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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA


Incorporated Association not for gain
Reg No/Nr 1955/000003/08

Part I Examination for the Fellowship of the


College of Anaesthetists of South Africa
6 September 2011
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

a)
b)
c)
d)

a)
b)
c)
d)

a)
b)

c)

Discuss the processes involved in the formation of the primary platelet plug.
(10)
What is role of thrombin in the coagulation pathway?
(7)
Discuss the processes that limit excessive clot formation.
(23)
Briefly explain
i)
The link between systemic inflammation and the activation of the
haemostatic mechanism.
(6)
ii)
Why some patients with Von Willebrands disease respond to dDAVP
and others only to cryoprecipitate.
(4)
[50]
Bespreek die prosesse betrokke in die ontwikkeling van die primre
plaatjieprop.
(10)
Wat is die rol van trombien in die koagulasiepad?
(7)
Bespreek die prosesse wat oormatige stolselformasie beperk.
(23)
Verduidelik kortliks
i)
Die skakel tussen sistemiese inflammasie en die aktivering van die
hemostatiese meganisme.
(6)
ii)
Hoekom sommige pasinte met Von Willebrandsiekte respondeer op
dDAVP en ander net op kriopresipitaat.
(4)
[50]
Briefly explain the term "transpulmonary pressure" and the clinical importance
thereof.
(3)
Indicate the average normal values for the end-expiratory and end-inspiratory
intrapleural and alveolar pressures (in cm H 2 O) for a 25-year-old male during
spontaneous non-exertional ventilation.
(4)
Briefly explain each of the following concepts, by making use of a simple
annotated air flow diagram
i)
Tidal volume.
ii)
Inspiratory reserve volume.
iii)
Expiratory reserve volume.
iv)
Residual volume
v)
Vital capacity
(10)

d)
e)
f)
g)

h)
i)

a)
b)

c)

d)
e)
f)
g)

h)
i)

a)

b)

c)

Provide the approximate average normal volumes in a 25-year-old healthy


male for each of the above mentioned parameters in question 2c).
(5)
Briefly explain what Functional Residual Capacity represents and why
spirometry cannot be used in a direct way to determine it.
(3)
Define the term respiratory minute volume.
(2)
Briefly explain what West Zone1 blood flow means and identify three clinical
situations in which West Zone 1 blood flow can be expected in the lungs of
patients in general.
(4)
List the four most important factors that determine the rate of gaseous
diffusion through the respiratory membrane.
(4)
Describe the functions of the principal groups of neurons in the medulla
oblongata and pons that are involved in the regulation of respiration.
(15)
[50]
Verduidelik kortliks die term transpulmonale druk en die kliniese belang
daarvan.
(3)
Dui die gemiddelde normale waardes aan vir die end-ekspiratoriese en endinspiratoriese intrapleurale drukke asook alveolre drukke (in cm H 2 O) in n
25-jarige man gedurende normale spontane asemhaling met rus.
(4)
Verduidelik kortliks elk van die volgende konsepte deur gebruik te maak van
n eenvoudige, benoemde lugvloeidiagram
i)
Getyvolume.
ii)
Inspiratoriese reserwe-volume.
iii)
Ekspiratoriese reserwe-volume.
iv)
Residuele volume.
v)
Vitale kapasiteit.
(10)
Gee die normale benaderde, gemiddelde volumes in n 25-jarige gesonde
man vir elk van bogenoemde parameters in vraag 2c).
(5)
Beskryf kortliks wat Funksionele Residuele Kapasiteit voorstel en hoekom ons
nie spirometrie direk kan gebruik om dit te meet nie.
(3)
Definieer die term respiratoriese minuutvolume.
(2)
Beskryf kortliks wat West-sone 1-bloedvloei beteken en gee drie kliniese
situasies waar West-sone 1-bloedvloei in die longe verwag kan word in
pasinte in die algemeen.
(4)
Lys die vier belangrikste faktore wat die tempo van gasdiffusie deur die
respiratoriese membraan benvloed.
(4)
Beskryf die funksies van die hoofgroepe neurone in die medulla oblongata en
pons wat betrokke is in die regulering van asemhaling.
(15)
[50]
Define the following
i)
Stroke Volume.
ii)
Cardiac Output.
iii)
Cardiac Index.
iv)
Mean Arterial Pressure.
v)
Systemic Vascular Resistance.
(15)
Explain in words, using relevant equations where necessary, the physiologic
mechanisms of the following determinants of Stroke Volume of the left
ventricle
i)
Preload.
ii)
Contractility.
iii)
Afterload.
(18)
Explain briefly how positive pressure ventilation reduces the left ventricular
afterload.
(3)

d)

e)

a)

b)

c)
d)

e)

a)

b)
c)
d)
e)

a)

b)

Draw and fully label the Pressure-Volume loop of the normal left ventricle.
Include in your labelling the events of the cardiac cycle that correspond to
each part of the loop.
(10)
Graphically illustrate the effect on left ventricular stroke volume of an
decrease in preload.
Do this by redrawing the Pressure-Volume loop of the left ventricle on a new
page, and on the same set of axes drawing the Pressure-Volume loop
corresponding to a state of decreased preload. It is not necessary to fully label
these loops.
[50]
Definieer die volgende
i)
Slagvolume.
ii)
Kardiale omset.
iii)
Kardiale indeks.
iv)
Gemiddelde arterile bloeddruk.
v)
Sistemiese vaskulere weerstand.
(15)
Verduidelik in woorde, met die gebruik van relevante vergelykings waar nodig,
die fisiologiese meganismes van die volgende determinante van slagvolume
van die linker ventrikel
i)
Voorlading.
ii)
Kontraktiliteit.
iii)
Nalading.
(18)
Verduidelik kortliks hoe positiewe drukventilasie die linker ventrikulere
nalading verminder.
(3)
Teken en annoteer volledig die Druk-Volumekurwe van n normale linker
ventrikel. Dui aan watter gebeurtenis in die kardiale siklus korrespondeer met
elke deel van die kurwe.
(10)
Illustreer grafies die effek van n vermindering in voorlading op die linker
ventrikulre slagvolume. Beantwoord hierdie vraag deur die DrukVolumekurwe oor te teken op n nuwe bladsy, en op dieselfde aksis die DrukVolumekurwe te teken wat korrespondeer met n staat van verminderde
voorlading. Dis nie nodig om hierdie kurwe te benoem nie.
(4)
[50]
Define cerebral
i)
Perfusion pressure.
(5)
ii)
Blood flow.
(5)
iii)
Metabolic rate of oxygen consumption.
(5)
iv)
Metabolic rate of glucose consumption.
(2)
Draw and annotate a cerebral autoregulation curve.
(3)
Briefly discuss the formation, circulation and absorption of cerebrospinal fluid.
(20)
Briefly describe the major compensatory mechanisms in the brain to
counteract a raised intracranial pressure.
(4)
Define the relationship between between partial pressure of carbon dioxide in
arterial blood and cerebral blood flow. How is this clinically used by
anaesthetists in the setting of acutely raised intracranial pressure?
(6)
[50]
Definieer serebrale
i)
Perfusiedruk.
ii)
Bloedvloei.
iii)
Metaboliese tempo van suurstofverbruik.
iv)
Metaboliese tempo van glukose-verbruik.
Teken en benoem n serebrale outoregulasiekurwe.

(5)
(5)
(5)
(2)
(3)

c)
d)
e)

Bespreek
kortliks
die
formasie,
sirkulasie
en
absorpsie
van
serebrospinaalvog.
(20)
Gee kortliks die major kompensatoriese meganismes in die brein wat
verhoogde intrakraniale druk teenwerk.
(4)
Definieer die verwantskap tussen die parsile druk van koostofdioksied in
arterile bloed en serebrale bloedvloei. Hoe gebruik narkotiseurs hierdie
konsep klinies in pasinte met akuut-verhoogde intrakraniale druk?
[50]

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
6 September 2011
Physiology
Paper 2

(2 hours)

Candidate Number:....................................................

