FCA (SA) Part I Past Papers - 2014 1st Semester 2 10 2014 PDF

FCA(SA) Part I
THE COLLEGES OF MEDICINE OF SOUTH AFRICA

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
24 March 2014
Physiology
Paper 1 (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) Describe in detail the stages of systole and diastole. (10)

b) Discuss the factors that determine the balance between MDO 2 (oxygen supply) and MVO2
(oxygen demand) in the myocardium. (20)
c) Explain the pathophysiology of the following
i) Systolic heart failure. (5)
ii) Diastolic heart failure. (5)
d) The heart may be described as being part of the endocrine system. Validate this statement
by describing in detail the hormones secreted by the heart and their actions. (10)
[50]
1 a) Beskryf in besonderhede die fases van sistolie en diastolie. (10)

b) Bespreek die faktore wat die balans bepaal tussen MDO2 (suurstofvoorsiening) en MVO2
(suurstofverbruik) van die miokard. (20)
c) Verduidelik die patofisiologie van die volgende
i) Sistoliese hartversaking. (5)
ii) Diastoliese hartversaking. (5)
d) Die hart kan beskou word as deel van die endokriene stelsel . Bevestig hierdie stelling deur
die hormone wat die hart produseer, en hul funksies in besonderhede beskryf.
(10)
[50]
2 a) Describe how a neonatal airway differs structurally from an adult airway. (5)
b) Discuss how the following systems are functionally and structurally different in a neonate
compared to a child over 1-year of age.
i) Cardiovascular system. (7)
ii) Respiratory system. (9)
iii) Liver. (4)
iv) Kidneys. (3)
v) Central nervous system. (2)
PTO/Page 2 Question 2 c)…
-2-
c) Discuss how a term neonate maintains a neutral thermal environment. (20)

[50]
2 a) Beskryf hoe die neonatale lugweg struktureel verskil van die van ’n volwassene. (5)
b) Beskryf hoe die volgende stelsels funksioneel en struktureel verskil tussen die neonaat en
’n kind van bo 1-jaar ouderdom
i) Kardiovaskulêre stelsel. (7)
ii) Respiratiriese stelsel. (9)
iii) Lewer. (4)
iv) Niere. (3)
v) Sentarle senuweerstelsel. (2)
c) Bespreek hoe die voltermyn neonaat ’n termies neutrale omgewing handhaaf. (20)
[50]
3 a) Draw an annotated sketch of the neuromuscular junction in skeletal muscle. (10)

b) Describe the steps in neuromuscular transmission. (10)
c) Based on the above, explain the muscle weakness associated with myasthenia gravis. (4)
d) Describe the effects of each of the following substances on neuromuscular transmission
i) Botulinum toxin. (2)
ii) Curare. (2)
iii) Neostigmine. (2)
e) Discuss the role of myosin and calcium in skeletal muscle contraction. (10)
f) Explain possible reasons for fatigue in skeletal muscle. (10)
[50]
3 a) Teken ’n benoemde skets van die neuromuskulêre aansluiting in skeletspier. (10)

b) Beskryf die stappe van neuromuskulêre oordrag. (10)
c) Gebaseer op bogenoemde, verduidelik die spierswakheid geassosieer met miastenia
gravis. (4)
d) Beskryf die effekte van elk van die volgende substanse op neuromuskulêre oordrga
i) Botulinim toksien. (2)
ii) Kurare. (2)
iii) Neostigmien. (2)
e) Bespreek die rol van miosien en kalsium in skeletspierkontraksie. (10)
f) Verduidelik die moontlike redes vir uitputting van skeletspier. (10)
[50]
4 a) Describe in detail the anatomy of the microcirculation in terms of the capillary endothelium
and its glycocalyx. You may make use of an annotated diagram. (15)
b) Discuss the regulation of perfusion of the microcirculation. (15)
c) Discuss the Starling equation. (10)
d) Explain how the recognition of the structure and role of the glycocalyx has changed
our understanding of microvascular fluid exchange and led to a revision of the Starling
equation. (10)
[50]
PTO/Page 3 Question 4…
-3-
4 a) Beskryf in besonderhede die anatomie van die mikrosirkulasie in terme van die kapillêre
endoteel en glikokaliks. U mag gebruik maak van ’n benoemde diagram.
b) Bespreek die regulering van perfusie van die mikrosirkulasie. (15)
c) Bespreek die Starlingvergelyking. (10)
d) Verduidelik hoe die ontdekking van die rol en struktuur van die glikokaliks ons begrip van
mikrovaskulêre vloeistofuitruiling verander het en gelei het tot ’n hersiening van die
Starlingvergelyking. (10)
[50]
-4-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

24 March 2014
Physiology
Paper 2 (3 hours)
All questions are to be answered
Al die vrae moet beantwoord word
Candidate Number:....................................................
Question 1 - 5
-5-
Question 1 / Vraag 1
a) List the cardiovascular changes that occur in pregnancy. [10]

Lys die kardiovaskulêre veranderinge met swangerskap.
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With respect to aldosterone
Met betrekking tot aldosteroon
a) What type of hormone is it? (1)
Watter tipe hormoon is dit?
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b) Which specific area in the adrenal gland is it secreted from? (1)

Van watter spesifieke area in die bynier word dit gesekreteer?
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c) Which area does it act on specifically in the kidney? (2)

Op watter spesifieke area van die nier werk dit?
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d) Describe aldosterone’s mechanism of action. (4)

Beskryf die werkingsmeganisme van aldosteroon.
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e) What triggers its release? (2)

Wat stimuleer die vrystelling daarvan?
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[10]
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a) Define cerebral perfusion pressure. (2)

Definieer serebrale perfusiedruk.
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b) Define intracranial hypertension. (2)

Definieer intrakraniale hipertensie.
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c) What is the relationship between cerebral blood flow and pCO2? (2)
Wat is die verwantskap tussen serebrale bloedvloei en pCO2?
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d) State two factors that govern the movement of a substance across the blood-brain barrier.
Gee twee faktore wat beheer uitoefen oor die beweging van ’n substraat oor die bloed-breinskans.
(2)
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e) List two causes of cerebral oedema. (2)

Lys twee oorsake van serebrale edeem.
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[10]
-8-
a) Draw the relationship between the alveolar pressure and the pulmonary arterial and venous
pressures in the following West zones in the sitting position
Teken die verwantskap tussen die alveolêre druk en die pulmonale arteriële en veneuse drukke
in die volgende sones van West in die sittende posisie
i) Zone 1 / Sone 1. (2)
ii) Zone 2 / Sone 2. (2)
iii) Zone 3 / Sone 3. (2)
b) List and explain the two mechanisms specific to the pulmonary vasculature that aid in lowering
pulmonary vascular resistance. (2)
Lys en verduidelik twee spesifieke meganismes van die pulmonale vaskulatuur wat help met die
vermindering van die pulmonale vaskulêre weerstand.
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c) Why is pulmonary vascular resistance high at either low or high lung volumes? (2)
Waarom is die pulmonale vaskulêre weerstand hoog by lae sowel as hoë longvolumes?
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[10]
-9-
a) Complete the following table

