Viva Q Topics Freq VIVA Review Subject 2007b2008a2008b2009a2009b2010a2010b2011a2011b2012a2012b2013a2013b2014a2014b2015a2015b2016a2016a22016b2016b2

2014b 1aCerebral blood flow and autoregulation 11 Neuro 1 1 1 1 1 1 1 1 1 1 1

2012a 1e

Cerebral Blood Flow - Affectors 11 Neuro 1 1 1 1 1 1 1 1 1 1 1

2008b 2a Cerebral Blood Flow 11 Neuro 1 1 1 1 1 1 1 1 1 1 12007b 7a Hypoxaemia 9 Resp 1 1 1 1 1 1 1 1 12015a 4c Neuromuscular blockers 8 Pharm 1 1 1 1 1 1 1 12008a 8b Invasive BP Monitoring 8 Measure 1 1 1 1 1 1 1 12014b 6a Dose response Curves 7 Pharm 1 1 1 1 1 1 12008a 6a Interpret - ABG 6 Resp 1 1 1 1 1 1

2008b 8f

Measurement - Pulse Oximetry 6 Measure 1 1 1 1 1 1

2008b 6a Insulin Physiology 6 Endo 1 1 1 1 1 1

2014b 4bInvasive pressure measurement 6 CVS 1 1 1 1 1 1

2008b 1d Dead space 5 Resp 1 1 1 1 12014a 2c Diuretic pharmacology 5 Renal 1 1 1 1 12015b 8aOpiods MOA 5 Pharm 1 1 1 1 1

2016b21aNeuromuscular blockers / Deep Tendon reflex 5 Pharm 1 1 1 1 1

2009b 6a Diuretics - Classify + MOA 5 Pharm 1 1 1 1 12014a 6c Humidity 5 Measure 1 1 1 1 12010b 3c Clark electrode 5 Measure 1 1 1 1 1

2009a 3b

Cardiac AP - ionic mechanisms 5 CVS 1 1 1 1 1

2015b 4bCardiac AP - Calcium role 5 CVS 1 1 1 1 12008b 8d Shunt 4 Resp 1 1 1 12009b 3c Determinants of GFR 4 Renal 1 1 1 12008a 7a Foetal -> Neonatal 4 Preg 1 1 1 12012b 6b Propofol 4 Pharm 1 1 1 1

�1

2008b 4b

Opioids MOA / CNS Effects 4 Pharm 1 1 1 1

2014b 3c Frusemide pharmacology 4 Pharm 1 1 1 1

2008a 6c

Frusemide associated biochem/alkalosis 4 Pharm 1 1 1 1

2010a 6f

Frusemide associated biochem 4 Pharm 1 1 1 1

2009b 6b Frusemide 4 Pharm 1 1 1 1

2010a 1a

Draw - Dose response curves 4 Pharm 1 1 1 1

2008a 4c Antibiotic resistance 4 Pharm 1 1 1 12008a 4b Antibiotic classification 4 Pharm 1 1 1 12015a 5b Agonist and antagonists 4 Pharm 1 1 1 12011a 4a Intracranial Pressure 4 Neuro 1 1 1 12007b 2a Neuromuscular Junction 4 MSK 1 1 1 12016a 6a Glucose Homeostasis 4 Metab 1 1 1 12014a 4a Glucose and lipid 4 Metab 1 1 1 12014b 8a Liver blood supply 4 Liver 1 1 1 1

2014a 1aHepatic physiology, structure and blood flow 4 Liver 1 1 1 1

2008a 2e Osmolarity vs Osmolality 4 Fluids 1 1 1 1

2008a 6b

Renal Acid Base (H+/HCO3/Buffers) 4 Acid Base 1 1 1 1

2013a 7c Renal Acid Base 4 Acid Base 1 1 1 12007b 1b Types of data 3 Stats 1 1 1

2013a 8a

Draw - Lung Pressure Volume Loop 3 Resp 1 1 1

2015a 2c Capnography 3 Resp 1 1 1

2015a 3bRenal bicarbonate handling 3 Renal 1 1 1

2008b 4c Opioids classification 3 Pharm 1 1 12010a 5c Mannitol 3 Pharm 1 1 1

�2

2008a 3c Local anaesthetic 3 Pharm 1 1 12008b 6b Insulin Preparations 3 Pharm 1 1 12010a 7d Clearance 3 Pharm 1 1 1

