PHYSICS MCQs

Cyprian Mendonca
 Topics

Measurement of blood gases

Measurement of gas flow

Monitoring ECG

Monitoring & Measurement of oxygen

Measurement of blood pressure

Agent monitoring

Severinghaus electrode

Clark electrode (blood: gas factor)

Mass spectrometry

Fuel cell

Infrared analyser

FTTTF
Mass spectrometry
 Mass Spectrometry
Rapid response time
Multiple gas analysis
Expensive
too bulky

Angle of deflection
depends on
charge mass ratio

Charge/mass

CO2 Enflurane
Charge/mass
O2

Blood gas analyser directly measures
Pa O2, PaCO2 and pH using
specific electrodes .

Membrane permeable to O2, CO2, H+

Bicarbonate

2 electrodes

Reference electrode : Ag /Agcl

Measuring electrode: pH glass

Electrolyte: NaHCO3, Kcl

CO2+H2O H2CO3 H+ +HCO3-

electrodes

H+ glass
Mesh -HCO3-
CO2 permeable teflon membrane
 H+ V
Measuring
electrode Reference electrode
Ag/AgCl

Ag/Agcl or calomel reference electrode

Buffer
H+ Kcl

H+ sensitive glass leaky membrane

Voltage change in the measuring electrode

 CO2 pH

Ref Elect Ag/AgCl Ag/Agcl

Hg/Hgcl
Measuring pH glass pH glass
Electrode
Electrolyte Kcl, Kcl
NaHCO3

Excess heparin in the sample lowers the pH
value

Sampled blood can be stored at room temp for
up to one hour

pH is usually calculated using Siggard-
Anderson nomogram

CO2 electrodes are maintained at room
temperature

CO2 electrodes have a response time of 20
secs
TFFFF
Response time 2-3 minutes
1 kPa = 30 minutes
2ml = 80 units of heparin

has CO2 sensitive glass

uses sodium bicarbonate as electrolyte

is an indirect method of measuring
carbon dioxide tension

is accurate to within 1mmHg

is temperature-dependent
FTTTT
Indirect: 0.01 unit of pH change per 0.1 kPa CO2

Fuel cell

Clark electrode

Paramagnetic oxygen anlaysers

 Finite shelf-life=1year
calibration
self generated voltage

No power supply

slow response
Lead anode
KOH

Pb + 2OH- PbO + 2e- + 2H2O Gold cathode


FiO2 reading is not affected

Life span of cell is affected

(N2O reacts with lead anode)

polarising voltage 0.7 V

Ag/AgCl
anode
KCl

Platinum cathode

Anode
Ag + Cl = AgCl + e

Cathode

O2 + 2H2O + 4e = 4OH

Electolyte
NaCl + OH = NaOH + Cl
Electrons donated at anode, consumed at
cathode
 Polarographic-platinum, Agcl

Fuel cell Clark

Anode Lead Ag/Agcl

Cathode gold platinum

Electrolyte KOH Kcl, Nacl


Has a Gold cathode

Has a platinum anode (lead)

Uses sodium hydroxide as the
electrolyte solution (KOH)

Require a voltage of 6-7 volts applied
across the electrodes (0.7 V for clark)

Is affected by the presence of N2O

TFFFT

a. Infrared analyser

b. Raman spectroscopy

c. Mass spectrometry

d. Refractometer

e. Quartz crystal

TTTTF

pH

Standard bicarbonate : Siggard-Anderson
nomogram

Carboxy haemoglobin

Oxyhaemoglobin saturation: ODC

Base excess

FTFTT
 a)measures Oxygen concentration
b)is the classical method of calibrating
vaporisers
c)is affected by water vapour
d)does not require prior calibration
e)is affected by temperature
FTTTT
All affected by water vapour except fuel cell

When sine waves of same frequency, amplitude
and phase are added, resulting sine wave will
have greater amplitude. If two sine waves are
180o out of phase, the resulting sine wave will
have zero amplitude and appears as straight
line. Addition of sine waves in a variable degree
of out of phase will result in respective change in
the amplitude.