Votooi die volgende tabel (9)
Blood flow. O2 Consumption. Percentage of total

Bloedvloei. O2-Verbruik. cardiac output.
Persentasie van
ml/100g/min. ml/100g/min. totale kardiale
omset.
Brain.
Brein.
Heart.
Hart.
Kidney.
Nier.
b) What is the pO2 in kPa or mmHg at the level of the inner medulla of the kidney? (1)
Wat is die pO2 in kPa of mmHg in die binnestemedulla van die nier?
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[10]
-10-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

24 March 2014
Physiology
Paper 2 (3 hours)
Question 6 - 10
-11-
a) Draw a fully annotated normal jugular venous pressure waveform. (8)

Teken ’n volledig benoemde normale jugulêre veneuse drukkurwe.
b) How does the jugular venous pressure wave form change in complete heart block? (2)
Hoe verander die jugulêre veneuse drukkurwe met volledige hartblok?
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[10]
-12-
a) Draw and annotate a normal spinal reflex arc. (5)

Teken en benoem ’n normale spinalerefleksboog.
b) Briefly discuss the oculo-cardiac reflex. (5)

Bespreek kortliks die okulokardiale refleks.
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[10]
-13-
a) Write down the Cockcroft-Gault equation. (2)

Skryf die Cockroft-Gaultvergerlyking neer.
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b) How accurate is this equation when used to approximate glomerular filtration rate? Explain your
answer. (3)
Hoe akkuraat is hierdie vergelyking wanneer dit gebruik word om glomerulêre filtrasietempo te
bepaal? Verduidelik u antwoord.
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c) Write down the equation for fractional excretion of sodium. (2)

Skryf die vergelyking neer vir die fraksionele eksresie van natrium.
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d) Explain how the fractional excretion of sodium can be used to differentiate causes of acute renal
failure. (3)
Verduidelik hoe die fraksionele uitskuiding van natrium gebruik kan word om te onderskei tussen
die oorsake van akute nierversaking.
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[10]
-14-
Membrane phospholipids /Membraanfosfolipiede
1 Tissue injury
3 4
5-HPETE Prostaglandin H2
Leukotrienes 5 Prostacyclin Prostaglandin

E2 & F2
Leukocytes Platelets Endothelium Smooth muscle
a) Name the enzymes indicated by the number. (4)

Noem die ensieme soos aangedui deur die nommer.
1
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6
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b) Name the intermediate – 2. / Benoem die intemediëre substans – 2. (1)
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c) Name the product – 5. / Benoem die produk – 5. (1)
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d) List the normal physiological functions of Prostacyclin. (2)

Lys die normale fisiologiese funksies van Prostasiklien.
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e) What is the function of prostaglandin on bronchial smooth muscle? (1)

Wat is die funksie van prostaglandien op brongiale gladdepsier?
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[10]

-16-
a) Describe the structure of a haemoglobin (Hb) molecule. (3)

Beskryf die struktuur van ’n hemoglobienmolekule (Hb).
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b) What is the oxygen binding capacity of Hb? (1)

Wat is die suurstofbindingskapasitieit van Hb?
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c) Draw and fully annotate a normal oxygen-Hb dissociation curve. (4)

Teken en benoem ’n normale suurstof-Hb-dissosiasiekurwe.
d) List the factors that cause a right shift in the oxygen-Hb dissociation curve. (2)
Lys die faktore wat ’n regswaartse skuif van die suurstof-Hb-dissosiasiekurwe sal veroorsaak.
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[10]
-17-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

24 March 2014
Physiology
Paper 2 (3 hours)
Question 11 - 15
-18-
Briefly describe the functional significance of each of the following cells / molecules in the immune
response
Beskryf kortliks die funksionele belang van elk van die volgende selle / molekules in die immuunrespons
a) B-cells / B-selle. (2)
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b) Regulatory T-cells / Regulatoriese T-selle. (2)
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c) Antigen-presenting cells / Antigeenpresenterende selle. (2)
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d) Immunoglobulin M / Immunoglobulien M. (2)
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e) Complement proteins / Komplement proteïene. (2)
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[10]
-19-
Define the following terms related to genetics

Definieer die volgende genetikaterme
a) Epigenetic inheritance / Epigeniese oorerwing. (3)
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b) Genetic mutation / Genetiese mutasie. (3)
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c) Channelopathy (give an example) / Kanaalopatie (gee ’n voorbeeld). (4)
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[10]

-20-
A patient presents with symptoms and signs of tachycardia, increased blood pressure (200/110 mmHg),
headache, cold hands and feet, and nausea and vomiting. A 24-hour urinary vanillylmandelic acid test
is positive and on CT scan a mass is seen on the left adrenal gland.
’n Pasiënt presenteer met simptome en tekens van tagikardie, verhoogde bloeddruk (200/110 mmHg),
hoofpyn, koue hande en voete, en naarheid en braking. ’n 24-Uur urinêre vanilielamandelsuurtoets is
positief en op RT-skandering is ’n massa sigbaar op die linker bynier.
a) What is the likely diagnosis in this patient? (1)

Wat is die waarskynlike diagnose in hierdie pasiënt?
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b) Explain the reasons for the positive vanillylmandelic acid. (1)

Verduidelik die redes vir die positiewe vanilielmandeliesesuur toets.
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c) Explain the mechanism and receptor interactions for the following symptoms
Verduidelik die meganisme en reseptorinteraksies van die volgende simptome
i) Tachycardia / Tagikardie. (2)
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ii) Raised blood pressure / Verhoogde bloeddruk. (2)
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PTO/Page 5 Question 13 c iii)…

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iii) Cold hands / Koue hande. (2)
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iv) Nausea and vomiting / Naarheid en braking. (2)
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[10]

-22-
a) Complete the following table regarding aerobic and anaerobic metabolism of glucose with
reference to the site in the cell where it occurs, amount of ATP produced, and the products
produced. (6)
Voltooi die volgende tabel aangaande aërobiese en anaërobiese metabolisme van glukose met
verwysing na waar in die sel dit plaasvind, die hoeveelheid ATP wat geproduseer word, en die
produkte geproduseer.
Anaerobic metabolism Aerobic metabolism

Anaërobiese metabolisme Aërobiese metabolisme
Site in cell.
Setel in sel.
Amount of ATP produced.
Hoeveelheid ATP
geproduseer.
Products produced.
Produkte geproduseer.
b) Explain the pathophysiology of diabetic ketoacidosis. (4)

Verduidelik die patofisiologie van diabetiese keto-asidose.
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[10]

-23-
a) Give the normal distribution of K+ between intracellular and extracellular fluid (where is most of
the K+ located?). (1)
+
Gee die normale distribusie van K tussen die intrasellulêre en ekstrasellulêre vloeistof (waar word
die meeste K+ aangetref?).
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b) What is the effect of hypokalemia on the resting membrane potential of excitable tissue?
Wat is die effek van hipokalemie op die rustende membraanpotensiaal van eksiteerbare weefsel?
(4)
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c) What is the effect of glucose administration on serum K+ levels? (2)

Wat is die effek van glukosetoediening op die serum-K+ vlakke?
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d) Describe the movement of K+ ions during the action potential of excitable tissue. (3)
+
Beskryf die beweging van K -ione gedurende die aksiepotensiaal van eksiteerbare weefsel.
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[10]
-24-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