Question 1 / Vraag 1
a)
List the three ways in which carbon dioxide is transported in the circulation.
a)
Lys die drie maniere hoe koolstofdioksied vervoer word in die sirkulasie.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
b)
Explain the Haldane effect.
b)
Verduidelik die Haldane-effek.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
c)

Write an equation that explains the relationship between carbon dioxide and
bicarbonate.
c)
Skryf n vergelyking neer wat die verwantskap tussen koolstofdioksied en bikarbonaat
verduidelik.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)

d)
Write the alveolar gas equation.
d)
Skryf die alveolre gasvergelyking neer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
[10]
Question 2 / Vraag 2
a)
Briefly explain the process of vitamin B12/cobalamin absorption.
a)
Beskryf kortliks die proses van vitamien B12/kobalamien absorpsie.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
b)
List the biochemical functions of vitamin B12/cobalamin.
b)
Lys die biochemiese funksies van vitamien B12/kobalamien.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
(4)
c)
List 3 clinical consequences of Vitamin B12 and Folate deficiency.
c)
Lys die kliniese gevolge van Vitamien B12 en Folaat gebrek.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
[10]
Question 3 / Vraag 3
a)
Explain the Carotid Baroreceptor reflex.
a)
Verduidelik die karotis baroreseptorrefleks.
_________________________________________________________________________
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(5)
b)
Explain the Bezold-Jarisch reflex.
b)
Verduidelik die Bezold-Jarischrefleks.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(5)
[10]
Question 4 / Vraag 4
a)
Write the equation for fractional excretion of sodium.
a)
Skryf die vergelyking neer vir die fraksionele ekskresie van natrium.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
b)
Define urine specific gravity.
b)
Definieer urien spesifieke soortlike gewig.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)

c)
c)

List four non-renal variables that affect creatinine and / or blood urea nitrogen levels.
Lys vier non-renale veranderlikes wat kreatinien en / of bloed ureumvlakke kan
benvloed.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(4)

d)
Define the term osmolality.
d)
Definieer die term osmolaliteit.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 5 / Vraag 5
a)
What is facilitated diffusion?
a)
Wat is gefasilliteerde diffusie?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
b)
List one substance that crosses cell membranes by facilitated diffusion.
b)
Lys een substans wat die selmembraan kruis deur middel van gefasilliteerde diffusie.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(1)
c)
What is the difference between primary and secondary active transport?
c)
Wat is die verskil tussen primre en sekondere aktiewe transport?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
d)

Explain the process of the primary active transport of hydrogen ions during the
formation of hydrochloric acid in the stomach.

d)

Verduidelik die proses van primre aktiewe transport van waterstofione gedurende
die vorming van soutsuur in die maag.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(5)
[10]
Question 6 / Vraag 6
Write succinct notes on the functions of each of the following cell types
Skryf kort notas oor die funksies van die volgende seltipes
a)
Basophils.
a)
Basofiele.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
b)
Eosinophils.
b)
Eosinofiele.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
c)
Natural killer cells.
c)
Natuurlike doderselle.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
d)
Monocytes.
d)
Monosiete.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

(2)
e)
Mast cells.
e)
Mastselle.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 7 / Vraag 7
a)
Cite three physiological functions of cholesterol.
a)
Noem drie fisiologiese funksies van cholesterol.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
b)
b)

State one specific function of each of the following enzymes


Noem een spesifieke funksie van elkeen van die volgende ensieme
i)
HMG-CoA reductase.
i)
HMG-KoA reduktase.
_________________________________________________________________(1)
ii)
Lipoprotein lipase.
ii)
Lipoproteenlipase.
_________________________________________________________________(1)
iii)
Hormone-sensitive lipase.
iii)
Hormoonsensitiewe lipase.
_________________________________________________________________(1)

c)
c)

Briefly explain the concept "transamination", by making use of one specific example.
Verduidelik kortliks die konsep "transaminasie" deur gebruik te maak van een
spesifieke voorbeeld.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
d)

Identify the specific hormone involved in the formation of leukotrienes from


arachidonic acid.
d)
Identifiseer die spesifieke hormoon betrokke by die sintese van leukotriene vanaf
aragidoonsuur.
_______________________________________________________________________(1)

e)

Identify one other cause of a negative nitrogen balance besides starvation or an


inadequate protein intake.
e)
Identifiseer een ander oorsaak van n negatiewe stikstofbalans benewens
uithongering of ontoereikende proteen-inname.
______________________________________________________________________ (1)
[10]

Question 8 / Vraag 8
A 60-year-old female patient, using anti-hypertensive medication (hydrochlorothiazide 25
mg/day), presents post-operatively with the following biochemical results
n 60-Jarige vroulike pasint, wat behandel word met antihipertensiewe geneesmiddels
(hidrochloortiasied 25mg/dag), presenteer postoperatief met die volgende biochemiese
uitslae
Arterial plasma pH: 7,56
Arterile plasma pH: 7,56
Arterile plasma HCO 3 -: 48mEkw/L
Arterial plasma HCO 3 : 48mEq/L
Arterial plasma PCO 2 : 40 mm Hg(5.3kPa)
Arterile plasma PCO 2 : 40 mm Hg(5.3 kPa)
Urinary Cl : 8 mEq/L
Urinre Cl- : 8 mEq/L
a)

Indicate which specific metabolic disorder is present and briefly motivate your
answer.
a)
Dui aan watter spesifieke metaboliese afwyking teenwoordig is en motiveer kortliks u
antwoord.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
b)

Identify one physiological compensatory mechanism that the body can utilise to try
and rectify this condition.
b)
Identifiseer een fisiologiese kompensatoriese meganisme wat die liggaam kan
gebruik om hierdie toestand te probeer regstel.
_______________________________________________________________________(1)
c)

Suggest one possible cause of this disorder in this patient, and indicate the
pathophysiological mechanisms involved.
c)
Stel een moontlike oorsaak voor vir hierdie afwyking in hierdie pasint, en dui die
onderliggende patofisiologiese meganismes aan.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
d)

Write succinct notes on the relationship between the ECF potassium ion and ECF
hydrogen ion concentrations.
d)
Skryf kort notas oor die verhouding tussen ESV kaliumioon- en ESV waterstofioonkonsentrasies.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
e)
e)

Name two important intracellular buffer systems.


Noem twee belangrike intrasellulre buffersisteme.

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 9 / Vraag 9
a)
a)

On the axis provided draw an annotated graph to indicate the relationship between
cardiac output and ventricular end diastolic volume in a normal heart
Teken 'n benoemde grafiek op die asse wat voorsien word om die verhouding aan te
dui tussen hartomset en ventrikulre eindiastoliese druk in n normale hart.

(2)
b)

On the diagram above indicate what effect the following conditions have on the
relationship.
i)
An increase in contractility.
(1)
ii)
A decrease in contractility.
(1)
iii)
Thiamine deficiency.
(1)
iv)
Running on a treadmill.
(1)
v)
A myocardial infarct with decreased ejection fraction.
(1)
vi)
Thyrotoxicosis.
(1)
vii)
Administratrion of intravenous glucagon.
(1)
viii)
Administration of intravenous dopamine at alpha adrenergic receptor active
doses.
(1)

b)

Dui op die diagram hierbo aan watter effek die volgende toestande op hierdie
verwantskap het.
i)
n Verhoging in kontraktiliteit.
(1)
ii)
n Verlaging in kontraktiliteit.
(1)
iii)
Tiamiengebrek.
(1)
iv)
Hardloop op n loopband.
(1)
v)
n Miokardiale infarksie met verlaagde ejeksiefraksie.
(1)
vi)
Tirotoksikose.
(1)
vii)
Toediening van intraveneuse glukagon.
(1)
viii)
Toediening van intraveneuse dopamien by alfa adrenerge reseptor-aktiewe
doserings.
(1)

[10]
Question 10 / Vraag 10
a)

Briefly explain how the hypothalamic receptors are able to monitor the body water
status on a continuous basis.
a)
Verduidelik kortliks hoe die hipotalamus-reseptore op n deurlopende basis in staat is
om die liggaamswaterstatus te moniteer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(4)
b)

Briefly explain how the hypothalamus ensures appropriate renal adjustments, of total
body water composition.
b)
Verduidelik kortliks hoe die hipotalamus toepaslike renale aanpassings verseker in
die totale liggaamswatersamestelling.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(4)
c)

Provide a brief physiological explanation of the changes in plasma osmolality if there


is a decrease in ADH secretion.
c)
Voorsien n kort fisiologiese verduideliking van die veranderinge in plasmaosmolaliteit indien daar 'n afname is in ADH afskeiding.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 11 / Vraag 11
a)

What is the approximate daily requirement for potassium in mmol/kg for healthy
patients?
a)
Wat is die benaderde daaglikse benodigheid van kalium in mmol/kg vir gesonde
pasinte?
_______________________________________________________________________(1)
b)

List 3 factors that cause potassium to move from the extracellular fluid into the
intracellular fluid.
b)
Lys 3 faktore verantwoordelik vir kalium beweging vanaf ekstrasellulre vog na die
intrasellulre vog.
_________________________________________________________________________
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
c)
What characteristic wave appears on the ECG of patients with severe hypokalaemia?
c)
Watter karakteristieke golf verskyn op die EKG van pasinte met erge hipokalemie?
_______________________________________________________________________(1)
d)
What is the effect of hypokalaemia on ventricular repolarisation?
d)
Wat is die effek van hipokalemie op ventrikulre repolarisasie?
_______________________________________________________________________(1)
e)
What is the effect of elevated aldosterone levels on plasma potassium concentration?
e)
Wat is die effek van verhoogde aldosteroonvlakke op plasma kaliumkonsentrasie?
_______________________________________________________________________(1)
f)