In a refractometer increased amplitude gives
rise to bright fringe, reduced amplitude gives rise
to dark fringe. There are two chambers. One is
reference chamber and a sample chamber. The
change in the phase of sine waves in the sample
chamber and resultant displacement of fringe
pattern is dependent on the type and
concentration of the anaesthetic agent.

Is based on the principle that O2 is repelled by the
magnetic field

Is incorporated into the blood gas analyser

can provide breath to breath measurement

Can measure CO2

Null deflection paramagnetic analyser has the
advantage of containing no moving parts

FFTFF
sample N2 N2

*Calibration

% O2
sample N2 N2
 Sample gas

Pulsed magnetic field

Reference gas

Differential pressure transducer

Sample gas with more oxygen attracted to the magnetic field

& produces pressure difference across the transducer

4%

21%

5%

7%

0.3%
FFTFF
40 mm Hg x 0.13 = 5.3 kPa
5.3 – 0.3 to 0.8 =4.5 to 5 kPa

Has a standard paper speed of 50mm/s.

Has a Normal axis between +30o to -90o

Has a maximal Q-Tc interval of 0.48s.

Has a QRS duration of 0.08-0.12s.

May have an inverted T wave in aVR
FFFTT
PR =0.12- 0.2, QT < 0.44, -30o to +90o
P= 0.1s, 2.5 mm,
a. applies to both electromagnetic radiation and
sound
b. changes the velocity of reflected sound
c. is based on the piezo-electric properties of
crystals
d. shows the shift to lower frequency if the source
is moving away from the receiver
e. can indicate the velocity of red cells
TFFTT

A lower signal to noise ratio is better than a
higher ratio

Diagnostic mode in the ECG monitor has a
frequency response of 0.5 to 40 Hz

CM5 configuration is ideal for detecting
arrhythmia

Signal to Noise ratio can be improved by using
filters.

Differential amplifier can reduce the electrical
interference
FFFTT
 12. Concerning ECG Monitoring

A high signal to noise ratio is better than a

higher ratio

Monitoring mode in the ECG monitor has a
frequency response of 0.5 to 40 Hz

Diagnostic mode 0.05 to 100 Hz.

CM5 configuration is ideal for detecting
ischaemia

Signal to Noise ratio can be improved by filters
 Right arm = red = C Manubrium
Clavicle =Neutral = green
Left arm = yellow = V5 position
Select lead 1

Monitoring mode : 0.5 - 40 Hz

Diagnostic mode: 0.05 -100Hz : ST segment, QRS not distorted
Amplifier amplifies the signal before it is displayed on the
monitor.

A differential amplifier measures the difference between the

potential from two sources. Any interference which is
common to the input terminal such as 50Hz mains
frequency is eliminated. This rejection of common input
frequency is known as common mode rejection.

Nail varnish

Methylene Blue

Tricuspid incompetence

Methaemoglobin

Carboxyhaemoglobin

TTTTT

accuracy : +/-2%, >70%: +/-3% 50-70%

Hypoperfusion External dyes, Nail varnish (black/green)

Ambient light Abnormal haemoglobins
Fluorescent, xenon HbMet, HbCO,
Movements Indocyanine green, Methy. blue
Diathermy
No effect
HbF, HbS, Bilurubin, anaemia
Acrylic nails.

a. Nitrous oxide
b. Oxygen
c. Helium
d. Entonox
e. Medical air

T FFFF

a. Nitrous oxide: 36.5 oC
b. Oxygen: -118.4 oC
c. Helium:
d. Entonox: -7 oC
e. Medical air: -140 oC
15. Regarding measurement of Gas flow
Examples of Constant Orifice/Variable Pressure
devices include