24 March 2014
Physiology
Paper 2 (3 hours)
Question 16 - 20
-25-
A motorcyclist sustains a traumatic brain injury and is intubated. He is ventilated manually. An arterial
blood gas analysis gives these results
’n Motorfietsryer doen ’n troumatiese breinbesering op en is geïntubeer. Hy word manueel geventileer.
’n Arteriële bloedgasanalise gee die volgende resultate
pH 7.48.
pCO2 25 mm Hg (3.3 kPa).
HCO3 28 mEq/ml.
a) What is the acid-base disturbance and the likely cause? (2)

Wat is die suur-basisversteuring en wat is die waarskynlike oorsaak?
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b) How does the body compensate over time for such a disturbance? (4)
Hoe sal die liggaam met verloop van tyd kompenseer vir hierdie versteuring?
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c) What is the likely effect of this disturbance on the cerebral blood flow? (2)
Wat is die waarskynlike effek van hierdie versteuring op serebrale bloedvloei?
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PTO/Page 3 Question 16 d)…

-26-
d) How is regulation of cerebral blood flow altered in severe traumatic brain injury? (2)
Hoe word die regulering van serebrale bloedvloei gewysig met troumatiese breinbesering?
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[10]

-27-
A 20-year-old previously healthy Durban woman presents with an altered level of consciousness
following the ingestion of a large number of analgesics. She is breathing 8 times per minute. Her arterial
blood gas on room air shows
’n 20-Jarige, voorheen gesonde vrou van Durban, presenteer met ’n onderdrukte bewussyn na die
inname van ’n groot hoeveelheid analgetika. Sy haal 8 keer per minuut asem. Haar arteriële
bloedgasanalise op kamerlug wys
pH: 7.21.
paCO2: 75 mmHg (10 KPa).
PaO2: 41 mmHg (5.5 KPa).
a) What is her alveolar partial pressure? (2)
Wat is haar alveolêre parsiële druk?
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b) What is her A-a gradient? (2)

Wat is haar A-a gradient?
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c) What would you consider to be a normal A-a gradient for a healthy non-smoker of her age?
Wat sou u beskou as ’n normale A-a gradient vir ’n gesonde nie-roker van haar ouderdom?
(2)
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d) What are the causes of an elevated A-a gradient? (2)

Wat is die oorsake van ’n verhoogde A-a gradient?
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PTO/Page 5 Question 17 e)…
-28-
e) What does the calculated value tell you about the cause of this patient’s hypoxaemia? (2)
Wat is die oorsaak van hierdie pasiënt se hipoksemie soos afgelei van die berekende waarde?
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[10]

-29-
Regarding placental oxygen transfer
Betreffende plasentale suurstofoordrag
a) By which process does this occur? (1)

Deur middel van watter proses vind dit plaas?
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b) State the law which describes the rate at which this process occurs. (4)
Gee die wet wat die tempo van hierdie proses beskryf.
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c) Explain the “double Bohr effect” as it pertains to placental oxygen transfer. (3)
Verduidelik die “dubbele Bohr effek” soos van toepassing op plasentale suurstofoordrag.
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d) What features of the haemoglobin of the foetus enhance its carriage of oxygen? (2)
Watter eienskappe van die fetale hemoglobien bevorder die dra van suurstof?
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[10]
-30-
a) What are the functions of vitamin K in the human body? (4)

Wat is die funksies van vitamien K in die menslike liggaam?
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b) How may a deficiency of vitamin B12 lead to a megaloblastic anaemia? (3)

Hoe sal ’n tekort van vitamien B12 lei tot megaloblastiese anemie?
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c) Name three ways in which vitamin D3 (calcitriol) maintains the plasma calcium concentration.
Noem drie maniere hoe vitamien D3 (kalsitriol) die plasmakalsiumkonsentrasie handhaaf. (3)
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[10]

-31-
A young adult is rescued after being trapped in a shack fire and is brought to casualty with confusion
and vomiting. He has no obvious burn injuries. He is administered 60% oxygen through a Venturi mask,
and initial blood tests are drawn, with results as follows
’n Jong volwassene word gered uit ’n huisbrand en word na ongevalle gebring met verwarring en
braking. Hy het geen sigbare brandwonde nie. Hy ontvang 60% suurstof met ’n Venturi-masker en die
eerste bloedtoetse lewer die volgende resultate
Arterial blood gas / Arteriële bloedgas

pH 7.36.
pO2 352 mmHg (47kPa).
pCO2 33.7 mmHg (4.5 kPa).
Bicarbarbonate / Bikarbonaat18 mmol/l.
Base excess / Basis oormaat -5.5.
Oxygen saturation / Suurstofsaturasie 100%.
Lactate / Laktaat 4 mmol/l.
Carbon monoxide assay: Koolstofmonoksied assai: CO 40% (nonsmokers / nie-rookers <3%),
(smokers/ rookers <10%).
a) What is the most likely diagnosis? (1)

Wat is die meers waarskynlike diagnose?
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b) What is the patient’s acid base status? (2)

Wat is die pasiënt se suur-basisstatus?
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-32-
c) Fully explain the mechanism for the patient’s lactate level. (7)
Verduidelik volledig die meganisme vir die pasiënt se laktaatvlak.
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[10]
-33-
FCA(SA) Part I
Reg No/Nr 1955/000003/08

26 March 2014
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 Discuss the antidysrhythmic drugs under the following headings

a) The Singh-Vaughan Williams classification. (6)
b) Mechanisms of action of each class of drugs. (18)
c) For each class of antidysrhythmic agent, list the dysrhythmias for which it may be used
(anatomical and /or electrocardiographic characteristics). (12)
d) Describe the adverse effects of
i) Flecainide. (5)
ii) Amiodarone. (9)
[50]
1 Bespreek die antidisritmiese middels onder die volgende hoofde
a) Die Sing-Vaughan-Williams klassifikasie. (6)
b) Werkingsmeganisme van elke middelklas. (18)
c) Lys die disritmieë waarvoor elke klas van die antidisritmiese middels gebruik kan word
(anatomiese en/of elektrokardiografiese eienskappe). (12)
d) Bespreek die ongewensde effekte van
i) Flecainide. (5)
ii) Amiodarone. (9)
[50]
2 a) Classify opioids according to their receptor action. For each class, list one example. (8)
b) Describe the distribution of opioid receptors in the human body. (7)
c) List the different types of opioid receptors. For each receptor describe the clinical effect
associated with that receptor. (14)
d) Describe the mechanism of action of morphine at an opioid receptor. (6)
e) Using pharmacokinetic principles, discuss the rapid onset and offset of action of
alfentanil. (5)
f) Using relevant pharmacological information, briefly discuss the utility of tramadol
usage for “rescue” pain management in the recovery room. (10)
[50]
-34-
2 a) Klassifiseer opioïede volgens hul reseptoraksie. Gee een voorbeeld van elke klas. (8)
b) Beskryf die verspreiding van opioïedreseptore in die menslike liggaam. (7)
c) Lys die verskillende tipes opioïedreseptore. Beskryf die kliniese effek wat geassosieer
word met elke reseptor. (14)
d) Beskryf die werkingswyse van morfien by ’n opioïedreseptor. (6)
e) Bespreek die vinnige aanvang en terminasie van werking van alfentanil deur gebruik te
maak van farmokokinetiese beginsels. (5)
f) Bespreek kortliks die gebruik van tramadol vir “redding”-pynhantering (“rescue pain
management”) in die herstelkamer deur gebruik te maak van relevante farmakologiese
inligting. (10)
[50]
3 Discuss the drug magnesium sulphate with regard to the following aspects
a) Physiological role of magnesium, and consequences of magnesium deficiency. Use
examples to illustrate this. (10)
b) Central mechanism of action and the implications for anaesthesia. (5)
c) Indications for use and therapeutic effects of magnesium sulphate in the cardiovascular,
respiratory, musculoskeletal and central nervous systems and in pregnancy. (25)
d) Important pharmacokinetic aspects of magnesium. (5)
e) The practical aspects with regards to dosing regimens and monitoring. (5)
[50]
3 Bespreek magnesiumsulfaat as geneesmiddel met betrekking tot die volgende

