FCA(SA)_Part_I_Past_Papers_1

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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICAIncorporated Association not for gain

Reg No 1955/000003/08

Part I Examination for the Fellowship of theCollege of Anaesthetists of South Africa

23 March 2010

Paper I Physiology - Long Questions (3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one isrequired 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 nvraag) geskryf word

1 a) While on a holiday expedition climbing Mount Kilimanjaro, a colleague in yourgroup collapses. As the only doctor in the party, you rush over to attend to him.Definei) Hypoxia. (2)ii) Hypoxaemia. (2)

b) Provide a classification of hypoxia with brief notes describing the physiologicimpact of each. (12)

c) List 5 causes of hypoxaemia. (5)d) What is the equation to calculate the oxygen content of blood? (2)e) Draw a normal oxygen-Haemoglobin dissociation curve clearly labelling all

physiologically important points on the illustration. (5)

f) Explain, using the alveolar gas equation explain why this climber may havecollapsed at this altitude. (7)

g) List the endocrine changes that occur from both acute and chronic exposure tohigh altitudes . (5)

Following your assessment of the climber, you administer supplemental oxygen to himand then discover that he is hypothermic.h) Define Hypothermia . (2)i) List the physiological mechanisms that humans possess to prevent hypothermia.

(8)(50)

1 a) Tydens n vakansie ekspidisie na die berg Kilimanjaro kollabeer n kollega in jougroep. As die enigste dokter in die groep snel u die persoon te hulp.Definieeri) Hipoksie. (2)ii) Hipoksemie. (2)

b) Verskaf n klassifikasie van hipoksie en skryf kort notas om die fisiologiese impakvan elk te verduidelik. (12)

c) Lys 5 oorsake van hipoksemie. (5)d) Wat is die vergelyking om die suurstof inhoud van bloed te bereken? (2)


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e) Teken n normale suurstof-Hemoglobien dissosiasie kurwe en benoem al diefisiologies belangrike punte op u grafiek. (5)

f) Verduidelik met gebruik van die alveolere gas vergelyking hoekom hierdiebergklimmer by n hoe hoogte gekollabeer het. (7)

g) Lys die endokriene veranderinge wat voorkom van beide akute en chronieseblootstelling aan hoe hoogtes. (5)

Nadat u die bergklimmer ondersoek het , gee u hom suurstof en u vind dat hy ook

hipotermies ish) Definieer Hipotermie. (2)i) Lys die fisiologiese meganismes wat die mens het om hipotermie te voorkom. (8)

[50]

2 a) With regards to the feeded (absorptive) state and fasted (post-absorptive) statei) Tabulate the differences in the management of the following

substrates: glucose, fats and proteins. (8)iii) Tabulate the most important hormonal changes during fasting and the

effect of each hormonal change on blood glucose. (6)b) Ketogenesis

i) Where does it occur? (1)ii) Describe ketogenesis schematically and show the ketone bodies). (4)c) In regard of the red blood

i) There are certain normal cell organelles absent. Tabulate the absentorganelles and the consequences thereof. (6)

ii) Name the energy source and type of metabolism. (2)iii) Tabulate the productsof carbohydrate metabolism and list one function of

each product. (8)d) In regards of gluconeogenesis

i) Name the 3 irreversible steps in the metabolism of piruvate to glucose.Also name the enzyme/steps responsible for the metabolism of pyrovate

to glucose. (6)ii) Name the 3sources of gluconeogenesis. (3)iii) Discuss shortly the control of gluconeogenesis . (6)

(50)

2 a) Met verwysing na die gevoede (absorbsie) staat teenoor die vastende (post-absorbsie) staati) Tabuleer die verskille in die hantering van die volgende substrate

glukose, vettte en proten. (8)ii) Tabuleer die mees belangrikste hormonale veranderinge gedurende vas

en dui aan die effek van elke hormonale verandering op bloed glukose. (6)b) Ketogenese

i) Waar vind dit plaas? (1)ii) Beskryf ketogenese skematies en dui die ketoon liggame aan. (4)

c) In verband met die rooibloedsel.i) Daar is sekere normale sel organelle afwesig.. Tabuleer die afwesige

organelle en die gevolge daarvan. (6)

ii) Noem die energie bron en tipe metabolism. (2)iii) Tabuleer die produkte van koolhidraat metabolisme en lys een funksie van

elke produk. (8)d) In verband met glukoneogenese


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i) Noem die 3 onomkeerbare stappe in die metabolisme van piruvaat naglukose.Noem ook die name van die ensieme verantwoordelik in die stappe in diemetabolisme vanaf pirovaat na glucose. (6)

ii) Noem 3 bronne van glukoneogenese. (3)iii) Bespreek kortliks die beheer van glukoneogenese. (6)

(50)

3 After surgical incision a patient starts bleeding. Discuss normal hemostasis under thefollowing headingsa) Describe the final common pathway in the clotting cascade. (10)b) List the substances produced in the vascular endothelium which

i) Initiates and aids haemostasis. (13)ii) Prevents clot formation and coagulation. (7)

c) Discuss platelets under the following headingsi) Physical and morphological characteristics. (10)ii) Procoagulant substances. (5)iii) Formation of the platelet plug. (5)

(50)

3 Na chirurgiese velinsnyding begin n pasint bloei. Bespreek normale hemostase onderdie volgende opskriftea) Beskryf die finale gemeenskaplike baan in die stollings kaskade. (10)b) Lys die substanse geproduseer in die vaskulere endoteel wat

i) Hemostase inisieer en aanhelp. (13)ii) Koaugulasie en stolsel formasie verhoed. (7)

c) Bespreek plaatjies onder die volgende opskriftei) Fisiese en morfologiese eienskappe. (10)ii) Prokoagulant substance. (5)

iii) Formasie van die plaatjie prop. (5)[50]

4 Discuss the physiology of ageing in a healthy individual, with respect to the followingsystems: Include both structural and functional alterations. Mention the implications ofthese if you were to anaesthetise a geriatric patienta) Autonomic nervous system. (10)b) The heart and vascular system. (15)c) Pulmonary system. (15)d) Hepatobiliary system. (5)e) Renal system. (5)

(50)