Pneumotachograph

Peak flow meter

Rotameter

Pitot tube

Wright respirometer

TFFTF
 Gas flow & Volume measurement

Pneumotachograph
fixed orifice, variable pressure drop, Q = P/R
- Fleisch Pneumotachograph
- Screen Pneumotachograph
- Pitot tube Pneumotachograph
- Hot wire Pneumotachograph

Peak flow meter

variable orifice, fixed pressure drop flow meter
 Gas flow & Volume measurement
Q = P/R

Direct measurement of volume
Spirometer & Wright Respirometer

Variable orifice- constant pressure drop
Rotameter, Peak flowmeter

Fixed orifice- variable pressure drop
Pneumotachograph, Pitot tube.
 16. The concentration of isoflurane in a
breathing system can be measured using

a. Mass spectrometer

b. Paramagnetic analyser

c. Refractometer

d. Infrared analyser

e. Ultrasonic analyser : velocity of sound

T FTTT

The composition of isothermal binary-gas
mixtures can be determined by measuring
the velocity of sound in the gas
 17. Flow can be measured by

The Fick principle

High frequency sound wave reflection

Change in temperature of a hot wire

Pressure drop across a constriction

Venturi effect

TTTTT
 Fick principle:
blood flow to any organ = Qx / [Ax-Vx]
Inhaled nitrous oxide is used.

Qx: amount of substance removed by the

organ

Ax: arterial conc.

Vx: venous concentration
18. Flow meters in anaesthetic machines

N2O can be used in an O2 flow meter without

changes in calibration

Are variable orifice variable pressure devices

Uses a straight tube and a bobbin

Have a linear scale

Both Laminar and turbulent flows are encountered
FFFFT

N2O, CO2 = MW =44, density similar =1.997 mg/cm3 at

0oC
Viscosity =1488 poise at 27oC, CO2 ?
LV HD
19. Rota meters in anaesthetic machines

Have an accuracy of about 2%

Are calibrated at 37oC and a pressure of 101.3
kPa

Reading should be taken from the bottom of
the bobbin

Are gas specific

At low flows, viscosity play important role

TFFTT
LV, HD
 Flow meters vs Altitude

Q =Pr4/nl = √P/ρl
High pressure = false high reading, over -
reads
Low pressure = false low reading, under-
reads

Back pressure ~ under-reads

LV, HD
 20. Distribution of ventilation is
measured by
a. Helium dilution technique
b. Body plethysmography
c. Nitrogen wash out
d. radioactive xenon
e. 100% oxygen

FFFTF
 20

Radioactive albumin : Perfusion

Radioactive gas (xenon)
 21. Wrights respirometer may give a low
reading when

a) high tidal volume is used (over-reads)

b) FiO2 = 0.3
c) Nitrous oxide is used
d) Humidification is used
e) mechanical ventilation is used (over-reads
due to high peak flow at the beginning)

Under-reads at low flows. Over-reads at high flow


Wright’s respirometer is a turbine
flowmeter

A series of tangential slits that cause
circular motion of the gas flow that
produces rotation around the vane

The vane does not rotate when the flow is
reversed

The composition of gas used does not
influence its performance

Under-reads at low flow and over reads at
high flow
 22. Pulse oximeter probes

[a] Emit near infra-red light.

[b] Once calibrated, do not need re-
calibrating.
[c] Can cause heating of contact tissues.
[d] Are damaged by mild detergents.
[e] Are rendered inaccurate by 70% isopropyl
alcohol

FTTFF
 23. Pneumotachograph
a. measures laminar flow
b. measures the pressure difference
c. is more accurate if heated to a
constant temperature
d. can be used to measure the volume
e. it shows a linear response only
within the calibration range

TTTTT
Measures Flow, volume = flow /time
 24. Regarding Temperature and
Heat
1. Absolute zero is -273K
2. Boiling point of water is +373K
3. Water freezes at +273K
4. SI unit of temperature is calorie
5. Daltons law states that Volume varies
directly with temperature

FTTFF
 24. Regarding Temperature and
Heat
1. Absolute zero is -273 C or 0 K
2. Boiling point of water is + 373K
3. Water freezes at +273K
4. SI unit of temperature is Kelvin
5. Daltons law states that Volume varies
directly with temperature