a) Fisiologiese rol van magnesium en gevolge van magnesiumtekort. Gebruik voorbeelde
ter illustrasie. (10)
b) Sentrale werkingsmeganisme en die implikasies vir narkose. (5)
c) Indikasies vir gebruik en terapeutiese effekte van magnesiumsulfaat in die
kardiovaskulêre, respiratoriese, muskuloskeletale en sentraalsenustelsel, en in
swangerskap. (25)
d) Belangrike farmakokinetiese aspekte van magnesium. (5)
e) Die praktiese aspekte ten opsigte van doseringsregimens en monitering. (5)
[50]
4 a) Describe the use of Albumin under the following headings

i) Describe the manufacturing process. (4)
ii) Discuss the role of Albumin in the human body. (8)
iii) Describe the pharmacological drug interactions with Albumin. (4)
iv) List the disadvantages of Albumin use in ICU. (2)
v) List the contraindications to Albumin. (2)
b) Fully discuss the pharmacological properties of the following colloids
i) Dextrans. (10)
ii) Gelatins. (10)
iii) Starches. (10)
[50]
4 a) Beskryf die gebruik van Albumien on die volgende hoofde

i) Beskryf die vervaardigingsproses. (4)
ii) Bespreek die rol van Albumien in die menslike liggaam. (8)
iii) Bespreek die farmakologiese middelinteraksie met Albumien. (4)
iv) Lys die voordele van Albumiengebruik in intensiewe sorg. (2)
-35-
v) Lys die kontraindikasies vir Albumiengebruik. (2)

b) Bespreek volledig die farmakologiese eieskappe van die volgende kolloiede
i) Dekstrane. (10)
ii) Gelatiene. (10)
iii) Stysels. (10)
[50]
-36-
FCA(SA) Part I
Reg No/Nr 1955/000003/08

26 March 2014
Pharmacology
Paper 4 (3 hours)

Al die vrae moet beantwoord word.
Question 1 - 5
-37-
For each of the following drugs, list the specific metabolite/s which may cause clinical adverse effects
or toxicity for the patient. Briefly describe the mechanism by which this occurs.
Lys vir elk van die volgende middels spesifieke metaboliet/e wat ongewensde kliniese effekte of
toksisiteit mag inhou vir die pasiënt. Beskryf die meganisme daarvan kortliks.
a) Halothane / Halotaan. (2)
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b) Sevoflurane / Sevofluraan. (2)
--------------------------------------------------------------------------------------------------------------------------------
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c) Pethidine / Petidien. (2)
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
d) Paracetamol / Parasetamol. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
e) Methanol / Metanol. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
[10]
-38-
Complete the following table

Voltooi die volgende tabel
FENTANYL ALFENTANIL
Protein binding.
Proteïenbinding.
Distribution and
elimination half-life.
Distribusie en
eliminasiehalfleeftyd.
Volume of distribution.
Volume van distribusie.
Clearance.
Opruiming.
pKa.
(1 x 10) = [10]
-39-
a) Define and give an example of a pharmacokinetic drug interaction. (2)

Definieer en gee ’n voorbeeld van ’n farmakokinetiese middelinteraksie.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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b) Define and give an example of a pharmacodynamic drug interaction. (2)

Definieer en gee ’n voorbeeld van ’n farmakodinamiese middelinteraksie.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
c) Briefly describe the influence of the following on the pharmacokinetics of opioids

Beskryf die invloed van die volgende op die farmakokinetika van opioïede
i) Gender / Geslag. (2)
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-------------------------------------------------------------------------------------------------------------------------------
ii) Age / Ouderdom. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
iii) Obesity / Vetsug. (2)
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[10]
-40-
With reference to volatile anaesthetic agents

Met verwysing na die vlugtige narkosemiddels
a) List 3 important factors which determine the alveolar anaesthetic tension. (3)
Lys 3 belangrike faktore wat die alveolêre narkosemiddelspanning sal bepaal.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) List 3 factors which determine the venous concentration of volatile anaesthetic agents. (3)
Lys 3 faktore wat die veneuse konsentrasie van vlugtige narkosemiddels bepaal.
--------------------------------------------------------------------------------------------------------------------------------
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c) Explain your understanding of / Verduidelik u begrip van

i) “Concentration effect” / “Konsentrasie-effek”. (2)
--------------------------------------------------------------------------------------------------------------------------------
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ii) “Second gas effect” / “Tweede-gaseffek”. (2)
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[10]
-41-
For each of the following drugs, list 2 adverse effects

Lys 2 newe-effekte vir elk van die volgende middels
a) Tricyclic antidepressants / Trisikliesantidepressante. (2)
--------------------------------------------------------------------------------------------------------------------------------
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b) Selective serotonin reuptake inhibitors / Selektiewe serotonieheropnameremmers. (2)
--------------------------------------------------------------------------------------------------------------------------------
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c) Monoamine oxidase inhibitors / Mono-amienoksidasie-inhibitore. (2)
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
d) Lithium / Litium. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
e) Benzodiazepines / Bensodiasepiene. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
[10]
-42-
FCA(SA) Part I
Reg No/Nr 1955/000003/08

26 March 2014
Pharmacology
Paper 4 (3 hours)

Question 6 - 10
-43-
a) What is contained in a vial of dantrolene? (3)

Wat is alles in ’n bottel dantroleen?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
b) How is it reconstituted? (2)

Hoe word dit hersaamgestel?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
c) What is the dose of dantrolene? (2)

Wat is die dosering van dantroleen?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
d) List 3 indications for the use of dantrolene. (3)

Lys 3 indikasies vir die gebruik van dantroleen.
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------
[10]
-44-
a) List 2 drugs (except suxamethonium), which are metabolised by pseudocholinesterase. (2)

Lys 2 middels (behalwe suksametonium) wat gemetaboliseer word deur
pseudocholienesterase.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) List 3 causes of decreased pseudocholinesterase activity. (3)

Lys 3 oorsake van verlaagde pseudocholienesterase aktiwiteit.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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c) List 2 causes of increased pseudocholinesterase activity. (2)