4 Bespreek die fisiologie van veroudering in die gesonde individu met respek tot dievolgende sisteme. Noem beide strukturele en funksionele veranderinge. Noem in elkesisteem die implikasies van hierdie veranderinge as u n geriatriese pasint narkose geea) Outonomiese senuwee stelsel. (10)b) Hart en vaskulere sisteem. (15)c) Pulmonale sisteem. (15)d) Hepatobiliere sisteem. (5)e) Renale sisteem. (5)

[50]


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The Colleges of Medicine of South AfricaIncorporated Association not for gain (Reg. No. 1955/000003/08)

Nonprofit Organisation (Reg No 009-874 NPO)

27 Rhodes Ave, PARKTOWN WEST 2193Private Bag X23, BRAAMFONTEIN 2017

Tel: +27 11 726-7037/8/9Fax: +27 11 726-4036

General: [email protected]

Academic Registrar: [email protected]: http://www.collegemedsa.ac.za

FCA(SA) PART I

Physiology

PAPER II(a)

Question 1 - 5

23 March 2010

14:00 16:00

Marks: 50

Examination Number:

1 Answer the questions on this questionnaire.2 This questionnaire must be handed in to the invigilator.3 The candidates examination number must appear on the questionnaire.


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Question1 / Vraag 1

Explain, using supporting equations, how total peripheral resistance influences cardiacoutput.Verduidelik met formules, hoe totale perifere vaskulere weerstand kardiale omset salbeinvloed.

...(10)

Question 2 / Vraag 2

a) List the principle functions of the liver.Lys die belangrikste funksies van die lewer.

...(5)


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b) List 5 proteins that are produced by the liver.Lys 5 proteene wat deur die lewer geproduseer word.

...(5)


a) Discuss the factors which control renal blood flow.

Bespreek die faktore wat renale bloedvloei beheer.

...(7)

b) In the following 3 functional parts of the kidneys , state which one has the most andwhich one the least blood supply per minute.In die 3 funksionele dele van die nier , noem watter deel het die meeste en watter deelhet die minste bloedvloei per minuuti) Cortex / kortex.(1)

ii) Outer medulla / Buitenste medulla......(1)

iii) Inner medulla / Binneste medulla......(10)


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a) Illustrate, on a single graph, the relationship between cerebral blood flow andIllustreer op een grafiek die verwantskap tussen serebrale bloedvloei eni) PaO...(2)

ii) PaCO.....(2)

Briefly discuss the cerebral blood supply.Bespreek serebrale bloedvloei kortliks.

.....(6)

Question 5 / Vraag 5List any 5 hormones produced by the anterior pituitary gland and explain what the physiologicrole and action of each isLys enige 5 hormone geproduseer deur die anterior hipofise en verduidelik wat die fisiologiese

rol en aksie van elkeen is.

....(10)


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FCA(SA) PART I

Physiology

PAPER II(b)

Question 6 - 10

23 March 2010

14:00 16:00

Marks: 50

Examination Number:



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a) Classify the 4 hypersensitivity reactions and briefly describe the immunologicalmechanism of each hypersensitivity reaction.Klassifiseer die 4 hipersensitiwiteits reaksies en beskryf kortliks die immunologiesemeganisme van elke hipersensitiwiteits reaksie.

...(8)

b) Give one clinical example of each type of hypersensitivity reaction.Gee een kliniese voorbeeld van elke tipe hipersensitiwiteits reaksie.

...(2)


List the main buffer systems of the body and indicate where each predominantly functions.Lys die belangrikste buffersisteme in die liggaam en dui aan waar elkeen hoofsaaklikfunksioneer.

....(10)


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Describe the intra uterine cardiovascular system of the fetus just before birth and highlight theimportant differences when compared to the adult circulation.Beskryf die intra uteriene kardiovaskulere sisteem van die fetus soos gesien net voor geboorteen lig die belangrike verskille met die volwasse sirkulasie uit.

...(10)


a) Discuss in short the transport of COin the blood.Bespreek kortliks die transport van COin die bloed.

............................(8)


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b) demonstrate the Haldane effect on a graph.Demonstreer die Haldane effek op die grafiek.

...........................................................................................................(2)


a) Write Starlings equation describing the forces of capillary filtration.Skryf Starling se vergelyking neer om die kragte van kapillere filtrasie te illustreer.

.....(1)

b) Describe what each constant and variable in the equation represents.Beskryf wat elke konstante en veranderlike in die vergelyking beteken.

......(7)


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c) What does a reflection coefficient of 1 imply?Wat impliseer n refleksie koeffisient van 1?

...(2)


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FCA(SA) PART I

Physiology

PAPER II(c)

Question 11 - 15

23 March 2010

14:00 16:00

Marks: 50

Examination Number:



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0 0.2 0.4 0.6 0.8

1 2 3 4 5

Pressure(mmHg)

The diagram depicts the ECG inrelation to time. The phases of thecardiac cycle are identified by thenumbers at the bottom as follows:

1. atrial systole2. isovolumic ventricular contraction3. ventricular ejection4. isovolumic ventricular relaxation5. ventricular filling.

Using the scale provided, plot thechanges in left atrial pressure in thediagram. (2)

Label each component of the atrialwave, and explain the cause of each in

terms of intracardiac events in thespace below. (6)

Provide realistic values on the axis. (2)

Time seconds

0 0.2 0.4 0.6 0.8

1 2 3 4 5

Druk(mmHg)

Die diagram wys die EKG inverwantskap met tyd. Die fases vandie kardiale siklus word geidentifiseer

met die nommers aan die onderkantvan die diagram as volg:

1. atriale sistolie2. isovolemiese ventrikulere

kontraksie3. ventrikulere ejeksie4. isovolemiese ventrikulere

ontspanning5. ventrikulere vulling.

Gebruik die diagram wat verskaf is om

die veranderinge in die linker atrialedrukke aan te dui. (2)

Benoem elke komponent van dieatriale kurwe en verduidelik dieoorsaak van elk in terme vanintrakardiale gebeure in dieonderstaande spasie. (6)

Verskaf realistiese waardes op dieaksis. (2)

Tyd (sekondes)


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....(10)


Ajaundicedpatient was admitted to hospital the data below represents 4 possible sets ofblood results (A B C D) obtained from the patient

Normal A B C DAlbumin g/l 42 37 42 25

K mmol/l 5.6 4 4 3IgG g/l 8 -18 15 28 15 24LDH u/l 90 200 400 400 150 240

ALP u/l 30 100 60 60 420 130NH4

+umol/l < 50 34 40 40 280INR 1.1 1.1 2.5 1.8Urineurobilinogenumol/day

2 6 25 3 0.5 25

Giving a physiological explanation which data set best fits a patient who has


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n Geelsugtige pasint word opgeneem in die hospital. Die data hieronder verteenwoordig 4moontlike stelle bloedresultate (A B C D) verkry vanaf hierdie pasint.

