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Worksheetsphysio exam
Total questions: 50
Worksheet time: 25mins
A 60-year-old male was admitted to ICU for a ruptured cerebral aneurysm and intracranial pressure (ICP) monitoring was inserted prior to cerebral protection. Which of the following causes maximal increase of the above monitoring?
Increased central venous pressure to 14 mmHg
Bucking and coughing on endotracheal tube
Ventilation with positive end expiratory pressure (PEEP of 10 cmH2O)
Hypercarbia with PaCO2 of 50 mmHg
A patient is sitting in upright position for a spirometry test for l hour. Which of the following best describes his ventilation perfusion (V/Q) relationship?
Areas with low V/Q has a lower 02 content.
Alveoli at the apex are smaller at the end of expiration.
Ventilation of apical alveoli is more than the bases.
pH of pulmonary venous blood over the apex is more acidotic than the base
A 45-year-old female presents with acute shortness of breath and is found to have a pulmonary embolism. Which of the following best describes the expected changes in her V/Q ratio?
V/Q ratio is significantly elevated in the affected lung region.
V/Q ratio remains normal as ventilation and perfusion are equally affected.
V/Q ratio is increased due to enhanced perfusion.
V/Q ratio is decreased due to impaired ventilation.
A 70-year-old male with chronic obstructive pulmonary disease (COPD) is being evaluated for his respiratory status. Which of the following factors is most likely to contribute to his increased work of breathing?
Decreased respiratory rate due to fatigue.
Increased dead space ventilation.
Decreased lung compliance leading to stiff lungs.
Increased airway resistance due to bronchoconstriction.
You noticed a patient remains awake after induction of anaesthesia despite adequate dose of intravenous anaesthetic agent and a functioning venous access.Which statement best explains the event?
Patient was not premedicated.
Patient has previous history of drug abuse
Patient is tachycardic.
Patient has low cardiac output
Surfactant is important for respiratory function. Which statement best describes it?
Surfactant is increased in the lungs of a heavy smoker.
Surfactant contains approximately 60% dipalmitoylphosphatetidylglycine.
Surfactant decreases surface tension.
Surfactant is increased in hyaline membrane disease.
The surgeon requests you to perform Valsalva manoeuvre following completion of total thyroidectomy. Which response is
Phase 2 response results in increase in blood pressure.
Phase 1 response results in sustained bradycardia.
Phase 4 response results in reflex bradycardia.
Phase 3 response results in sustained drop in blood pressure.
A patient undergoing lung resection surgery is monitored for changes in pulmonary function. Which of the following is most likely to occur postoperatively?
Decreased vital capacity (VC).
Increased functional residual capacity (FRC).
Increased tidal volume (TV).
Decreased residual volume (RV).
A 30-year-old man weighing 70 kg is ventilated in an intensive care unit for severe acute respiratory distress syndrome (ARDS). The monitor shows generated tidal volume of 250 ml with peak airway pressure of 40cmH2O. Which of the following best explains the above changes?
Increased in airway resistance
Reduced in gas exchange
Reduced in respiratory compliance
Increased in alveolar recruitment
A patient presented to the emergency department with breathlessness following an acute asthmatic attack. What best explains the increase work of breathing in this patient?
Increased respiratory fatigue
Increased lung compliance
Increased lung parenchyma resistance
Increased airway resistance
You are discussing on non-respiratory function of the lung with your colleague.
Which statement best refers to the above?
Lung can filter most of the small inhale particles 2um in size.
Lung acts as blood reservoir which contains 25% of the circulating blood volume.
Lung has an efficient fibrinolytic system.
Lung mediates immune functions through Lamellar bodies.
A 60-year-old patient underwent a laparotomy for an obstructed right inguinal hernia. He has a background history of ischaemic heart disease and has an ejection fraction of 50%. Balancing the myocardial oxygen supply to the myocardial oxygen demand during this surgery is important.