Lys 2 oorsake van verhoogde pseudocholienesterase aktiwiteit.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
d) What does the DIBUCAINE NUMBER refer to? (3)

Waarna verwys die DIBUKAÏENNOMMER?
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
[10]
-45-
Describe the mechanism of action of the following antiemetic drugs

Beskryf die werkingsmeganisme van die volgende anti-emetiese middels
a) Metoclopramide / Metoklopramied. (3)
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b) Droperidol / Droperidol. (2)
--------------------------------------------------------------------------------------------------------------------------------
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c) Cyclizine / Siklisien. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
d) Dexamethasone / Deksametasoon. (3)
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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[10]
-46-
Define the following terms

Deifnieer die volgende terme
a) Dependence / Afhanklikheid. (3)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Tachyphylaxis / Tagifilakse. (2)
--------------------------------------------------------------------------------------------------------------------------------
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c) Tolerance / Toleransie. (2)
--------------------------------------------------------------------------------------------------------------------------------
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d) Addiction / Verslawing. (3)
--------------------------------------------------------------------------------------------------------------------------------
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[10]

-47-
With regard to asthma, classify bronchial smooth muscle relaxants and give one example of each.
Betreffende asma, klassifiseer brongiale gladdespierverslappers en gee ’n voorbeeld van elk.
(5x2=10)
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[10]
-48-
FCA(SA) Part I
Reg No/Nr 1955/000003/08

26 March 2014
Pharmacology
Paper 4 (3 hours)

Question 11 - 15
-49-
a) Define contrast-induced nephropathy. (1)

Definieer kontrasgeïnduseerde nefropatie.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) List five risk factors for contrast-induced nephropathy. (5)

Lys vyf risikofaktore vir kotrasgeïnduseerde nefropatie.
--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
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c) List four preventative measures. (4)

Lys vier voorkomende maatreëls.
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--------------------------------------------------------------------------------------------------------------------------------
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-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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[10]

-50-
Explain the implications of the following factors on the onset of action and /or duration of action of local
anaesthetic preparations
Verduidelik die implikasies van die volgende faktore op die aanvang van werking en / of werkingsduur
van lokaalverdowers
a) Alkalinisation / Alkalinisasie. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Increased lipid solubility / Verhoogde lipiedoplosbaarheid. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
c) Increased protein binding / Verhoogde proteïenbinding. (2)
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
d) Added adrenaline / Adrenalien byvoeging. (2)
-------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
e) Pregnancy / Swangerskap. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
[10]
-51-
Explain the mechanism of the following adverse effects of diclofenac

Verduidelik die meganisme van die volgende ongewensde effekte van diklofenak
a) Gastric bleeding / Maagbloeding. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Renal function impairment / Renale funksie inkorting. (4)
-------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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c) Bronchospasm / Brongospasma. (2)
-------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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d) Hypertension / Hipertensie. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
[10]

-52-
a) Define volume of distribution. (2)

Definieer volume van distribusie.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
b) List the variables that affect volume of distribution. (8)

Lys die veranderlikes wat die volume van distribusie beïnvloed.
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--------------------------------------------------------------------------------------------------------------------------------
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[10]

-53-
Select the most appropriate beta blocker for the treatment of each of the following conditions and
motivate your choice
Kies die mees toepaslike betablokker vir die behandeling van die volgende toestande en motiveer u
antwoord
a) Thyroid storm / Tireoïedstorm. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Cocaine overdose / Kokaïenoordosering. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
c) Phaeochromocytoma / Feochromositoom. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
d) Post-myocardial infarction / Postmiokardiale infarksie. (2)
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
-54-
e) Post-myocardial infarction in an insulin-dependent diabetic. / Postmiokardiale infarksie in ’n

insulienafhanklike diabeet. (2)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
[10]
-55-
FCA(SA) Part I
Reg No/Nr 1955/000003/08

26 March 2014
Pharmacology
Paper 4 (3 hours)

Question 16 - 20
-56-
a) List five examples of Cytochrome P450 INDUCERS. (5)

Lys vyf voorbeelde van Sitochroom P450 INDUSEERDERS.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
b) List five examples of Cytochrome P450 INHIBITORS. (5)

Lys vyf voorbeelde van Sitochroom P450 INHIBEERDERS.
-------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
[10]

-57-
a) Describe the physicochemical properties of Mannitol. (4)

Beskryf die fisies-chemiese eienskappe van Mannitol.
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
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------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
b) List 3 uses of Mannitol. (3)

Lys 3 gebruike vir Mannitol.
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
c) List the contraindications to the use of Mannitol. (3)

Lys die kontraïndikasies vir die gebruik van Mannitol.
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
[10]

-58-
Compare Gabapentin and Pregabalin under the following headings

Vergelyk Gabapentien en Pregabalien onder die volgende hoofde
Gabapentin Pregabalin
Time to maximum
absorption.
Tyd to maksimale
absorpsie.
Oral bioavailability.
Orale
biobeskikbaarheid.
Metabolism and
elimination.
Metabolisme en
eliminasie.
Drug interactions.
Middelinteraksie.
Starting doses.
Begindosis.
[10]

-59-
a) Which bacterium produces the Botulin neurotoxin? (1)

Watter bakterie produseer Botulienneurotoksien?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Describe the mechanism of action of Botulin. (2)

Beskryf die werkingsmeganisme van Botulien.
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
c) List three uses of Botulin. (3)

Lys drie gebruike van Botulien.
-------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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d) Briefly describe the side effects of Botulin. (4)

Beskryf kortliks die newe-effekte van Botulien.
--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
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[10]
-60-
With regard to antibiotics

Met betrekking tot antibiotika
a) Draw a diagram depicting concentration dependent killing. On your graph indicate the post-
antibiotic effect (PAE), bolus of antibiotic, and minimum inhibitory concentration (MIC)
Teken ’n diagram wat konsentrasie-afhanklike doding voorstel. Dui die postantibiotiese effek aan
op u diagram (PAE), bolus antibiotika, en minimum inhibitoriese konsentrasie (MIC). (6)
b) List one example of an antibiotic which displays concentration dependent killing. List one known
side-effect of this antibiotic. (2)
Gee een voorbeeld van ’n antibiotika wat konsentrasie-afhanklike doding gee. Gee ook een
bekende newe-effek van hierdie antibiotikum.
-------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
-61-
c) What is meant by the term “post-antibiotic effect”? (2)

