1 000 Practice MTF MCQs for the Primary and Final FRCA 1st Edition Hozefa Ebrahim (Editor)
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1,000PracticeMTF MCQsforthePrimary andFinalFRCA Editedby HozefaEbrahim UniversityHospitals,Birmingham
MichaelClarke WorcestershireAcuteHospitalsNHSTrust
HusseinKhambalia
HealthEducationEngland,NorthWest
InsiyaSusnerwala
HealthEducationEngland,NorthWest
RichardPierson
TheDudleyGroupNHSFoundationTrust
AnnaPierson
TheDudleyGroupNHSFoundationTrust
NatishBindal
QueenElizabethHospitalBirmingham
UniversityPrintingHouse,CambridgeCB28BS,UnitedKingdom
OneLibertyPlaza,20thFloor,NewYork,NY10006,USA
477WilliamstownRoad,PortMelbourne,VIC3207,Australia
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79AnsonRoad,#06–04/06,Singapore079906
CambridgeUniversityPressispartoftheUniversityofCambridge. ItfurtherstheUniversity’smissionbydisseminatingknowledgeinthepursuitof education,learning,andresearchatthehighestinternationallevelsofexcellence.
www.cambridge.org
Informationonthistitle:www.cambridge.org/9781108465830 DOI:10.1017/9781108566100
©CambridgeUniversityPress2019
Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress.
Firstpublished2019
PrintedandboundinGreatBritainbyClaysLtd,ElcografS.p.A.
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. LibraryofCongressCataloging-in-PublicationData Names:Ebrahim,Hozefa,editor.
Title:1,000practiceMTFMCQsfortheprimaryand finalFRCA/editedbyHozefaEbrahim [andsixothers].
Othertitles:1000practiceMTFMCQsfortheprimaryand finalFRCA|Onethousandpractice MTFMCQsfortheprimaryand finalFRCA
Description:Cambridge,UnitedKingdom;NewYork,NY:CambridgeUniversityPress, 2019.|Includesindex.
Identifiers:LCCN2018037315|ISBN9781108465830(paperback)
Subjects:|MESH:RoyalCollegeofAnaesthetists(GreatBritain)|Anesthesia – methods| Anesthetics – pharmacology|UnitedKingdom|ExaminationQuestions Classification:LCCRD81|NLMWO218.2|DDC617.9/6–dc23 LCrecordavailableathttps://lccn.loc.gov/2018037315
ISBN978-1-108-46583-0Paperback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyof URLsforexternalorthird-partyinternetwebsitesreferredtointhispublication anddoesnotguaranteethatanycontentonsuchwebsitesis,orwillremain, accurateorappropriate.
.........................................................................................................................................................................................
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationthatisin accordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawn fromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthattheinformationcontained hereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychangingthrough researchandregulation.Theauthors,editors,andpublishersthereforedisclaimallliabilityfordirector consequentialdamagesresultingfromtheuseofmaterialcontainedinthisbook.Readersarestrongly advisedtopaycarefulattentiontoinformationprovidedbythemanufacturerofanydrugsorequipment thattheyplantouse.
ListofContributors vi
ForewordbyDrTinaMcLeod ix
Preface xi
Acknowledgements xii
ListofAbbreviations xiii
1a PhysiologyQuestions 1
1b PhysiologyAnswers 33
2a AnatomyQuestions 99
2b AnatomyAnswers 133
3a PharmacologyQuestions 178
3b PharmacologyAnswers 210
4a PhysicsQuestions 264
4b PhysicsAnswers 299
5a ClinicalAnaesthesiaQuestions 334
5b ClinicalAnaesthesiaAnswers 426 Index 547
Contributors SujiAbraham
ConsultantAnaesthetist
WorcestershireAcuteHospitals
NHSTrust
IrmeetBanga
SpecialistRegistrarinAnaesthesia
WestMidlandsDeanery
RajneeshBankenahally
ConsultantAnaesthetist
HeartofEnglandNHSTrust
NatishBindal
ConsultantAnaesthetist
QueenElizabethHospitalBirmingham
LowriBowen
ConsultantAnaesthetist
Children’sHospitalforWales,Cardiff
ToniBrunning
SpecialistRegistrarinAnaesthesia
WorcestershireAcuteNHSTrust
MichaelClarke
ConsultantAnaesthetist
WorcestershireAcuteHospitalsNHSTrust
EdCopley
ConsultantAnaesthetist
Northamptonshire
SatinderDalay
ST7Anaesthetics
BirminghamSchoolofAnaesthesia
MattDavies
ConsultantAnaesthetist
RussellsHallHospital,Dudley
NickDodds
SpecialistTraineeinAnaesthesia andIntensiveCareMedicine
SevernDeanery
LauraDyal
SpecialistRegistrarinAnaesthesia
WestMidlandsDeanery
HozefaEbrahim ConsultantinAnaesthesia
UniversityHospitals,Birmingham
IanEwington
ConsultantAnaesthetist
QueenElizabethHospitalBirmingham
