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Primary FCARCSI
October 2011 OSCE/Viva Viva - 1 Pharmacology Two examiners, one asking questions, one marking. Draw the neuromuscular junction and briefly explain it’s function Can you classify neuromuscular blocking drugs? Tell me about depolarising muscle relaxants. Can you further classify non depolarising muscle relaxants? How do they work? Tell me more about rocuronium. Can you swiftly reverse the effects of rocuronium?
Define volume of distribution. Define clearance. Define half life. Use graphs or diagrams to help if you wish. Draw a graph to demonstrate what happens when an intravenous infusion of a drug is started until steady state is reached. What influences this steady state?
Tell me what diabetes is. Tell me about the different formulations of commercially available insulin and what influences their action. Classify oral antidiabetic agents. Give and example from each classification.
Define inotrope. Name some inotropes. How do they work? Can you draw and explain a graph that links fibre length with contractility? What receptors does adrenaline act on? What about noradrenaline?
What factors affect the uptake of the inhaled volatile anaesthetic agents ? Tell me more about the solubility of the agents.
Physiology
Tell me about the preoperative assessment of a patient with regard to tendency to bleed. What abnormal clotting conditions do you know? Tell me more about haemophilia. Discuss warfarinisation. What is INR?
How does the body respond to haemorrhage? Don’t discuss clotting here.
Discuss methods for assessing the conscious state of a patient. Tell me more about GCS. What happens to the brain if intracranial pressure increases? Define brainstem death? How is it diagnosed?
Tell me what vasopressin is. Where is it manufactured? When is it released? What does it do?
Define dead space. What methods can we use to measure dead space? Can you draw a graph and write down an equation to explain those methods? VIVAs -2Pharmaco 1. Induction agents / compare and contrast all 4 main agents (Prop., Thio,Ketamine, Etomidate) Mechanism of action for each; SEs Pharmacodynamics for Etomidate and Thio 2. Antiemetics Some physio of vomiting Classes; Receptors; SEs of antihistaminics and anticholinergics Examples and SEs of Butyrophenones 3. Drugs that inhibit gastric secretion and neutralize gastric acid Classes; SEs of antiH2 Omeprazole; Mech of action; h1/2; SEs Antiacids; examples; SEs; which ones do you use and why 4.Neuromuscular blocking agents Started with mech of action of depol and nondepolirizing agents; Structure of each in brief (not to draw or anything stupid la this) Compare and contrast Rocuronium and Vecuronium; Adv and Disadvantages of using each Some questions on Suggamadex Atracurium; how is it different; Differences between Atrac and Cisatracurium 5. Vaporizers Draw one (plenum) describe features Define SVP Ex of SVP for Iso, Halothane, Desflurane Questions on Desflurane; Why is it different; Describe the features of Desflurane vaporizer Returned to the Plenum Vaporizer; bimetallic strip; heat sink; why? define latent heat of vaporization Physiology 1. Pain and pain pathways Chemicals involved; Receptors;Ascending and Descending pathways;Neorumodulation; Plasticity; Other afferents; Opioids effects Mechanism of psychology of pain ? 2. O2 storage and transport Asked flux equation; Discussed about stores of O2 :FRC, HB, Mioglobin; How much in blood; How much dissolved? Can you change that amount? How? Some questions on dissociation curve (which was like a gift question) 3. Starling forces along capillaries (wanted the numerical values for all the pressures in periphery, lung and kidney) Stopped on kidney Starling forces; Discussed about filtration pathologies affecting the Starling forces in periphery 4. Altitude and Diving physiology Discussed more about altitude than diving Acute and chronic adaptation Chemoreceptors involved (periphery and central) Effects of hypoventilation on alveolar gas equation 5. BP measurement Asked about sphigmomanometer; cuff sizes, DINAMAP mechanism, Von Recklinhausen oscillotonometer Invasive BP monitoring What is piezoelectric resistance Resonance and Damping; Draw curves for damping |
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