Summer 2006

Q1. A 70 year old womans blood pressure is found to be elevated on two separate occasions
(180/105. !escribe t"e mec"anisms of action and t"e possible adverse effects of two dru#
classes t"at you would consider usin# to lower blood pressure in t"is woman.
Q$. A 10 year old #irl wit" ast"ma is still sufferin# recurrent moderately severe attac%s of
ast"ma despite treatment wit" an in"aled beta&$ adrenoceptor a#onist. !iscuss t"e
mec"anisms of action and side effects of two classes of dru#s you would consider addin# to
"er treatment re#imen' so as to reduce fre(uency and severity of attac%s.
Q). !escribe t"e treatment of arr"yt"mias' #ivin# special attention to t"e *au#"an +illiams
classification and side effects of two classes of anti&arr"yt"mic dru#s.
Q,. -"e levels of plasma lipoproteins in "uman sub.ects are used dia#nostically to evaluate
cardiovascular ris%. /ame t"e two lipoproteins mainly responsible for c"olesterol transport
and state 0123 of t"e properties by w"ic" t"ese two may be distin#uis"ed.
Q5. A family travel to Australia to visit t"eir relations. 1n arrival in 4ydney' t"e mot"er
e5periences c"est pain and is admitted to "ospital. 4"e is found to "ave a pulmonary
embolus. !escribe "ow a pulmonary embolus interferes wit" respiratory function.
Q6. !escribe t"e intrinsic ability of t"e "eart to adapt to c"an#es in venous return. 7llustrate
your answer wit" a dia#ram.
Q7. 7n a #roup on a "i%in# tour to t"e "istoric site of 8ac"u 9icc"u in t"e 9eruvian Andes'
some develop acute mountain sic%ness but ot"ers acclimatise normally to t"e "i#" altitude.
!escribe t"e cardiovascular and respiratory c"an#es t"at occur durin# acclimatisation.
Q8. 1n suddenly standin# upri#"t' you may feel di::y and faint. !escribe t"e refle5
p"ysiolo#ical response w"ic" normally counteracts postural "ypotension.
Q;. !escribe t"e c"an#es in left ventricular pressure occurrin# durin# t"e cardiac cycle.
7llustrate your answer wit" a dia#ram #ivin# absolute values of pressure.
1
Q10. 9rior to elective sur#ery for a "ip replacement' a patient is found to "ave a "aemo#lobin
of 8#/dl. !iscuss t"e balance between o5y#en availability and demand in t"is situation.
Q11. A youn# man is brou#"t to t"e Accident and <mer#ency !epartment followin# a stab
wound to t"e ,
t"
ri#"t intercostal space and "as developed a pneumot"ora5. =ist t"e layers of
t"e c"est wall t"at t"e %nife "as passed t"rou#". +"ere does t"e neurovascular bundle lie in
t"e intercostal space and w"at does it contain> +"at are t"e surface mar%in#s of t"e pleural
cavities>
Q1$. !urin# a routine p"ysical e5amination' you auscultate your patients c"est. !escribe or
draw t"e surface mar%in#s of t"e "eart and t"e "eart valves. 7ndicate w"ere you would place
a stet"oscope to listen to eac" valve.
Q1). !escribe t"e diap"ra#m' wit" reference to its attac"ments and nerve supply. =ist t"e openin#s
t"at e5ist to allow passa#e of structures between t"e t"oracic and abdominal cavities? include
t"e vertebral levels of t"ese openin#s and name t"e structures w"ic" pass t"rou#" t"em.
Q1,. A $; year old man develops s"oulder pains followin# a tennis matc". <5plain wit"
reference to t"eir attac"ments' "ow t"e muscles of t"e s"oulder #irdle control rotation of t"e
scapula w"en reac"in# out and openin# a door.
Q15. A $; year old man accidentally puts "is "and t"rou#" a s"eet of #lass' causin# a
laceration of "is t"enar eminence. !escribe t"e movements of t"e t"umb. 7ndicate t"e
muscles involved and t"eir innervation.
September 2006
Q1. A youn# women presents to t"e Accident @ <mer#ency !epartment wit" dysp"a#ia
(difficulty swallowin#' after swallowin# a lar#e piece of biscuit. !escribe t"e structure'
course and relations of t"e t"oracic oesop"a#us. !escribe t"e points at w"ic" t"e oesop"a#us
is narrowed.