Normaal A B C DAlbumien g/l 42 37 42 25K mmol/l 5.6 4 4 3IgG g/l 8 -18 15 28 15 24LDH u/l 90 200 400 400 150 240

ALP u/l 30 100 60 60 420 130NH4

+umol/l < 50 34 40 40 280INR 1.1 1.1 2.5 1.8Urieneurobilinogeenumol/dag

2 6 25 3 0.5 25

Gee met fisiologiese verduideliking watter data stel(A,B,C of D) die beste pas in n pasint met

a) Haemolysis / Hemolise.

...(3)

b) Liver failure / Lewer versaking.

...(4)

c) Bile duct obstruction / Galweg obstruksie.

(3)


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The anion gap of a patient is reported to be 20 pre-operatively.Die anioon gaping van n pasient word gerapporteer as 20 pre-operatief.

a) How can the anion gap be calculated?Hoe word die anioongaping bereken?

...(1)

b) What does it represent?Wat verteenwoordig dit?

...(3)

c) List three causes of an increased anion gap metabolic acidosis and three causes of anormal anion gap metabolic acidosis.Lys 3 oorsake van verhoogde anioongaping metaboliese asidose en 3 oorsake vannormale anion gaping metaboliese asidose.

...

...(6)

(10)


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Red blood cells only have a limited lifespan. Explain schematically the breakdown ofhaemoglobin in the red blood cell.Rooi bloed selle het n beperkte leeftydperk. Verduidelik skematies die afbraak vanhemoglobien.

....(10)


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Label the phases of the ventricular myocyte action potential, and state which ion channels areinvolved in each phase.Indicate the absolute and relative refractory periods.Benoem die fases van die ventrikulere miosiet aksie potensiaal , en dui aan watter ioon kanaleis betrokke in elke fase .

Dui die absolute en relatiewe refraktere periodes aan.

....(10)


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FCA(SA) PART I

Physiology

PAPER II(d)

Question 16 - 20

23 March 2010

14:00 16:00

Marks: 50

Examination Number:



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a) A normal person undergoing a test known as maximal breathing capacity in a room at760 mmHg (101.3 kPa) , breathing room air may, through a maximal inspiratory effort,increase the partial pressure of alveolar oxygen to a value no greater than.n Normale persoon ondergaan n toets bekend as maksimale asemhalings kapasiteit inn kamer by 760 mmHg (101.3 kPa) met kamerlug. Die persoon kan deur maksimale

inspiratoriese pogings die parsiele druk van alveolere suurstof verhoog na n waardevan nie meer as.

......(2)

b) If an individuals dead space ventilation is 1.9 liters/min, alveolar ventilation is 5.6

liters/min, and breathing frequency is 15 breaths/ min, what is his tidal volume?As n persoon n dooie spasie ventilasie van 1.9 liters/min, alveolere ventilasie is 5.6

liters/min, en asemhalings tempo is 15 / min, wat is die persoon se getyvolume?

......(2)

c) What is the likely immediate effect on arterial pH and paCO2 if a subject doubles hisbreathing frequency and reduces his tidal volume to 1/2 normal? Explain.Wat is die moontlike onmiddellike effek op arteriele pH en paCO2 as n persoon syasemhalings tempo verdubbel en sy getyvolume die helfte van normaal hou?Verduidelik.

......(2)

d) A patient is brought to the casualty department suffering from an overdose ofa barbiturate. He exhibits hypoventilation caused by respiratory centre depression. He isgiven 100% oxygen to breathe and minute ventilation decreases markedly, but hismixed venous PO2rises to 128 mmHg (17 kPa).n Pasint word na noodgevalle gebring wat n oordosis barbiturate gedrink het. Hyhipoventileer as gevolg van respiratoriese sentrum onderdrukking. Hy word 100%suurstof gegee om in te asem en sy minuut ventilasie daal merkbaar , maar sy gemengveneuse PO2styg tot 128 mmHg (17 kPa).


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i) Explain the response to oxygen therapy.Verduidelik die respons op die suurstof terapie.

......(2)

ii) What is the correct treatment?Wat is die korrekte behandeling?

......(2)


Complete the following table, which describes the normal physiological changes in pregnancy,with the words increased, decreasedor no changewith respect to the non-pregnant state.Voltooi die onderstaande table wat die normale fisiologiese veranderinge in swangersakapbeskryf , met verhoog , verlaag o f geen veranderingmet respek tot die nie swanger status.

MATERNAL VARIABLE AVERAGE CHANGE IN PREGNANCY

Total lung capacityFunctional residual capacity

Residual volume

Vital capacity

Closing volume

Minute ventilation

Tidal volume

Respiratory rate

Dead space

Arterial pCO2Arterial pH

Arterial pO2


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b) The following values are measured for the potassium ion in a normal subjectDie volgende waardes word gemeet in die normale persoon

Plasma K+ 5 meq/literUrine K+ 50 meq/literRenal creatinine clearance 80 ml/minUrine formation rate 1.5 ml/minute

What is the patient's potassium clearance, and what does this answer imply about renalpotassium handling?

Plasma K+ 5 meq/literUriene K+ 50 meq/literRenael kreatinien opruiming 80 ml/minUrien formasie tempo 1.5 ml/minuteWat is die pasint se Kalium opruiming en wat impliseer hierdie antwoord oor die nier seKalium hantering?

......(2)

c) Briefly describe the endocrine functions of the kidney.Beskryf kortliks die endokriene funksie van die niere.

(5)

Question 19 /Vraag 19

a) What is the difference in definition between osmolarityand osmolality?Definieer die verskil tussen osm olar i tei t enand osmolal i te i t?

...(2)


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b) Give the definition of an osmolar gapand name one substance which might causesuch a gap.Gee die definisie van osmo lare gaping en noem een substans wat so n gaping magveroorsaak.

......(2)

c) Explain what is meant by tonic i tyand give a formula for its calculation.Verduidelik wat word bedoel met tonis i te i t en gee n formule om dit te bereken.