RichardHodgson ConsultantAnaesthetist
TheCountyHospital,Hereford
ChaitraHolla
SpecialistRegistrarinAnaesthesia HeartofEngland NHSTrust
PhillipHowells
SpecialistTrainee
BirminghamSchoolofAnaesthesia
HealthEducationEngland,WestMidlands
HusseinKhambalia
SpecialistTraineeinTransplantSurgery
HealthEducationEngland, NorthWest
LauraKocierz
SpecialistRegistrarinAnaesthesia WestMidlandsDeanery
SajithKumar
ConsultantAnaesthetist
HeartofEnglandNHSTrust
RamyLabib
ConsultantAnaesthetist
WorcestershireAcuteHospitals NHSTrust
NicholasLascelles
SpecialistRegistrarinAnaesthesia GloucesterRoyalHospital
KatherineLaver
SpecialistTraineeinAnaesthesia andIntensiveCareMedicine WestMidlandsDeanery
PeterLax
ConsultantinAnaestheticsand IntensiveCareMedicine
RAFTacticalMedicalWing
AdamLow
ConsultantAnaesthetist
QueenElizabethHospital,Birmingham
VivienneMadden
SpecialistRegistrarinAnaesthesia WestMidlandsDeanery
HarshaMistry
SpecialistRegistrarinAnaesthesia WestMidlandsDeanery
RachelMoore
ConsultantAnaesthetist UniversityHospitalsBirmingham
SingaraselvanNagarajan
AssociateConsultant,Women’ s Anaesthesia
KKWomen’sandChildren’sHospital, Singapore
RajenNathwani
ConsultantinAnaesthesiaandIntensive CareMedicine
UniversityHospitalofCoventryand Warwickshire
PhilipPemberton
SpecialistRegistrarinAnaesthesia WestMidlandsDeanery
AnnaPierson
ConsultantAnaesthetist
TheDudleyGroupNHSFoundationTrust
RichardPierson
ConsultantAnaesthetist TheDudleyGroupNHSFoundation Trust
JanePilsbury
ConsultantAnaesthetist UniversityHospitalsBirmingham
NagendraPinnamaneni
SpecialistRegistrarinAnaesthesia EastMidlandsDeanery
PriyaRamchandran
SpecialistRegistrarinAnaesthesia WestMidlandsDeanery
CarlaRichardson
ConsultantAnaesthetistand CriticalCare UniversityHospitalsBirmingham
KarimRizkallah ST8,GeneralSurgery NorthWestDeanery
AhmedSalama
SpecialistTraineeinAnaesthesia WestMidlandsDeanery
SandeepSharma
SpecialtyDoctor BirminghamHeartlandsHospital
NaginderSingh
ConsultantAnaesthetist
QueenElizabethHospital Birmingham
InsiyaSusnerwala SpecialistTraineeinAnaesthesia HealthEducationEnglandNorthWest
RobertTipping ConsultantAnaesthetist
QueenElizabethHospital
Birmingham
LauraTulloch ConsultantinAnaesthesiaand IntensiveCareMedicine
WorcesterAcuteHospitalsNHSTrust
ElenorWhittingham SpecialistRegistrarinAnaesthesia
WestMidlandsDeanery
Foreword Therehavebeenanumberofsinglebestanswerbookspublishedrecently,butthereisa paucityofnewtrue–falsemultiple-choicebooks.Whilsttheinternetprovidesawelcome educationalresource,itisoftenunregulatedandofvariablequalityandabooksuchasthis, whichisaccuratelyresearched,isavaluableadditiontothebookshelf.Theethosofthisbook isproblem-basedlearning,whichhasmanyadvantagesoverthetraditionaltextbookinthat itprovidesinformationindigestiblebite-sizedchunks.
Thisbookhas1000true–falsemultiplechoicequestions.The600basicsciencequestions comprise150ineachofanatomy,physiology,pharmacologyandphysicsandwillbeuseful forcandidatessittingboththeprimaryandthe finalFRCA.The400clinicalquestionsare gearedtoward finalFRCAcandidates,makingthisauniqueMCQbookwhichcanbeused throughouttheexaminationjourney.
Whilstthequestionsareusefulforexampractice,theanswersprovideawealthof information,includingkeydiagrams,andthispublicationisthereforeausefultextbook initsownright.Itcanbeusedbytraineesandtrainersasabaseofknowledgeforviva practiceandshouldbeavailableineverydepartment.
IcongratulateDrEbrahimandhisco-authorsontheproductionofthisbook – whichI stronglyrecommendtoallanaesthetists.
DrTinaMcLeodMBBSFRCA ConsultantAnaesthetist,HeartofEnglandNHSFoundationTrust
Preface Revisingforexamscanbeaperiodofmixedemotions.Someenjoythechallengeoflearning newmaterial,butagreatmany finditatimeofstress.Letusmakethattimeeasierforyou.
Onequietafternooninthecoffeeroom,Iheardsomeofmydeartraineesstressingover some badquestions. Itistruethatsomequestionsarepoorlywritten – notinthisbook,I hope,asallofourquestionshavebeenwrittenbyseasonededucationalistsandpeer reviewedbymanyexamcandidates – butnevertheless,booksandtheinternetarelittered withambiguousquestions.Indeed,the right answercanchangewithtime.However,Itried toreassurethemthatanyquestionthathascausedthemtodiscusstheseambiguitieswould surelyhaveresultedinthemgainingmoreknowledge.Thesewordsappearedtohelp, althoughIknewthatanyaddedstressatthisdifficulttimewasfarfromwelcome.