Q$. A youn# c"ild is brou#"t to t"e Accident and <mer#ency !epartment after in"alin# a
peanut. !escribe t"e trac"ea and bronc"ial tree wit"in t"e t"ora5' includin# t"eir structure'
position and relations. 7nto w"ic" se#mental bronc"us is an in"aled forei#n body most li%ely
to lod#e if a patient is standin# upri#"t> 1r lyin# down>
Q). A patient presents to "er A9 wit" a mass in t"e lateral breast and fullness in "er a5illa.
!escribe t"e structure of t"e female breast' includin# relations' blood supply and lymp"atic
draina#e. +"at structures in t"e a5illa mi#"t be dama#ed durin# sur#ery>
Q,. A footballer dislocates "is s"oulder durin# a matc"' dama#in# t"e a5illary nerve.
!escribe t"is nerve' includin# its ori#in' course and distribution (motor and cutaneous. +"at
is its root value> Bow would you test for its function clinically>
Q5. +"en puttin# up a s"elf' you use a screwdriver to attac" it to t"e wall. !efine t"e
movements of pronation and supination of t"e upper limb. /ame and briefly describe t"e
.oints involved in pronation and supination. /ame two pronators and two supinators.
Q6. 7n t"e "uman lun#' t"e alveolar surface is composed of two main cell types. Compare
briefly t"e metabolic functions and capabilities of type 7 and type 77 pneumocytes.
Q7. !raw and label a myocardial pacema%er potential. 3elate eac" p"ase to t"e
correspondin# c"an#e in ion conductance.
Q8. !escribe t"e cardiac actions of t"e neurotransmitters noradrenaline and acetylc"oline.
Q;. Compare and contrast t"e pressure differences in t"e systemic and pulmonary
circulations' accompanied by numerical values.
Q10. 7n a #roup on a "i%in# tour to t"e "istoric site of 8ac"u 9icc"u in t"e 9eruvian Andes'
some develop acute mountain sic%ness but ot"ers acclimati:e normally to t"e "i#" altitude.
!escribe t"e cardiovascular and respiratory c"an#es t"at occur durin# acclimati:ation.
Q11. A $5 year old man was admitted t"rou#" A @ < wit" carbon mono5ide poisonin#. Bow
does carbon mono5ide affect t"e carria#e of o5y#en and t"e o5y#en dissociation curve>
Q1$. !escribe t"e effects of different levels of e5ercise on "eart rate' stro%e volume and
cardiac output (uotin# appro5imate values.
Q1). <5plain w"y t"e combination of nitrates and beta bloc%ers may be more effective t"an
eit"er alone in treatin# a patient wit" an#ina.
Q1,. !escribe t"e difference between t"e two types of bloc%ers of t"e rennin an#iotensin
system wit" reference toD
a 8ec"anism of action
b <fficacy in treatin# blood pressure.
c 9roduction of dry cou#"
Q15. <5plain t"e advanta#es of in"aled t"erapy over systemic t"erapy in t"e mana#ement of
ast"ma and c"ronic obstructive airways disease.
Summer 2007
1. Aive t"e surface mar%in#s of A== of t"e followin#D
EaF t"e outline of t"e "eart?
EbF t"e formation of t"e brac"iocep"alic veins?
EcF t"e superficial palmar arterial arc"?
EdF t"e fle5or retinaculum?
EeF t"e position of t"e base of t"e breast and nipple.
$. !escribe t"e effects of #ravity on t"e distribution of pulmonary blood flow.
). A )0 year old is investi#ated followin# a Gmini&stro%eH and found to "ave a patent
foramen ovale on ec"ocardio#ram. !escribe t"e ri#"t atrium' includin# t"e main internal
features. Add a note on t"e development of t"e interatrial septum.
,. A patient is found to "ave a pulmonary embolus followin# a lon#&"aul fli#"t. !escribe
anatomical and p"ysiolo#ical dead space and e5plain "ow an embolus affects t"e
p"ysiolo#ical dead space.