2012a 2c

Beta blockers pharmacology 3 Pharm 1 1 1

2011b 5a Asthma Drugs 3 Pharm 1 1 1

2010a 4c

Length - tension relationship 3 MSK 1 1 1

2011a 2a Thermoregulation 3 Metab 1 1 12014a 5b Physical principles of flow 3 Measure 1 1 1

2008b 3a

Non Invasive BP Monitoring 3 Measure 1 1 1

2008b 2c Measurement of CBF 3 Measure 1 1 12009a 1b Measurement - Ultrasound 3 Measure 1 1 12008a 4a Bacteria classification 3 ID 1 1 12010b 6a Coagulation cascade 3 Haem 1 1 12008a 2f Distribution of IV solutions 3 Fluids 1 1 12010a 5d Colligative properties 3 Fluids 1 1 12012b 4a Calcium physiology 3 Fluids 1 1 12014b 3b Anion gap 3 Fluids 1 1 12011a 6d Thyroid Gland Physiology 3 Endo 1 1 12008a 5d Valsalva Manoeuvre 3 CVS 1 1 12014a 8a Valsalva 3 CVS 1 1 1

2008b 8e

Pulmonary Vascular Resistance 3 CVS 1 1 1

2008b 7b

Draw - Pressure Volume Loop 3 CVS 1 1 1

2010b 2a

Determinants of Cardiac Output 3 CVS 1 1 1

2011b 1a Coronary Blood Flow 3 CVS 1 1 12013b 5d Catecholamines - Classify 3 CVS 1 1 12010a 7g Measures of Distribution 2 Stats 1 1

�3

2010a 7f

Measures of Central Tendency 2 Stats 1 1

2010a 2e

Response to sup O2 - ?shunt 2 Resp 1 1

2011b 3c Response to sup O2 2 Resp 1 1

2011b 3a

Pregnancy - Resp Changes 2 Resp 1 1

2014a 7b Obesity vs resp 2 Resp 1 1

2008b 8a

Image - CXR Lung Collapse 2 Resp 1 1

2010a 2b Henderson Hasselbach 2 Resp 1 1

2008a 7b

Foetal Hb - O2 Dissociation Curve 2 Resp 1 1

2011a 5a Draw - Flow Volume Loop 2 Resp 1 12011b 3d A-a gradient 2 Resp 1 12014b 6b Renal clearance 2 Renal 1 12010b 8b Renal blood flow 2 Renal 1 12011a 7a Functions of the Kidney 2 Renal 1 12010b 8a Draw - nephron + blood 2 Renal 1 12009b 3d Counter current multiplier 2 Renal 1 12010a 7b Volume of distribution 2 Pharm 1 12013a 4b Sedative drugs 2 Pharm 1 1

2011b 8b

Pulmonary Hypertension - Drugs 2 Pharm 1 1

2008a 1c

Plasma conc + effect/time curves ACEi 2 Pharm 1 1

2014b 7bPharmacology of local anaesthetics 2 Pharm 1 1

2015a 3c Pharmacology of diuretics 2 Pharm 1 12014a 7c Obesity vs pharmacology 2 Pharm 1 12008a 5b Noradrenaline 2 Pharm 1 12008b 4a Non opiod analgesics 2 Pharm 1 1

