) Indicator dilution technique. ») Fick Principle. (Compare and contrast the pulmonary circulation and the renal circulation. ‘What is a Portal system and give example ? Write an account on the hepatic prota system. ‘Write an account of the physiological consequences of a rapid blood loss of 2 litres over 15 minutes in a 70kg male ? Write short notes on the physiological effects and the clinical significance of a Valsalva manoewrre, ‘What do you understand by the term “‘Auto-regulation and the significance of auto-regulation Discuss the mechanisms responsible for auto-regulation and the significance of auto- regulation Write an account of the pressure-volume relationship of the left ventricle . ‘What is ventricular compliance and how do P.V. Loop alter with changes in compliance ? Define myocardial contractility. How do you measure or estimate myocardial contractili Outline the factors that determine myocardial contractility. Write an account ofthe physiological effects of anaemia, Discuss the physiological effects of hypoxaemia, Outline the physiological effects of a rapid head-up tlt. Describe the consequences of a 30° head-down tilt on the cardiovascular and respiratory function. ‘Write am account on the regulation and control of blood volume. Discuss myocardial ©; supply and demand, What are the normal myocardial energy substrates ? Define after-load and re-load. List the factors that determine after-load and pre-load. ‘What is Starling’s Law of the heart ? How does this relate to Guyton’s Cardiac output curves ? ‘What do you understand by vascular impedance ? How does this differ from vascular resistance ? Describe the Baroreceptor reflex . Deseribe the venous return curves and discuss the factors that determine venous return. ‘What is Venous compliance ?21 211 2 22.1 23 21 24 24.1 24.2 25 25.1 26 27 29 29.1 30 31 32 321 322 33 34 36 37 371 38 39 40 40.1 a 2 What is Atrial Naturetic Peptide ? What are the physiological functions of ANP. ? Compare and contrast the action potentials in the atrial muscle, SA Node, AV node and Ventricular muscle, Elaborate on the various ionic currents responsible for them. What are the effects of Ach, Adrenalin, Lignocaine and Digoxin ? Draw the cardiac cycle (Wigger’s Diagram). Super-impose the aortic curve. Draw the pressure wave forms seen as @ pulmonary artery catheter is introduced into a patient. Explain the waves seen. How will it change with atrial Abrilletion, complete heart block, nodal rhythm, mitral regurgitation and tricuspid regurgitation ? ‘What factors determine the aortic pressure waveform ? How isthe Dicrotic notch produced ? ‘What is Sinus arrhythmia ? Explain how Kussmaul’s sign is produced. Explain how heart sounds are produced, especially the splitting of the 2" sound. ‘What is the value of measuring arterial-venous oxygen difference ? Elaborate on the A-V DO; in the various regional circulations. Compare and contrast laminar and Turbulent flow. Apply Laplace's Law to the ventricular chamber, the aorta and the capillaries. How is the E.C.G produced ? ‘What is a Unipolar Lead and a Bipolar Lead ? Elaborate on the placement and polarity of the various leads. Explain the E.C.G changes with hypo and byperkalaemia, hypocalcaemia and Digoxin Toxicity. Determinants of Wall Tension of the ventricle and clinical significance, Outline the extrinsic and intrinsic regulation of cardiac performance. What are the physiological effects of quadriplegia ? ‘What are the cardiovascular responses to exercise ? Mlustrate the physiological changes with the aid of Guyton’s Cardiac Output and Venous Retum Graphs. What are the effects of the lithotomy position ? ‘What are the factors that determine myocardial perfusion and myocardial oxygen consumption ? (Outline the pattern of coronary blood flow. What is the coronary A-V O; difference ‘List and classify the factors that influence coronary blood flow. How do you measure coronary blood flow ? 