Wat word bedoel met die term “postantibiotiese effek”?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
[10]
-62-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 March 2014
Physics
Paper 5 (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 Automated non-invasive blood pressure monitors

a) Describe in detail how automated non-invasive blood pressure monitors measure a
patient’s blood pressure. (25)
b) List the advantages of automated non-invasive blood pressure monitors. (5)
c) Discuss the factors that may affect the accuracy of the non-invasively measured blood
pressure. (20)
[50]
1 Outomatiese nie-indringende bloeddrukmonitors

a) Beskryf in besonderhede hoe die outomatiese nie-indringende bloeddrukmonitors ’n
pasiënt se bloeddruk meet. (25)
b) Lys die voordele van nie-indringende outomatiese bloeddrukmonitors. (5)
c) Bespreek die faktore wat die akkuraatheid van nie-indringende bloeddrukmeting mag
beïnvloed. (20)
[50]
2 Describe the method of carbon dioxide (CO2) detection by the following devices, including
physical principles, advantages, disadvantages, and potential confounders
a) Colorimetric CO2 detector. (10)
b) In-line capnograph. (20)
c) Side-stream capnograph. (20)
[50]
-63-
2 Beskryf die metode van koolsuurgasmeting (CO2) met die volgende apparate, insluitend die
fisiese beginsels, voordele, nadele, en mootlike beperkings
a) Kolorimetriese CO2 meter. (10)
b) In-lynkapnografie. (20)
c) Systroomkapnografie. (20)
[50]
3 a) A sine wave has different characteristics. Name and define each part of it (make use
of diagram/s to explain). (10)
b) Explain what Fourier analysis of a wave pattern means. (2)
c) Explain the Doppler effect. (10)
d) List uses of the Doppler effect in medical practice. (3)
e) Discuss how ultrasound can be used to asses cardiac function. For each example
discuss the technique, physical principles, the side effects, advantages and
disadvantages. (25)
[50]
3 a) ’n Sinusgolf het verskeie eienskappe. Benoem en definieer elke deel daarvan (maak
gebruik van ’n diagram/me om te verduidelik). (10)
b) Verduidelik wat Fourieranalise van ’n golfpatroon behels. (2)
c) Verduidelik die Doppler-effek. (10)
d) Lys die gebruike van die Doppler-effek in mediese praktyk. (3)
e) Berspreek hoe ultraklank gebruik kan word om hartfunksie te ondersoek. Bespreek die
tegniek, fisiese beginsels, newe-effekte, voordele en nadele betrokke by elke voorbeeld.
(25)
[50]
4 With respect to volatile anaesthesia

a) Define
i) Vapour. (4)
ii) Volatile anaesthetic agent. (2)
iii) Higher volatility. (2)
iv) Saturated vapour pressure. (2)
v) Saturated vapour concentration. (2)
vi) What influences saturated vapour pressure and saturated vapour concentration of a
specific agent? (4)
b) An electronically controlled plenum vapouriser consists of two parts: an Aladin
cassette and a central processing unit. Describe the following features of the cassette
i) The measures that ensure that the correct agent is delivered. (6)
ii) Explain how the cassettes are designed to ensure efficient vaporisation and the
delivery of the correct vapour concentration. (4)
iii) What information must the central processing unit (CPU) have to ensure the correct
vapour concentration is delivered at the fresh gas outlet? (4)
iv) Compare the mechanism of delivery of desflurane using an Aladin cassette and a
Tec 6 vapouriser. (10)
c) Explain the term “pumping effect” and the mechanisms employed with different
vaporisers to decrease this effect. (10)
[50]
-64-
4 Met betrekking tot die vlugtige narkosemiddels

a) Definieer
i) Damp. (4)
ii) Vlugtige narkosemiddel. (2)
iii) Hoër vlugtigheid. (2)
iv) Versadigde dampdruk. (2)
v) Versadigde dampkonsentrasie. (2)
vi) Wat beïnvloed die versadigde dampdruk en versadigde dampkonsentrasie van ’n
spesifiek agens? (4)
b) ’n Elektroniesbeheerde plenumverdamper bestaan uit twee dele: ’n Aladinkasset en

’n sentrale proseseringseenheid. Beskryf die volgende eienskappe van die kasset
i) Die maatreëls wat verseker dat die regte agens gelewer word. (6)
ii) Verduidelik hoe die kassette ontwerp is om te verseker dat effektiewe verdamping
en verskaffing van die korrekte dampkonsentrasie plaasvind. (4)
iii) Watter inligting word benodig deur die sentrale proseseringeenheid (“CPU”) om te
verseker dat die korrekte dampkonsentrasie gelewer word by die varsgasuitlaat?
(4)
iv) Vergelyk die meganisme van desfluraanlewering met ’n Aladinkasset en ’n Tec 6
verdamper. (10)
c) Verduidelik die term “pompeffek” en die meganismes betrokke in verskillende
verdampers om hierdie effek te verminder. (10)
[50]
-65-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 March 2014
Physics
Paper 6 (3 hours)
Question 1-5
-66-
Lasers
a) Define the LASER acronym. (1)

Definieer die akroniem “LASER”.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------
b) What are the components of a LASER system? (4)

Wat is die komponente van ’n LASER-sisteem?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
c) What are the potential hazards of LASERS? (3)

Wat is die potensiële gevare van LASERS?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
d) List two methods of minimising the hazards of LASERS. (2)

Lys twee metodes om die gevare van LASERS te verminder.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
[10]
-67-
Heat loss / Hitteverlies
a) List 4 mechanisms of heat loss in an anaesthetised patient. (4)

Lys 4 meganismes van hitteverlies in die pasiënt onder narkose.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
b) Provide an example of intervention employed in theatre to limit heat loss for each of the above
mechanisms. (4)
Gee ’n voorbeeld van ingryping in die teater om hitteverlies te beperk vir elk van die bogenoemde
meganismes.
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
c) What 4 factors will affect the temperature of a fluid delivered to a patient during an intravenous
infusion? (2)
Watter 4 faktore beïnvloed die temperatuur van ’n vloeistof toegedien aan ’n pasiënt tydens ’n
intraveneuse infusie?
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------
[10]
-68-
Manual bag resuscitator / Manuele sakresussitator
Draw an annotated diagram of a manual bag-resuscitator used typically during the transport of a
ventilated patient. Include in your diagram all the possible unidirectional valves that may be present in
such a device. [10]
Teken ’n benoemde diagram van ’n manuele sakresussitator wat tipies gebruik word gedurende die
vervoer van ’n geventileerde pasiënt. Sluit al die moontlike unidireksionele kleppe in op u diagram soos
dit mag voorkom in so ’n apparaat.
-69-
Pressure / Druk
a) Fill in the equivalent conversion values