�4

2011b 4d NMB SoO, Potency 2 Pharm 1 12011b 4c NMB moa 2 Pharm 1 12011b 4b NMB classify 2 Pharm 1 12008b 2b Morphine 2 Pharm 1 12013b 2e Metoclopramide 2 Pharm 1 12008b 5c Laxatives 2 Pharm 1 12016b2 5cKetamine Pharmacology 2 Pharm 1 12010b 6b Heparin 2 Pharm 1 12008b 7d Dobutamine 2 Pharm 1 1

2011b 6e

Cardiac AP - drugs affecting 2 Pharm 1 1

2010b 1c Beta blockers - classify 2 Pharm 1 12013b 1c Adrenaline 2 Pharm 1 12008a 3b Pain pathways 2 Neuro 1 12013a 6b Pain motor response 2 Neuro 1 1

2008b 2d

Grey vs white matter blood flow 2 Neuro 1 1

2008a 3a Def - Pain 2 Neuro 1 12011a 2c Thermoneutral Zone 2 Metab 1 12014b 8b Nutrition 2 Metab 1 12014a 6b Oxygen measurement 2 Measure 1 1

2009b 2b

Measurement - Temperature 2 Measure 1 1

2007b 5a Measurement - Gas Flow 2 Measure 1 12007b 3a Measurement - ECG 2 Measure 1 1

2008a 8a

Measurement - Cardiac Output 2 Measure 1 1

2009a 1a Image - US Neck vessles 2 Measure 1 1

2013a 5a

Draw - Right atrial pressure trace 2 Measure 1 1

2013b 1a Hypersensitivity Reactions 2 Immune 1 1

�5

2012a 4c

Storage of blood + changes 2 Heam 1 1

2012a 4b Blood groups 2 Heam 1 1

2007b 4a

Bilirubin Production/Clearance 2 Haem 1 1

2013b 2d

Lower oesophageal sphincter 2 GIT 1 1

2012a 7a

Normal Saline Composition 2 Fluids 1 1

2011a 7b Hyperkalaemia Effects 2 1 Fluids 1 1

2011a 1a

Hartmann's solution composition 2 Fluids 1 1

2016a 3aFluid flow - turbulent / 2 Fluids 1 12008a 2b Electrolyte distributions 2 Fluids 1 12011a 1b Crystalloids vs colloids 2 Fluids 1 1

2010a 5e

Pituitary gland - anatomy, hormones 2 Endo 1 1

2010a 5f ADH 2 Endo 1 12013b 5c SA node anatomy 2 CVS 1 12011b 8a Pulmonary Artery Pressure 2 CVS 1 12011b 6d Draw - SA node AP 2 CVS 1 1

2014a 8bDeterminants of Venous Return 2 CVS 1 1

2008a 5a

Catecholamines - Synthesis 2 CVS 1 1

2013b 5e

Catecholamines - Structure-activity 2 CVS 1 1

2011b 1b Beta receptors 2 CVS 1 12013b 7a Image - US Neck vessles 2 Anatomy 1 12013a 7a Acid base 2 Acid Base 1 1

2009b 1a

Image - Lung pressure volume loop 2 1 1

�6

2009b 1b Def - Compliance 2 1 12009a 8b Cell membrane physiology 2 1 12009b 2c Basal Metabolic Rate 2 1 12009a 3d Anti-arrhythmic drugs 2 1 1

2009a 6b

Ageing effect on Pharmacokinetics 2 1 1

2013b 4b Sensitivity/Specificity 1 Stats 12012b 2b Research design 1 Stats 12009b 7e Normal Distribution 1 Stats 12012b 2a Levels of evidence 1 Stats 12007b 1a Image - stats table 1 Stats 12012b 2d Drug development 1 Stats 12010a 7h Critical Evaluation 1 Stats 12010b 7d Box Plots 1 Stats 12012b 2c Bias 1 Stats 12016a 2d Work of Breathing 1 Resp 12016a21d West’s zones of the lung 1 Resp 12015a 2a VQ relationships 1 Resp 12008b 8c V/Q relationship/mismatch 1 Resp 1

