Title: Jamjar MCQ's / 2020

Q: ADH increases the activity of
1. Baroreceptor firing
2. Na/K/2Cl on Thick Ascending Loop
3. Aquaporin-2 channels on basolateral membrane
4. V4 receptors in the pituitary
[...]
A: Na/K/2Cl on Thick Ascending Loop

Q: What is TRUE about acid-base physiology
1. Weak base readily accepts H^+
2. pH 7.4 = [H^+] 60mmol/L
3. OH^– is an independent variable
4. A decrease in pH from 7.4 to 7.1 doubles the hydrogen ion concentration
[...]
A: A decrease in pH from 7.4 to 7.1 doubles the hydrogen ion concentration

Q: Which nerve fibre has the fastest speed of conduction
1. Aa
2. Ab
3. Ad
4. C
[...]
A: Aa

Q: Which lung volume/capacity increases in pregnancy
1. ERV
2. RV
3. Expiratory Capacity
4. Inspiratory Capacity
[...]
A: Inspiratory Capacity

Q: What is most true about lymph
1. High protein content
2. Low in platelets
3. Contains all clotting factors
4. Daily flow 4ml/min
[...]
A: Contains all clotting factors
Extra: There were 2 qns ‘most true about lymphatics’ recalled to contain
- daily lymph flow
- the protein concentration in the ISF/liver
  Note: the protein content of lymph is low and mimics ISF [protein] everywhere except the liver

Q: The EDPVR relationship of the cardiac pressure-volume diagram is a measure of:
1. Inotropy
2. Chronotropy
3. Dromotropy
4. Lusitropy
[...]
A: Lusitropy

Q: The myotome for the knee reflex
1. L4
2. S1
3. L5
4. S2
[...]
A: L4

Q: Daily volume of saliva secretions
1. 1-2L
2. 0.5-1L
3. 0.6ml/min
4. 0.3ml/min
[...]
A: 1-2L

Q: The central venous pressure ‘c wave’ corresponds to which ECG event
1. QRS
2. P wave
3. end of QRS
4. begining of T wave
[...]
A: end of QRS
Extra: Due to RV valve bulging backwards into RA as RV contracts

Q: The action of Levosimendan on K_ATP channels
1. closes
2. opens
3. stabilises
4. removes Ca^2+ plug
[...]
A: opens

Q: The myotome for the ankle reflex
1. L4
2. S1
3. L5
4. S2
[...]
A: S1

Q: An example of a 3rd generation cephalosporin
1. Cefepime
2. Cefuroxime
3. Ceftazidime
4. Cefazolin
[...]
A: Ceftazidime

Q: The Respiratory Quotient for a protein diet
1. 0.5
2. 0.7
3. 0.8
4. 1.0
[...]
A: 0.8
Extra: Proteins: The respiratory quotient for protein metabolism can be demonstrated by the chemical equation for oxidation of albumin: C_72H_112N_18O_22S + 77 O_2 → 63 CO_2 + 38 H_2O + SO_3 + 9 CO(NH_2)_2 The RQ for protein is approximately 0.8. RQ = 63 CO_2/ 77O_2 = 0.8 Due to the complexity of the various ways in which different amino acids can be metabolized, no single RQ can be assigned to the oxidation of protein in the diet; however, 0.8 is a frequently utilized estimate Openanaesthesia.org

Q: Normal thermal neutral zone in awake adult
1. 0.2-0.5 °C
2. 36.5-37.3 °C
3. 25-30 °C
4. 32-34 °C
[...]
A: 25-30 °C
Extra: Thermoneutral Zone = ambient temp where we do not have to actively regulate our body temp

Q: Evaporation
1. Accounts of 50% heat loss at ambient temperature
2. Body temperature does not have to exceed ambient temperature
3. Increases in high humidity environments
4. Accounts for 500ml of water loss per day
[...]
A: Body temperature does not have to exceed ambient temperature
Extra: Evaporation = transfer of heat by evaporation of water   600-700ml of water evaporates / day   20% heat loss   The only way to lose heat when ambient temp > Body temp   Evaporative heat loss depends on the vapour pressure of water in air so at higher humidities the rate of evaporation decreases

Q: Measurement of blood volume is Plasma Volume divided by
1. 1 - Hematocrit
2. 1 - ECF
3. 1 - Interstitial water
4. 1 - Packed Cell Volume
[...]
A: 1 - Hematocrit

Q: Which is true of hepatic extraction ratio
1. Diazepam has high HER
2. GTN has low HER
3. HER is high for capacity dependent drugs
4. HER is high for flow dependent drugs
[...]
A: HER is high for flow dependent drugs
Extra: - Intrinsic clearance = hepatic metabolism of drugs if unlimited & all drug was unbound
- High intrinsic clearance (lignocaine, M, propranolol)
  - Almost all drug presented to liver removed
  - ∴limited by HBF
- Low intrinsic clearance (warfarin, diazepam)
  - Liver already maximally metabolising
  - ∴limited by enzyme activity
- PPB → only unbound drug can be metabolised
  - High IC → ∆ PPB has maximal effect on clearance
  - Low IC → ∆ PPB has significant effect on clearance
- Hepatic BF →↑BF = ↑drug presented for metabolism per unit time
  - High IC = ↑BF = ↑Clearance
  - Low IC = ↑BF = not much ∆ clearance