What is the effect of hyperkalaemia on the resting membrane potential of cardiac


myocytes?
f)
Wat is die effek van hiperkalemie op die rustende membraanpotensiaal van kardiale
miosiete?
_______________________________________________________________________(1)
g)

In the event of a cardiac arrest from hyperkalaemia, will the heart be in a state of
contraction or of relaxation?
g)
Sal die hart in n staat van kontraksie of ontspanning wees tydens kardiale arres
weens hiperkalemie?
_______________________________________________________________________(1)
How many potassium ions are exchanged for the 3 sodium ions in the Na+/K+
ATPase pump found in the membrane of most body cells?
h)
Hoeveel kaliumione word uitgeruil vir die 3 natriumione in die Na+/K+-ATPase pomp
gevind in die membraan van meeste liggaamselle?
_______________________________________________________________________(1)
10]
h)

Question 12 / Vraag 12
a)

Name the nerve fibre types that transmit nociceptive impulses from the periphery to
the dorsal root of the spinal cord.
a)
Noem die tipes senuweevesels wat die nosiseptiewe impulse vanaf die periferie na
die dorsale wortelganglion vervoer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
b)

Through which spinal cord tract are most nociceptive impulses transmitted to the
brain?
b)
Deur watter spinaalkoordtraktus word die meeste nosiseptiewe impulse vervoer na
die brein?
_______________________________________________________________________(1)
c)

What is the major excitatory neurotransmitter at the NMDA receptor?

c)
Wat is die hoof eksitatoriese neuro-oordragstof by die NMDA-reseptor?
_______________________________________________________________________(1)
d)
What ion is usually transmitted through the NMDA receptor?
d)
Watter ioon word gewoonlik deur die NMDA-reseptor vervoer?
_______________________________________________________________________(1)
e)
What ion may reduce transmission at the NMDA receptor?
e)
Watter ioon mag die oordrag by die NMDA-reseptor inhibeer?
_______________________________________________________________________(1)
f)
What ion is transmitted through the inhibitory GABA receptor?
f)
Watter ioon word deurgelaat deur die inhibitoriese GABA-reseptor?
_______________________________________________________________________(1)
g)
Name two endogenous opioids that inhibit nociception.
g)
Noem twee endogene opioede wat nosisepsie inhibeer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
h)

Through which receptor does noradrenaline (norepinephrine) mediate supraspinal


inhibition of nociception?
h)
Deur watter reseptor medieer noradrenalien (norepinefrien) supraspinale inhibisie
van nosisepsie?
_______________________________________________________________________(1)
[10]
Question 13 / Vraag 13
a)
List the three forms in which calcium circulates in plasma.
a)
Lys die drie vorms waarin kalsium sirkuleer in die plasma.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
b)
What is measured in laboratory plasma calcium analysis?
b)
Wat word gemeet in die laboratorium kalsiumanalise?
_______________________________________________________________________(1)
c)
c)

Explain the rationale for calculating corrected calcium from this laboratory value
Verduidelik die motivering vir die berekening van gekorrigeerde kalsium vanaf die
laboratoriumwaarde.
_______________________________________________________________________(1)
d)
What is the effect of parathyroid hormone on plasma calcium concentrations?
d)
Wat is die effek van paratiroiedhormoon op plasmakalsiumkonsentrasie?
_______________________________________________________________________(1)
e)
e)

Name two mechanisms that cause hypocalcaemia in chronic renal failure.


Noem die twee meganismes wat in chroniese nierversaking hipokalsemie

veroorsaak.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
f)

What is the mechanism of secondary hyperparathyroidism observed in patients with


chronic renal failure.
f)
Wat is die meganisme van sekondere hiperparatireose gesien in pasinte met
chroniese nierversaking.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
Question 14 / Vraag 14
Regarding skeletal muscle
Betreffende skeletspier:
a)
What protein makes up the thin contractile filaments?
a)
Uit watter proteen bestaan die dun kontraktiele filamente?
_______________________________________________________________________(1)
b)
What protein makes up the thick contractile filaments?
b)
Uit watter proteen bestaan die dik kontraktiele filamente?
_______________________________________________________________________(1)
Ca2+ must be released within the cell to initiate muscle contraction.To which protein
does Ca2+ bind to cause these contractile filaments to be able to interact to cause
contraction?
c)
Kalsium moet vrygestel word binne die sel om spierkontraksie te inisieer. Aan watter
proteen bind Ca2+ sodat hierdie kontraktiele filament interaksie met mekaar kan
ondergaan om saam te trek?
_______________________________________________________________________(1)
c)

What is the name of the cell structure usually responsible for the storage of Ca2+?
Wat is die naam van die selstruktuur wat gewoonlik verantwoordelik is vir die stoor
van Ca2+?
_______________________________________________________________________(1)

d)
d)

What is the name of the channel through which Ca2+ is released from the storage
structure?
e)
Wat is die naam van die kanaal deur wat Ca2+ vrygestel word vanaf die stoororganel?
_______________________________________________________________________(1)
e)

f)

What receptor is found at the neuromuscular junction of nerves innervating skeletal


muscle?
f)
Watter reseptor word gevind by die neuromuskulre aansluiting waar senuwees die
skeletspier innerveer?
_______________________________________________________________________(1)
g)

By what intracellular mechanism is muscle contraction terminated?

g)
Deur watter intrasellulre meganisme word spierkontraksie getermineer?
_______________________________________________________________________(1)
h)
Explain the phenomenon of rigor mortis (post-mortem muscle stiffness).
h)
Verduidelik die konsep van rigor mortis ( post-morten spierstyfheid).
_______________________________________________________________________(1)
i)
In what forms does the muscle cell store energy for immediate and short-term use?
i)
In watter vorm stoor die spiere energie vir onmidelike en korttermyn gebruik?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 15/ Vraag 15
a)

Name the toxic byproduct produced by deamination of amino acids in the liver that
accumulates in liver failure?
a)
Noem die toksiese newe-produk geproduseer deur die deaminasie van aminosure in
die lewer wat akkumuleer in lewerversaking.
_______________________________________________________________________(1)
b)

The functioning liver detoxifies this above mentioned substance by combining it with
CO 2 to form a water-soluble molecule. Name this molecule.
b)
Die lewer detoksifiseer hierdie bogenoemde substans deur dit te kombineer met CO 2
om n wateroplosbare molekule te vorm. Noem di molekule.
_______________________________________________________________________(1)
c)

A coagulopathy is frequently seen in patients with obstructive jaundice. Explain the


reason for this.
c)
n Koagulopatie word dikwels in pasinte met obstruktiewe geelsug gesien. Gee
redes hiervoor.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
d)
d)

What volume of blood is normally contained within the liver of healthy adults?
Wat is die volume bloed normaalweg teenwoordig in die lewer van n gesonde
volwassene?
_______________________________________________________________________(1)
e)
Explain why ketone bodies are released by the liver when in lipolytic states.
e)
Verduidelik hoekom ketoonliggame vrygestel word deur die lewer in lipolitiese state.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
f)
f)

How does the liver compensate for hypoglycaemia.


Hoe kompenseer die lewer vir hipoglikemie?