2012b 8e

Respiratory response to sedation 1 Resp 1

2008a 6e

Respiratory response to acidosis 1 Resp 1

2015b 1aOxygen Cascade 1 Resp 1

2013a 2a

Oxygen adminstration - masks 1 Resp 1

2011a 5c

Obstructive vs Restrictive Disease 1 Resp 1

2007b 8a

Image - TV + Airflow / time graph 1 Resp 1

2016a 2a FRC 1 Resp 12008b 1c ETCO2 vs PaCO2 1 Resp 1

�7

2011a 5b

Dynamic airways compression 1 Resp 1

2013b 2b Cough reflex 1 Resp 12010b 3d Alveolar gas equation 1 Resp 12016b2 5aRenal Water handling 1 Renal 12014a 2b Renal sodium handling 1 Renal 12014a 2a Renal physiology, nephron 1 Renal 1

2013b 3b

Glomerular-tubular feedback 1 Renal 1

2012b 3b Placental drug transfer 1 Preg 12012a 3a Neonatal Vital Signs 1 Preg 12014b 5b Gas exchange placenta 1 Preg 12014b 5c First breath physiology 1 Preg 12014b 5a CVS changes pregnancy 1 Preg 12012a 8f Zero order kinetics 1 Pharm 12012b 4b Verapamil 1 Pharm 1

2014b 1bVasopressin pharmacology 1 Pharm 1

2012b 3d Uterine Drugs 1 Pharm 1

2012a 8a

Thiopentone - SoO Determinants 1 Pharm 1

2012a 8c Thiopentone - PK 1 Pharm 1

2012a 8b

Thiopentone - Conc/Time Curves 1 Pharm 1

2008a 1f Therapeutic Index 1 Pharm 12012b 3c Syntocinon 1 Pharm 12011a 8a SNP structure 1 Pharm 12011a 8b SNP pharmacology 1 Pharm 12014a 3a Propofol pharmacology 1 Pharm 12016a 5bPropofol / CNS effects 1 Pharm 12008b 5a Prokinetics 1 Pharm 12013b 7c Pharmacodynamics 1 Pharm 1

�8

2011a 6c Oral Hypoglycaemic Drugs 1 Pharm 12011a 3a Oral drug absorption 1 Pharm 12008b 5d Octreotide 1 Pharm 12012b 8d Neuroleptic 1 Pharm 12012b 8b Midazolam 1 Pharm 12010b 1a Metoprolol PK 1 Pharm 12010b 1b Metoprolol A/E 1 Pharm 12010a 4e Malignant Hyperthermia 1 Pharm 12007b 6b Inotropes 1 Pharm 12012b 8a Ideal sedative 1 Pharm 12012b 8c Haloperidol 1 Pharm 12010a 7c Half life 1 Pharm 12012b 7e Haemostatic agents 1 Pharm 12012a 5d Gentamicin 1 Pharm 12011a 3c First pass metabolism 1 Pharm 12010a 7a Fentanyl Conc/Time Curve 1 Pharm 12008a 1d Emax 1 Pharm 12010a 1c efficacy 1 Pharm 12010a 1b ED50/potency 1 Pharm 12008a 1e EC50 1 Pharm 1

2016b 4cDrug ionization, pKa and dissociation 1 Pharm 1

2010a 4f Dantrolene 1 Pharm 1

2010a 1d

competitive vs non antagonists 1 Pharm 1

2008a 1a Captopril 1 Pharm 12013b 6b Calcium Channel Blockers 1 Pharm 1

2014a 3bBolus and infusion pharmacokinetics 1 Pharm 1

2011a 3b Bioavailability 1 Pharm 12010b 5b Benzodiazepines 1 Pharm 12016b2 2aAtropine 1 Pharm 1

�9

2011a 2d Antipyuretics 1 Pharm 12016b2 5bAntihypertensives / RAAS 1 Pharm 12016b2 7cAnticoagulant 1 Pharm 12013a 3c Anti-thyroidal drugs 1 Pharm 12013a 6c Analgesia 1 Pharm 12008a 6d Acetazolamide 1 Pharm 1