......(2)

d) A woman runs the Two Oceans Marathon on a 35C day. It is determined that she loses3 liters of sweat, which is hypotonic. During the marathon, she drinks 3 liters of H2O.For each parameter listed below, indicate whether it is increased, decreased, orunchanged in the new steady state, and why.n Vrou hardloop die Twee Oseane Marathon op n 35 grade Celsius dag.Dit wordbereken dat sy 3 liter sweet wat hipotonies is. Sy drink 3 liter H2O gedurende diemarathon.Voltooi die volgende tabel in die nuwe besadigde staat ( steady state)

Increased, decreased, orunchanged / Verhoog, Verlaag

of onveranderd

Why / Hoekom

Plasma osmolarity /Plasma osmolariteit

ECF volume /Ekstra Sellulere VogVolumeHaematocrit /Hematokrit

Total body water /Totale Liggaams

Water(4)


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a) What are the values given for normal intraocular pressure?Wat is die normale waarde van intra okulere druk?

..(1)

b) List factors that may influence intraocular pressure.Lys die faktore wat intra okulere druk mag beinvloed.

......(3)

c) Write short notes on the oculocardiac reflex.Skryf kort notas oor die okulokardiese refleks

......(6)


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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICAIncorporated Association not for gain

Reg No 1955/000003/08

Part I Examination for the Fellowship of the

College of Anaesthetists of South Africa

24 March 2010

Paper III Pharmacology Long Questions (3 hours)



1 Discuss the pharmacology of the local anaesthetics under the following headingsa) Classification. (10)b) Mechanism of action. (10)c) Cardiotoxicity. (10)d) Physico-chemical determinants of

i) Potency. (2)ii) Duration of action. (2)iii) Onset of action. (2)

e) Metabolism. (4)f) Neurological complications. (10)

[50]

1 Bespreek die farmakologie van die lokale verdowingsmiddelsa) Klassifikasie. (10)b) Meganisme van werking. (10)c) Kardiotoksisiteit. (10)d) Fisies-chemiese bepalers van

i) Aktiwiteit. (2)ii) Duurte van werking. (2)iii) Aanvang van werking. (2)

e) Metabolisme. (4)f) Neurologiese komplikasies. (10)

[50]

2 a) A patient known to have heart failure and chronic permanent atrial fibrillationPresents with a ventricular rate of 170/minute and symptoms of shortness ofbreath and light headedness.Identify the pharmacologic alternatives (from various classes) to block the AV nodeand discuss the respective drugs with regard toi) The mechanism of action and resultant effects.ii) Important side effects and contra-indications. (30)

PTO/ Page 2 Question 2 b)...


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-2-

b) Discuss the mechanism of action of dopamine and explain the effects of the drug asseen with increasing dose of administration with specific reference to thehaemodynamic and renal effects. (20)

[50]

2 a) n Pasint bekend met hartversaking en chroniese permanente atriale fibrillasie

presenteer met n ventrikulre spoed van 170/minuut en simptome vankortasemheid en lighoofdigheid.Identifiseer die farmakologiese alternatiewe (uit verskillende klasse) om die AV nodete blokkeer en bespreek die onderskeie middels ten opsigte vani) Die meganisme van werking en gevolglike effekte.ii) Belangrike newe effekte en kontraindikasies. (30)

b) Bespreek die meganisme van werking van dopamien en verduidelik die effekte vandie middel soos gesien met toenemende inkremente van toediening met spesifiekeverwysing na die hemodinamiese en renale effekte. (20)

[50]

3 Dexmedetomidine is a unique drug which is widely used for anaesthesia andprocedural sedation in adults and children. Its use can however have dangerousconsequences.Discuss this statement taking into account the indications for its use, its physico-chemical properties, and pharmacokinetic and pharmacodynamic profile. [50]

3 Deksmedetomidien is n unieke middel wat wyd in narkose vir sedasie in kinders envolwassenes gebruik word. Die gebruik daarvan mag egter gevaarlike gevolgeinhou.Bespreek hierdie stelling, inaggenome die indikasies vir gebruik, die fisies-chemieseeienskappe, asook die farmakokinetiese en dinamiese profiel. [50].

4 a) Discuss the mechanisms by which suxamethonium causes the following sideeffects

i) Hyperkalemia.ii) Prolonged apnoea.iii) Malignant hyperthermia.iv) Bradycardia.iv) Fasiculations.v) Anaphylaxis.vi) Increased intraocular pressure. (25)

b) Define

i) The concept of the ED95(effective dose 95) for any muscle relaxant.ii) The relevance of the ED95.iii) The intubation dose of a muscle relaxant in relation to the ED95.iv) How the potency of a muscle relaxant influences the ED95. (10)

c) What is laudanosine, and why is it important for the anaesthetist? (4)d) What is sugammadex, what is its mechanism of action, and how is it metabolised

and eliminated? (6)e) What is gantacurium, and what is significant about the metabolism of the drug? (5)

[50]PTO/ Page 3 Question 4 a)


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-3-

4 a) Bespreek die meganismes waarvolgens suksametonium die volgende newe-effekte veroosaaki) Hiperkalemie.ii) Verlengde apnee.iii) Maligne hipertermie.

iv) Bradikardie.v) Fassikulasies.vi) Anafilakse.vii) Verhoogde inrta-okulre druk. (25)

b) Definieeri) Die begrip ED95( effektiewe dosis 95) van n spierverslapper.ii) Die relevansie van ED95iii) Intubasie dosering van n spierverslapper volgens die ED95.iv) Hoe die potensie van n spierverslapper die ED95binvloed. (10)

c) Wat is laudanosien en hoekom is dit belangrik vir die narkotiseur? (4)d) Wat is sugammadex, wat die werkingswyse daarvan, en hoe word dit

gemetaboliseer en ge-elimineer? (6)e) Wat is gantakurium, en wat is besonders in die metabolisme van die middel? (5)[50]


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FCA(SA) PART I

Pharmacology

PAPER IV(a)

Question 1 - 5

24 March 2010

14:00 16:00

Marks: 50

Examination Number:



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1 List the opioid receptor types and the anatomical location of each. (5)What are the intracellular results of opioids binding to these receptors? (5)Lys die opioied reseptor tipes, asook die anatomiese area waar elk voorkom.Wat is die intrasellulre gevolge van opioiede wat op hierdie reseptore bind?

[10]

2 Briefly outline the mechanism of action ofBespreek kortliks die meganisme van werking van

a) Methyl-dopa / Metieldopa.