5. A t"irty&five year old man wit" a "istory of myocardial infarction and severe familial
"yperc"olesterolaemia is started on Atorvastatin and Aemfibro:il. +rite s"ort notes on
t"e potential benefits and ris%s of t"is t"erapy.
6. An individual "as t"eir blood pressure measured as 1$5/80 mmB#. Calculate pulse
pressure and estimate mean blood pressure and e5plain your reasonin#. +"at values
would you estimate for left ventricular pressure in t"is individual (systolic/diastolic.
7. Iou are called to e5amine a #entleman wit" a respiratory tract infection in t"e middle
lobe of "is ri#"t lun#. +"at are t"e surface mar%in#s of t"e ri#"t lun# includin# t"e
fissures> +"ere would you place your stet"oscope to auscultate t"e ri#"t middle lobe>
8. A 75 year old ladys blood pressure is found to be elevated on two separate occasions
(180/105 mmB#. !escribe t"e mec"anism of action of a dru# class t"at you would use
as your first c"oice to lower "er blood pressure. 7f "er blood pressure improved but did
not reduce to optimal levels of J1,0/;0 mmB#' w"at dru# would you add to your first
c"oice and w"y>
;. 0low&volume curves are very useful in t"e dia#nosis of respiratory disease. !raw and
describe a normal flow&volume curve.
10. !escribe t"e cause' effect and treatment of neonatal respiratory distress syndrome.
+"at is t"e si#nificance of t"e lecit"in/sp"in#omyelin ratio>
11. +"at is "eart bloc%> !escribe t"e various de#rees of "eart bloc%.
1$. A )0 year old male is stabbed in "is a5illa? "e is brou#"t to t"e Accident @
<mer#ency !epartment wit" profuse bleedin# and a rapidly fallin# blood pressure.
!escribe t"e course of t"e a5illary artery' includin# its parts' branc"es and relations to t"e
brac"ial ple5us.
1). Kriefly describe t"e ventilatory responses to "ypo5ia and "ypercapnia.
1,. A man falls on "is outstretc"ed "and. <5plain t"e li%ely conse(uences of t"is in.ury.
!escribe t"e boundaries and contents of t"e anatomical snuff bo5.
15. Keta&bloc%ers are an important #roup of dru#s t"at are widely used in clinical
practice.
EaF Kriefly e5plain t"eir classification based on t"eir action on beta receptors providin#
one e5ample of a dru# on eac"?
EbF =ist t"ree clinical conditions in w"ic" t"e use of beta&bloc%ers is indicated and
describe t"e mec"anism of action of t"e dru# in two of t"ese t"ree e5amples.
September 2007
1. A ,8 year old man complains of central c"est pain. !escribe or draw t"e arterial
blood supply of t"e "eart' addin# a note on its venous draina#e. Add a brief note on
t"e embryolo#y of t"e ri#"t atrium.
$. +it" t"e aid of a dia#ram' illustrate and e5plain t"e c"an#es in left ventricular
pressure durin# t"e cardiac cycle. Also' indicate w"en t"e A* and aortic valves are
open.
). A $)&year&old woman is usin# salbutamol in"aler for fre(uent attac%s of ast"ma.
a. Bow does salbutamol provide relief in suc" attac%s>
b 4u##est t"ree side effects t"at may occur wit" t"e lon#&term use of salbutamol.
c 7f t"e patient is not well&controlled on salbutamol' name one dru# t"at can be co&
administered.
,. !escribe t"e boundaries and contents of t"e carpal tunnel. +"at is carpal tunnel
syndrome and w"at are t"e li%ely causes and conse(uences>
5. Betero:y#osity for t"e condition of familial "yperc"olesterolaemia (0B "as a
fre(uency of about 1/600 in t"e #eneral population. +"at is t"e molecular defect
underlyin# t"is condition. 4tate w"et"er you t"in% it would be responsive to statin
t"erapy' #ivin# reasons for your answer.