2008a 1b

ACE inhibitors Pharmacology 1 Pharm 1

2010a 8b Spinal cord blood supply 1 Neuro 12010a 8a Spinal cord anatomy 1 Neuro 12011b 2e Serotonin 1 1 Neuro 12015a 4a Reflex arcs 1 Neuro 12014b 7a Nerve action potentials 1 Neuro 1

2008a 5c

Autonomic Nervous System Anatomy 1 Neuro 1

2010a 4b

Skeletal muscle physiology 1 MSK 1

2010a 4a Draw - sarcomere 1 MSK 12012b 5d Urea cycle 1 Metab 12011a 2b Diurnal variation 1 Metab 12015a 6b Metabolism 1 Metab 12014b 8c Fasting and stress 1 Metab 1

2014a 4bDaily nutritional requirements 1 Metab 1

2010b 2d Measurement error 1 Measure 1

2009b 1c

Measurement - Compliance 1 Measure 1

2008b 1b Measurement - CO2 1 Measure 12012b 8f EEG principles 1 Measure 1

2012a 1c

EEG activity in relation to flow 1 Measure 1

2008b 1a Draw - Capnograph 1 Measure 1

�10

2011b 5b Aerosol Delivery systems 1 Measure 12014a 7a Spirogram, FRC, CV 1 Measure 12010a 6b Liver drug metabolism 1 Liver 12012b 5c Liver - ammonia 1 Liver 12012b 5a Image - liver acinus 1 Liver 12010a 6a Functions of the liver 1 Liver 12010a 6d Consequences of cirrhosis 1 Liver 12015b 6bAnaphylaxis Physiology 1 Immune 12013b 1b Histamine 1 Immune 1

2009a 2a

Defence mechanism against infection 1 Immune 1

2011b 2b Cytokines 1 Immune 12011b 2c Complement system 1 Immune 12011b 2d Adaptive Immunity 1 Immune 1

2011b 2a

Acute inflammatory response 1 Immune 1

2012a 5a Image - Identify bacteria 1 ID 12012a 4d Group and screen 1 Heam 12012a 4a Components of blood 1 Heam 12012b 7a Whole blood processing 1 Haem 12016a2 7bTests of Coagulation 1 Haem 12015a 8b Haemoglobin 1 Haem 12012b 7b Blood additives 1 Haem 12013b 2a Swallowing 1 GIT 12008b 6c Re-feeding syndrome 1 GIT 12008b 5b GIT secretions 1 GIT 1

7cGastric Emptying 1 GIT 1

2008a 2a

Total body water - distribution 1 Fluids 1

2008a 2c Def - Osmosis 1 Fluids 12008a 2d Def - Diffusion 1 Fluids 12011a 6b Insulin Deficiency Effects 1 Endo 1

�11

2013a 3a Image - Thyroid hystology 1 Endo 12011b 7a Hormone - definition 1 Endo 1

2015a 8aIron pharmacology and physiology 1 Endo 1

2011a 8d Vasomotor centre 1 CVS 1

2011a 8c

Vasoactive endothelial secretions 1 CVS 1

2011b 6b

Resting membrane potential 1 CVS 1

2010a 3c Regulation of contractility 1 CVS 12015a 7a Obesity vs cardiovascular 1 CVS 1

2008b 7c

Myocardial O2 demand/supply 1 CVS 1

2010a 3b IPPV effect on CVS 1 CVS 1

2007b 6a

Interpret - Haemodynamic Parameters 1 CVS 1

2015a 1b ECG principles 1 CVS 12011b 6a Draw - Cardiac Muscle AP 1 CVS 1

2014b 4aCardiac pressure waves and vs vasopressors 1 CVS 1

2014a 8c Cardiac Function curves 1 CVS 1

2010a 3a

Arterial Line Interpretation - Swing 1 CVS 1

2012a 6a

Pulmonary Vascular Anatomy 1 Anatomy 1

2008a 3d Lumbar Puncture 1 Anatomy 12013b 2c Larynx Innervation 1 Anatomy 12016a2 3cLarynx anatomy 1 Anatomy 12010b 7a Internal Jugular Vein 1 Anatomy 12014a 8d ICC insertion 1 Anatomy 12016a 4a Acid base - buffer systems 1 Acid base 12009b 1d Surfactant 1 1