.....(4)

b) Reserpine / Reserpien.

.(3)

c) Guanethedine / Guanetidien

.(3)


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3 Briefly outline the pharmacology of spironolactone by referring toBespreek kortliks die farmakologie van spironolaktoon deur te verwys na

d) Mechanism of action / Meganisme van werking.

(3)

b) Uses / Gebruike.

.(3)

c) Side-effects / Newe-effekte.

(4)

4 a) What is dantrolene?Wat is dantroleen?..

..

..

.......................................................................................(2)

b) What are the indications for its use?Wat is die indikasies vir die gebruik daarvan?

..

..

..

.......................................................................................(2)


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c) What is the dose of dantrolene?Wat is die dosis van dantroleen?..

.....(1)

d) What are the side effects of dantrolene?

Lys die newe-effekte van dantroleen?..

..

..

.......................................................................................(3)

e) How is dantrolene formulated in the vials it is supplied in?Hoe word dantroleen geformuleer in die ampules waarin dit verskaf word?..

..

..

.......................................................................................(2)

[10]

5 Briefly outline the side-effects and contra-indications of nitroglycerine use.Bespreek kortliks die newe-effekte en kontra-indikasies van nitrogliserien gebruik.

...(10)


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FCA(SA) PART I

Pharmacology

PAPER IV(b)

Question 6 - 10

24 March 2010

14:00 16:00

Marks: 50

Examination Number:



35/73

6 Identify the prominent pharmacokinetic differences between the following pairs ofdrugs. For each pair indicate what the resultant clinical implications of the identifieddifference are.Identifiseer die prominente farmakokinetiese verskille tussen die volgende tweemiddels. Gee ook die gevolglike kliniese implikasie van die verskil.

a) Diazepam and lorazepam / Diasepam en lorasepam.

....

..

.......................................................................................................(2)

b) Propranolol and atenolol / Propranolol en atenolol...

..

..

......................................................................................................(2)

c) Glyceryl trinitrate and isosorbide mononitrate / Gliseriel trinitraat en isosorbiedmononitraat...

..

........................................................................................................(2)

d) Atropine and glycopyrrolate /Atropien en glikopirrolaat...

..

..

......................................................................................................(2)

e) Amlodipine and nifedipine /Amlodipien en nifedipien...

..

..

......................................................................................................(2)

[10]


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7 Indicate one important effect of each of the following antihypertensive drugs on theadministration of general anaesthetic. Also indicate the appropriate precaution(s) thatshould be taken.Toon een belangrike effek aan wat elk van die volgende antihipertensiewe middelsop die toediening van algemene narkose het. Noem ook die toepaslike voorkomendemaatre(s)l wat geneem moet word.

a) Hydrochlorothiazide / Hidrochlorotiasied...

..

..

......................................................................................................(2)

b) Enalapril / Enalapril...

..

..

........................................................................................................(2)

c) Atenolol /Atenolol...

..

..

........................................................................................................(2)

d) Verapamil / Verapamil...

..

..

........................................................................................................(2)

e) Clonidine / Klonidien.

..

..

..

........................................................................................................(2)


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8 What antiemetics would you feel are indicated and contra-indicated in the followingclinical situations?Watter anti-emetika voel u is geindikeerd en gekontraindikeerd vir die volgendekliniese situasies?a) A patient with Parkinsons disease / n Pasint met Parkinonisme.

..

..

..

........................................................................................................(2)

b) Children / Kinders...

..

..

........................................................................................................(2)

c) Pregnant patients / Swanger pasinte...

..

..

........................................................................................................(2)

d) Patient with benign prostate hypertrophy / Pasint met benign prostaat hipertrofie.

....

..

........................................................................................................(2)

e) Patient with Menieres disease / Pasint met Meniere se siekte..

..

..

........................................................................................................(2)

[10]


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9 List five drugs with clinically significant interactions with non-steroidal inflammatorydrugs and describe the mechanism of each interaction.Noem vyf middels met klinies belangrike interaksies met nie-steroiedinflammatoriese middels en beskryf die meganisme van elke interaksie.

.....

.....

..........

.....

.....

.....

.....

..

.....

.....

.....

.....

...................................[10]

10 List five different drugs that may prolong the action of succinylcholine and describethe mechanism of the interaction in each case.

Noem vyf middels wat die effekte van suksinielcholien kan verleng en beskryf diemeganisme van die interaksie in elke geval......

.....

.....

.....

.....

.....

.....

.....

..

.....

.....

.....

...................................[10]


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FCA(SA) PART I

Pharmacology

PAPER IV(c)

Question 11 - 15

24 March 2010

14:00 16:00

Marks: 50

Examination Number:



40/73

11 List 5 drugs metabolised by plasma cholinesterase.Indicate into which class of drugs each may be classified.Lys vyf middels wat deur plasmacholien esterase afgebreek word.Toon aan waar elk van die middels geklassifiseer mag word.

.....

.....

..........

.....

.....

.....

.....

..

.....

.....

.....

.....

...................................[10]

12 Define the following / Definieer die volgendea) Clearance / Opruiming.

..

..

..

....................(2)

b) Context sensitive half life / Konteks sensitiewe halfleeftyd...

..

..

......................(3)

c) Volume of distribution / Volume van distribusie...

..

..

....................(2)


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d) Elimination half-life / Eliminasie halfleeftyd...

..

..

......................(3)

13 Syntocinon (oxytocin) is routinely used during anaesthesia for Caesarian section.Syntocinon (oksitosien) word roetineweg gebruik tydens narkose vir keisersnee.

a) How is this drug formulated?Hoe word hierdie middel geformulering?..

..

..

....................(2)

b) What are its mechanisms of action?Wat is die meganisme van werking?..

..

......................(2)

c) What are the indications for the administration of this drug?Wat is die indikasies vir toediening van die middels?..

..

..

....................(2)

d) What is the dose?Wat is die dosering?..

..

..

....................(2)


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e) What side effects may occur?Watter newe-effektekan verwag word?..

..

..

....................(2)

[10]

14 With respect to the Cephalosporins / Met betrekking tot die Kefalosporienea) Describe their mechanism of action / Beskryf die meganisme van werking.

..

..

..

....................(2)

b) Classify them, giving one example of a drug in each category.Klassifiseer elk van die middels en gee een voorbeeld uit elke kategorie...

..