Studyingforexamsisasmuchabouthavingtherightpositiveattitudeasitisabout cramminginformation!
ThebasicsciencesfortheFRCAexamarewelldefined.Thisbookhas150questionsfor eachofthefourbasicsciences – anatomy,physics,pharmacologyandphysiology.The questionshavebeenwrittentocovertheentiresyllabus.Itisoursuggestionthatyouonly startpractisingMCQsonceyouhavespentappropriatetimereadingthecorematerial.
Findsomequiettimetocompleteapredeterminednumberofquestions,underexam conditions.Markthem,andthengothroughyourresults.Forstemsinwhichyouare scoring4sand5s,youclearlyhaveagoodgraspofthetopic.Patyourselfonthebackand moveon.Forstemsinwhichyouarescoring3orless,afterreadingourexplanation,spend justafewmoreminutesconcentratingonreadingmoreaboutthattopic.Wedonotadvise goingbacktothedrawingboardandspendinghoursrereadingtheentiretopic,asthiswill notbethebestuseofyourtime.Fiveminutesoftargetedreadingusuallyyieldsthemajority ofinformationneededforthatquestion.
Usethistechniquefortheclinicalquestionsaswell.
TheFRCAexamination-settersarenottryingtotrickyou.TheMCQexamisatestof knowledge.Ifyou findaparticularquestioneasy,itisprobablybecauseyouhavegotthe knowledge.Ifaquestionisdifficult,spendsometimereadingthattopic.Inourexperience, timewellspentalwayspaysoff.Keepapositivementalattitude.
Thatquietafternoon,afewofusmadethedecisiontocompilethebestofourquestions, andembarkuponanotherproject.Ihopethisbookishelpfultoyou.Andpleaseremember, onedayyou’llbetheteacher.
Goodluck.
Acknowledgements Firstly,IextendmygratitudetoDrSyednaMohammedBurhanuddinforallhiswisdom throughoutmylife.Withouthim,IwouldnotbewhereIam.
Somanypeoplehavegivenussupportalongtheway,inmanydifferentguises;Ithank thosewhohavedraftedquestionsandexplanations,proof-readourwork,givensuggestions forthecontent,givenusencouragementalongtheway,andkepttheprojectgoing. Thankyou!
Toconsultants,programmetrainingdirectors,regionaladvisors,traineesandjobbing consultantswhohavegivenusinspiration,experienceandeducationthroughoutouryears asdoctors.
ToEllieWhittinghamforherhelpwiththeillustrations.Ellieisaperfectcombinationof scientistandartist.
ToMike,Richard,Anna,Hussein,InsiyaandNatishforbeinggoodfriendsandexcellent authors.Thanksfortoleratingmyincessantemails,phonecallsandcorridor-pestering!
Finally,thankyoutoallourfamiliesforallowingustohideinourstudiestypingaway. Tasneem,MustafaandFaridaEbrahim,CharlotteNorris,AmeliaandJamesClarke,George andHenryPierson,Umme-HaniandAbbasKhambalia,SudeshandMunishwarBindal, thankyou!
Abbreviations A&Eaccidentandemergency
AAAabdominalaorticaneurysm
AAGBIAssociationofAnaesthetistsofGreatBritainandIreland
ABGarterialbloodgas
ABParterialbloodpressure
ACEangiotensin-convertingenzyme
AChacetylcholine
ACTactivatedclottingtime
ACTHadrenocorticotrophichormone
ADCCantibody-dependentcell-mediatedcytotoxicity
ADHantidiuretichormone
ADHDattentiondeficithyperactivitydisorder
AFEamniotic fluidembolism
AFLPacutefattyliverofpregnancy
AFOIawake fibreopticintubation
AKIacutekidneyinjury
ALFacuteliverfailure
ALIacutelunginjury
ALPalkalinephosphatase
ALSadvancedlifesupport
ALTalanineaminotransferase
AMPA α-amino-3-hydroxy-5-methyl-4-isoxazolepropionicacid
ANPatrialnatriureticpeptide
ANSautonomicnervoussystem
AOPapnoeaofprematurity
APACHEAcutePhysiologyAndChronicHealthEvaluation
APTTactivatedpartialthromboplastintime
ARDSacuterespiratorydistresssyndrome
ASaorticstenosis
ASAAmericanSocietyofAnesthesiologists
ASDatrialseptaldefect
ASISanteriorsuperioriliacspine
ASTaspartateaminotransferase
ATLSadvancedtraumalifesupport
ATPadenosinetriphosphate
AVatrioventricular
BBBblood–brainbarrier
BCISbonecementimplantationsyndrome
BGbloodglucose
BiPAPbilevelpositiveairwaypressure
BISbispectralindex
BMIbodymassindex
BMRbasalmetabolicrate
BPbloodpressure
BSAburnsurfacearea
BTSBritishThoracicSociety
BZDbenzodiazepine
CABGcoronaryarterybypassgraft
cAMPcyclicadenosinemonophosphate
CBFcerebralblood flow
CDHcongenitaldiaphragmatichernia
CEPODConfidentialEnquiryintoPerioperativeDeaths
CFAMcerebralfunctionanalyzingmonitor