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2)
[10]
Question 16 / Vraag 16
In maternal physiology, list the average maximum physiological changes associated with
pregnancy in the following organ systems
In moederlike swangerskapsfisiologie, lys die gemidelde maksimum fisiologiese
veranderinge in die volgende sisteme
a)
Minimum Alveolar Concentration of Anaesthetic Vapours
a)
Minimum Alveolre Konsentrasie van narkosedampe.
_______________________________________________________________________(1)
b)
Glomeruler filtration rate.
b)
Glomerulre filtrasiespoed.
_______________________________________________________________________(1)
c)
Haemoglobin.
c)
Hemoglobien.
_______________________________________________________________________(1)
d)
Platelets.
d)
Plaatjies.
_______________________________________________________________________(1)
e)
Functional Residual Capacity.
e)
Funksionele Residuele Kapasiteit.
_______________________________________________________________________(1)
f)
PaCO 2
_______________________________________________________________________(1)
g)
HCO 3
_______________________________________________________________________(1)
h)
Diastolic blood pressure.
h)
Diastoliese bloeddruk.
_______________________________________________________________________(1)
i)
Peripheral vascular resistance.
i)
Perifere vaskulre weerstand.
_______________________________________________________________________(1)
j)

Pulmonary vascular resistance.

j)
Pulmonale Vaskulre weerstand.
_______________________________________________________________________(1)
[10]
Question 17 / Vraag 17
A patient suffers from type I (insulin dependent) diabetes. laboratory investigations as
follows
n Pasint ly aan tipe 1 (insulien-afhanklike) diabetes. Laboratorium ondersoeke is soos volg
Plasma:
Na+
K+
ClTotal /Totale CO 2
Urea /Ureum
Creatinine/ Kreatinien
Glucose/ Glukose

142 mmol/l
4.8 mmol/l
110 mmol/l
14 mmol/l
18.0 mmol/l
168 umol/l
27.9 mmol/l

Arterial blood gas / Arterile bloedgas


F i O 2 =60% F i O 2 = 60%
pH
7.20
PaO 2
98 mmHg / 13kPa
39 mmHg / 5.2kPa
PaCO 2
HCO 3 12 mmol/L
O 2 Saturation 95% / O 2 Saturasie 95%
Urine Dipstix: Ketone +++: / Uriene doopstokkie: Ketone +++
Glucose ++++ / Glukose ++++
a)

Name the ketones that are present and give a full biochemical explanation how
ketones are synthesized.
a)
Noem die ketone wat teenwoordig is en gee n volledige biochemiese verduideliking
hoe ketone gesintetiseer word.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(6)
b)
Discuss fully the patients acid base status.
b)
Bespreek hierdie pasint se suur basis status volledig.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(4)

[10]
Question 18 / Vraag 18
Briefly discuss Nitric Oxide (NO) under the following headings
Bespreek kortliks Nitriese Oksied (NO) onder die volgende hoofde
a)
Synthesis.
a)
Sintese.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(4)
b)
Half life.
b)
Halflewe.
_______________________________________________________________________(1)

c)
Functions in the human body.
c)
Funksies in die menslike liggaam.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(5)
[10]

Question 19 / Vraaag 19
a)
a)

Draw a fully annotated diagram of the oxyhemoglobin dissociation curve.


Teken
n
ten
volle
geannoteerde
diagram
van
die
hemoglobiendissosiasiekurwe.

suurstof-

(6)
b)
Superimpose a CO 2 dissociation curve on the above diagram.
b)
Teken n CO 2 -dissosiasiekurwe op bostaande grafiek.
_______________________________________________________________________(1)
c)
Name three factors which shift the oxyhemoglobin-dissociation curve to the left
c)
Noem drie faktore wat die suurstof-hemoglobiendissosiasiekurwe na links skuif.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(3)
[10]
Question 20 / Vraag 20
Draw a fully detailed and annotated sketch of the neuromuscular junction.
Teken n volledig gedetaileerde en benoemde skets van die neuromuskulre aansluiting.

[10]

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

7 September 2011

Pharmacology
Paper 3

(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

a)

b)

c)
d)

e)
f)

Draw the following dose response curves

i)
ii)
iii)
i)
ii)
iii)
i)
ii)
i)
ii)

An agonist.
An agonist in the presence of a competitive antagonist.
Discuss these curves.
(5)
Define volume of distribution.
What are the factors that determine a drugs volume of distribution?
What is meant by a small, moderate and large volume of distribution,
giving an example of a drug for each.
(10)
Fully define the term half-life.
What are the factors that determine a drugs half-life?
(10)
What is zero order kinetics?
Discuss the metabolism of ethanol as an example of zero order kinetics.

(10)
Explain the concept of ion trapping, providing an example of where ion
trapping may occur.
(5)
Explain why
i) The peak pharmacological effect of warfarin only occurs after 48 hours.
ii) The main antidepressant effect of tricyclic antidepressants only occurs
after 2 weeks.

iii) The duration of action of aspirin is not directly related to the plasma halflife.
(10)
[50]
1

a)

b)

c)
d)

e)
f)

As regards neuraxial opioids

a)
b)
c)
d)
e)
f)
g)

h)

Teken die volgende dosis-responskurwes


i)
n Agonis.
ii)
n Agonis in die teenwoordgiheid van n kompeterende antagonis.
iii)
Bespreek hierdie kurwes.
(5)
i)
Definieer volume van distribusie.
ii)
Wat is die faktore wat n middel se volume van distribusie benvloed?
iii)
Wat word bedoel by n klein, matige en groot volume van distribusie en
gee n voorbeeld van n middel vir elk?
(10)
i)
Definier volledig die term halflewe.
ii)
Wat is die faktore wat n middel se halflewe bepaal?
(10)
i)
Wat is nul-orde kinetika?
ii)
Bespreek die metabolisme van etanol as n voorbeeld van nul-orde
kinetika.
(10)
Verduidelik die konsep van ioonvasvanging (ion trapping) en voorsien n
voorbeeld van waar ioonvasvanging mag voorkom.
(5)
Verduidelik waarom
i)
Die piek-farmakologiese effek van warfarin eers na 48-uur voorkom.
ii)
Die effektiewe farmakologiese effek van trisikliese antidepressante
eers na 2 weke voorkom.
iii)
Die werkingsduur van aspirien is nie direk verwant aan die
plasmahalfleeftyd nie.
(10)
[50]

Explain the reasoning for giving opioids neuraxially as opposed to


intravenously.
(4)
Define both an opioid and an opiate.
(4)
Discuss the differences in efficacy between lipophilic and hydrophilic opioids
given intrathecally.
(8)
List the adverse effects of neuraxial opiates, the mechanism by which the
adverse effects occur, and how they would be treated.
(13)
Write notes on the use of morphine given epidurally vs. intrathecally.
(8)
List the dosages for epidural administration of morphine, fentanyl and
sufentanil as a bolus.
(3)
What are the benefits of adding fentanyl to bupivicaine for spinal anaesthesia
for a Caesarian section. What are the dosages used for fentanyl and
bupivicaine?
(5)
What are the advantages and disadvantages of using Pethidine neuraxially?
(5)
[50]

Met betrekking tot neuraksiale opioede

a)
b)
c)

Verduidelik die redenasie om opioede neuraksiaal toe te dien teenoor


intraveneuse toediening.
(4)
Definier beide n opioed en opiaat.
(4)
Bespreek die verskille in effektiwiteit tussen lipofiliese en hidrofiliese opioede
met intratekale toediening.
(8)

d)
e)
f)
g)
h)

Lys die ongewensde effekte van neuraksiale opioede, die meganisme


waarop die newe-effekte berus en hoe dit behandel kan word.
(13)
Skryf notas oor die gebruik van epidurale- versus intratekale morfien.
(8)
Lys die doserings van epidurale morfien, fentanyl en sufentanil as
bolusdoserings.
(3)
Wat is die voordele van fentanyl byvoeging tot bupivakaen vir spinal narkose
vir n keisersnit? Wat is hierdie doserings fentanyl en bupivakaen?
(5)
Wat is die voordele en nadele van neuraksiale Pethidine?
(5)
[50]

a)
b)
c)
d)
e)

f)
g)

Fully define the term MAC.


Discuss all the derived MAC values.
What are the MAC values of current inhalational agents.
Discuss the term MAC multiples with reference to current volatile agents.
Draw the chemical structure of
i)
Sevoflurane, desflurane, halothane, isoflurane and enflurane.
ii)
Which of these agents are isomers.
What are the effects of bromide, chlorine, fluorine and hydrogen in these
compounds.
Discuss the relationship between the volatile agents and liver dysfunction. (9)

(5)
(8)
(7)
(6)
(10)
(1)
(4)
[50]

a)
b)
c)
d)
e)

f)
g)

a)
b)
c)
d)

Definier die term MAK volledig.


Bespreek al die afgeleide MAK-waardes.
Wat is die MAK-waardes van die huidige inhalasiemiddels?
Bespreek die term MAK-veelvoude met verwysing na die huidige dampe.
Teken die chemiese struktuur van
i)
Sevofluraan, desfluraan, halotaan, isofluraan and enfluraan.
ii)
Watter van hierdie agente is isomere?
Wat is die efekte van bromied, chloried, fluoried en waterstof in hierdie
verbindings?
Bespreek die verwantskap tussen dampe en lewerdisfunksie?

Write short notes on the mechanisms of action of paracetamol.


Describe the metabolism and excretion of paracetamol.
What are the principles in the management of an acute paracetamol
overdose.
Briefly discuss the differences in the pharmacokinetics between orally, rectally
and intravenously administered paracetamol.

(5)
(8)
(7)
(6)
(10)
(1)
(4)
(9)
[50]

(10)
(20)
(10)
(10)
[50]

a)
b)
c)
d)

Skryf kort notas oor die werkingsmeganismes van parasetamol.


