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Question 1
Incorrect
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The SI unit of measurement is kgm2s-2 in the System international d'unités (SI).
Which of the following derived units of measurement has this format?Your Answer: Force
Correct Answer: Energy
Explanation:The derived SI unit of force is Newton.
F = m·a (where a is acceleration)
F = 1 kg·m/s2The joule (J) is a converted unit of energy, work, or heat. When a force of one newton (N) is applied over a distance of one metre (Nm), the following amount of energy is expended:
J = 1 kg·m/s2·m =
J = 1 kg·m2/s2 or 1 kg·m2·s-2The unit of velocity is metres per second (m/s or ms-1).
The watt (W), or number of joules expended per second, is the SI unit of power:
J/s = kg·m2·s-2/s
J/s = kg·m2·s-3Pressure is measured in pascal (Pa) and is defined as force (N) per unit area (m2):
Pa = kg·m·s-2/m2
Pa = kg·m-1·s-2 -
This question is part of the following fields:
- Physiology
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Question 2
Correct
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Which of the following would most likely explain a failed post-operative analgesia via local anaesthesia of a neck abscess?
Your Answer: pKA
Explanation:For the local anaesthetic base to be stable in solution, it is formulated as a hydrochloride salt. As such, the molecules exist in a quaternary, water-soluble state at the time of injection. However, this form will not penetrate the neuron. The time for onset of local anaesthesia is therefore predicated on the proportion of molecules that convert to the tertiary, lipid-soluble structure when exposed to physiologic pH (7.4).
The ionization constant (pKa) for the anaesthetic predicts the proportion of molecules that exists in each of these states. By definition, the pKa of a molecule represents the pH at which 50% of the molecules exist in the lipid-soluble tertiary form and 50% in the quaternary, water-soluble form. The pKa of all local anaesthetics is >7.4 (physiologic pH), and therefore a greater proportion the molecules exists in the quaternary, water-soluble form when injected into tissue having normal pH of 7.4.
Furthermore, the acidic environment associated with inflamed tissues favours the quaternary, water-soluble configuration even further. Presumably, this accounts for difficulty when attempting to anesthetize inflamed or infected tissues; fewer molecules exist as tertiary lipid-soluble forms that can penetrate nerves.
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This question is part of the following fields:
- Physiology
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Question 3
Incorrect
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A healthy 27-year old male who weighs 70kg has appendicitis. He is currently in the operating room and is being positioned to have a rapid sequence induction.
Prior to preoxygenation, the compartment likely to have the best oxygen reserve is:Your Answer: Lung
Correct Answer: Red blood cells
Explanation:The following table shows the compartments and their relative oxygen reserve:
Compartment Factors Room air (mL) 100% O2 (mL)
Lung FAO2, FRC 630 2850
Plasma PaO2, DF, PV 7 45
Red blood cells Hb, TGV, SaO2 788 805
Myoglobin 200 200
Interstitial space 25 160Oxygen reserves in the body, with room air and after oxygenation.
FAO2-alveolar fraction of oxygen rises to 95% after administration of 100% oxygen (CO2 = 5%)
FRC- Functional residual capacity – (the most important store of oxygen in the body) – 2,500-3,000 mL in medium sized adults
PaO2-partial pressure of oxygen dissolved in arterial blood (80 mmHg breathing room air and 500 mmHg breathing 100% oxygen)
DF -dissolved form (0.3%)
PV-plasma volume (3L)
TG-total globular volume (5L)
Hb-haemoglobin concentration
SaO2-arterial oxygen concentration (98% breathing air and 100% when preoxygenated) -
This question is part of the following fields:
- Physiology
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Question 4
Incorrect
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A patient on admission is given an infusion of 1000 mL of 10% glucose and 500 mL of 20% lipid over a 24 hour period.
Which of these best approximates to the energy input over this time period?Your Answer: 1100 kcal
Correct Answer: 1300 kcal
Explanation:1% solution contains 1 g of substance per 100 mL.
A solution of 10% glucose is 10 g/100mL. Therefore 1000 mL of this glucose solution will contain 100 g.
1 g of glucose yields about 4 kcal of energy. One litre of 10% glucose will therefore release approximately 4x100g = 400 kcal of energy.
A solution of 20% fat is 20 g/100mL. Therefore 1000 mL of this fat solution will have 200 g and 500 mL will contain 100 g.
1 g of fat yields approximately 9 kcal. 500 mL of 20% fat therefore has the potential to yield 900 kcal of energy.
The total energy input over this 24 hour period is approximately 400kcal + 900kcal = 1300 kcal.
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This question is part of the following fields:
- Physiology
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Question 5
Correct
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A 61-year-old woman with myasthenia gravis is admitted to the ER with type II respiratory failure. There is a suspicion of myasthenic crisis.
She is in a semiconscious state. Her blood pressure is 160/90 mmHg, pulse is 110 beats per minute, temperature is 37°C, and oxygen saturation is 84 percent.
With a PaCO2 of 75 mmHg (10 kPa) breathing air, blood gas analysis confirms she is hypoventilating.
