fca(sa)_part_i_past_papers 4

7/27/2019 FCA(SA)_Part_I_Past_Papers 4

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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gainReg No/Nr 1955/000003/08

Part I Examination for the Fellowship of theCollege of Anaesthetists of South Africa

6 September 2011

PhysiologyPaper 1 (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more thanone 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

1 a) Discuss the processes involved in the formation of the primary platelet plug.(10)

b) What is role of thrombin in the coagulation pathway? (7)c) Discuss the processes that limit excessive clot formation. (23)d) Briefly explain

i) The link between systemic inflammation and the activation of thehaemostatic mechanism. (6)

ii) Why some patients with Von Willebrands disease respond to dDAVPand others only to cryoprecipitate. (4)

[50]

1 a) Bespreek die prosesse betrokke in die ontwikkeling van die primreplaatjieprop. (10)

b) Wat is die rol van trombien in die koagulasiepad? (7)c) Bespreek die prosesse wat oormatige stolselformasie beperk. (23)d) Verduidelik kortliks

i) Die skakel tussen sistemiese inflammasie en die aktivering van diehemostatiese meganisme. (6)

ii) Hoekom sommige pasinte met Von Willebrandsiekte respondeer opdDAVP en ander net op kriopresipitaat. (4)

[50]

2 a) Briefly explain the term "transpulmonary pressure" and the clinical importancethereof. (3)

b) Indicate the average normal values for the end-expiratory and end-inspiratoryintrapleural and alveolar pressures (in cm H2O) for a 25-year-old male duringspontaneous non-exertional ventilation. (4)

c) Briefly explain each of the following concepts, by making use of a simpleannotated air flow diagram

i) Tidal volume.ii) Inspiratory reserve volume.iii) Expiratory reserve volume.iv) Residual volumev) Vital capacity (10)


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d) Provide the approximate average normal volumes in a 25-year-old healthymale for each of the above mentioned parameters in question 2c). (5)

e) Briefly explain what Functional Residual Capacity represents and whyspirometry cannot be used in a direct way to determine it. (3)

f) Define the term respiratory minute volume. (2)g) 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 ofpatients in general. (4)

h) List the four most important factors that determine the rate of gaseousdiffusion through the respiratory membrane. (4)

i) Describe the functions of the principal groups of neurons in the medullaoblongata and pons that are involved in the regulation of respiration. (15)

[50]

2 a) Verduidelik kortliks die term transpulmonale druk en die kliniese belangdaarvan. (3)

b) Dui die gemiddelde normale waardes aan vir die end-ekspiratoriese en end-inspiratoriese intrapleurale drukke asook alveolre drukke (in cm H2O) in n

25-jarige man gedurende normale spontane asemhaling met rus. (4)c) Verduidelik kortliks elk van die volgende konsepte deur gebruik te maak vann eenvoudige, benoemde lugvloeidiagrami) Getyvolume.ii) Inspiratoriese reserwe-volume.iii) Ekspiratoriese reserwe-volume.iv) Residuele volume.v) Vitale kapasiteit. (10)

d) Gee die normale benaderde, gemiddelde volumes in n 25-jarige gesondeman vir elk van bogenoemde parameters in vraag 2c). (5)

e) Beskryf kortliks wat Funksionele Residuele Kapasiteit voorstel en hoekom ons

nie spirometrie direk kan gebruik om dit te meet nie. (3)f) Definieer die term respiratoriese minuutvolume. (2)g) Beskryf kortliks wat West-sone 1-bloedvloei beteken en gee drie kliniese

situasies waar West-sone 1-bloedvloei in die longe verwag kan word inpasinte in die algemeen. (4)

h) Lys die vier belangrikste faktore wat die tempo van gasdiffusie deur dierespiratoriese membraan benvloed. (4)

i) Beskryf die funksies van die hoofgroepe neurone in die medulla oblongata enpons wat betrokke is in die regulering van asemhaling. (15)

[50]

3 a) Define the followingi) Stroke Volume.ii) Cardiac Output.iii) Cardiac Index.iv) Mean Arterial Pressure.v) Systemic Vascular Resistance. (15)

b) Explain in words, using relevant equations where necessary, the physiologicmechanisms of the following determinants of Stroke Volume of the leftventriclei) Preload.ii) Contractility.