(10)
Beskryf die metabolisme en ekskresie van parasetamol.
Wat is die beginsels in die hantering van n akute parasetamol-oordosering?
(10)
Bespreek kortliks die verskille in die farmakokinetika tussen orale, rektale en
intraveneuse parasetamol.

(20)

(10)
[50]

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
7 September 2011
Pharmacology
Paper 4

(2 hours)

Candidate Number:.............................................
Question 1/ Vraag 1
Explain the main mechanism of action of the following drugs used in the treatment of
diabetes.
Verduidelik die werkingsmeganisme van die volgende middels wat gebruik word in die
behandeling van diabetes.
(2)
a)
Metformin.
a)
Metformien.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
b)
Sulphonylureas.
(2)
b)
Sulfonielureums.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
c)
Acarbose.
(1)
c)
Acarbose.
_________________________________________________________________________
d)
Insulin.
(3)
d)
Insulien.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
e)

Glucagon.

(2)

e)
Glukagon.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]
Question 2/ Vraag 2
a)
What is the mechanism of action of statins?
(2)
a)
Wat is meganisme van werking van die statiene?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
a)
What are the clinical effects of statins?
(2)
b)
Wat is die kliniese effekte van die statiene?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
b)
List the main side effects of statins.
(4)
c)
Lys die belangrikste newe-effekte van die statiene.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
c)
What are the consequences of acute postoperative statin discontinuation?
(2)
d)
Wat is die die postoperatiewe gevolge van die akute staking van statiene?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]
Question 3/ Vraag 3
List side effects of corticosteroids.
(9)
Lys die newe-effekte van kortikosteroede.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Which corticosteroid preparation has mainly mineralocorticoid effects?
(1)
Watter kortikosteroedformuleringe het hoofsaaklik mineralokortikoed effekte?
_________________________________________________________________________
[10]
Question 4/ Vraag 4
a)
a)

Complete the table regarding the clinical effects and their appropriate receptor for
adenosine.
Voltooi die tabel omtrent die kliniese effekte en hul ooreenstemmende reseptor vir
adenosien.
(3)
Receptor responsible/
Verantwoordelik Reseptor

Clinical effect/ Kliniese Effek

A1
A2
A3
b)
What are the indications for adenosine?
(2)
b)
Wat is die indikasies vir adenosien?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
c)
What are the side effects of adenosine?
(3)
c)
Wat is die newe-effekte van adenosien?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
d)
In what conditions is adenosine contraindicated?
(2)
d)
By watter toestande is adenosien teenaangedui?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
[10]
Question 5/ Vraag 5
a)
Define context sensitive half-time.
(1)
a)
Definieer konteks-sensitiewe halfleeftyd.
_________________________________________________________________________

b)
b)

c)
c)

Complete the following graph using plasma concentration versus time to illustrate
how context sensitive half-time is derived.
Voltooi die volgende grafiek deur gebruik te maak van plasmakonsentrasie en tyd
om te illustreer hoe konteks-sensitiewe halflewe afgelei is
(3)

Label the axes and complete the following graph for the context sensitive half-times
of Remifentanil, propofol, fentanyl and sufentanil.
Benoem die asse en voltooi die volgende grafiek vir die konteks-sensitiewe
halflewes van remifentanil, propofol, fentanyl en sufentanil.
(6)

[10]

Question 6/ Vraag 6
a) Classify anti-arrhythmic agents and give an example for each group
(5)
a) Klassifiseer antidisritmiese middels en gee n voorbeeld vir elke groep.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
b)
b)

Write notes on the side- effects of amiodarone.


Skryf notas oor die newe-effekte van amiodaroon.

(5)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
[10]
Question 7/ Vraag 7
a) List agents responsible for prolonging non-depolarising neuromuscular blockade.
a) Lys agente verantwoordelik vir die verlenging van n nie-depolariserende
neuromuskulre blokkade.
(6)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
b)

The use of reversal agents is mandatory after non-depolarising muscle relaxants have
been administered? Discuss briefly
b) Die gebruik van omkeer is essensieel na nie-depolariserende spierverslappers
toegedien is? Bespreek kortliks.
(4)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
[10]
Question 8/ Vraag 8
a) Give the recommended maximum dosages of the following local anaesthetic agents
when used for local infiltration.
a) Gee die voorgestelde maksimum doserings van die volgende lokaalverdowers met
gebruik vir lokaalinfiltrasie.
(3)
Agent/ Agens
Lignocaine
Lignokaen

Bupivacaine
Bupivakaen

Ropivicaine

Dose/ Dosering

Ropivikaen
b) How would the toxic effects occurring from lignocaine infiltration present?
b) Hoe sal die toksiese effekte van lignokaen-infiltrasie presenteer?
(4)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
c) Describe the treatment of bupivicaine toxicity.
c) Beskryf die behandeling van bupivakaentoksisiteit.
(3)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
[10]
Question 9/ Vraag 9
Concerning dantrolene
Betreffende dantroleen
a)
a)

List the indications for its usage.


Lys die indikasies vir gebruik.

(3)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
b)
b)

Briefly explain the mechanism of action.


Verduidelik kortliks die werkingsmeganisme.

(4)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
c)
c)

Give the recommended dosages.


Gee die aanbevole doserings.

(3)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

__________________________________________________________________________
__________________________________________________________________________
[10]
Question 10 / Vraag 10
Complete the following table with the agents (readily available) you would use to deliberately
decrease blood pressure intra-operatively, and very briefly describe the mechanism of action
of each.
Voltooi die volgende tabel met die middels (geredelik beskikbaar) wat u sal gebruik om
doelbewus bloeddruk intra-operatief te laat daal, en beskryf kortliks die meganisme van
werking van elk
Agent

Mechanism of action/ Meganisme van werking

Question 11 / Vraag 11
a)
a)

Make short notes on the principles behind prescribing prophylactic antibiotics.


Skryf kort notas oor die beginsels rakende die voorskryf van profilaktiese antibiotika.
(4)
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b) List the drugs that are used for post needle stick HIV prophylaxis.
b) Lys die middels wat gebruik word vir postnaaldprik MIV-profilakse.
(3)
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c)

What are the side effects of drugs used in the treatment of human immune deficiency
(HIV)/Aids?
c) Wat is die newe-effekte van middels wat gebruik word in die behandeling van menslike
immuungebrek (MIV/Vigs)?
(3)
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[10]

Question 12 / Vraag 12
a)
What are the side effects of tramadol?
a)
Wat is die newe-effekte van tramadol?
(3)
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b)
Describe the mechanism of action of codeine.
b)
Beskryf die meganisme van werking van kodeen.
(2)
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c)
What are the adverse effects of non-steroidal anti-inflammatory drugs?
c)
Wat is die ongewensde effekte van die nie-steroed anti-inflammatoriese middels? (3)
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d)
What are the side effects of dextropropoxyphene?
d)
Wat is die newe-effekte van dekstropropoksifeen?
(2)
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[10]
Question 13 / Vraag 13
Antibiotic pharmacokinetics/ Antibiotika farmakokinetika
a)
What is meant by the term post antibiotic effect (PAE)?
a)
Wat word bedoel met die term post-antibiotiese effek (PAE)?
(2)
________________________________________________________________________
b)

Complete the following two graphs and indicate on the graphs


Minimal Inhibitory Concentration (MIC).
Concentration of the surviving organism.
Bolus dose of antibiotic.
b)
Voltooi die volgende twee grafieke en dui aan op die grafieke
Minimum inhibitoriese konsentrasie (MIC).
Konsentrasie van die oorlewende organisme.
Bolusdosering antibiotika.
i)
Time dependent killing
i)
Tyd-afhanklike dood (Time dependent killing)

(3)

ii)
ii)

Concentration dependent killing


Konsentrasie-afhanklike dood (Concentration dependent killing)

(3)

c) Provide an example of an antibiotic showing time dependent killing.


c) Gee n voorbeeld van n antibiotika verantwoordelik vir tyd-afhanklike dood.
(1)
________________________________________________________________________
d)
d)

Provide an example of an antibiotic showing concentration dependent killing


Voorsien n voorbeeld van n antibiotika verantwoordelik vir konsentrasie-afhanklike
dood.
(1)
________________________________________________________________________
[10]
Question 14/ Vraag 14
Make notes on the following agents that are added to local anaesthetic drugs indicating the
reason for adding them to local anaesthesia and their mechanism of action.
Skryf notas oor die volgende middels wat by lokaalverdowers gevoeg word en dui die rede
aan vir byvoeging by lokaalverdowing, en gee die werkingsmeganisme.
a)
Hyaluronidase.
a)
Hyaluronidase.
(2)
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b)
b)

Bicarbonate.
Bikarbonaat.

(2)

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c)
c)

Neostigmine.
Neostigmine.