2343 43.1 43.2 44 aad 45 45.1 46 46.1 4 48 48.1 49 30 si 3 53.1 54.1 55 56 56.1 362 7 38 What is cerebral perfusion pressure ? What determines C.P.P and how do you measure it? ‘What is O; content/sat of jugular venous blood ? Discuss the factors influencing cerebral blood flow. ‘Outline how you would measure cerebral blood flow. Describe the features of the hepatic portal system, and the factors influencing flow ‘What is the blood gas picture of hepatic portal blood ? Describe the features of blood supply of the liver How do you measure liver blood flow Describe the regulation of vascular tone including the various mediators involved. ‘What is Staring's Hypothesis ? ‘What are the functions ofthe microcirculation and the factors influencing it? Outline the differences in the Autonomic innervation of the blood vessels in the various regional circulations. Describe the factors determining skeletal muscle blood flow. Outline the factors that alter cutaneous blood flow. What are the function ofthe endothelium ? ‘What are the composition of lymph ? What is the function of the lymphatic system ? ‘What are the features of the Pulmonary circulation. ? (compare it withthe system circulation). Classify and list the factors that determine Pulmonary blood flow. Explain the fluid exchange in the Pulmonary circulation. What are the features of the renal circulation ? ‘Explain about auto-regulation in the kidney and its clinical significance How do you measure renal blood flow ? Outline the physiological effects of haemodilation. Describe the physiological effects of water immersion. 2410 u B b “ 1s 16 " 18 9 20 20.1 BLOOD TRANSFUSION Dr. Peter Kam Outline the different types of blood groups ‘What determine the nature of a blood group ? ‘What isthe Rh system ? How do you assess the system and outline the problems that may be associated with Rh incompatibility ? What is a Cross-match Procedure ? Elaborate on the tests used. What is a Coomb’s Test ? ‘What is a direct anti-globin test and an indirect anti-globin test ? ‘What isthe clinical significance of these tests ? List the changes that occur during storage of blood Why are red blood cells biconcave discs ? What are the advantages ? Write an account on the hazards of blood transfusion: (Classify the hazards and how you would reduce them) ? What is the composition of fresh frozen plasma, cryoprecipitate and supernatant ? How would you detect or investigate a blood transfusion “Reaction” ? ‘What is platelet and what are its finetions ? Discuss the detailed sequential changes in stored blood (giving approximate quantitative alterations with respect to time). (Outline the functions of Plasma ‘Outline the functions of Plasma Proteins, What is the half life ofthe various factors in blood ? Outline the coagulation cascade. Cutline the fibrinolytic system. ‘What is the role of Protein C and Protein S? ‘What isthe function of Plasmin ? Outline the Symthesis and Breakdown of Haemoglobin, ‘What is Lymph ? Outline the fictions of lymphatic Fluid and how they are recycled. 2510 nN il 2 3 4 15 16 ” 171 172 ACID-BASE PHYSIOLOGY Dr. Peter Kam Definitions : 2) Acid b) Base ©) Buffer 4) Acidosis vs acidaemia ©) Alkslosis vs Alkalaemia ) PH 2) PKA~in temns of 4) fonisation 4i) Law of Mass Action (Dissociation Constant) 4) Standard Bicarbonate & base Excess ‘What is the Henderson-Hasselbach Equation ? How much Acid does the body produce per day ? What are the types of acids produced ? How does the kidney handle fixed acids ? (Outline the Body Butter Systems. Intracellular Buffers Interstitial uid Bufer Buffers in the blood ‘What are their relative contributions to overall Buffer capacity ? Describe how the body handles acid. Or how does the body excrete its acid load ? List the blood buffers Define “Titrable Acidit ‘What contributes to Titrable Acidity ? Explain how haemoglobin acts as a buffer. Give the biochemical basis of its buffering action ‘What is the relative Buffering Capacity of Hb ? ‘Why is it large ? How does it compare with plasma Proteins ? List the physiological Buffers ‘What do you understand by the term “Buffer Base” ? Give an account of Renal compensation for Acidosis. ‘What is the normal range of blood pH? At what limits of pH is it compatible with life ? Outline compensation for Metabolic Acidosis. Outline the physiological effects of Metabolic Alkalosis. How is Respiratory Acidosis compensated ? Outline the secretion and excretion of H+ ions by the kidney. Describe the distribution of earbonie Anbydrase in the Body and its fiction. Define Anion Gap. What contributes to Anion Gap ? How do you; 26173 18 19 19.1 20 a 2 23 24 241 25 2) measure anion gap ? b). Estimate it? Discuss the clinical relevance. Describe the ammonium mechanism in the kidney and its contribution to Acid-base Balance. ‘What is the difference between whole body (in-vivo) and in-vitro titration curves ? ‘What is the clinical significance of this ? What is the ; 2) Davenport diagram ? ») __Sigaard-Anderson Nomogram ? Cutline the principles of the Sigeard-Anderson Method of Acid-Base measurement. How do you measure; a) pH ») p02 ) pCO, @) Standard Bicarbonate How do you calibrate a blood gas analysis machine ? ‘What are the potential sources of error in a blood gas result ? Classify them. ‘What is the effect of Heparin on a ABG result? 