cGMPcyclicguanosinemonophosphate
CHEOPSChildren’sHospitalofEasternOntarioPainScale
CIMcriticalillnessmyopathy
CIPcriticalillnesspolyneuropathy
cLMAclassiclaryngealmaskairway
CLPcleftlipandpalate
CMAPcompoundmuscleactionpotential
CMRO2 cerebralmetabolicoxygenrequirement
CMVcytomegalovirus
CNcranialnerve
CNBcentralneuraxialblock
CNScentralnervoussystem
COcardiacoutput
COETTcuffedoralendotrachealtube
COHbcarboxyhaemoglobin
COMTcatechol-О-methyltransferase
COPDchronicobstructivepulmonarydisease
COXcyclo-oxygenase
CPcerebralpalsy
CPAPcontinuouspositiveairwaypressure
CPETcardiopulmonaryexercisetesting
CPDcitratephosphatedextrose
CPRcardiopulmonaryresuscitation
CPSPchronicpostsurgicalpain
CRFcontinuousradiofrequency
CRHcorticotropin-releasinghormone
CRMO2 cerebralmetabolicrateforoxygen
CRPScomplexregionalpainsyndrome
CRTcathoderaytube
CScaesareansection
CSEcombinedspinal–epidural
CSFcerebrospinal fluid
CTcomputerizedtomography
CTGcardiotocography
CTPAcomputerizedtomographypulmonaryangiography
CTZchemoreceptortriggerzone
CVCcentralvenouscatheter
CVOcombinedventricularoutput
CVPcentralvenouspressure
CVScardiovascular
CXRchestX-ray
CYPcytochromeP450
DAductusarteriosus
DAGdiacylglycerol
DASDifficultAirwaySociety
DIdiabetesinsipidus
DJduodenojejunal
DLCOdiffusingcapacityofthelungsforcarbonmonoxide
DLTdoublelumentube
DNAdeoxyribonucleicacid
DOPAdihydroxyphenylalanine
DPdorsalispedis
2,3-DPG2,3-diphosphoglycerate
DPP4dipeptidylpeptidase4
DVTdeepveinthrombosis
DXAdual-energyX-rayabsorptiometry
EBPepiduralbloodpatch
ECFextracellular fluid
ECGelectrocardiogram
ECMOextracorporealmembraneoxygenation
ECSTEuropeanCarotidSurgeryTrial
ECTelectroconvulsivetherapy
EDemergencydepartment
ED50 effectivedose50%
EDVenddiastolicvolume
EEGelectroencephalogram
EMGelectromyography
EMLAeutecticmixtureoflocalanaesthetics
ENTearnoseandthroat
ESVendsystolicvolume
ESWLextracorporealshock-wavelithotripsy
ETCO2 endtidalcarbondioxide
ETTendotrachealtube
EVARendovascularaorticaneurysmrepair
FAD+ flavinadeninedinucleotide(oxidizedform)
FADH flavinadeninedinucleotide(reducedform)
FBCfullbloodcount
FCP finalcommonpathway
FDG fluorodeoxyglucose
FEFforcedexpiratory flow
FEV1forcedexpiratoryvolumein1second
FFPfreshfrozenplasma
FiO2 fractionofinspiredoxygen
FRCfunctionalresidualcapacity
FSHfollicle-stimulatinghormone
FVCforcedvitalcapacity
GAgeneralanaesthetic
GABA γ amino-butyricacid
GBSGuillain–Barrésyndrome
GCSGlasgowcomascore
GDPguanosinediphosphate
GFRglomerular filtrationrate
GHgrowthhormone
GHB γ-hydroxybutyrate
GIgastrointestinal
GLPglucagon-likepeptide
GnRHgonadotropin-releasinghormone
GORDgastro-oesophagealrefluxdisease
GPCRG-protein-coupledreceptor
GTNglyceryltrinitrate
GTPguanosinetriphosphate
GUgenitourinary
HALFhyperacuteliverfailure
Hbhaemoglobin
HbAadulthaemoglobin
HbFfetalhaemoglobin
hCGhumanchorionicgonadotropin
HDLhigh-densitylipoprotein
HDUhigh-dependencyunit
HELLPhaemolysis,elevatedliverenzymesandlowplatelets
HEShydroxyethylstarch
HFOVhigh-frequencyoscillatoryventilation
HIIhigh-impactinterventions
HIVhumanimmunodeficiencyvirus
HLAhumanleucocyteantigen
HLHShypoplasticleftheartsyndrome
HMEheatandmoistureexchanger
HOCMhypertrophicobstructivecardiomyopathy
hPLhumanplacentallactogen
HPVhypoxicpulmonaryvasoconstriction
HRheartrate
HRThormonereplacementtherapy
5-HT5-hydroxytryptamine
HZherpeszoster
IABPintra-aorticballoonpump
IAPintra-abdominalpressure
IBWidealbodyweight
ICAinternalcarotidartery
ICDintercostalchestdrain
ICFintracellular fluid
ICPintracranialpressure
ICUintensivecareunit
IEinfectiveendocarditis
IFintrinsicfactor
IJVinternaljugularvein
IMintramuscular
INRinternationalnormalizedratio
IOPintraocularpressure
IP3 inositoltriphosphate
IPPVintermittentpositivepressureventilation
ISFinterstitial fluid
ITP3 inositoltriphosphate
IVintravenous
IVCinferiorvenacava
IVFintravascular fluid
LAlocalanaesthetic
LADleftanteriordescendingartery
LAPleftatrialpressure
LBBBleftbundlebranchblock
LD50 lethaldose50%
LDHlactatedehydrogenase
LFJVlow-frequencyjetventilation