iii) Afterload. (18)c) Explain briefly how positive pressure ventilation reduces the left ventricular

afterload. (3)


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d) 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 toeach part of the loop. (10)

e) Graphically illustrate the effect on left ventricular stroke volume of andecrease in preload.Do this by redrawing the Pressure-Volume loop of the left ventricle on a newpage, and on the same set of axes drawing the Pressure-Volume loopcorresponding to a state of decreased preload. It is not necessary to fully labelthese loops. [50]

3 a) Definieer die volgendei) Slagvolume.ii) Kardiale omset.iii) Kardiale indeks.iv) Gemiddelde arterile bloeddruk.v) Sistemiese vaskulere weerstand. (15)

b) Verduidelik in woorde, met die gebruik van relevante vergelykings waar nodig,die fisiologiese meganismes van die volgende determinante van slagvolume

van die linker ventrikeli) Voorlading.ii) Kontraktiliteit.iii) Nalading. (18)

c) Verduidelik kortliks hoe positiewe drukventilasie die linker ventrikulerenalading verminder. (3)

d) Teken en annoteer volledig die Druk-Volumekurwe van n normale linkerventrikel. Dui aan watter gebeurtenis in die kardiale siklus korrespondeer metelke deel van die kurwe. (10)

e) Illustreer grafies die effek van n vermindering in voorlading op die linkerventrikulre slagvolume. Beantwoord hierdie vraag deur die Druk-

Volumekurwe oor te teken op n nuwe bladsy, en op dieselfde aksis die Druk-Volumekurwe te teken wat korrespondeer met n staat van verminderdevoorlading. Dis nie nodig om hierdie kurwe te benoem nie. (4)

[50]

4 a) Define cerebrali) Perfusion pressure. (5)ii) Blood flow. (5)iii) Metabolic rate of oxygen consumption. (5)iv) Metabolic rate of glucose consumption. (2)

b) Draw and annotate a cerebral autoregulation curve. (3)

c) Briefly discuss the formation, circulation and absorption of cerebrospinal fluid.(20)

d) Briefly describe the major compensatory mechanisms in the brain tocounteract a raised intracranial pressure. (4)

e) Define the relationship between between partial pressure of carbon dioxide inarterial blood and cerebral blood flow. How is this clinically used byanaesthetists in the setting of acutely raised intracranial pressure? (6)

[50]

4 a) Definieer serebralei) Perfusiedruk. (5)

ii) Bloedvloei. (5)iii) Metaboliese tempo van suurstofverbruik. (5)iv) Metaboliese tempo van glukose-verbruik. (2)

b) Teken en benoem n serebrale outoregulasiekurwe. (3)


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c) Bespreek kortliks die formasie, sirkulasie en absorpsie vanserebrospinaalvog. (20)

d) Gee kortliks die major kompensatoriese meganismes in die brein watverhoogde intrakraniale druk teenwerk. (4)

e) Definieer die verwantskap tussen die parsile druk van koostofdioksied inarterile bloed en serebrale bloedvloei. Hoe gebruik narkotiseurs hierdiekonsep klinies in pasinte met akuut-verhoogde intrakraniale druk? [50]


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FCA(SA) Part I




6 September 2011

PhysiologyPaper 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 andbicarbonate.

c) Skryf n vergelyking neer wat die verwantskap tussen koolstofdioksied en bikarbonaatverduidelik.

__________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)


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d) Write the alveolar gas equation.d) Skryf die alveolre gasvergelyking neer._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)[10]


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]


a) Explain the Carotid Baroreceptor reflex.a) Verduidelik die karotis baroreseptorrefleks.__________________________________________________________________________________________________________________________________________________


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______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(5)

b) Explain the Bezold-Jarisch reflex.b) Verduidelik die Bezold-Jarischrefleks.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(5)[10]


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)


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c) List four non-renal variables that affect creatinine and / or blood urea nitrogen levels.c) 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]


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 theformation of hydrochloric acid in the stomach.