..

..

..

....................(4)

c) List one indication for each category / Lys een indikasie vir elk...

..

..

..

..

....................(4)


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15 List pharmacologic agents that may be used to increase the heart rate indicating for

each the pharmacologic mechanism of action.Lys farmakologiese middels wat gebruik kan word om die harttempo te verhoog en geevir elk die farmakologiese meganisme van werking.

.....

.....

.....

.....

.....

.....

.....

.....

..

.....

.....

.....

.....

...................................[10]


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FCA(SA) PART I

Pharmacology

PAPER IV(d)

Question 16 - 20

24 March 2010

14:00 16:00

Marks: 50

Examination Number:



45/73

16 Classify the colloid plasma volume expanders. (4)List the side effects of each group. (6)Klassifiseer die koloied plasmaveruimers.Lys die newe-effekte van elk van die groepe.

.....

.....

..........

.....

.....

.....

.....

..

.....

.....

.....

.....

...................................[10]

17 What is protamine sulphate?Wat is protamiensulfaat?

..........................

.............

..........................(2)

List the side effects can you expect when using this drug.Lys die newe-effekte van die middel..............

.............

.............

.............

.............

..........................(4)


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What is the mechanism by which each of these side effects are caused?Wat is die meganisme van elk van die newe-effekte ?.............

.............

.............

.............

..........................(4)

18 Refractory shock in severe sepsis are often not responsiveness to inotropes normallyused. Vasopressin and Methylene blue may be of use in this situation.Refraktre skok tydens erge sepsis reageer dikwels nie tot inotrpoe terapie watnormaalweg gebruik word nie. Vasopressien en metileen blou mag van nut wees inhierdie situasie

a) What is the mechanism of action of methylene blue?What is die meganisme van werking van metileen blou?

............

......

...........................(2)

b) How can it potentially reverse refractory shock?Hoe kan dit refraktre skok potensiel omkeer?

......

......

......

...........................(3)

c) What is the mechanism of action of vasopressin?Wat is die meganisme vab werking van Vasopressien?......

......

......

...........................(2)

d) How can it potentially reverse refractory shock?Hoe kan dit refraktre skok potensiel omkeer?......

......

......

...........................(3)


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19 Describe the mechanism of action of the following drugs, and mention how theeffect of each can be reversedBeskryf die meganisme van werking van die volgende antistolmiddels, enwaarmee die effek daarvan omgekeer kan word

a) Aspirin /Aspirien.......

......

......

...........................(2)

b) Abciximab /Absiksimab.......

......

......

...........................(2)

c) Clopidogrel / Klopidogrel.......

......

......

...........................(2)

d) Heparin / Heparien.......

......

......

...........................(2)

e) Fondaparinux / Fondaparinux.......

......

......

...........................(2)

[10]


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20 Briefly Discuss antiretroviral drugs (ART) under the following headingsBespreek antiretrovirale middels kortliks onder die volgende hoofde

a) Classification / Klassifikasie.

.............

.............

.............

.............

.............

..................................(5)

Side-effects and problems relevant to the anaesthetist / Newe-effekte en problemerelevant tot die narkotiseur.

..........................

.............

.............

.............

..................................(5)

[10]


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FCA(SA) Part I

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain

Reg No 1955/000003/08

Part I Examination for the Fellowship of theCollege of Anaesthetists of South Africa

25 March 2010

Paper V Physics - Long Questions (3 hours)



1 a) Discuss the mechanism for the abnormalities seen in the sidestream capnograph

signal above during an anaesthetic for a neonate with a fast spontaneousbreathing rate. (6)

b) Draw and annotate the time-based capnogram that will appear when theinspiratory valve of the breathing circuit fails in the open position. (4)

c) Write notes on infrared spectrographic measurement of carbon dioxide. (10)d) Describe the chemical reaction that occurs when carbon dioxide enters an

absorber. (10)e) Discuss the physical properties of CO2. (10)

[40]

1 a) Bespreek die meganisme vir die afwykings gesien in bogenoemde

Systroom kapnograafsein soos verkry tydens narkose vir n neonaat met nvinnige spontane respiratoriese tempo. (6)

b) Teken en benoem die tydgebaseerde kapnogram wat sal verskyn as dieinspiratoriese klep van die asemhalingsisteem faal in die oop posisie. (4)

c) Maak aantekeninge oor die infrarooi-spektrografiemeting van koolsuurgas. (10)d) Beskryf die reaksie wat voorkom as koolsuurgas n koolsuurgasabsorbeerder tee

kom (10)e) Bespreek die fisiese eienskappe van CO2. (10)

[40]PTO/ Page 2 Question 2


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-2-

2 Draw 3 separate curves showing the relationship between pressure and time,gas flow and time, lung volume and time under the following conditionsa) i) When a constant pressure is delivered. (6)

ii) When a constant volume is delivered. (6)

iii) Explain what is meant be the acronym SIMV giving a brief description of

what occurs during SIMV. (6)b) What is PEEPi(intrinsic or auto PEEP)? (2)c) List methods to determine ideal PEEP. (4)d) List the side effects of PEEP. (10)e) How can compliance be calculated in a ventilated patient? (2)f) What is dynamic compliance? How can it be determined? (4)g) What is static compliance? How can it be determined? (4)h) What is normal compliance in cmH2O? (2)i) How can different causes of a change in compliance be elucidated from the

airway pressure graph? (4)[50]

2 Teken 3 aparte kurwes en toon die verwantskap tussen druk en tyd, gasvloei entyd asook longvolume en tyd onder die volgende omstandighedea) i) Wanneer n konstante druk gelewer word. (6)

ii) Wanneer n konstante volume gelewer word. (6)

iii) Verduidelik wat bedoel word met die akroniem SIMV en gee n kort

beskrywing van wat gebeur gedurende SIMV. (6)

b) Wat is PEEDi(PEEPi), (intrinsieke of outo-PEED)? (2)

c) Lys die metodes om idiale PEED te bepaal. (4)

d) Lys die ongewensde effekte van PEED. (10)

e) Hoe kan meegewendheid bereken word in n geventileerde pasint? (2)

f) Wat is dinamiese meegewendheid? Hoe kan dit bepaal word? (4)

g) Wat is statiese meegewendheid? Hoe kan dit bepaal word? (4)

h) Hoeveel is die normale meegewendheid in cmH2O? (2)

i) Hoe kan verskillende oorsake van n verandering in meegewendheid afgeleiword van die lugwegdrukkkurwe? (4)

[50]

PTO/ Page 3 Question 3


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-3-

3 a) Name and explain in detail the effect shown above. (20)b) The most commonly used face mask for administering supplemental oxygen to

spontaneously breathing patients utilises this effect.What volume of air is entrained by a 40% oxygen mask at an oxygen flow rate of

8l/min (how your calculations)? (10)c) Given the following parameters

Tidal volume = 500 mls,Respiratory rate = 30/min,Inspiratory: expiratory ratio = 1:2,40% mask with oxygen supply flow of 8l/min.