LHluteinizinghormone
LIFleftiliacfossa
LMAlaryngealmaskairway
LMWHlowmolecularweightheparin
LOAFlateraltwolumbricals,opponenspollicis,abductorpollicisbrevisand flexor pollicisbrevis
LORlossofresistance
LOSloweroesophagealsphincter
LRAlocoregionalanaesthesia
LVleftventricle
LVEDVleftventricularenddiastolicvolume
LVEFleftventricularejectionfraction
LVESVleftventricularendsystolicvolume
LVHleftventricularhypertrophy
LVRSlungvolumereductionsurgery
MAmaximumamplitude
MACminimumalveolarconcentration
MAOmonoamineoxidase
MawPmeanairwaypressure
MDMA3,4-methylenedioxy-N-methylamphetamine(Ecstacy)
MENmultipleendocrineneoplasia
MEPmotorevokedpotentials
METmetabolicequivalent
MGmyastheniagravis
MHmalignanthyperpyrexia
MHRAMedicinesandHealthcareProductsRegulatoryAgency
MImyocardialinfarction
MPAPmeanpulmonaryarterypressure
MRmagneticresonance
MRImagneticresonanceimaging
NAD+ nicotinamideadeninedinucleotide(oxidizedform)
NADHnicotinamideadeninedinucleotide(reducedform)
NAP3ThirdNationalAuditProject
NASCETNorthAmericanSymptomaticCarotidEndarterectomyTrial
NCAnurse-controlledanalgesia
NDMRnon-depolarizingmusclerelaxant
NDNMBnon-depolarizingneuromuscularblock
NECnecrotizingenterocolitis
NGnasogastric
NICUneonatalintensivecareunit
NKneurokinin
NKCCNa-K-2Clco-transporter
NMDA N-methyl-D-aspartate
NMJneuromuscularjunction
NNBCNationalNetworkforBurnCare
NNTnumberneededtotreat
NR Reynold’snumber
NRSnumericalratingscale
NSAIDnon-steroidalanti-inflammatorydrug
NTSnucleustractussolitarius
NYHANewYorkHeartAssociation
OAosteoarthritis
ODPoperatingdepartmentpractitioner
OHDCoxygen–haemoglobindissociationcurve
OLVone-lungventilation
ORIFopenreductioninternal fixation
OSAobstructivesleepapnoea
PApulmonaryartery
PACpulmonaryarterycatheter
paCO2 arterialpartialpressureofcarbondioxide
pACO2 alveolarpartialpressureofcarbondioxide
PAFCpulmonaryartery flotationcatheter
paO2 arterialpartialpressureofoxygen
pAO2 alveolarpartialpressureofoxygen
PAPpulmonaryarterialpressure
PAWPpumonaryarterywedgepressure
PCApatient-controlledanalgesia
PCEApatient-controlledepiduralanalgesia
PCIpercutaneouscoronaryintervention
pcjO2 conjunctivaloxygentension
PCWPpulmonarycapillarywedgepressure
PDParkinson’sdisease
PDApatentductusarteriosus
PDEphosphodiesterase
PDPHpost-dural-punctureheadache
PEEPpositiveend-expiratorypressure
PEFRpeakexpiratory flowrate
PETpositronemissiontomography
PFOpatentforamenovale
PGApostgestationalage
PGE2 prostaglandinE2
PGI2 prostacyclin
PHpulmonaryhypertension
PHNpostherpaticneuralgia
PICUpaediatricintensivecareunit
PIP2 phosphatidylinositol
PMCSperimortemcaesareansection
PNMTphenylethanolamine N-methyltransferase
PNSperipheralnervoussystem
POCDpostoperativecognitivedysfunction
PONVpostoperativenauseaandvomiting
PPARperoxisomeproliferator-activatedreceptor
PPHpostpartumhaemorrhage
PPIprotonpumpinhibitor
ppoFEV1%predictedpostoperativeFEV1percentage
PRFpulsedradiofrequency
PRLprolactin
PSISposteriorsuperioriliacspine
PSNSparasympatheticnervoussystem
PTprothrombintime
PTHparathyroidhormone
PVRpulmonaryvascularresistence
QAIquaternaryammoniumion
QTccorrectedQT
RArightatrium
RCOGRoyalCollegeofObstetriciansandGynaecologists
REMrapideyemovement
RERrespiratoryexchangeratio
RFradiofrequency
RMPrestingmembranepotential
RMSrootmeansquare
RNAribonucleicacid
ROSreactiveoxygenspecies
ROSCreturnofspontaneouscirculation
RQrespiratoryquotient
RRrespiratoryrate
RRTrenalreplacementtherapy
RSIrapidsequenceinduction
rSO2 regionalcerebraloxygensaturation
RTAroadtrafficaccident
RULrightupperlobe
RUQrightupperquadrant
RVrightventricle
RVLMrostralventrolateralmedulla
RVOTrightventricularoutflowobstruction
SAsinoatrial
SADsupraglotticairwaydevice
SAHsubarachnoidhaemorrhage
SCSspinalcordstimulation
SCUFslowcontinuousultrafiltration
SEstatusepilepticus
SIPsympatheticallyindependentpain
SIRSsystemicinflammatoryresponsesyndrome
SLEDsustainedlow-efficiencydialysis
SMPsympatheticallymaintainedpain
SNAPsensorynerveactionpotential
SNPsodiumnitroprusside
SNRsignal-to-noiseratio
SPstumppressure