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d) Verduidelik die proses van primre aktiewe transport van waterstofione gedurendedie vorming van soutsuur in die maag.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(5)[10]


Write succinct notes on the functions of each of the following cell typesSkryf 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._________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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(2)

e) Mast cells.e) Mastselle._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)[10]


a) Cite three physiological functions of cholesterol.a) Noem drie fisiologiese funksies van cholesterol.__________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)

b) State one specific function of each of the following enzymesb) 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) Briefly explain the concept "transamination", by making use of one specific example.

c) Verduidelik kortliks die konsep "transaminasie" deur gebruik te maak van eenspesifieke voorbeeld.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)

d) Identify the specific hormone involved in the formation of leukotrienes fromarachidonic acid.

d) Identifiseer die spesifieke hormoon betrokke by die sintese van leukotriene vanafaragidoonsuur.

_______________________________________________________________________(1)


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e) Identify one other cause of a negative nitrogen balance besides starvation or aninadequate protein intake.

e) Identifiseer een ander oorsaak van n negatiewe stikstofbalans benewensuithongering of ontoereikende proteen-inname.

______________________________________________________________________ (1)[10]


A 60-year-old female patient, using anti-hypertensive medication (hydrochlorothiazide 25mg/day), presents post-operatively with the following biochemical resultsn 60-Jarige vroulike pasint, wat behandel word met antihipertensiewe geneesmiddels(hidrochloortiasied 25mg/dag), presenteer postoperatief met die volgende biochemieseuitslaeArterial plasma pH: 7,56 Arterile plasma pH: 7,56Arterial plasma HCO3

-: 48mEq/L Arterile plasma HCO3-: 48mEkw/L

Arterial plasma PCO2: 40 mm Hg(5.3kPa) Arterile plasma PCO2: 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 youranswer.

a) Dui aan watter spesifieke metaboliese afwyking teenwoordig is en motiveer kortliks uantwoord.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)

b) Identify one physiological compensatory mechanism that the body can utilise to tryand rectify this condition.

b) Identifiseer een fisiologiese kompensatoriese meganisme wat die liggaam kangebruik om hierdie toestand te probeer regstel.

_______________________________________________________________________(1)

c) Suggest one possible cause of this disorder in this patient, and indicate thepathophysiological mechanisms involved.

c) Stel een moontlike oorsaak voor vir hierdie afwyking in hierdie pasint, en dui dieonderliggende patofisiologiese meganismes aan.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)

d) Write succinct notes on the relationship between the ECF potassium ion and ECFhydrogen ion concentrations.

d) Skryf kort notas oor die verhouding tussen ESV kaliumioon- en ESV waterstofioon-konsentrasies.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)

e) Name two important intracellular buffer systems.e) Noem twee belangrike intrasellulre buffersisteme.


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___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)[10]


a) On the axis provided draw an annotated graph to indicate the relationship betweencardiac output and ventricular end diastolic volume in a normal heart

a) Teken 'n benoemde grafiek op die asse wat voorsien word om die verhouding aan tedui tussen hartomset en ventrikulre eindiastoliese druk in n normale hart.

(2)

b) On the diagram above indicate what effect the following conditions have on therelationship.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 hierdieverwantskap 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)


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[10]


a) Briefly explain how the hypothalamic receptors are able to monitor the body waterstatus on a continuous basis.

a) Verduidelik kortliks hoe die hipotalamus-reseptore op n deurlopende basis in staat isom 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 indie totale liggaamswatersamestelling.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(4)

c) Provide a brief physiological explanation of the changes in plasma osmolality if thereis a decrease in ADH secretion.

c) Voorsien n kort fisiologiese verduideliking van die veranderinge in plasma-osmolaliteit indien daar 'n afname is in ADH afskeiding.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)[10]


a) What is the approximate daily requirement for potassium in mmol/kg for healthypatients?

a) Wat is die benaderde daaglikse benodigheid van kalium in mmol/kg vir gesondepasinte?

_______________________________________________________________________(1)

b) List 3 factors that cause potassium to move from the extracellular fluid into theintracellular fluid.

b) Lys 3 faktore verantwoordelik vir kalium beweging vanaf ekstrasellulre vog na dieintrasellulre vog.

__________________________________________________________________________________________________________________________________________________


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___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(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 kardialemiosiete?

_______________________________________________________________________(1)

g) In the event of a cardiac arrest from hyperkalaemia, will the heart be in a state ofcontraction or of relaxation?

g) Sal die hart in n staat van kontraksie of ontspanning wees tydens kardiale arresweens hiperkalemie?