(2)

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d)
d)

Clonidine.
Klonidien.

(2)

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e)
e)

Ketamine.
Ketamien.

(2)

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[10]
Question 15 / Vraag 15
Drug Calculations [show full calculations]
Middelberekeninge [wys die volle bewerkinge]:
a)

You are admitting a 70kg patient from a local hospital on an adrenaline infusion. 5mg
has been added to 200ml of normal saline running at 135ml/hour. What is the rate in
ug/kg/min?
a)
U neem n 70kg pasint op vanaf n lokale hospitaal met n adrenalieninfuus. 5mg is
by 200ml normale saline gevoeg en loop teen 135ml/uur. Wat is die tempo in
ug/kg/min?
(5)
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b)

You are asked to inject 8 mls of 50% dextrose into 200mls of Ringer lactate solution.
What is the final concentration of dextrose contained in this 200ml bag in % and
mg/ml
b)
U word gevra om 8ml 50% dekstrose in 200ml Ringerslaktaat te spuit. Wat is die
finale konsentrasie dekstrose in hierdie 200ml sak in % en in mg/ml?
(5)
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[10]
Question 16 / Vraag 16
Briefly discuss the mechanism of action of the following anticoagulants
Beskryf kortliks die werkingsmeganisme van die volgende antistolmiddels
a)
Fondaparinux.
a)
Fondaparinux.
(2)
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b)
Clopidogrel.
b)
Klopidogrel.
(2)
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c)
Tirofiban.
c)
Tirofiban.
(2)
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d)
Dabigatran etexilate
d)
Dabigatran etexilate.
(2)
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e)
Rivaroxaban.
e)
Rivaroxaban.
(2)
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[10]
Question 17 / Vraag 17
a)
What is Entenox?
a)
Wat is Entenox?
(1)
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b)
b)

List the desirable effects of nitrous oxide.


Lys die wenslike effekte van laggas.

(2)

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c)
c)

List the undesirable side effects of nitrous oxide.


Lys die onwenslike effekte van laggas.

(7)

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[10]
Question 18 / Vraag 18
Define the following terms
Definieer die volgende terme
a)
a)

pKa.
pKa.

(2)

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b)
b)

Bioavailability.
Biobeskikbaarheid.

(2)

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c)
c)

Bioequivalence.
Bio-ekwivalensie (Bioequivalence).

(2)

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d)
d)

Clearance.
Opruiming.

(2)

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e)
Mean residence time.
e)
Mean residence time.
(2)
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[10]
Question 19 / Vraag 19
a)
a)

Explain briefly the mechanisms of action through which ketamine exerts its effects.
Verduidelik kortliks die werkingsmeganisme waardeur ketamien sy effekte uitoefen.
(3)
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b)
b)

List the side effects of ketamine


Lys die newe-effekte van ketamien.

(4)

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c)
c)

What potential advantages does the use of S-ketamine have over the racemic
mixture
Watter potensile voordele het die gebruik van S-ketamien bo die rasemiese
mengsel?
(3)

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[10]
Question 20 / Vraag 20
a) How do tricyclic antidepressants modulate their analgesic effect in neuropathic pain?
a) Hoe moduleer trisikliese antidepressante hul analgetiese effek in neuropatiese pyn?(3)
________________________________________________________________________
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b) List the common side effects of the tricyclic antidepressants.
b) Lys die algemene newe-effekte van die trisikliese antidepressante.
(5)
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c) List the drug interactions seen with tricyclic antidepressant agents.
c) Lys die middelinteraksies gesien met die trisikliese antidepressante.
(2)
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[10]

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
8 September 2011
Physics
Paper 5

(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

Diffusion of gases and fluids influences all physiological processes


a)
Describe diffusion and the factors influencing the diffusion of gases.
(15)
b)
Describe diffusion of gasses in the body making reference to diffusion within
the lungs and across membranes. Use two gases as examples.
(15)
c)
Describe how diffusion can lead to a build up of osmotic pressure and thus
oedema.
(20)
[50]

Diffusie van gasse en vloeistowe benvloed alle fisiologiese prosesse


a)
Beskryf diffusie en die faktore wat diffusie van gasse benvloed.
(15)
b)
Beskryf die diffusie van gasse deur die liggaam met verwysing na diffusie
binne die longe en oor membrane. Gebruik twee gasse as voorbeelde. (15)
c)
Beskryf hoe diffusie kan lei tot die opbou van osmotiese druk en dus edeem.
(20)
[50]

You are an anaesthesiologist working in a coastal village. You are required to


transport an intubated and ventilated 70 kg patient from theatre to the intensive care
unit 15 minutes away from theatre. The nurse prepares an ambubag and an E type
(5 litre) oxygen cylinder for you. The pressure on the Bourdon type gauge of the
oxygen cylinder reads 5000 kPa.
a)
Classify the Ambubag according to the Mapleson classification.
(2)
b)
What are the fresh gas flow requirements of this system in a patient
i)
Breathing spontaneously?
(2)
ii)
Requiring controlled ventilation?
(2)
c)
What is Avogadros hypothesis?
(2)
d)
What is the molecular weight of O 2 ?
(2)
e)
According to Avogadros volume
i)
What is the volume of 1 mole of oxygen at STP?
(2)
ii)
What is the volume of the same gas at room temperature? (20 degrees
Celsius)?
(5)
f)
Describe a Bourdon gauge by means of an annotated diagram.
(10)

g)
h)

i)

i)
What is the gauge pressure of a full E type oxygen cylinder?
(2)
ii)
What percentage of full is your cylinder?
(6)
You set the oxygen flow on the cylinder to 10L/min and ventilate the patient
manually while you set off to ICU. Using Boyles law, calculate whether there
is enough oxygen in the cylinder for the 15min journey to ICU.
(5)
Which Mapleson circuit would make the most efficient use of the remaining
oxygen if the patient was
i)
breathing spontaneously?
(5)
ii)
being bagged manually?
(5)
In each case give a brief explanation, as well as providing a diagram to
illustrate your answer.
[50]

U is n anestesioloog werksaam in n kusdorp. U moet n gentubeerde en


geventileerde 70kg pasint van teater na die intensiewe sorgeenheid neem, 15
minute daarvandaan. Die verpleegster berei die ambusak en n E-tipe (5 liter)
suurstofsilinder vir jou voor. Die druk op die Bourdonmeter van die suurstofsilinder
lees 5000 kPa.
a)
Klassifiseer die Ambusak volgens die Maplesonklassifikasie.
(2)
b)
Wat is die varsgasvloeivereistes van hierdie sisteem in n pasint wat
i)
Spontaan asemhaal?
(2)
ii)
Gekontroleerde ventilasie benodig?
(2)
c)
Wat is Avogadro se hipotese?
(2)
d)
Wat is die molekulre massa van O 2 ?
(2)
e)
Vogens Avogadro se volume
i)
Wat is die volume van 1 mol suurstof by STP?
(2)
ii)
Wat is die volume van dieselfde gas by kamertemperatuur?
(20 degrees Celsius)?
(5)
f)
Beskryf die Bourdon-meter met behulp van n benoemde diagram.
(10)
g)
i)
Wat is die meterdruk van n vol E-tipe suurstofsilinder?
(2)
ii)
Watter persentasie van vol is u silinder?
(6)
h)
U stel die suurstofvloei van die silinder op 10L/min en ventileer die pasint
manueel op pad na ICU. Gebruik Boyle se wet en bereken of daar genoeg
suurstof in die silinder is vir die 15 minute reis na die intensiewesorgeenheid.
(5)
i)
Watter Maplesonsisteem sal die effektiefste wees ten opsigte van die gebruik
van die oorblywende suurstof indien die pasint
i)
spontaan asemhaal?
(5)
ii)
manueel geventileer word?
(5)
j)
Gee in elke geval n kort beskrywing en diagram om u antwoord te illustreer.
[50]

a)
b)
c)
d)

e)
f)

Define compliance with reference to the lung.