Which of the following values is the most accurate representation of her alveolar oxygen tension (PAO2)?Your Answer: 7.3
Explanation:The following is the alveolar gas equation:
PAO2 = PiO2 − PaCO2/R
Where:
PAO2 is the partial pressure of oxygen in the alveoli.
PiO2 is the partial pressure of oxygen inhaled.
PaCO2 stands for partial pressure of carbon dioxide in the arteries.
The amount of carbon dioxide produced (200 mL/minute) divided by the amount of oxygen consumed (250 mL/minute) equals R = respiratory quotient. With a normal diet, the value is 0.8.By subtracting the partial pressure exerted by water vapour at body temperature, the PiO2 can be calculated:
PiO2 = 0.21 × (100 kPa − 6.3 kPa)
PiO2 = 19.8Substituting:
PAO2 = 19.8 − 10/0.8
PAO2 = 19.8 − 12.5
PAO2 = 7.3k Pa -
This question is part of the following fields:
- Physiology
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Question 6
Incorrect
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A global cerebral blood flow (CBF) of 35 ml/100 g/min (Normal CBF = 54 ml/100 g/min) can lead to which of the following?
Your Answer: Irreversible brain damage
Correct Answer: Poor prognostic EEG
Explanation:CBF is defined as the blood volume that flows per unit mass per unit time in brain tissue and is typically expressed in units of ml blood/100 g tissue/minute. The normal average CBF in adults human is about 50 ml/100 g/min, with lower values in the white matter (,20 ml/100 g/min) and greater values in the gray matter (,80 ml/100 g/min).
Low CBF levels between 30-40 ml/100 g/min may begin to show poor prognostic EEG. EEG findings consistently associated with a poor outcome are isoelectric EEG, low voltage EEG, and burst suppression (specifically burst suppression with identical bursts), as well as the absence of EEG reactivity.
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This question is part of the following fields:
- Physiology
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Question 7
Correct
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The following is normally higher in concentration extracellularly than intracellularly
Your Answer: Sodium
Explanation:The ions found in higher concentrations intracellularly than outside the cells are:
ATP
AMP
Potassium
Phosphate, and
Magnesium Adenosine diphosphate (ADP)Sodium is a primarily extracellular ion.
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This question is part of the following fields:
- Physiology
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Question 8
Incorrect
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During exercise, muscle blood flow can increase by 20 to 50 times.
Which mechanism is the most important for increased blood flow?Your Answer: Sympathetic cholinergic stimulation
Correct Answer: Local autoregulation
Explanation:Skeletal muscle blood flow is in the range of 1-4 ml/min per 100 g when at rest. Blood flow can reach 50-100 ml/min per 100 g during exercise. With maximal vasodilation, blood flow can increase 20 to 50 times.
The adrenal medulla releases catecholamines and increases neural sympathetic activity during exercise. Normally, alpha-1 and alpha-2 would cause vasoconstriction in the muscle groups being used, but vasodilatory metabolites override these effects, resulting in a so-called functional sympathectomy. Local hypoxia and hypercarbia, nitric oxide, K+ ions, adenosine, and lactate are some of the stimuli that cause vasodilation.
However, the splanchnic and cutaneous circulations, which supply inactive muscles, vasoconstrict.
Sympathetic cholinergic innervation of skeletal muscle arteries is found in some species (such as cats and dogs, but not humans). Vasodilation is induced by stimulating smooth muscle beta-2 adrenoreceptors, but at rest, the alpha-adrenoreceptor effects of adrenaline and noradrenaline predominate. During exercise, the skeletal muscle pump promotes venous emptying, but it does not necessarily increase blood flow.
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This question is part of the following fields:
- Physiology
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Question 9
Incorrect
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One of the non-pharmacologic management of COPD is smoking cessation. Given a case of a 60-year old patient with history of smoking for 30 years and a FEV1 of 70%, what would be the most probable five-year course of his FEV1 if he ceases to smoke?
Your Answer: The FEV1 will return to normal within 5 years
Correct Answer: The FEV1 will decrease at the same rate as a non-smoker
Explanation:For this patient, his forced expiratory volume in 1 second (FEV1) will decrease at the same rate as a non-smoker.
There is a notable, but slow, decline in FEV1 when an individual reaches the age of 26. An average reduction of 30 mls every year in non-smokers, while a more significant reduction of 50-70 mls is observed in approximately 20% of smokers.
Considering the age of the patient, individuals who begin smoking cessation by the age of 60 are far less likely to achieve normal FEV1 levels, even in the next five years. It is expected that their FEV1 will be approximately 14% less than their peers of the same age.
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This question is part of the following fields:
- Physiology
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Question 10
Incorrect
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Anaesthetic awareness is most probable in general anaesthesia for which surgical operation?
Your Answer: Emergency caesarean section
Correct Answer: Emergency surgery for major trauma
Explanation:Awareness during general anaesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder.
The incidence of awareness during general anaesthesia with current anaesthetic agents and techniques has been reported as 0.2-0.4% in nonobstetric and noncardiac surgery, as 0.4% during caesarean section, and as 1.5% in cardiac surgery.
The incidence during major trauma surgery is higher. Incidence of recall has been reported to be as high as 11-43% in major trauma cases.
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This question is part of the following fields:
- Physiology
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