_______________________________________________________________________(1)

h) 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 pompgevind in die membraan van meeste liggaamselle?

_______________________________________________________________________(1)10]


a) Name the nerve fibre types that transmit nociceptive impulses from the periphery tothe dorsal root of the spinal cord.

a) Noem die tipes senuweevesels wat die nosiseptiewe impulse vanaf die periferie nadie dorsale wortelganglion vervoer.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)

b) Through which spinal cord tract are most nociceptive impulses transmitted to thebrain?

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?


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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 supraspinalinhibition of nociception?

h) Deur watter reseptor medieer noradrenalien (norepinefrien) supraspinale inhibisievan nosisepsie?

_______________________________________________________________________(1)[10]


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) Explain the rationale for calculating corrected calcium from this laboratory valuec) 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) Name two mechanisms that cause hypocalcaemia in chronic renal failure.e) Noem die twee meganismes wat in chroniese nierversaking hipokalsemie


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veroorsaak._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)

f) What is the mechanism of secondary hyperparathyroidism observed in patients withchronic renal failure.

f) Wat is die meganisme van sekondere hiperparatireose gesien in pasinte metchroniese nierversaking.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)


Regarding skeletal muscleBetreffende 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)

c) Ca2+must be released within the cell to initiate muscle contraction.To which proteindoes Ca2+bind to cause these contractile filaments to be able to interact to causecontraction?

c) Kalsium moet vrygestel word binne die sel om spierkontraksie te inisieer. Aan watterproteen bind Ca2+ sodat hierdie kontraktiele filament interaksie met mekaar kanondergaan om saam te trek?

_______________________________________________________________________(1)

d) What is the name of the cell structure usually responsible for the storage of Ca2+?

d) Wat is die naam van die selstruktuur wat gewoonlik verantwoordelik is vir die stoorvan Ca2+?_______________________________________________________________________(1)

e) What is the name of the channel through which Ca2+is released from the storagestructure?

e) Wat is die naam van die kanaal deur wat Ca2+ vrygestel word vanaf die stoororganel?_______________________________________________________________________(1)

f) What receptor is found at the neuromuscular junction of nerves innervating skeletalmuscle?

f) Watter reseptor word gevind by die neuromuskulre aansluiting waar senuwees dieskeletspier innerveer?

_______________________________________________________________________(1)

g) By what intracellular mechanism is muscle contraction terminated?


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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 withCO2to form a water-soluble molecule. Name this molecule.

b) Die lewer detoksifiseer hierdie bogenoemde substans deur dit te kombineer met CO2om n wateroplosbare molekule te vorm. Noem di molekule.

_______________________________________________________________________(1)

c) A coagulopathy is frequently seen in patients with obstructive jaundice. Explain thereason for this.

c) n Koagulopatie word dikwels in pasinte met obstruktiewe geelsug gesien. Geeredes hiervoor.

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)

d) What volume of blood is normally contained within the liver of healthy adults?d) 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) How does the liver compensate for hypoglycaemia.f) Hoe kompenseer die lewer vir hipoglikemie?


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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(2)[10]


In maternal physiology, list the average maximum physiological changes associated withpregnancy in the following organ systemsIn moederlike swangerskapsfisiologie, lys die gemidelde maksimum fisiologieseveranderinge in die volgende sisteme

a) Minimum Alveolar Concentration of Anaesthetic Vapoursa) 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) PaCO2_______________________________________________________________________(1)

g) HCO3_______________________________________________________________________(1)

h) Diastolic blood pressure.h) Diastoliese bloeddruk._______________________________________________________________________(1)

i) Peripheral vascular resistance.

i) Perifere vaskulre weerstand._______________________________________________________________________(1)

j) Pulmonary vascular resistance.