0oC = 273 K
 Gas laws

Daltons: In a mixture of gases, pressure
exerted by each gas is same as that which
it would exert if it alone occupied the
container.
Absolute Zero 0K -273C -459F
Freezing point 273K 0C 32F
H2O
Boiling point 373K 100C 212F

K=C+273
C=5/9(F-32)
F=9/5(C+32)
 25, Invasive blood pressure
a. is higher in dorsalis pedis artery as compared
to brachial artery in supine position

b. Requires a system pressurised to 300kPa
(mm Hg)
c. records a higher systolic pressure as
compared to NIBP
d. is unreliable in hypertensive patient
e. Records a more accurate mean arterial
pressure as compared to NIBP
 Factors affecting damping

fn = √D ./pLC
2

fn = natural frequency ,
D = diameter of catheter,
p = density,
L =length,
C = compliance.
 Resonance and damping

Inertial forces : mass
Mass –spring system

Elastic forces: spring

Friction forces: medium

Fluid

Diaphragm

Viscous effect of fluid •fn = √D ./pLC
2
 Resonance and damping

Square wave test D2 /D1 = 5 /10 =0.5

Amplitude ratio = D. coeff
300 mmHg

D2 D1

1 cycle,; fn = speed / 1 cycle (mm)

 The loss of pressure in the bag, compliant
tubing, stopcocks, length >120 cm, kinking
Stiff tube, diaphragm of the cannula, blood clots and air bubbles

Critical damping= no oscillations, no
overshoot.

Under-damped more than 3 cycles before
reaching zero.

Amplitude ratio of 0.1 = optimum damping
= damping coefficient 0.6 -0.7, 0.64

fn =√ D2./pLC

increased compliance reduces natural
frequency

a) 7.5 mm Hg is equivalent to 10 cm H2O

b) 1 kPa is equal to a pressure of 7.5 mm
Hg

c) 1 bar is equal to 15 psi

d) A mercury barometer used to measure
atmospheric pressure is sealed with a
vacuum above the surface of the liquid

e) Aneroid gauges do not contain liquid
 Atmospheric pressure
1 bar = 15 psi =1000cm H20 =750 mm Hg
=100kPa
1 psi =6.89 kPa

a. is dependent on the viscosity of the fluid

b. doubles if the radius of the cannula is doubled

c. doubles if the length of the cannula is halved

d. is inversely proportional to the length of the
cannula

e. doubles if the pressure is doubled.

TFTTT

Q is proportional to the r4

Q =P r4/nl
 28. With regard to accidental
electrocution
(a) The risk of ventricular fibrillation increases with
increasing current frequency.
(b) The risk of ventricular fibrillation is greater with
alternating current.
(c) The use of battery operated equipment avoids the
risk of ventricular fibrillation.
(d) The risks of electrocution is reduced by earthing
the patient.
(e) All electrical equipment in the operating theatre
should be earthed (battery operated).

FTFFF
 29.

a) The blood gas results are normal to this
patient

b) An echocardiogram would be useful.

c) A ventilation perfusion scan would be helpful
in diagnosis

d) An intrapulmonary shunt is accountable for
these findings

e) An increased dead space is accountable for
these findings.

FTTFT
 30.With respect to statistics

Null hypothesis states that there is no real
difference between two sets of data

Rejection of the null hypothesis leads to
acceptance of the alternate hypothesis

Beta error occurs if the null hypothesis is
wrongly rejected.

Alpha error states that the null hypothesis has
been wrongly accepted

Power of a study can be increased by raising
the number of observations
TTFFT
 BJA, CEACCP

The null hypothesis would therefore be
that intra-articular morphine is no better
than placebo.

A type I error ( alpha) occurs when the
null hypothesis is incorrectly rejected. A
type II error (beta) occurs when the null
hypothesis is incorrectly accepted
GOOD LUCK