Calculate the average fraction of oxygen (during inspiration) in the air that thepatient will inspire if the entrainment orifices on the entrainment device are tapedover to prevent air from diluting the masks oxygen supply. (show working). (10)

d) Comment on the how the above fraction is affected in the following scenarios

i)During inspiration by the change in respiratory flow rates that are typically seenduring inspiration. (6)ii) By an increase in respiratory rate. (2)iii) By a decrease in respiratory rate. (2)

[50]

3 a) Noem en verduidelik in besonderhede die effek wat hierbo aangetoon word. (20)b) Die mees algemeen gebruikte gesigsmasker om suurstof toe te dien aan n

Pasint wat spontaan asemhaal maak gebruik van hierdie effek. Watter volumelug word deur n 40% suurstofmasker meegevoer tydens n suurstofvloeitempovan 8l/min (wys jou berekeninge)? (10)

c) Gegee die volgende inligtingGetyvolume = 500 ml,Respiratoriese tempo = 30/min,Inspirasie: ekspirasie-verhouding = 1:2,40% masker met suurstofvloeitempo van 8l/min.

Bereken die gemiddelde suurstof-fraksie (tydens inspirasie) in die lug wat diepasint sal inasem as die meevoeropeninge op die meevoertoestel toegeplak isom te verhoed die masker se suurstoftoevoer verdun word met lug (toonbewerkings). (10)

PTO/ Page 4 Question 3 d)


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-4-

d) Lewer kommentaar oor hoe bogenoemde fraksie benvloed word onder dievolgende omstandighedei) Gedurende inspirasie as gevolg van die veranderinge in vloeitempo wat

tipies gesien word tydens inspirasie. (6)ii) Met n toename in respiratoriese tempo. (2)

iii) Met n afname in respiratoriese tempo. (2)[50]

4 a) Describe in detail how oxygen is stored in a major hospital. Include in youranswer a detailed description of the storage systems. (30)

b) List all the safety mechanisms that may be employed throughout the entireoxygen delivery system to prevent a hypoxic mixture being administered to apatient. (20)

[50]

4 a) Beskryf in besonderhede hoe suurstof in n groot hospitaal geberg word. Gee nbreedvoerige beskrywing van die bergingstelsels as deel van u antwoord. (30)b) Maak n lys van al die veiligheidsmeganismes wat deur die hele

suurstofleweringstelsel gebruik kan word om te verseker dat n hipoksiesemengsel nie aan n pasint gelewer word nie. (20)

[50]


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FCA(SA) PART I

Physics

PAPER VI(a)

Question 1 - 5

25 March 2010

14:00 16:00

Marks: 50

Examination Number:



54/73


The Perfect Gas Laws / Die Ideale Gaswette

1 a) Define the first gas law, Boyles law.Definieer die eerste gaswet, Boyle se wet.

.(2)

b) Define the second gas law, Charles law.Definieer die tweede gaswet, Charles se wet.

.(2)

c) Define the third perfect gas law.Definieer die derde idiale gaswet.

.(2)

d) State Henrys law for solubility of gases.Gee Henry se wet vir die oplosbaarheid van gasse.

.(2)


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e) Define what 1 Newton is.Definieer 1 Newton.

.(2)


Explain what is meant by the term alternating current.Bespreek wat bedoel word met die term wisselstroom.

....(10)


a) Define the acronym LASER.Defineer die akroniem LASER.

..

.

.

.(2)


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b) Name the most common lasers in use and give an example of their therapeutic use.Noem die mees algemeenste lasers in gebruik met n voorbeeld van hul terapeutieseaanwending. (4)

Type of LASER/ Tipe LASER Therapeutic use / Terapeutiese gebruik

c) List the complications and measures that can be taken to reduce the risks of damagefrom laser usage.Maak n lys van die komplikasies en maatrels wat geneem kan word om die risikos vanlasergebruik te verminder. (4)

ComplicationKomplikasie

Measure to reduce complicationMaatrel om risiko te verminder

Question4 / Vraag 4

Draw a normal thromboelastogram (TEG) and describe six parameters of importance in a TEGcurve.Teken n normale trombo-elastogram (TEG) en beskryf ses parameters van belang by dieTEG-kurwe. (10)


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Write short notes on cerebral oximetry (near-infrared spectroscopy).Skryf saaklike notas oor serebrale oksimetrie (naby-infrarooispektroskopie).

....(10)


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FCA(SA) PART I

Physics

PAPER VI(b)

Question 6 - 10

25 March 2010

14:00 16:00

Marks: 50

Examination Number:



59/73


a) Define critical temperature.Definieer kritiese temperatuur.

..(2)

b) Define pseudocritical temperature.Definieer pseudokritiese tempreatuur.

..(2)

c) What is the pseudocritical temperature of Entonox? Why is this important?Wat is die pseudokritiese temperatuur van Entenox? Waarom is dit belangrik?

...

......(4)

d) What is the Poynting effect?Wat is die Poyntingeffek?

..(2)


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Question 7/ Vraag 7

Vaporisers:

a) How does atmospheric pressure / altitude affect modern vaporisers?Hoe benvloed atmoferiese druk / hoogte moderne verdampers?

..(2)

b) How does temperature affect vaporisation of volatile agents?Hoe benvloed temperatuur die verdamping van vlugtige agense?

..(2)

c) What does TEC mean?Wat beteken die term TEC?

..(1)

d) Describe one method of temperature compensation in a vaporiser.Beskryf een metode van temperatuurkompensasie in n verdamper.

...