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j) Pulmonale Vaskulre weerstand._______________________________________________________________________(1)

[10]


A patient suffers from type I (insulin dependent) diabetes. laboratory investigations asfollowsn Pasint ly aan tipe 1 (insulien-afhanklike) diabetes. Laboratorium ondersoeke is soos volg

Plasma:Na+ 142 mmol/lK+ 4.8 mmol/lCl- 110 mmol/lTotal /TotaleCO2 14 mmol/lUrea /Ureum 18.0 mmol/lCreatinine/ Kreatinien 168 umol/lGlucose/ Glukose 27.9 mmol/l

Arterial blood gas /Arterile bloedgasF iO2=60% F iO2= 60%pH 7.20PaO2 98 mmHg / 13kPaPaCO2 39 mmHg / 5.2kPaHCO3

- 12 mmol/LO2Saturation 95% /O2 Saturasie95%

Urine Dipstix: Ketone +++: / Uriene doopstokkie: Ketone +++Glucose ++++ /Glukose++++

a) Name the ketones that are present and give a full biochemical explanation howketones are synthesized.

a) Noem die ketone wat teenwoordig is en gee n volledige biochemiese verduidelikinghoe ketone gesintetiseer word.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________________________________

(6)

b) Discuss fully the patients acid base status.b) Bespreek hierdie pasint se suur basis status volledig.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

(4)


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[10]


Briefly discuss Nitric Oxide (NO) under the following headingsBespreek 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) Draw a fully annotated diagram of the oxyhemoglobin dissociation curve.a) Teken n ten volle geannoteerde diagram van die suurstof-

hemoglobiendissosiasiekurwe.


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(6)

b) Superimpose a CO2dissociation curve on the above diagram.b) Teken n CO2 -dissosiasiekurwe op bostaande grafiek._______________________________________________________________________(1)

c) Name three factors which shift the oxyhemoglobin-dissociation curve to the leftc) Noem drie faktore wat die suurstof-hemoglobiendissosiasiekurwe na links skuif.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(3)[10]


Draw a fully detailed and annotated sketch of the neuromuscular junction.Teken n volledig gedetaileerde en benoemde skets van die neuromuskulre aansluiting.

[10]


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FCA(SA) Part I


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

1 a) Draw the following dose response curves

i) An agonist.ii) An agonist in the presence of a competitive antagonist.iii) Discuss these curves. (5)

b) i) Define volume of distribution.

ii) What are the factors that determine a drugs volume of distribution?iii) What is meant by a small, moderate and large volume of distribution,

giving an example of a drug for each. (10)c) i) Fully define the term half-life.

ii) What are the factors that determine a drugs half-life? (10)d) i) What is zero order kinetics?

ii) Discuss the metabolism of ethanol as an example of zero order kinetics.

(10)e) Explain the concept of ion trapping, providing an example of where ion

trapping may occur. (5)f) 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.


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iii) The duration of action of aspirin is not directly related to the plasma half-life. (10)

[50]

1 a) Teken die volgende dosis-responskurwesi) n Agonis.ii) n Agonis in die teenwoordgiheid van n kompeterende antagonis.iii) Bespreek hierdie kurwes. (5)

b) 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)c) i) Definier volledig die term halflewe.

ii) Wat is die faktore wat n middel se halflewe bepaal? (10)d) i) Wat is nul-orde kinetika?

ii) Bespreek die metabolisme van etanol as n voorbeeld van nul-ordekinetika.(10)

e) Verduidelik die konsep van ioonvasvanging (ion trapping) en voorsien nvoorbeeld van waar ioonvasvanging mag voorkom. (5)f) 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]

2 As regards neuraxial opioids

a) Explain the reasoning for giving opioids neuraxially as opposed tointravenously. (4)

b) Define both an opioid and an opiate. (4)c) Discuss the differences in efficacy between lipophilic and hydrophilic opioids

given intrathecally. (8)d) List the adverse effects of neuraxial opiates, the mechanism by which the

adverse effects occur, and how they would be treated. (13)e) Write notes on the use of morphine given epidurally vs. intrathecally. (8)f) List the dosages for epidural administration of morphine, fentanyl and

sufentanil as a bolus. (3)g) What are the benefits of adding fentanyl to bupivicaine for spinal anaesthesiafor a Caesarian section. What are the dosages used for fentanyl andbupivicaine? (5)

h) What are the advantages and disadvantages of using Pethidine neuraxially?(5)

[50]

2 Met betrekking tot neuraksiale opioede

a) Verduidelik die redenasie om opioede neuraksiaal toe te dien teenoorintraveneuse toediening. (4)

b) Definier beide n opioed en opiaat. (4)c) Bespreek die verskille in effektiwiteit tussen lipofiliese en hidrofiliese opioede

met intratekale toediening. (8)