Gee die ekwivalente konversiewaardes
1 atmosphere = _______kPa = _________ cmH20 = _____________ mmHg =
__________________________________________mbar. (4)
b) A 10 litre oxygen cylinder has a pressure of 137 bar. If a 40% oxygen mask is attached and oxygen
flow of 8 litres/minute is commenced, how long will it take before the oxygen flow stops flowing.
Show your calculations. (6)
’n 10 Liter suurstofsilinder het ’n druk van 137 bar. Hoe lank sal dit neem totdat suurstofvloei staak
indien ’n 40% suurstofmasker gebruik word met 8 liters/minuut vloei. Wys u berekeninge.
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[10]
-70-
a) Base units are the building blocks of the International Systems of Units (SI System) from which
all other units of measurement can be derived. List any 5 SI base units including their
abbreviations. (5)
Basiseenhede is die boustene van die “International System of Units” (SI-sisteem) vanwaar alle
ander eenhede van meting afgelei kan word. Lys enige 5 SI-basiseenhede met die betrokke
afkortings.
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--------------------------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------------------------
b) Derived units are expressed in terms of SI base units. Express the following derived units in terms
of their base units.
Afgeleide eenhede word uitgedruk in terme van SI-basiseenhede. Druk die volgende eenhede uit
in terme van hul basiseenhede.
i) Frequency / Frekwensie. (1)
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--------------------------------------------------------------------------------------------------------------------------------
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ii) Pressure (show the derivation) / Druk (wys die berekening). (4)
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------
[10]
-71-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 March 2014
Physics
Paper 6 (3 hours)
Question 6-10
-72-
Protein C levels are negatively associated with mortality in septic ICU patients. Using a cut-off value of
<20% protein C activity on admission to predict death in 100 consecutive patients admitted to the ICU
with sepsis, the following table was obtained
Proteïen C-vlakke word negatief geassosieer met mortaliteit in septiese ISE pasiënte. Die volgende
tabel is verkry deur ’n afsnypunt van <20% proteïen C-aktiwiteit met opname te gebruik om sterftes in
100 opeenvolgende septiese pasiënte te voorspel met opname in die ISE
Mortality
Yes No
Protein C level <20% 65% 35%
Protein C level >20% 5% 95%
Using the figures above calculate the following showing any relevant formulas
Gebruik die syfers hierbo en bereken die volgende en gee die relevante formules
a) Sensitivity / Sensitiwiteit. (2)
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b) Specificity / Spesifisiteit. (2)
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c) Positive predictive value / Positiewe voorspellingswaarde. (2)
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-73-
d) Negative predictive value / Negatiewe voorspellingswaarde. (2)
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e) Likelihood ratio / Waarskynlikheidsverhouding. (2)
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[10]
-74-
a) Define the term “Suction”. (1)
Definieer die term “Suiging”.
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b) Which two parameters are used to classify suction apparatus? (2)

Watter twee parameters word gebruik om die suigapparate te klassifiseer?
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c) List the components used in a suction apparatus. (4)

Lys die komponente van ’n suigapparaat.
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d) How is suction checked during an anaesthetic machine check? (1)

Hoe word suiging getoets gedurende die toets van die narkosemasjien?
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e) What are the characteristics of the suction apparatus for scavenging of waste anaesthetic gases?
(2)
Wat is die eienskappe van die suigapparaat wat gebruik word vir die opruiming van oorslot
narkosegasse?
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[10]
-75-
With regard to airway equipment, define the following

Definieer die volgende met betrekking tot lugwegtoerusting
a) Direct laryngoscope. (1)

Direkte laringoskopie.
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b) Video laryngoscope. (1)

Videolaringoskopie.
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c) Optical laryngoscope. (1)

Optiese laringoskopie.
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d) Optical stylet. (1)

Optiese stilet.
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PTO/Page 6 Question 8 e)…

-76-
e) In performing laryngoscopy with a Mackintosh blade is the view likely to be better with a direct or
video laryngoscope? Briefly explain your answer. (6)
Sal die laringoskopiesig beter wees met direkte laringoskopie of met videolarigoskopie wanneer
’n Mackintoshlem gebruik word? Verduidelik kortliks u antwoord.
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[10]
-77-
Complete the following table of tests of coagulation.

Voltooi die volgende tabel oor toetse vir koagulasie.
Main indication. Technical Likely

performance of confounders.
Hoofindikasie. test.
Moontlike
Tegniese beperkers.
uitvoering van
toets.
aPTT (3)
INR (3)
In vitro
platelet
testing.(4)
In-vitro
plaatjietoets.
[10]

-78-
a) What does the acronym BIS stand for? (1)

Waarvoor staan die akroniem BIS?
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b) If the BIS monitor reads 70, what would you conclude? (3)
Wat sal u aflei indien die BIS-monitor 70 lees?
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c) If the BIS monitor reads 55, what would you conclude? (2)
Wat sal u aflei indien die BIS-monitor 55 lees?
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d) What are the limitations of the BIS monitor? (4)

Wat is die beperkings van die BIS-monitor?
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[10]
-79-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 March 2014
Physics
Paper 6 (3 hours)
Question 11-15
-80-
Theatre fires and explosions / Teaterbrande en ontploffings.
a) Define the Stoichiometric concentration of any combustible vapour and oxidizing agent. (2)
Definieer die Stoigoimetriese konsentrasie van enige vlambare damp en oksidasie-agent.
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b) List the essential components of the traditional fire triangle required for a fire or explosion to occur.
(3)
Lys die essensiële komponente van die tradisionele branddriehoek wat benodig word vir ’n brand
of ontploffing om plaas te vind.
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c) What measures are taken in theatre to prevent static electricity build-up? (2)
Watter maatreëls word getref in teater om die opbou van statiese elektrisiteit te voorkom?
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d) What immediate measures will you take to prevent the spread of the fire in theatre? (3)
Watter onmiddelike maatreëls sal u tref om die verspreiding van ’n brand in teater te voorkom?
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[10]
-81-
a) What do you understand by the term ‘natural exponential functions’? (2)

Wat verstaan u met die term “natuurlike eksponensiële funksies”?
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b) Name the technique used to measure cardiac output with a pulmonary artery catheter. (1)
Noem die tegniek wat gebruik word om kardiale omset met ’n pulmonale arteriekateter te meet.
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c) Describe the practical technique itself and the physical principles used to measure cardiac output
using a pulmonary artery catheter. (7)
Beskryf die praktiese tegniek en die fisiese beginsels wat gebruik word om kardiale omset te
bepaal met ’n pulmonale arteriekateter.
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[10]
-82-
a) List the factors that influence the Reynolds number and the equation to calculate this relationship.
(4)
Gee die faktore wat die Reynoldsgetal beïnvloed asook die vergelyking om dit te kan uitwerk.
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b) What is significant about the Reynolds number? (3)

Wat is betekenisvol aangaande die Reynoldsgetal?
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c) Define the term “critical flow”. (3)

Verduidelik die begrip “kritiese vloei”.
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[10]

-83-
a) Explain how MRI units produce images. (3)

Verduidelik hoe die MRI-eenheid beelde produseer.
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b) Name 5 safety concerns that should be considered when working in the MRI unit. (5)
Noem 5 veiligheidsoorwegings wat in gedagte gehou moet word in die MRI-eenheid.
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c) When purchasing anaesthetic equipment for use inside the MRI suite what specifications should
the equipment and monitoring devices adhere too? (2)
Aan watter spesifikasies moet toerusting en moniteringsapparate voldoen vir gebruik in die MRI-
eenheid wanneer aankope vir narkoseapparaat gedoen word?
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[10]

-84-
Humidification/Heat moisture exchangers (HME)

Humidifisering/Hitte-voguitruilers (“HME=Heat moist exchangers”)
a) Define both absolute and relative humidity. (2)

Definieer beide absolute and relatiewe humiditeit.
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b) Why is it clinically necessary to use a HME? (2)
Waarom is dit nodig om ’n HME te gebruik in kliniese praktyk?
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c) Explain how a HME humidifies inspired gas. (6)

Verduidelik hoe die HME die ingeasemde gas humidifiseer.
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[10]
-85-
FCA(SA) Part I

Reg No/Nr 1955/000003/08

28 March 2014
Physics
Paper 6 (3 hours)
Question 16-20
-86-
a) In statistics what is “correlation” and the correlation co-efficient? (4)