..(5)


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Question 8/ Vraag 8

Pulse oximetry:

Draw an annotated diagram of the haemoglobin extinction curves include 4 species ofhaemoglobin. Mark the isobestic point.Teken n benoemde diagram van die hemoglobienafplattingskurwes sluit 4

hemoglobienspesies in. Merk die isobestiese punt. (10)


Pacemakers: / Pasaangers:

Classify pacemakers.Klassifiseer pasaangers. (10)

Position I II III IV V

Question 10/ Vr aag 10

Neuromuscular monitoring: / Neurom us kulre mo nitering :

Describe 4 commonly used stimulation patterns by means of annotated diagrams.

Beskryf met behulp van benoemde diagramme 4 algemeen gebruikte stimulasiepatrone. (10)


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FCA(SA) PART I

Physics

PAPER VI(c)

Question 11 - 15

25 March 2010

14:00 16:00

Marks: 50

Examination Number:



63/73


Match the following statistical tests with their correct data applications

Pas die volgende statistiese toetse met hul korrekte data-toepassings (9)

Mann-Whitney U-Test

Paired-t Test

Unpaired-t Test

One-way ANOVA Two-way ANOVA

Wilcoxon signed-rank Test

Kruskal-Wallace Test

Friedman Test

Chi squared Test

One Data Group

Een Data

Groepering

Two Data Groups

Twee Data

Groeperings

Multiple Data Groups

Veelvuldige Data Groeperings

Normally Distributed

Data

Normaal-verspreide

data

Non-normally

distributed data

Nie-

Normaalverspreide

data

Nominal Data

Nominale data

b) What does ANOVA stand for?

Wat beteken ANOVA?

..(1)


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Electricity and Electrical Shock / Elektr is i tei t en Elektr iese Skok

a) At what current range does microshock occur?By watter stroomreikwydte kom mikroskok voor?

..(2)

b) What is the current range for macro shock to occur?By watter stroomreikwydte kom makroskok voor?

..(2)

c) From list below complete the following table by filling the space with the corresponding letterVoltooi die onderstaande tabel deur die ooreenstemmende letters in die spasies in te vul

(6)

i) Recommended safe limit for cardiac equipmentAanbevole veilige limiet vir kardiale toerusting

ii) Threshold of perceptionPersepsiedrempel

iii) Ventricular fibrillationVentrikulre fibrillasie

iv) Maximum fault current for monitoring equipmentMaksimale stroomfout vir moniteringstoerusting

v) Pain, fainting, mechanical injuryPyn, bewussynsverlies, meganiese besering

vi) Burns, defibrillation effect

Brandwonde, defibrillasie-effek

1mA

50mA

6000mA

10A

100A

500A


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Operating room fires / Teaterbrande

a) List the three components (fire triad) required for fire to occur.Lys die drie komponente (brandtriade) benodig vir brande om te ontstaan.

...

......(3)

b) Give 2 examples of each as answered above.Gee 2 voorbeelde van elk in die antwoord hierbo.

...

......(3)

c) Define a stochiometric concentration.

Definieer n stogiometriese konsentrasie.

...

......(3)

d) What is the commonest cause of fire in operating theatres?Wat is die algemeenste oorsaak van brande in die operasieteater?

..(1)


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Manufacture of anaesthetic gases / Vervaardiging van narkosegasse

a) What is the name of the process by which liquid oxygen is commercially manufactured?Wat is die naam van die proses waardeur vloeibare suurstof kommersieel vervaardig

word?

...

......(2)

b) Which chemical is heated to produce Nitrous Oxide?Watter chemiese stof word verhit om laggas te produseer?

...

......(2)

c) What is the name of the substance that home oxygen concentrators use to removenitrogen from the air?Watter substans word in tuis-suurstofkonsentreerders gebruik om stikstof uit die lug te

verwyder?

...

......(2)

d) What is the percentage of pure oxygen found in hospital oxygen supplies?

Watter persentasie suiwer suurstof word gevind in die hospitaal suurstofvoorraad?

...

......(2)


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e) What percentage of pure oxygen are oxygen concentrators capable of producing?Watter persentasie suiwer suurstof kan voorsien word deur suurstofkonsentreerders?

...

......(2)


Gas Flow / Gasvloei

a) Briefly describe the differences between laminar and turbulent flow.Beskryf kortliks die verskille tussen laminre- en turbulente vloei.

...

...

......(5)

b) List the factors that increase the probability of turbulent flow.Lys die faktore wat die moontlikheid vir turbulente vloei sal verhoog.

...

...

......(5)


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FCA(SA) PART I

Physics

PAPER VI(d)

Question 16 - 20

25 March 2010

14:00 16:00

Marks: 50

Examination Number:



69/73


The following set of numbers represents the ages of patients on an operating list.Die volgende reeks getalle verteenwoordig die ouderdomme van pasinte op n operasielys.

10, 10, 10, 10, 15, 15, 20, 40, 50

Using this data complete the followingGebruik hierdie inligtinge om die volgende te voltooi

a) What is the mode?Wat is die modus?

...

......(2)

b) What is the mean?Wat is die gemiddelde?

...

......(2)

c) What is the median?Wat is die mediaan?

...

......(2)

d) What is the range?Wat is die reikwydte?

...

......(2)


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e) What type of data is age?

...

......(2)


By means of diagrams show the Maplesons classification of breathing systems.Gee met behulp van diagramme die Mapleson-klassifikasie vir asemhalingsisteme.

....(10)


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a) What is the difference between Gauge and French sizing?Wat is die verskil tussen Gauge en French-grootte?

...

......(2)

b) Explain which cannula would produce the faster infusion rate. An 18 gauge central linecannula or an 18 gauge peripheral intra venous cannula?Verduidelik watter kannule vinniger sal vloei, n 18 gauge sentrale lynkannule of n 18gauge perifre veneuse kannule?

..........

...

..........

...

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c) Draw the pin index system for oxygen.Teken die pen-indeks-sisteem vir suurstof. (2)


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a) List the physical methods by which temperature is lost. Give an example of where eachone of these principles is seen during an anaesthetic or operation.Maak n lys van die fisiese maniere waardeur temperatuur verlore gaan. Gee nvoorbeeld vir elk van hierdie maniere gedurende n narkose of operasie. (8)

Method/ Met ode Example / Voorbeeld

b) Why do bubbles form in fluid that is heated?Hoekom vorm borrels in vloeistof wat verwarm word?

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Briefly explain how cardiac output is measured using the oesophageal doppler technique.Verduidelik korteliks hoe n esofageale doppler kardiale omset meet.

(10)

Date post:	04-Jun-2018
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