SPECTsingle-photonemissioncomputedtomography
SSEPsomatosensoryevokedpotential
STPstandardtemperatureandpressure
SVPsaturatedvapourpressure
SVRsystemicvascularresistance
SVTsupraventriculartachycardia
T3 triiodothyronine
T4 thyroxine
TACOtransfusion-associatedcirculatoryoverload
TAPtransversusabdominisplane
TBSAtotalbodysurfacearea
TCItarget-controlledinfusion
TCDtranscranialDopplerultrasound
TEGthromboelastogram
TENStranscutaneouselectricalnervestimulation
TFPItissuefactorpathwayinhibitor
THcellsT-helpercells
TIAtransientischaemicattack
TIVAtotalintravenousanaesthesia
TLCtotallungcapacity
TMJtemporomandibularjoint
TNtrigeminalneuralgia
TOFtrainoffour or tracheo-oesophageal fistula
TPNtotalparenteralnutrition
TRALItransfusion-relatedacutelunginjury
TRAMtransverserectusabdominismyocutaneous
TRHthyrotropin-releasinghormone
TRVPtransientreceptorpotentialvanilloid
TSHthyroid-stimulatinghormone
TURPtransurethralresectionoftheprostate
UFHunfractionatedheparin
URTIupperrespiratorytractinfection
USSultrasoundscan
VAEvenousairembolism
VASvisualanaloguescale
VCvitalcapacity
VD volumeofdistribution
VFventricular fibrillation
VRIIIvariablerateintravenousinsulininfusion
VRSvisualratingscale
VSDventricularseptaldefect
VTventriculartachycardia
VTEvenousthromboembolism
VZVvaricellazostervirus
WFNSWorldFederationofNeurosurgeons
WPWWolff–Parkinson–Whitesyndrome
ListofAbbreviations
1a PhysiologyQuestions Question1 Regardingcardiacmusclestructure,whichofthefollowingstatementsarecorrect?:
a.Thevolumeoftheleftventricleismaximalattheatrialendsystolicpause
b.Therightcoronaryarteryusuallysuppliesboththerightatriumandventricle,andpart oftheleftatrium
c.Cardiacmusclecellshaveonenucleus,butmanymitochondria
d.Striatedcardiacmuscle fibresaremorestructuredthanskeletalmuscle fibres
e.ThesarcoplasmicreticulumsequesterscalciumviaaNa+/K+-ATPasepump
Question2 Regardingconductionthroughtheheart:
a.Conductionthroughthecardiacseptumisusuallyuni-directionalfromlefttoright
b.Leftbundlebranchblockusuallyproducesleftaxisdeviationonthe12-leadECG
c.Rightbundlebranchblockusuallyproducesrightaxisdeviationonthe12-leadECG
d.StimulationofthetenthcranialnerveinducesslowingofAVconduction
e.Wolff–Parkinson–Whitesyndromeisalwaysassociatedwithanaccessoryconducting bundle
Question3 Withregardtothecardiacactionpotential:
a.Sodiuminfluxviafastsodiumchannelsoccursduringphase0ofthenodalcardiacaction potential
b.Theabsoluterefractoryperiodextendsintophase3oftheactionpotential
c.Theplateauphaseisduetoadecreaseincellmembranepermeabilityofcalcium
d.TheNa+/K+ pumpisinvolvedintherestorationofionicgradientsinphase4ofthe nodalactionpotential
e.SlowL-typeCa2+ channelsareinvolvedinbothnodalandconductionsystemaction potentials
Question4 Regardingautomaticitywiththesinoatrial(SA)nodeandtheatrioventricular(AV)node:
a.TheSAnodeisprincipallyresponsiblefortheheart’sautomaticity
b.Thethresholdpotentialforthenodalactionpotentialis –90mV
c.ParasympatheticstimulationoftheSAnodecausesaslowingofheartrateviaanincrease inmembraneCa2+ permeability
d.TheSAnodedoesnothaveanabsoluterefractoryperiod
e.TheAVnodehasalongerphase4thantheSAnode
Question5
Withregardtothecardiaccycle:
a.The firstheartsoundrepresentstheclosureoftheaorticvalve
b.ThesecondheartsoundoccursatthebeginningoftheTwaveontheECG
c.ThepeakofleftventricularpressureoccurswiththeQRScomplexontheECG
d.Ventricularvolumebeginstoincreasewhentheatrioventricularvalvesopen
e.ThepeakofaorticpressurecorrespondswiththeTwave
Question6 Thisquestionconcernsthecardiaccycle – diastole,perfusion,lusitropy:
a.Themyocardiumisentirelydependentonperfusionoccurringduringdiastole
b.Lusitropyreferstothemyocardialrelaxation
c.Atrestdiastoleaccountsfor0.5secondsofacardiaccyclelasting0.8seconds
d.Ventricular fillingisrapidduringearlydiastole
e.Atrialcontractionduringlatediastoleaccountsforthemajorityofenddiastolicventricularvolume
Question7 WithrespecttotheCVPwaveform:
a.Irregularcannon ‘ awaves ’ areduetocompleteheartblock
b.The ‘ vwave ’ issmallerintricuspidincompetence