(2)
Describe in terms of the underlying physical principles, the effect that a
decrease in pulmonary compliance has on the work of breathing.
(10)
Discuss the difference between static and dynamic compliance.
(4)
When doing a bedside estimate of compliance on a ventilated patient in ICU
with a fixed tidal volume, which measured value would you use for calculating
static compliance and which value in the calculation of dynamic compliance?
(4)
Draw a graph of a negative exponential process (washout curve) and define
and illustrate the time constant.
(5)
What is the relationship between compliance and the time constant in the
lung?
(5)

g)
h)

a)
b)

c)
d)

e)
f)
g)
h)

What is the clinical significance of the time constant, duration of expiration and
the setting of expiratory time in the mechanically ventilated patient?
(10)
A recruitment manoeuvre performed in a mechanically ventilated patient
results in an increase in pulmonary compliance. Which ventilator value would
you expect to differ from the pre-recruitment value if ventilation is
i)
volume cycled?
ii)
pressure cycled?
State whether this value is increased or decreased. Give the reason/s for your
answer.
(10)
[50]
Definier meegewendheid met verwysing na die long.
(2)
Beskryf die effek wat n vermindering in pulmonale meegewendheid op die
arbeid van asemhaling het in terme van die onderliggende fisiese beginsels.
(10)
Bespreek die verskil tussen statiese en dinamiese meegewendheid.
(4)
Watter gemete waarde sal u gebruik in n geventileerde pasint in die ISE
wanneer n meegewendheidsbepaling langs die bed gemaak word om
statiese meegewendheid te bereken, en watter gemete waarde sal u gebruik
vir die berekening van dinamiese meegewendheid?
(4)
Teken n grafiek van n negatiewe eksponensile proses (uitwaskurwe)
en definieer en illustreer die tydskonstante.
(5)
Wat is die verwantskap tussen meegewendheid en die tydskonstante in die
long?
(5)
Wat is die kliniese betekenis van die tydskonstante, duur van ekspirasie en
ekspiratoriese tydverstelling in die meganies geventileerde pasint. (10)
n Herwinningsmaneuver uitgevoer in n meganies-geventileerde pasint
veroorsaak n verhoging in longmeegewendheid. Watter ventilatorwaarde sal
u verwag om te verskil van die pre-herwinningswaarde as ventilasie
i)
volumebeheer?
ii)
drukbeheer is?
Stel of hierdie waarde verhoog of verlaag is. Gee die rede/s vir u antwoord.
(10)

[50]
The Thromboelastogram (TEG) tracing represents different phases of clot formation
and subsequent breakdown. A normal tracing is shown below.

a)

Explain the mechanism by which Thromboelastogram (TEG) tracing is


generated. A diagram may be used to illustrate your answer.
(10)
b)
Define the components of the tracing that are used to qualitatively assess the
various steps of clot formation and breakdown: R,K, -angle MA and A60, as
shown above. Explain what aspects of clot formation each of these describe?
(20)
c)
(In each of a, b and c below give as many examples as possible where
relevant)
i)
Which factors increase R?
(3)
ii)
Which factors decrease R?
(3)
iii)
What does a reduced -angle represent?
(2)
d)
What characteristic of a clot does MA describe?
(2)
e)
How can primary fibrinolysis be distinguished from secondary fibrinolysis
using the TEG?
(4)
f)
What advantages does the TEG offer over conventional coagulation
testing?(3)
g)
List 3 limitations that TEG has in assessing coagulation.
(3)
[50]
4

Die Tromboelastogram (TEG) verteenwoordig verskillende fases van stolselformasie


en daaropvolgende afbraak. n Normale gram word hieronder vertoon.

a)
b)

c)

d)
e)
f)
g)

Verduidelik die meganisme hoe die Tromboelastogramgrafiek (TEG) gevorm


word. n Diagram mag gebruik word om u antwoord te illustreer.
(10)
Definieer die komponente van die grafiek wat gebruik word om kwalitatief die
verskeie stappe van stolselformasie en afbraak te assesseer: R, K, -hoek,
MA and A60, soos hierbo gewys. Verduidelik watter aspek van
stolselformasie word verteenwoordig deur elk.
(20)
(Gee soveel relevante voorbeelde as moontlik in a, b en c hieronder)
i)
Watter faktore vermeerder R?
(3)
ii)
Watter faktore verminder R?
(3)
iv)
Wat verteenwoordig die -hoek?
(2)
Watter eienskap van die stolsel word deur MA beskryf.
(2)
Hoe kan primre fibrinolise onderskei word van sekondre fibrinolise deur
gebruik te maak van die TEG?
(4)
Watter voordele het die TEG bo konvensionele stollingstoetse?
(3)
Lys 3 beperkinge van die TEG in die beoordeling van stolling.
(3)
[50]

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
8 September 2011
Physics
Paper 6

(2 hours)

Candidate Number:
Question 1 / Vraag 1
Complete the following table by stating if the statements about Gas Laws are true or false.
Where you indicated the answer as false, please briefly explain the correct answer in the
space below the table. (Indicate the letter of the statement you are referring to in your
answer)
Voltooi die volgende tabel deur aan te dui of die stellings oor Gaswette waar of onwaar is.
Verduidelik die korrekte antwoord kortlik waar u aangedui het dat die stelling vals is.
Statement
Stelling
a
b

Molecular energy has no influence on pressure.


Molekulre energie het geen invloed op druk nie.
Increasing temperature increases volume if pressure is kept constant.
Temperatuurverhoging verhoog volume as druk konstant gehou word.

Partial pressure of a vapour is dependent upon fluid surface area.


Parsile druk van n damp is afhanklik van die vloeistof oppervlakarea.

The number of atoms in 12g of 12C is called Avogadros number.


Die aantal atome in 12g 12C word Avogadro se getal genoem.
Pressure exerted by a mixture of gasses is independent of
temperature.
Druk uitgeoefen deur mengsel gasse is onafhanklik van
temperatuur.
Thickness of a membrane does not influence diffusion through it.
Dikte van membraan benvloed nie diffusie deur die membraan nie.

True or False
Waar of Vals

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[10]
Question 2/ Vraag 2
a)
a)

Briefly describe how ultrasound waves are generated and how lateral resolution
varies with depth.
Beskryf kortliks hoe ultraklankgolwe gegenereer word en hoe laterale resolusie
varieer met diepte.
(4)

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b)

Why does ultrasound travel faster in bone than in water, and what effect will this
have on imaging?
b)
Hoekom beweeg ultraklank vinniger in been as in water en watter effek het dit op die
beeld?
(3)
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c)

List 3 advantages Transoesphageal echocardiography (TOE) has over


conventional trans-thoracic echocardiography.
c)
Lys 3 voordele wat Transesofageale eggo (TEE) het bo konvensionele
transtorakale eggo-kardiografie.
(3)
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[10]
Question 3/ Vraag 3
a)
Show graphically the relationship between pressure and turbulent flow in vessels.
a)
Dui grafies die verhouding aan tussen druk en turbulente vloei in bloedvate.
(3)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

__________________________________________________________________________
__________________________________________________________________________
b)
What factors influence turbulent flow rate? Give the relationships.
b)
Watter faktore benvloed turbulente vloeitempo? Gee die verhoudings.
(5)
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c)
Where is turbulent flow most likely to occur in a normal circulatory system?
c)
Waar vind turbulente vloei mees waarskynlik plaas in gesonde vaskulre sisteem?
(2)
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[10]
Question 4 / Vraag 4
a)
Explain how the viscosity of gases affects flow.
a)
Verduidelik hoe die viskositeit van gasse vloei benvloed.
(3)
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b)
b)

Explain how a variable orifice flow meter functions.


Verduidelik hoe varieerbare opening-vloeimeter werk.

(6)

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c)
c)

Why must the bobbin rotate?


Hoekom moet die dobber roteer?

(1)

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[10]
Question 5/ Vraag 5
a)
What is an adiabatic change in a gas?
a)
Wat is n adiabatiese verandering in n gas?
(3)
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__________________________________________________________________________
__________________________________________________________________________
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b)
b)

How does a cryoprobe function?


Hoe werk n kriosonde?

(5)

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c)
c)

What risks are associated with the use of cryoprobes?


Watter risikos word geassosieer met die gebruik van n kriosonde?