6. A youn# tall and t"in male presents wit" sudden onset of unilateral c"est pain and
pro#ressively increasin# breat"lessness. C"est L&ray confirmed t"e dia#nosis of
pneumot"ora5.
a !escribe t"e various pressures actin# on t"e wall of t"e alveoli.
b +"at is tension pneumot"ora5 and w"at are its cardiovascular conse(uences>
7. A ,5 year old lady is dia#nosed wit" breast carcinoma. !escribe t"e position' blood
supply and lymp"atic draina#e of t"e breast. +"at are t"e si#ns of breast carcinoma>
8. +it" t"e aid of a dia#ram' describe t"e c"an#es in membrane potential occurrin# in a
myocardial 4A node pacema%er cell durin# a normal cardiac cycle' and t"e ion
c"annels involved.
;. Kriefly describe "ow t"e elastic properties of t"e lun# and c"est wall can influence
t"e effectiveness of ventilation and t"e efficiency wit" w"ic" ventilation is performed.
10. A patient is suspected of "avin# a ri#"t lun# pulmonary embolism seven days post&
operatively. !escribe or draw t"e structures in t"e "ilum of t"e ri#"t lun#' includin#
t"e arteries' veins and lymp"atics. +"ic" nerve travels anterior to t"e "ilum' and w"ic"
nerve travels posterior to t"e "ilum>
11. -wo individuals plan to perform "eavy e5ercise. 9erson A is a well&trained at"lete
"avin# a restin# "eart rate of 50 beat per minute. 9erson K does not perform re#ular
e5ercise and "as a restin# "eart rate of 80 beat per minute.
A <5plain w"y it is advanta#eous for 9erson A to "ave a slower restin# "eart rate
t"an person K>
K !iscuss t"e cardiac ad.ustments t"at will occur as t"e two individuals perform
t"e planned "eavy e5ercise.
1$. A si5ty year old male "as "ad one episode of sudden cardiac deat" and a five year
"istory of "eart failure secondary to isc"aemic "eart disease. +rite s"ort notes on t"e
optimal p"armacolo#ical approac" to treatin# t"is patient.
1). A footballer dislocates "is s"oulder durin# a football matc". !escribe t"e anatomy of
t"e s"oulder .oint' namin# t"e structures w"ic" contribute to its stability. +"at nerve
may be dama#ed by a dislocated s"oulder and w"at are t"e motor and sensory
tests for t"is nerve>
1,. A patient wit" c"ronic obstructive pulmonary disease (C19! is #iven some
additional o5y#en to breat"e to try and improve t"e arterial blood 91$. 4uddenly' t"e
patient stops breat"in#. <5plain w"y.
15. !escribe "ow coronary blood flow varies wit" t"e cardiac cycle. 7llustrate your
answer wit" a dia#ram.
JC2 CVR Short Notes Paper May-June 2008
1. Aive t"e surface mar%in#s of ALL of t"e followin#D
EaF t"e obli(ue fissure of t"e ri#"t lun#
EbF t"e formation of t"e brac"iocep"alic veins
EcF t"e deep palmar arterial arc"
EdF t"e position for auscultation of t"e pulmonary valve
EeF t"e boundaries of t"e anatomical snuff bo5
$. A 55 year old patient complains of pain in t"e centre of t"e c"est w"en e5ercisin#.
An#io#rap"y is performed and reveals 75M bloc%a#e of t"e left coronary artery.
!escribe t"e blood supply and venous draina#e of t"e "eart. +"y is bloc%a#e of t"e left
coronary artery so si#nificant>
). An elderly woman sustains a mid&s"aft fracture of "er ri#"t "umerus. +"at nerve is
vulnerable to in.ury> +"at vessel accompanies t"is nerve> Bow would you test t"e motor
and sensory functions of t"is nerve>
,. Bi#" !ensity =ipoprotein (B!= is sometimes referred to as G#ood c"olesterolH
because it is involved in returnin# c"olesterol from perip"eral tissues to t"e liver from
w"ere it can be eliminated from t"e body. !escribe "ow B!= carries out t"is function.
7nclude mention of "ow c"olesterol is pic%ed up by B!= and t"e t"ree ways in w"ic"
t"at c"olesterol is transferred to t"e liver. +"at is t"e ma.or "ealt" problem caused by
elevated c"olesterol in t"e blood>
5. A ,5 year old mans blood pressure is found to be elevated on two separate occasions
(avera#e N 178/10,mmB#. !escribe t"e mec"anism of action of a dru# class t"at you
would use as your first c"oice to lower "is blood pressure. 7f "is blood pressure
improved but did not reduce to optimal levels of J1,0/;0mmB#' describe t"e mec"anism
of action of a second dru# t"at you would add to your first c"oice. Aive reasons for your
c"oices of dru#s.