27MEASUREMENT. A. BLOOD PRESSURE Dr. Peter Kam, 10 u na 12 ‘Anew pressure transducer is being marketed. How would you assess its suitability for direct arterial BP monitoring ? How would you calibrate an arterial BP pressure transducer ? What do you understand by the terms ; a) Frequency response ) Natural Frequency ©) Damping, Optimal Damping and Critical Damping, ‘What are the specifications required for a pressure transducer used for arterial B.P.monitoring ? What are the Static and Dynamic Tests for a Pressure Transducer used for arterial BP monitoring ? ‘What are the factors that will contribute to Damping of Arterial Trace ? ‘What may cause an overshoot or oscillations of a Trace ? Outline the sources of error that may arise from invasive arterial BP monitoring, ‘How does a Sphygmomanometer work ? ‘What are the recommended sizes of cuffs ? Explain the errors in using either too large or too small cuff. Explain how these errors arise. ‘What are the Korotkoff sounds ? Explain the oscillometric principle used in automated BP machines. How is Systolic, mean and diastolic BP measure by the automatic non-invasive BP instrument ‘What sort of errors in measurement are seen with NIBP ? 12.1 How do the readings compare wit intra-arterial BP recording .? B 4 1s 16 7 1 q72 ‘What is an oscillotometer ? How does a Penaz BP measurement instrument work ? How may the Doppler instrument be used to measure BP ? Classify the methods of Measuring BP ? How does a Transducer Work ? ‘What are the different types of Transducer ? ‘What is a Wheatstone bridge ? CARDIAC OUTPUT Classify the Methods of measuring cardiae output List the advantages and disadvantages of each technique, including their sources of errors in ‘measurement. ‘What is the Fick principle ? 283 32 ‘What is the Direct Fick Principle ? ‘What is the Indirect Fick Principle ? How is O, consumption measured ? Explain the Dye Dilution Technique . What Dyes are used ? How are they chosen ? Explain the thermodilution technique. What are its advantages ? ‘What is its accuracy ? ‘What isthe principle of the thoracic impedance technique of measuring cardiac output ? How is the Doppler principle used to measure cardiac output ? BLOOD FLOW What are the various methods used to measure blood flow ? Outline the physical principles involved. How can you measure limb blood flow ? ‘What is a limb Pletysmograph ? Compare and contrast the various methods of measuring aortic blood flow. ‘What are th principles used to measure regional blood flow ? GASES How do you measure O; and CO; in a Gaseous mixture ? How would you measure the O, content of a blood sample ? ‘What is a Paramagnetic Gas ? Explain how a Paramagnetic O> analyser works ? What is a fuel-cell O, analyser ? ‘What are its advantages and disadvantages ? ‘What are the principles of measuring O- Saturation ? What is the isobestic Point ? ‘What is Lambert's law ? De Beer’s Law? How does a Pulse Oximeter work ? ‘What sort of errors may arise ? ‘What are its limitations ? How would you measure end-tidal CO; ? ‘What information may be obtained from End-Tidal measurement ? How does the Modem End-Tidal CO, analyser work ? What information may be obtained from End-tidal Measurement ? Explain the physiological basis. ‘What is a Nitrogen Meter ? 