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d) Lys die ongewensde effekte van neuraksiale opioede, die meganismewaarop die newe-effekte berus en hoe dit behandel kan word. (13)

e) Skryf notas oor die gebruik van epidurale- versus intratekale morfien. (8)f) Lys die doserings van epidurale morfien, fentanyl en sufentanil as

bolusdoserings. (3)g) Wat is die voordele van fentanyl byvoeging tot bupivakaen vir spinal narkose

vir n keisersnit? Wat is hierdie doserings fentanyl en bupivakaen? (5)h) Wat is die voordele en nadele van neuraksiale Pethidine? (5)

[50]

3 a) Fully define the term MAC. (5)

b) Discuss all the derived MAC values. (8)

c) What are the MAC values of current inhalational agents. (7)d) Discuss the term MAC multiples with reference to current volatile agents. (6)e) Draw the chemical structure of

i) Sevoflurane, desflurane, halothane, isoflurane and enflurane. (10)

ii) Which of these agents are isomers. (1)

f) What are the effects of bromide, chlorine, fluorine and hydrogen in thesecompounds. (4)

g) Discuss the relationship between the volatile agents and liver dysfunction. (9)[50]

3 a) Definier die term MAK volledig. (5)

b) Bespreek al die afgeleide MAK-waardes. (8)

c) Wat is die MAK-waardes van die huidige inhalasiemiddels? (7)d) Bespreek die term MAK-veelvoude met verwysing na die huidige dampe. (6)

e) Teken die chemiese struktuur vani) Sevofluraan, desfluraan, halotaan, isofluraan and enfluraan. (10)

ii) Watter van hierdie agente is isomere? (1)

f) Wat is die efekte van bromied, chloried, fluoried en waterstof in hierdieverbindings? (4)

g) Bespreek die verwantskap tussen dampe en lewerdisfunksie? (9)[50]

4 a) Write short notes on the mechanisms of action of paracetamol. (10)b) Describe the metabolism and excretion of paracetamol. (20)

c) What are the principles in the management of an acute paracetamoloverdose. (10)

d) Briefly discuss the differences in the pharmacokinetics between orally, rectallyand intravenously administered paracetamol. (10)

[50]

4 a) Skryf kort notas oor die werkingsmeganismes van parasetamol. (10)b) Beskryf die metabolisme en ekskresie van parasetamol. (20)c) Wat is die beginsels in die hantering van n akute parasetamol-oordosering?

(10)d) Bespreek kortliks die verskille in die farmakokinetika tussen orale, rektale en

intraveneuse parasetamol. (10)

[50]


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FCA(SA) Part I




7 September 2011

PharmacologyPaper 4 (2 hours)

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

Question 1/ Vraag 1

Explain the main mechanism of action of the following drugs used in the treatment ofdiabetes.Verduidelik die werkingsmeganisme van die volgende middels wat gebruik word in diebehandeling 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)


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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._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Which corticosteroid preparation has mainly mineralocorticoid effects? (1)Watter kortikosteroedformuleringe het hoofsaaklik mineralokortikoed effekte?_________________________________________________________________________

[10]

Question 4/Vraag 4

a) Complete the table regarding the clinical effects and their appropriate receptor foradenosine.

a) 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._________________________________________________________________________


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b) Complete the following graph using plasma concentration versus time to illustrate

how context sensitive half-time is derived.b) Voltooi die volgende grafiek deur gebruik te maak van plasmakonsentrasie en tyd

om te illustreer hoe konteks-sensitiewe halflewe afgelei is (3)

c) Label the axes and complete the following graph for the context sensitive half-timesof Remifentanil, propofol, fentanyl and sufentanil.

c) Benoem die asse en voltooi die volgende grafiek vir die konteks-sensitiewehalflewes 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) Write notes on the side- effects of amiodarone.b) Skryf notas oor die newe-effekte van amiodaroon. (5)


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__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[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 havebeen 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 agentswhen used for local infiltration.

a) Gee die voorgestelde maksimum doserings van die volgende lokaalverdowers metgebruik vir lokaalinfiltrasie. (3)

Agent /Agens Dose/DoseringLignocaineLignokaen

BupivacaineBupivakaen

Ropivicaine


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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 dantroleneBetreffende dantroleen

a) List the indications for its usage.a) Lys die indikasies vir gebruik. (3)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Briefly explain the mechanism of action. (4)b) Verduidelik kortliks die werkingsmeganisme.