(2)

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[10]
Question 6/ Vraag 6
a)
a)

Defibrillators : Briefly describe the mechanism of action of a basic monophasic


defibrillator circuit with the aid of an annotated diagram.
Defibrillators: Beskryf kortliks die meganisme van werking van n monofasiese
defibrillatorstroombaan met behulp van n geannoteerde diagram.
(6)

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b)
b)

Explain the following electrical principles underlying defibrillator function


Verduidelik die volgende beginsels wat defibrillatorfunksie onderl
i)
Capacitance.
i)
Kapasitansie.
(2)
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ii)
Waveforms.
ii)
Golfpatrone.
(2)
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[10]
Question 7 /Vraag 7
a)
List the main components of an intra-arterial blood pressure measuring system.
a)
Lys die hoofkomponente van n intra-arterile bloeddrukmoniteringsisteem.
(5)
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b)

Why should a pressure transducer be positioned at the same level as the


patients heart?
b)
Waarom moet n drukomsetter op dieselfde hoogte as die pasint se hart geplaas
word?
(2)
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c)

Why should an intra-arterial blood pressure measurement system have a high natural
frequency?
c)
Waarom moet n intra-arterile bloeddrukmoniteringsisteem n ho natuurlike
frekwensie h?
(3)
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[10]
Question 8 / Vraag 8
a)
Explain the Fick Principle.
a)
Verduidelik die Fick-beginsel.
(4)
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b)
b)

Describe with the use of appropriate formulae, how this principle may be used
to determine cardiac output.
Beskryf met die gebruik van toepaslike formules hoe hierdie beginsel gebruik kan
word om kardiale uitwerp te bepaal.
(6)

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[10]

Question 9 / Vraag 9
a)
a)
in

If barometric pressure= 750mmHg, CO 2 =6%, O 2 =15%, what are the PO 2 and PCO 2
in mmHg?
Indien barometriese druk = 750mmHg, CO 2 =6%, O 2 =15%, wat is die PO 2 en PCO 2

mmHg?
(2)
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b)

What determines the volume of gas dissolved in a liquid at constant ambient


pressure?
Support your answer by stating and naming an appropriate gas law.
b)
Wat bepaal die volume gas opgelos in n vloeistof by konstante
omgewingsdruk?
Ondersteun u antwoord deur n toepaslike gaswet te gee en te benoem.
(3)
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c)
List two methods which can analyse the O 2 level in a mixture of N 2 , N 2 O and O 2 .
c)
Lys twee metodes wat die O 2 -inhoud kan bepaal in n mengsel van N 2 , N 2 O en
O 2 .(2)
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In a normothermic patient T=37,2oC undergoing an elective procedure, the
anaesthesia is maintained with Isoflurane 1,2% in a mixture of O 2 and N 2 O. Is the
N 2 0 in the patients alveoli a gas or a vapour? Explain.
d)
Narkose word in n normotermiese pasint (T=37,2oC) onderhou met Isofluraan 1,2%
in n mengsel van O 2 en N 2 O wat n elektiewe prosedure ondergaan. Is die N 2 O
in die pasint se alveoli n gas of n damp? Verduidelik.
(3)
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[10]
d)

Question 10 / Vraag 10
a)
a)

Explain the mechanism of action of the carbon dioxide absorber in a circle system
with the aid of appropriate formulae.
Verduidelik die meganisme van werking van die koolsuurgas-absorbeerder in
n sirkelsisteem met behulp van toepaslike formules.
[8]

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b)
b)

List two possible negative reactions that may occur in the absorber.
Lys twee moontlike negatiewe reaksies wat in die absorbeerder kan voorkom.

(2)

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[10]
Question 11 / Vraag 11
a)
a)

Describe the physical principle used in surgical diathermy.


Beskryf die fisiese beginsel waarop die chirurgiese diatermie berus.

(5)

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b)
b)

How does monopolar diathermy differ from bipolar diathermy.


Hoe verskil monopolre diatermie van bipolre diatermie?

(2)

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c)
List the advantages and disadvantages of monopolar versus bipolar diathermy.
c)
Lys die voordele en nadele van monopolre versus bipolre diatermie.
(3)
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[10]
Question 12 / Vraag 12
a)
a)

List the characteristics required for a stimulus to monitor the neuromuscular junction.
Lys die eienskappe benodig vir n stimulus om die neuromuskulre aansluiting
te moniteer.
(5)
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b)
b)

Briefly describe the pattern/s of stimulation used to monitor the use of a


Beskryf kortliks die stimulasiepatroon/e gebruik om die volgende te monitor
i)
Depolarising neuromuscular blocking agent.
i)
Depolariserende neuromuskulre blockers.
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ii)
Nondepolarising neuromuscular blocking agent.
ii)
Nie-depolariserende neuromuskulre blockers.
(4)
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[10]
Question 13 / Vraag 13
a)

a)

Compare the energy required to heat inspired gas from room temperature to
body temperature with the energy required to humidify dry inspired gas in the upper
respiratory tract.
Vergelyk die energie benodig om ingeasemde gas te verhit vanaf kamertemperatuur
tot liggaamstemperatuur met die energie benodig om droe ingeasemde gas te
humidifiseer in die boonste respiratoriese traktus.
(6)

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b)
b)

How can this energy cost be minimised during anaesthesia?


Hoe kan hierdie energiekoste vermider word gedurende narkose?

(4)

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[10]
Question 14 / Vraag 14
a)
Describe the effect of the movement of electrons in a conductor.
a)
Beskryf die effek van die beweging van elektrone in n geleier.
(2)
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b)
b)

What are the physical factors which affect the flow of electrons? Use diagrams
to illustrate your answer.
Wat is die fisiese faktore wat die vloei van elektrone benvloed? Gebruik diagramme
om u antwoord te illustreer.
(5)

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c)
c)

How are these modified to assist in the generation of a strong magnetic field for
magnetic resonance imaging?
Hoe word dit gemodifiseer om te assisteer in die generasie van n sterk magneetveld
vir magnetiese ressonansie beelding?
(3)

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[10]
Question 15 / Vraag 15
a)
Define heat and the SI unit for temperature.
a)
Definieer hitte en die SI-eenheid vir temperatuur.
(2)
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b)

Briefly describe a method of intraoperative measurement of temperature and list


the advantages and any disadvantages of this method.
b)
Beskryf kortliks n metode vir intraoperatiewe temperatuurmeting en lys die voordele
en enige nadele van hierdie metode.
(5)
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c)
c)

List the possible sites for intraoperative temperature monitoring.


Lys die moontlike plekke vir intraoperatiewe temperatuurmeting.

(3)

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[10]
Question 16 / Vraag16
a)
a)

Explain how each of the following affect vaporiser output


Verduidelik hoe elk van die volgende verdamperuitset benvloed
i)
Flow rate.
i)
Vloeitempo.
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ii)
Temperature.
ii)
Temperatuur.
(2)
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iii)
The pumping effect.
iii)
Die pumping-effek.
(2)
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b)

Describe what design modifications may be used to decrease variations in vaporiser


output as described in your answers above for
b)
Beskryf watter onwerpmodifikasies gebruik mag word om variasies in
verdamperuitset te beperk, soos beskryf in u antwoord hierbo.
i)
Flow rate.
i)
Vloeitempo.
(1)
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ii)
Temperature.
ii)
Temperatuur.
(2)
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iii)
iii)

The pumping effect.


Die pumping-effek.

(2)

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[10]
Question 17 / Vraag 17
a)
a)

Define and in each case give the units in which they are measured
Definieer en gee die eenhede waarin die volgende gemeet word
i)
Absolute humidity.
i)
Absolute humiditeit.
(2)
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b)
Relative humidity
b)
Relatiewe humiditeit.
(3)
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c)
c)

Explain the physics that result in water accumulating in the tubing of a circle system
breathing circuit.
Verduidelik die fisika verantwoordelik vir water wat akkumuleer in die
asemhalingsisteempype van n sirkelsisteem.
(3)

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d)
Where does this water originate from?
d)
Waar kom hierdie water oorspronklik vandaan?
(1)
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e)
Which device helps to prevent the water from accumulating in the first place?
e)
Watter apparaat help eerstens om te voorkom dat water akkumuleer?
(1)
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[10]
Question 18 / Vraag 18
a)
a)

Explain the following terms


Verduidelik die volgende terme
i)
Null hypothesis.

i)
Nulhipotese.
(2)
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ii)
is the probability of a Type I error. What is a Type I error?
ii)
is die waarskynlikheid van n Tipe I fout. Wat is n Tipe I fout?
(1)
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iii)
is the probability of a Type II error. What is Type II error?
iii)
is die waarskynlikheid van n Tipe II fout. Wat is n Tipe II fout?
(1)
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b)
Give the formula for determining the power of a statistical test.
b)
Gee die formule vir die bepaling van die krag van n statistiese toets.
(1)
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c)
c)

Write brief notes on the factors that influence the power of a study.
Skryf kort notas oor die faktore wat die krag van n studie benvloed.

(5)

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[10]
Question 19 / Vraag 19

A
B

a)
Label the letters A,B,C and D
a)
Benoem letters A,B,C en D.
(4)
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b)
Give a description of how the electrode measures oxygen tension.
b)
Gee n beskrywing van hoe die elektrode suurstofspanning meet.
(6)
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[10]
Question 20 / Vraag 20
Regarding the pneumotachograph
Betreffende die pneumotakograaf
a)
Write short notes explaining the principles of a pneumotachograph.
a)
Skryf kort notas om die beginsels van n pneumotakograaf te verduidelik.
(6)
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b)
Briefly describe any advantages it offers over other flowmeters.
b)
Beskryf kortliks die voordele wat dit bied bo ander vloeimeters.
(2)
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c)
Mention how its accuracy may be affected.
c)
Verduidelik hoe die akkuraatheid benvloed mag word.
(2)
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[10]