2910.1 102 2 How does it work ? ‘When would you use it ? ‘What are the limitations of Capnography ? How do you measure inhalational anaesthetic concentrations in the circuit ? HUMIDITY Define humidity - Absolute and Relative Humidity. What is the water content of alveolar gas ? ‘What is the latent heat of vaporisation ? Plot S.V.P. against temperature. Define S.V.P. Define Dew Point. How does a Regnault's Hygrometer work ? ‘What are the Methods used to measure humidity, How do you measure the water content or humidity of expired gas ? GAS FLOW How do you measure gas flow ? How does a rotameter work ? What is its accuracy and limitations ? ‘What is a Pneumotachograph ? How does it work ? ‘What are its limitations ? ‘What is a Wright's Spirometer ? What are its limitations? What is its Accuracy? How does it differ from a Wright’s Peak Flow Meter ? ‘What is a Fixed Orifice and Variable Orifice Flow Meter ? PRESSURE GAUC What is; ‘Bourdon Pressure Gauge? Aneroid Pressure Gauge? ‘What is the pressure in an Oxygen Cylinder ? How reliable is the pressure gauge as an indicator of the amount of N2O in a cylinder & why ? ‘What is critical temperature and pressure ? MISCELLANEOUS MEASUREMENTS. 30Mainly related to specific systems. Body Pletysmograph ~ Principles and Applications Wheatstone Bridge - use and Principles ? Basal Metabolic Rate. Outline the uses of ultrasound in clinical practice. 3110 n 2 B Ba 4 41 15 16 MISCELLANEOUS QUESTIONS OF PHYSIOLOG' Dr, Peter Kam AGEING Describe the physiological changes occurring in the elderly patients. What are the effects of ageing on ; a) CYS. >) Respiratory ©) Pharmacological response of drugs. Discuss the body fluid changes occurring with ageing. OBESITY Outline the physiological consequences of morbid obesity. List the pharmacological implications of morbid obesity. CELLULAR PHYSIOLOGY Describe a cell membrane; its structure and physiological properties ‘What is Nernst Equation ? Apply it to cell membrane. What isthe significance of Cyclic AMP ? What are G Proteins ? ‘What is their physiological role ? Outline the physiological role of Nitric Oxide. examples of Second messengers and their role, ‘What is Calmodulin and its physiological role? Describe the processes that control the passage of substances across cell membrane, Indicate which require energy, and which are against cone. Gradient. ‘What do you understand by the term ANTIPORT and SYMPORT and give examples. ? ‘What is the function of the Endoplasmic Reticulum ? ‘What isthe importance of Na-K ATPase ? List examples of 1*, 2" and 3 Messengers. ‘What is an Exponential process ? Briefly outline the physiological processes that follow exponential relationships. ‘What is Gibbs-Donnan Equilibrium? ‘What is the physiological significance and give examples. Define Viscosity. ‘What is Reynold’s No. and its significance ? 327 7a 18 18.1 19 19.1 What is Pouseuille's Law ? Indicate its applications. What is Laplace's law ? How is it applied in physiology ? ‘What is Avogardo’s Hypothesis ? What is Avogardo’s Number ? Define; 8) Dalton’s Law of partial pressure b)—Charle’s Law ) Boyle's Law ® Graham's Law ©) Fick's Law of difference oe10 n 12 13 4 15 16 7 18 19 20 al 2 2B 24 28 27 TEMPERATURE Dr. Peter Kam Write an account on the regulation of body temperature in an adult. Discuss the differences in temperature regulation between the adult and the neonate. ‘What ae the norma limits of temperature in man and how are they regulated ? ow does the body respond to fill in body temperature ? Discuss the compensatory cardiovascular response to a decrease or increase in body ‘temperature, Outline the metabolic mechanisms for the regulation of body temperature. Outline the physiological effects of hypothermia. ‘How does temperature affect acid-base regulation and measurement ? Define core temperature. Compare oesophageal, nasopharyngeal, tympanic, rectal and axillary temperatures. ‘What do you understand by non-shivering thermogenesis? Outline the physiology of shivering, ‘What is the contribution of convection, radiation, conduction and evaporation to heat loss ? Outline the principles ofthe methods used to reduce heat loss during anaesthesia, ‘What is latent heat of vaporisation ? ‘What is the term “thermoneutral zone” mean ? Classify the methods of measuring temperature, List their advantages and disadvantages. How does a mercury thermometer work ? Describe the physics of a thermistor and a thermocouple . ‘What is the “Secbeck” and “Peltier” effects. Define relative and absolute humidity; saturated vapour pressure. Plot SVP against temperature, Cutline the methods of measuring humidity. ‘What isthe water content of expired gas. Discuss the physiological effects of malignant hyperpyrexia. What is “heat stroke” ? ‘What is the difference between heat and temperature ? What is the inter threshold range ? Describe how anaesthesia influences temperature regalatory mechanisms. 34