____________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Give the recommended dosages. (3)c) Gee die aanbevole doserings.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________


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____________________________________________________________________________________________________________________________________________________

[10]

Question 10 /Vraag 10

Complete the following table with the agents (readily available) you would use to deliberatelydecrease blood pressure intra-operatively, and very briefly describe the mechanism of actionof each.Voltooi die volgende tabel met die middels (geredelik beskikbaar) wat u sal gebruik omdoelbewus bloeddruk intra-operatief te laat daal, en beskryf kortliks die meganisme vanwerking van elk

Agent Mechanism of act ion/Meganisme van werking


a) Make short notes on the principles behind prescribing prophylactic antibiotics.a) Skryf kort notas oor die beginsels rakende die voorskryf van profilaktiese antibiotika.

(4)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

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 menslikeimmuungebrek (MIV/Vigs)? (3)

____________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


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a) What are the side effects of tramadol?a) Wat is die newe-effekte van tramadol? (3)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Describe the mechanism of action of codeine.b) Beskryf die meganisme van werking van kodeen. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

d) What are the side effects of dextropropoxyphene?

d) Wat is die newe-effekte van dekstropropoksifeen? (2)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]Question 13/ Vraag 13

Antibiotic pharmacokinetics/Antibiotika farmakokinetikaa) 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 twographs and indicate on the graphs

Minimal Inhibitory Concentration (MIC).

Concentration of the surviving organism.

Bolus dose of antibiotic.b) Voltooi die volgende tweegrafieke en dui aan op die grafieke

Minimum inhibitoriese konsentrasie (MIC).

Konsentrasie van die oorlewende organisme.

Bolusdosering antibiotika.

i) Time dependent killingi) Tyd-afhanklike dood (Time dependent killing) (3)


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ii) Concentration dependent killingii) 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) Provide an example of an antibiotic showing concentration dependent killingd) 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 thereason 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 redeaan vir byvoeging by lokaalverdowing, en gee die werkingsmeganisme.

a) Hyaluronidase.a) Hyaluronidase. (2)________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________

b) Bicarbonate.b) Bikarbonaat. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Neostigmine.

c) Neostigmine. (2)

________________________________________________________________________________________________________________________________________________


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________________________________________________________________________________________________________________________________________________

d) Clonidine.d) Klonidien. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

e) Ketamine.e) Ketamien. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


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. 5mghas been added to 200ml of normal saline running at 135ml/hour. What is the rate inug/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 inug/kg/min? (5)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________

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 % andmg/ml

b) U word gevra om 8ml 50% dekstrose in 200ml Ringerslaktaat te spuit. Wat is diefinale konsentrasie dekstrose in hierdie 200ml sak in % en in mg/ml? (5)

________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


Briefly discuss the mechanism of action of the following anticoagulantsBeskryf kortliks die werkingsmeganisme van die volgende antistolmiddels

a) Fondaparinux.a) Fondaparinux. (2)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

b) Clopidogrel.b) Klopidogrel. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Tirofiban.

c) Tirofiban. (2)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

d) Dabigatran etexilated) Dabigatran etexilate. (2)

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________

e) Rivaroxaban.e) Rivaroxaban. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


a) What is Entenox?a) Wat is Entenox? (1)________________________________________________________________________


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b) List the desirable effects of nitrous oxide.b) Lys die wenslike effekte van laggas. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) List the undesirable side effects of nitrous oxide.c) Lys die onwenslike effekte van laggas. (7)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


Define the following termsDefinieer die volgende terme

a) pKa.a) pKa. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) Bioavailability.b) Biobeskikbaarheid. (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

c) Bioequivalence.c) Bio-ekwivalensie (Bioequivalence). (2)

________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________

d) Clearance.d) Opruiming. (2)


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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

e) Mean residence time.e) Mean residence time. (2)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

[10]


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

(3)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

b) List the side effects of ketamineb) Lys die newe-effekte van ketamien. (4)

________________________________________________________________________

__________________________________________________________

fca(sa)_part_i_past_papers 4

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