c.NormalCVPis0–8mmHg
d.The ‘ydescent’ isdemonstratingpassiveventricular filling
e.The ‘ cwave ’ isthetallestwave
Question8 ThisquestionconcernstheP-Vrelationship,andtheFrank–Starlingcurve:
a.TheFrank–Starlinglawstatesthattheforceofcontractionisrelatedtotheinitial fibre length
b.Theforceofmyocardialcontractionisproportionaltotheinitial fibrelength,untilan upperlimitisreached
c.Beforethemitralvalveopensthereisadecreaseinpressureintheventricle,butno changeinvolume
d.Beforeaorticvalveclosurethereisanincreaseinvolumewithnoassociatedchangein pressure
e.Theaorticvalveopenswhenthepressureintheventricleislowerthanthatintheaorta
Question9 Withrespecttocardiacoutputformulae:
a.CO=HR×(ESV – EDV)
b.TheFickprinciplecannotbeusedtocalculateblood flowthroughtheliver
c.OnlycalculatedvaluesareusedintheFickequation
d.TheoxygenuptakeformsthedenominatorintheFickequation
e.ShuntsdonotaffecttheaccuracyofthecalculationofcardiacoutputviatheFick principle
Question10 Regardingpreload,afterloadandcontractility:
a.Afterloadisincreasedbyperipheralvasoconstriction
b.Increasedafterloadcausesanincreasedstrokevolume
c.Preloadcanbelikenedtoendsystolicvolume
d.PreloadcanbeestimatedbymeasurementofCVP
e.Preloadandafterloadaretheonlyfactorsaffectingcontractility
Question11 Regardingheartrateandcoronaryblood flow:
a.ThesympatheticoutflowcontrollingheartrateisviaT1–T8
b.Therightcoronaryarteryisthedominantvesselinhalfthepopulation
c.Therightcoronaryarteryarisesfromtheposterioraorticsinus
d.Atrialnatriureticpeptide(ANP)isavasodilator
e.Thenucleusambiguusisinvolvedinintegrationoftheafferentinputsaffectingheartrate frombaroreceptors,chemoreceptorsandhighercentres
Question12 WithregardtotheValsalvamanoeuvre:
a.Asquarewaveresponseisseeninautonomicneuropathy
b.Adiminishedchemoreceptorreflexcausestheabnormalresponseinautonomic neuropathy
c.Itcanbeusedtoterminatesupraventriculartachycardia
d.Thefallinbloodpressureisexaggeratedinpatientsunderspinalanaesthesia
e.Itdecreasestheintensityofmostheartmurmursonauscultation
Question13 Withregardtothephysiologicalcontrolofbloodpressure:
a.Baroreceptorsinthecarotidsinusareinnervatedbythevagusnerve
b.Thevasomotorcentresarefoundinthehypothalamusandmedulla
c.Highercentreshavenoinfluenceonthevasomotorcentres
d.Lowpressurebaroreceptorsarefoundintheatria,ventriclesandpulmonaryvessels
e.TheBainbridgereflexcausesareflexbradycardia
Question14 Withregardtotheleftventricularenddiastolicvolume:
a.Inanormalheartitisapproximately30ml
b.Itisameasureofpreload
c.Itisreducedinexercise
d.Itisindependentofventricularcompliance
e.Itisincreasedindiastolicheartfailure
Question15
Thefollowingwillcausearteriolestoconstrict:
a.Directinjurytothevessel
b.DecreasedtissuepH
c.Decreasedtissueoxygentension
d.ThromboxaneA2
e.Bradykinin
Question16
Thefollowingmediatorscausevasoconstrictioninvascularsmoothmuscle:
a.Epinephrine
b.PGF2α
c.Serotonin
d.PGI2
e.Adenosine
Question17
Thefollowingfactorsmaypredisposetoturbulent flowwithinatube:
a.Smalldiameter
b.Largediameter
c.Highviscosity
d.Lowvelocity
e.Highdensity
Question18 Thefollowingstatementsaretrueregardingthelymphaticsystem:
a.Lymphcontainsclottingfactors
b.Proteincontentoflymphisgenerallymorethanthatofplasma
c.Thelymphaticsystemcontainsvalves
d.Skeletalmusclecontractionaidslymphatic flow
e.Thethoracicductisthelargestlymphaticvessel
Question19 Regardingblood flowinarteriolesandcapillaries:
a.Arteriolesarethemainsiteofresistancetoblood flow
b.Blood flowincapillariesispulsatile
c.Capillarieshavenosmoothmuscle
d.Changesintemperaturecanaffect flow
e.Precapillarysphinctershaverichsympatheticinnervation
Question20 Inarigidtube:
a.Flowisdirectlyproportionaltothefourthpoweroftheradius
b.Flowisinverselyproportionaltothepressuredifference
c.Resistanceisdirectlyproportionaltothelength
d.Resistanceisdirectlyproportionaltothesquareoftheradius
e.Iftheradiusisdoubled,theresistanceisincreasedby16times
Question21 Thefollowinglungvolumesorcapacitiescanbemeasuredbyspirometry:
a.Functionalresidualcapacity
b.Vitalcapacity
c.Totallungcapacity