6. Kriefly describe t"e influence of t"e elastic properties of t"e lun# on t"e effectiveness
of ventilation and wor% of breat"in#.
7. A premature infant is born wit" respiratory distress due to a lac% of surfactant. +"at is
surfactant and w"at is its role in lun# function normally>
8. Kriefly describe t"e relative contribution of autore#ulation and neural re#ulation on
cerebral blood flow.
;. !escribe t"e effects on t"e "eart of bloc%in# t"e response to EaF va#al and EbF
sympat"etic stimulation.
10. 1n suddenly standin# upri#"t' you may feel di::y and faint. !escribe t"e effects of
standin# upri#"t from a supine position and t"e refle5 p"ysiolo#ical responses t"at
normally counteract t"is.
4"ort /ote Question 9aper O 4eptember $008
Q! "hat #ou$% be a typ&'a$ (a$ue o) 'ar%&a' output &n a hea$thy youn* a%u$t+
,&(e a br&e) o(er(&e# o) 'ar%&a' output re*u$at&on an% br&e)$y %es'r&be the e))e'ts
o) se(ere e-er'&se on 'ar%&a' output!
Q2! A 2. year o$% man #as a%m&tte% throu*h A / 0 #&th 'arbon mono-&%e
po&son&n*! 1o# %oes 'arbon mono-&%e a))e't 'arr&a*e o) o-y*en an% the o-y*en
%&sso'&at&on 'ur(e+ 1o# #ou$% you mana*e th&s pat&ent+
Q2! L&st the mo(ements o) the thumb! "hat are the ma&n mus'$es that per)orm
ea'h o) these mo(ements an% #hat &s the&r ner(e supp$y+ "hat &s 3ennett4s
)ra'ture+
Q5! 6ou are as7e% to &nsert a nee%$e to %ra&n a pneumothora-! 8es'r&be or %ra#
e-a't$y #here you #ou$% %o th&s an% #hat $ayers you #ou$% pass throu*h! "hat &s
a tens&on pneumothora-+
Q.! "hat &s heart b$o'7! 8es'r&be the (ar&ous %e*rees o) heart b$o'7!
Q6! "hen putt&n* up a she$)9 you use a s're#%r&(er to atta'h &t to the #a$$! Name
an% br&e)$y %es'r&be the :o&nts &n(o$(e% &n pronat&on an% sup&nat&on! 0-p$a&n the
anatom&'a$ bas&s o) the )a't that a r&*ht-han%e% person 'an use a manua$
s're#%r&(er to t&*hten s're#s #&th *reater )or'e than a $e)t-han%e% person!
Q7! A pat&ent #&th bro7en r&bs &s %&a*nose% #&th a pneumothora-! 8es'r&be the
)or'es that *enerate the norma$ &ntrap$eura$ pressure an% e-p$a&n #hat happens
%ur&n* a s&mp$e pneuomothora-!
Q8! 3r&e)$y %&s'uss the )a'tors that a))e't res&stan'e to )$o# &n a b$oo% (esse$!
Q;! Lo# %ens&ty $&poprote&n <L8L= &s the ma&n $&poprote&n &n )ast&n* human b$oo%!
"&th re*ar% to L8L>
<&= "hat &s &ts ma:or ro$e &n the '&r'u$at&on+
<&&= 3y #hat metho% &s &t &n'orporate% &nto 'e$$s &n the bo%y+
<&&&= ?n be&n* ta7en up &nto 'e$$s #hat are &ts e))e'ts on metabo$&' pro'esses
#&th&n su'h 'e$$s+
Q0! A 5. year o$% man presents at A/0 #&th an a'ute asthma atta'7 an% &s *&(en
sa$butamo$ by nebu$&@er! "hat &s the a%(anta*e o) a%m&n&strat&on by &nha$at&on
o(er system&' therapy+ 8es'r&be the me'han&sm o) a't&on o) Sa$butamo$! "hat
s&%e-e))e'ts shou$% be e-pe'te% )rom th&s %ru*!