Wat beteken die statistiese terme “korrelasie” en die korrelasiekoëffisiënt?
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b) What is the limitation of a correlation co-efficient? (2)

Wat is die beperking van ’n korrelasiekoëffisiënt?
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c) The following correlation plots are taken from a study assessing the use of central venous
pressure (CVP) to predict ventricular filling volume or cardiac performance in response to a fluid
challenge. Interpret the results of the correlation plots labelled Figure 1 and Figure 2. (2)
Die volgende korrelasiegrafieke is geneem uit ’n studie wat sentraalveneuse druk (“CVP”) gebruik
om ventrikulêre vullingsdruk of kardiale uitwerp te voorspel na ’n vloeistofbolus. Interpreteer die
resultate van die korrelasiegrafieke gemerk Figuur 1 en Figuur 2.
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Figure 1 Figure 2
RVEDVI – Right RVEDVI – Right

ventricular end ventricular end
diastolic volume
diastolic volume
index; SVI – Stroke
index; CVP – Volume Index.
Central venous
Pressure.
-87-
Kumar A, Anel R. Pulmonary artery occlusion pressure and central venous pressure fail to predict
ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects.
Critical Care Medicine 2004; 32: 691-699
d) What can be deduced from the results presented above? (2)

Wat kan afgelei word uit die resultate hierbo?
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[10]

-88-
Neuromuscular transmission / Neuromuskulêre oordrag
a) What is meant by the abbreviation “TOF ratio”? (2)

Wat word bedoel met die afkorting “TOF-ratio”?
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b) What TOF ratio is now the standard to indicate adequate reversal of muscle relaxants
administered? (1)
Watter TOF-ratio is nou standaard om voldoende omkeer van spierverslappers aan te dui?
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c) What objective method is most commonly used in theatre to calculate the TOF ratio? (1)
Watter objektiewe metode word algemeen in teater gebruik om die TOf-ratio te bereken?
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d) Explain how the above device is constructed and the principle of calculation of the TOF ratio using
the method named above (supply an equation if possible). (6)
Verduidelik hoe bogenoemde apparaat saamgestel is asook die beginsel vir berekening van die
TOF-ratio met die metode hierbo genoem (voorsien ’n vergelyking waar moontlik).
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[10]
-89-
With respect to oxygen monitoring

Met verwysing na suurstofmonitering
a) Why is infra-red analysis not used to monitor oxygen concentration? (1)

Waarom word infrarooi-analise nie gebruik om suurstofkonsentrasie te monitor nie?
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b) Explain the method of paramagnetic differential oxygen analysis (Hummel cell). (9)
Verduidelik die metode van paramagnetiese differensiaal-suurstofanalise (Hummel-sel).
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[10]

-90-
List the advantages of capnography and capnometry over pulse oximetry in the trauma patient who
presents for anaesthesia and surgery. [10]
Lys die voordele van kapnografie en kapnometrie bo polsoksimetrie in die troumapasiënt wat
presenteer vir narkose en chirurgie.
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-91-
Regarding electrocardiographic monitoring.

Betreffende elektrokardiografiese monitoring.
a) Explain how cardiac biological potentials are conducted through ECG electrodes. (4)
Verduidelik hoe kardiale biologiese potensiale gelei word deur EKG-elektrodes.
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b) List 2 broad reasons that may cause a loss or interference of signal to the monitor. (1)
Lys, breedweg gesproke, 2 redes vir die verlies of versteuring van die sein na die monitor.
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c) Explain the concept of band-pass and band-reject filters and how they can be used to ensure
stability of cardiac monitor recording and display of cardiac biological potentials. (5)
Verduidelik die konsep van “band-pass” en “band-reject” filters en hoe dit gebruik kan word om
stabiliteit van kardiale monitoropname en vertoon van kardiale biologiese potensiale te verseker.
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[10]

FCA (SA) Part I Past Papers - 2014 1st Semester 2 10 2014 PDF

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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

1 a) Describe in detail the stages of systole and diastole. (10)

1 a) Beskryf in besonderhede die fases van sistolie en diastolie. (10)

c) Discuss how a term neonate maintains a neutral thermal environment. (20)

3 a) Draw an annotated sketch of the neuromuscular junction in skeletal muscle. (10)

3 a) Teken ’n benoemde skets van die neuromuskulêre aansluiting in skeletspier. (10)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

a) List the cardiovascular changes that occur in pregnancy. [10]

b) Which specific area in the adrenal gland is it secreted from? (1)

c) Which area does it act on specifically in the kidney? (2)

d) Describe aldosterone’s mechanism of action. (4)

e) What triggers its release? (2)

a) Define cerebral perfusion pressure. (2)

b) Define intracranial hypertension. (2)

e) List two causes of cerebral oedema. (2)

i) Zone 1 / Sone 1. (2)

ii) Zone 2 / Sone 2. (2)

iii) Zone 3 / Sone 3. (2)

a) Complete the following table

Blood flow. O2 Consumption. Percentage of total

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

a) Draw a fully annotated normal jugular venous pressure waveform. (8)

a) Draw and annotate a normal spinal reflex arc. (5)

b) Briefly discuss the oculo-cardiac reflex. (5)

a) Write down the Cockcroft-Gault equation. (2)

c) Write down the equation for fractional excretion of sodium. (2)

Membrane phospholipids /Membraanfosfolipiede

Leukotrienes 5 Prostacyclin Prostaglandin

Leukocytes Platelets Endothelium Smooth muscle

a) Name the enzymes indicated by the number. (4)

b) Name the intermediate – 2. / Benoem die intemediëre substans – 2. (1)

PTO/Page 6 Question 9 c)…

c) Name the product – 5. / Benoem die produk – 5. (1)

d) List the normal physiological functions of Prostacyclin. (2)

e) What is the function of prostaglandin on bronchial smooth muscle? (1)

PTO/Page 7 Question 10…

a) Describe the structure of a haemoglobin (Hb) molecule. (3)

b) What is the oxygen binding capacity of Hb? (1)

c) Draw and fully annotate a normal oxygen-Hb dissociation curve. (4)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Part I Examination for the Fellowship of the

a) B-cells / B-selle. (2)

b) Regulatory T-cells / Regulatoriese T-selle. (2)

c) Antigen-presenting cells / Antigeenpresenterende selle. (2)

d) Immunoglobulin M / Immunoglobulien M. (2)

e) Complement proteins / Komplement proteïene. (2)

Define the following terms related to genetics

a) Epigenetic inheritance / Epigeniese oorerwing. (3)

b) Genetic mutation / Genetiese mutasie. (3)

c) Channelopathy (give an example) / Kanaalopatie (gee ’n voorbeeld). (4)

PTO/Page 4 Question 13…

a) What is the likely diagnosis in this patient? (1)

b) Explain the reasons for the positive vanillylmandelic acid. (1)

i) Tachycardia / Tagikardie. (2)

ii) Raised blood pressure / Verhoogde bloeddruk. (2)

PTO/Page 5 Question 13 c iii)…

iii) Cold hands / Koue hande. (2)

iv) Nausea and vomiting / Naarheid en braking. (2)

PTO/Page 6 Question 14…