Which of the following best contributes to the balance?
Heart rate
Coronary vascular resistance
Coronary perfusion pressure
Haematocrit
You are discussing about peripheral chemoreceptors in a physiology tutorial. Which of the following best describes the above?
Stimulated by low arterial O2 tension
Stimulated by low arterial O2 content
Inhibited by low blood flow
Stimulated by anaemia
A 20-year-old man is running on a treadmill for 30 minutes. Which of the following receives the most of the blood distribution?
Heart
Muscle
Kidney
Brain
The renal handling of the electrolytes is affected by aldosterone level. Which of the following will be the most affected?
Calcium
Potassium
Sodium
Magnesium
A 50-year-old lady was admitted into the intensive care unit for acute myocardial infarction with cardiogenic shock. You intend to increase the oxygen delivery to the tissues. Which action is best taken to achieve it?
Increasing the fraction of inspired oxygen (FiO2) to 1.0
Correction of the arterial blood pH
Increasing the haemoglobin concentration to above 10 g/d1
Increasing the cardiac output
The composition of fluid filtered at the glomerulus varies at different points along the nephron. A sample of fluid from a nephron is obtained experimentally from an otherwise healthy anaesthetised patient immediately after nephrectomy for a small localised transitional cell tumour of the renal pelvis. It has the following composition:
Na+ concentration 140 mmol L-1
K+ concentration 4.5 mmol L-1
Glucose concentration 4.8 mmol L-1
Osmolality 285 mosm Kg-1
From which of the following sites is the fluid most likely to have been obtained:
Ascending limb of loop of Henle
Collecting duct
Bowman capsule
Distal convoluted tubule
A 40-year-old female is admitted to ICU for diabetic ketoacidosis. She has a background of Insulin-Dependent Diabetes Mellitus and chronic kidney disease. She is severely acidotic with a serum glucose of 22 mmol/L.
Which statement best explains the above?
Reduction of renal blood flow secondary to volume depletion.
Binding of excess B-hydroxybutric acid and acetoacetic acid with the reabsorbed bicarbonate in the proximal tubule.
Reduction in the renal excretion of ammonium at the collecting duct
Hyperglycaemia induced osmotic diuresis
The venous blood is drained from the myocardium through various veins. One of the veins drains into all of the heart chambers directly.
Which of the following veins the above is referring to?
Great cardiac vein
Anterior cardiac vein
Thebesian vein
Middle cardiac vein
Glucose is transported across the blood-brain barrier (BBB) and is the only source of energy
for the brain cells.
Which mechanism enables it?
Active transport
Pinocytosis
Facilitated diffusion
Simple diffusion
A 20-year-old male was admitted to ICU for a traumatic brain injury. A non-invasive transcranial Doppler was performed to assess his cerebral blood flow.
Which is the main factor that affects the finding?
Cerebral metabolic rate for oxygen consumption (CMR 2)
PaCO2
PaO2
Cerebral perfusion pressure
A 37-year-old man was involved in a motor vehicle accident. On arrival to Emergency Department, his BP was 80/50 inmHg and HR was 120/min. He was pushed to OT for emergency laparotomy in view of suspected intra-abdominal bleed.
Which is the most likely compensatory mechanism in response to the above?
Increased aldosterone secretion
Stimulation of renal sympathetic nerve activity via O2 effect
Reduced anti diuretic hormone secretion
Angiotensin I constricts renal arterioles
You are seeing a patient in pre-anaesthetic clinic. His heart rate is 75/bpm Electrocardiogram
shows a normal sinus rhythm.
Which statement best describes the above physiology?
The cardiac action potential lasts longer than nerve action potential.
The sinoatrial node action potential has no phase 1 and 2.
The inward sodium current is involved in sinoatrial node potential.
The resting membrane potential of ventricular muscle is —30 to —50 mV.