d.Inspiratoryreservevolume
e.Expiratoryreservevolume
Question22 Regardinglungcompliance:
a.Thenormaltotallungcomplianceis200cmH2O.ml 1
b.Staticcomplianceisgreaterthandynamiccompliance
c.Complianceisincreasedwhenapatientissupine
d.Itisdeterminedbythegradientofthepressure–volumecurve
e.Itisgreatlyreducedinacuterespiratorydistresssyndrome(ARDS)
Question23 Regardingrespiratorydeadspace:
a.Indeadspace,theV/Qratioiszero
b.Asdeadspaceincreases,paCO2 falls
c.Itisincreasedbygeneralanaesthesia
d.TotaldeadspaceisdeterminedusingtheBohrequation
e.Itisgreaterintheapicesofthelungsthanthebases
Question24 Whenreferringtoworkofbreathing:
a.Itisdeterminedbytheareainsideapressure–volumecurve
b.Inspiratoryworkisthatwhichovercomestheelasticrecoilofthethoracicwall
c.Expiratoryworkisthatwhichovercomesairwayresistance
d.Worktoovercomenon-elasticforcesislostasheat
e.Respiratoryworkincreasesinaventilatedpatient
Question25 Regardingthefunctionalresidualcapacity(FRC):
a.Itisapproximately30ml.kg 1
b.PulmonaryvascularresistanceishighestatFRC
c.Itmaybelessthantheclosingcapacity
d.Itisincreasedunderanaesthesia
e.Itisdecreasedinpregnancy
Question26 Concerningrespiratorymechanics:
a.Thediaphragmisresponsiblefor50%oftheairthatentersthelungsduringspontaneous respiration
b.Athirdofthediaphragmatic fibresareslowtwitch fibres
c.Thetranspulmonarypressureisequaltothedifferencebetweenthepressurewithinthe lungsandtheintrapleuralpressure
d.Theaccessorymusclesofrespirationservetostabilizetheupperribcageandtoprevent in-drawinginnormalrespiration
e.Complianceofthelungisdefinedasthechangeinpressureperunitchangeinvolume
Question27 Concerningsurfactant:
a.Before32–34weeks’ gestation,itsproductionisinadequateandthispredisposesto respiratorydistresssyndrome
b.TypeIIalveolarepithelialcellsareresponsibleforitsproduction
c.Less fluidisdrawnfromcapillariesintoalveoliasaresultofitsaction
d.Thehysteresisareaofthepressure–volumeloopisincreasedasaresultofitsactionin reducingsurfacetension
e.Largeralveoliareseentocollapsemorereadilyasaresultofitsaction
Question28 Regardingventilationandperfusionmatchingintheuprightlung:
a.Fromapextobase,ventilationincreases;blood flowalsoincreases,butlessrapidly
b.Theventilation/perfusionratioishigherattheapexofthelunganddecreasesprogressivelytowardsthebaseofthelung
c.Thedifferenceinpartialpressuresbetweentheapexandbaseofthelungisgreaterfor carbondioxidecomparedwiththatforoxygen
d.Hypoxaemiathatresultsfromventilation/perfusioninequalitycanbecorrectedbyan increaseinventilation
e.Pulmonaryemboliresultinanincreaseintheventilation/perfusionratio
Question29 Concerningalveolarventilationandthealveolargasequation:
a.Atrest,thelevelofalveolarventilationisthemaindeterminantofthepO2 of alveolargas
b.Hypoventilationalwaysresultsinanincreasedarterialpressureofcarbondioxideinthe bloodstream
c.Therespiratoryquotientiscalculatedbytheoxygenconsumptiondividedbythecarbon dioxideproduction
d.Facedwithhyperventilation,ittakeslongerforpCO2 toreachequilibriumascompared withpO2
e.Shuntreferstoareasofthelungswhereventilationisadequate,butperfusionis deficient
Question30 Concerningthedistributionofblood flowinthelungdescribedbyWest:
a.Zone1doesnotexistundernormalconditions
b.Inzone2,thedifferencebetweenalveolarandarterialpressuresdetermines blood flow
c.Inzone3:Pa>PA>Pv wherePv=venouspressure,Pa=arterialpressureandPA=alveolarpressure
d.Fromapextobase,thepressureresponsiblefordrivingblood flowincreases
e.Inzone2,thearteriovenouspressuredifferencedeterminesblood flow
Question31 Withreferencetointermittentpositivepressureventilation(IPPV):
a.Theadditionofpositiveend-expiratorypressure(PEEP)increasesthedeadspace
b.Itincreasesthefunctionalresidualcapacity(FRC)
c.ItreducesV/Qmismatch
d.Itresultsinanincreaseinantidiuretichormone(ADH)secretion
e.Highairwaypressurescauseadecreaseinpulmonaryvascularresistance
Question32 Athighaltitude(2500mabovesealevel):
a.TheFiO2 is20.9%
b.Theoxygen–haemoglobindissociationcurve(OHDC)ismovedtothe rightinitially
c.Hypoxicpulmonaryvasoconstrictionisbeneficial