Q: What is the intracellular concentration of Cl- (mmol/L)
1. 4
2. 26
3. 65
4. 110
[...]
A: 4

Q: Mixed venous O2 will decrease with:
1. Hyperbaric oxygen treatment
2. Decreased tissue oxygen consumption
3. Severe anaemia
4. Muscle relaxation
[...]
A: Severe anaemia

Q: Which of the following attenuate hypoxic pulmonary vasoconstriction
1. Acidaemia
2. Hypercapnia
3. Iron deficiency
4. Alveolar hypoxia
[...]
A: MCQ was recalled as shown, however… All enhance HPVC   Attenuation via alkalosis and volatiles
This is a popular topic for vivas and so worthwhile knowing
Extra: Nunn's describes the proposed mechanism
aritcle describing mechanisms https://watermark.silverchair.com/mkw076.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAsMwggK_BgkqhkiG9w0BBwagggKwMIICrAIBADCCAqUGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMO_DwQqDj0gjuiT5eAgEQgIICdsNB2wDCNcAyKOZ_sAQhG1MFxMOHu0M55l0D9j_-ZeKYNdjiFaQusJHDg1zWTQozB_SDUaI1CwGUaMpHEtSFnjSYjkQzuKiglfCD5xgUVdyp45yuyHxT19-er9mcxqhFoRF8O4XzqaLfYY2o_PaKQyWog2eepYVn-P7TC2w_985Gcsn2le1Bo_6mMT1IAMFsdoo8cZ42tjOojexPeuC6UQfks4Hh4PeKW12O19n6sIgy_oFYEoH7Nbp0bjPwztsu2b06Z68ZFy40ou8tlh7Q9THi7tAkClhoex-3K9gOMYsXlrLI9G04l5UG0MFwY1HELTc4aBaOBCdS0sCBop9E9d2GMT298mjNZ5Nq5kEB5ptmvvhXFoO3nPckOmY1FLcppGYzrJm_4QFTQUjGqLHlcAsgdPOadCRIrXTETpi33omjaLkBDgr6JDDA--KgjFHCkIKORc-azim5Borh22-1AhwRZ7V9IQIJaVNe_claxY17WShGydcevKe8uBeaXRCG9tAmqB9UmGD4uEAm5RmlaIz8gHwTxksWk2TgYffpScXpnmSpuWLyrvAU01qiFnayjR16sRQICGhEa2Swlk4ijFQyNAUVEBOkdbhoV72bR4zrbpciQphEjQ3sAZZyvFGv4VlzVQTDgyaZuAzVYjxikxWvEVD4vHh4UgNIvTRNrOHJZ0wuRNW_9HL9_UYPT-2ycSRWHySXnTe4Fr2eScVyILv13dLK1ImhkKvSMBl0yjOECzptXTNeeupr_0WSP6K15hdKKV3_6nM5gCj46rRTBjlWudFIa9UtjV2QdIpj_dhQMEhU4no1PpYmXlubcg1ZmF6cGyYoGw

Q: Which is true for GTN
1. Protein binding 5%
2. Half life 1-3mins
3. Bioavailability 30%
4. Hepatic Metabolism
[...]
A: Half life 1-3mins

Q: Which of the following is action of DOP receptor
1. Analgesia
2. Miosis
3. Euphoria
4. Bradycardia
[...]
A: Analgesia
Extra: The DOP receptor was the first to be cloned and is less widely distributed relative to the other opioid receptors. Highest densities are found in the olfactory bulb, cerebral cortex, nucleus accumbens and the caudate putamen. DOP receptors are located presynaptically on primary afferents where they inhibit the release of neurotransmitters. Through both spinal and supraspinal sites, the receptor is involved in the antinociceptive/analgesic actions of some opioids. However, DOP receptor agonists have also been shown to reduce gastrointestinal tract motility and cause respiratory depression.5 Studies with DOP receptor knockout mice revealed that they display hyperlocomotor activity and it is assumed the receptor, under basal conditions, may dampen locomotor behaviour. DOP receptor knockout mice also displayed anxiogenic and depressive-like responses, suggesting that the receptor may act to regulate mood.

Q: By which mechanism is Sotalol metabolised in the body?
1. Not metabolized
2. Hepatic metabolism
3. Plasma esterases
4. Renal metabolism
[...]
A: Not metabolized

Q: Which nerve fibres are the first to be affected by hypoxia
1. A fibre
2. B fibres
3. C fibres
4. D fibres
[...]
A: B fibres

Q: Which structure is most caudal
1. Laryngeal incisure
2. Hyoid bone
3. Thyroid Notch
4. Cricoid Cartilage
[...]
A: Cricoid Cartilage

Q: Which structure is most cranial:
1. Coeliac trunk
2. SMA
3. IMA
4. Renal arteries
[...]
A: Coeliac trunk