A 30 year-old-man is undergoing decompressive craniectoniy severe traumatic brain injury. The surgeon noted cerebral oedema upon opening the dura.
Which is the fastest strategy to address the problem?
Controlled hyperventilation to induce cerebral vasoconstriction
Insertion of the extraventricular drain (EVD) to drain the cerebral spinal fluid (CSF)
Increase fraction inspired of oxygen (FiO2)
Elevation of the patient's head to facilitate cerebral venous drainage
In the premature newborn, the glottis is at which level relative to the cervical spine?
A. C3
B. C4
C. C5
C6
Which of the following statements regarding the diaphragm is FALSE?
Its insertion point is a mobile, central tendon that originates from fibers and is attached to the xiphoid process, lower six ribs, and lumbar vertebral bodies.
The diaphgram can move up to 10cm during forced inspiration.
It is made up of fast-twitch, high-oxidative capacity, and fatigue-resistant fibers, making it an ideal principal muscle of inspiration.
Relaxation of the diaphragm and elastic recoil of the lungs constitute the mechanism for passive exhalation.
Maximizing which of the following lung parameters is the most important factor in prevention of postoperative pulmonary complications?
Tidal volume (Vt)
Inspiratory reserve volume (IRV)
Vital capacity (VC)
Functional residual capacity (FRC)
Which of the following parameters can best signify residual muscle weakness in the post-anaesthesia care unit?
Tidal volume
Forced expiratory volume
Forced inspiratory volume
Forced vital capacity
A 33-year-old woman with 20% carboxyhemoglobin is brought to the ER for treatment of smoke inhalation. Which of the following is LEAST consistent with a diagnosis of carbon monoxide poisoning?
Oxyhaemoglobin dissociation curve shifted far to the left
Cyanosis
PaO2 105mmHg, oxygen saturation 80% on initial room air arterial blood gases (ABGs)
98% oxygen saturation on dual-wavelength pulse oximeter
A 60-year-old man is undergoing an emergency laparotomy for an intestinal obstruction. His vital signs show a BP of 80/49 mmHg and HR of 125/min. He is noted to have a urine output of less than 0.5 ml/kg/hr for the last 2 hours.
Which factor that is most likely the cause of the above?
Sympathetic nervous system activation
Increased in cardiac output
Systemic hypotension
Hypothermia
A 55-year-old patient presented with diabetic foot ulcer. He was subsequently intubated and brought to the intensive care unit. His vital signs: BP 75/47 mmHg, HR 145/minute.
Which of the following best explains the clinical presentation?
Positive pressure ventilation
Increased in myocardial contractility
Increased in venous capacitance
Decreased in systemic vascular resistance
One of the physiological responses in severe dehydration is to conserve total body water.
Which mechanism best explains it?
Antidiuretic hormone increases permeability of the collecting duct to the water.
Macula densa in the distal convoluted tubules contracts the afferent arterioles, causing reduction of the glomerular filtration rate.
Counter-current multiplier by the loop of Henle to increase the osinolality of the interstitial fluid.
Counter-current exchanger by the vasa recta keeping the interstitial medullary gradient
You are attending a post parathyroidectomy patient who complains of ‘muscle cramp'. His total blood calcium level is 1.6 nuno1/L.
Which is the most likely effect on the heart as the result of the above?
Increases myocardial contractility
Reduces the depolarisation threshold
Prolong T wave in the ECG
Creates the funny current by the sinoatrial nodes
Which of the following statements is true about total cerebral blood flow?
Accounts for 15% of the cardiac output
Below a mean arterial pressure of 60mmHg the cerebral blood flow is proportional to the systolic blood pressure
Decrease during seizure activity
Is mainly regulated by the autonomic nervous system
1. A 37-year-old man undergoing general anaesthesia develops tachycardia upon surgical skin incision. Which mechanism explains his heart rate response?
Decreased permeability of the SA node to sodium influx
ecreased permeability of the cardiac muscle to calcium influx
Increased permeability of the SA node to sodium influx
Increased permeability of the SA node to potassium efflux
All are true regarding blood- brain barrier except for?
Particle of low molecular weight pass through more readily than larger particles
Endocytosis is an important mechanism for transport of substances across it
Lipophilic drugs are transported across by facilitated diffusion
Tight junction span adjacent endothelial cell
1. Regarding the kidney, which of the following statements are correct?
Approximately 85% of inulin is cleared from the blood during one passage through the kidney
The haematocrit must be known to calculate the effective renal plasma flow
Inulin may be used to estimate renal plasma flow
Renal blood flow can be estimated using para-aminohippuric acid
1. Renal blood flow:
Is equivalent to 400ml/min/100g of tissue
Is very high due to the kidneys high metabolic rate
Is less per unit weight that the brain
Is equally distributed between cortex and medulla
1. Intracranial pressure (ICP) is the pressure within the cranial. Which is the immediate mechanism in the brain to compensate high ICP.
translocation of CSF into spinal canal
B. Reduction of CSF production
Increase in reabsorotion of CSF
Herniation of brain through foreman magnum
CSF is the medium that facilitate the control of ventilation. Which one is the best to describe its role above?
Its facilitate the absorption of O2 to trigger respiratory centre
A. It provides the medium for the diffusion of CO2 to trigger central chemoreceptor
Its pH value helps to triger respiratory centre
Its electrolytes content trigger the ionic changes for the function of inspiratory centre
When a person is standing, blood flow in the lungs is:
Lowest at the base because that is where alveolar pressure is greater than arterial pressure
Highest at the base because that is where the difference between arterial and venous pressure is greatest
Equal at the apex and the base
Highest at the apex owing to the effects of gravity on arterial pressure
If the Intrapleural pressure becomes atmospheric, the changes in the lungs would include:
Increased compliance
Decreased work of breathing
Decreased air way resistance
Collapse of alveoli
Which of these statements concerning respiration is NOT true?
Higher brain centers can modify the activity of the respiratory center
A decrease in pH of the blood increases respiration rate
The Bohr effect allows carbon dioxide to bind more easily to hemoglobin that has released its oxygen
An increase in carbon dioxide in the blood causes pH to decrease
When considering factors that contribute to increased myocardial work, which of the following is the LEAST influential?
Stroke volume
Heart rate
Ventricular systolic pressure
Contractility
Concerning baroreceptors, which one of the following is INCORRECT
they are stretch receptors
baroreceptors in the carotid sinus are more sensitive than aortic receptors to changes in blood pressure
they are located in the carotid sinus and aortic arch
the neuronal discharge decreases as the mean arterial pressure increases
The pulse pressure increases with an increase in
stroke volume
LVEDV
blood viscosity
systematic vascular resistance
Which of the following will NOT occur with an increase in inotropy?
increases dp/dt
increases end-diastolic volume
decreases contraction time
increases ejection fraction
A 25-year-old man sustained a traumatic brain injury with increased intracranial pressure. Which statement best describes the compensatory mechanism in this situation?
Exhaustion of the compensatory mechanism results in linear rise of intracranial pressure.
Buffering involves alteration of cerebrospinal fluid and blood volumes
Brain parenchyma volume plays an important role as a compensatory mechanism.
Lymphatics is a crucial component to compensate for the intracranial pressure.
Functional residual capacity (FRC) is the volume of gas in the lungs at the end of normal expiration. Which condition will increase its capacity?
Pregnancy
First month of life
Pneumothorax
Emphysema
Central and peripheral chemoreceptors are involved in the control of respiration. Which statement is true?
Central chemoreceptor is directly stimulated by arterial CO2.
Central chemoreceptor is sensitive to arterial pH
Peripheral chemoreceptors directly affect minute ventilation.
Peripheral chemoreceptors respond to a change in arterial pO2.