�12

2009b 7f Statistical Tests 1 12009b 4d Specific gravity 1 12009a 5a Red Blood Cell - Functions 1 1

2014a 6aOxygen pharmacodynamics 1 1

2015a 7b Obesity vs other organs 1 12009b 4b Ketone bodies 1 1

2014a 5cIonic changes across membranes 1 1

2009b 1d

Interpret - Ventilator waveforms 1 1

2009b 4a Interpret - Urinalysis 1 12009a 8d Electrolyte disturbances 1 12009b 7a Draw - ECG trace 1 12009a 8a Draw - cell membrane 1 12009b 1d Compliance - determinants 1 12009b 5d Common allergens 1 12009b 6c Cardiac arrest meds 1 12009b 5b Anaphylaxis treatment 1 12009a 6a Alcohol Pharmacokinetics 1 1Prac Blood Brain Barrier 0 Neuro

2016a 2eSplanchnic blood flow / Teleripressin 0 Liver

Prac Response to altitude 0

PracPregnancy - CVS Changes 0

PracPenicillin - Classify, Adverse Effects 0

Prac Neurotransmitters 0Prac Neonate Resp Differences 0Prac Hypercarbia 0Prac Functions of the lung 0

�13

Prac Diabetic Ketoacidosis 0Prac Breath holding 0

PracAntiseptics and Sterilization 0

�14

Graph Sourced Key Points Subject Revised Marked

Cell Membrane Cell

SA node Action Potential Pacemaker potential -70 to -40mV, length 0.2s

CVS 1 1

LV Volume/Time Draw 2x horizontal lines50mls

120mls

Rememberatrial kick, Isovol periods

CVS 1

Cardiac Conducting System Bachman, Wenkebach, Thorel. Slow fast slow fastest.

CVS 1

Vascular Function Curve CVS 2

Valsalva Manoeuvre 4 Phases, 2 graphs; s/dBP and HR vs time, Phase 1: ↑ ITP, ↑preload, ↑CO, ↑BP, ↓HR.., Phase 2: ↓ preload, ↓ BP, ↑SNS ->↑HR, ↑TPR, narrow pulse pressure.., Phase 3: ↓ITP, ↓preload, ↓ BP, Phase 4: return of preload, overshoot of BP and undershoot of HR before return to baseline

CVS 2

Pulmonary Artery Pressure Draw y:pressure, x:time, 4 phases, 2 horizontal guidelines (10 and 25), 1-5, 0-25, 10-25, 5-10.

CVS 2

Left Ventricle Pressure Volume Loop Start with EDPVR, ESPVR, vol 50-120, pres 20-115

CVS

ECG trace Y: Volts (mV)

X: Time (s)

Intervals:0.1, 0.1, 0.1, 0.34

CVS

ECG activity in relation to pressure Draw 2x vertical isovolumetric periods at R-S and at end T

CVS

Catecholamine Synthesis Start with tyrosine, 5 steps to adrenaline, 4 enzymes

CVS

Graph

�1

!

Cardiac Muscle Action Potential RMP -90mV, ARP 0,1,2,3 , RRP 3, peak 30mV, length 0.5s

CVS

Cardiac Function Curve CVS

Antibody Response Immune 1

Immune System Immune

Thermodilution Curve y: decreasing temp, x: time, AUC inversly proportional to CO, recirculation

Measurement

2

Fast Flush Test Optimal damping - 3x oscillations, damping coefficient A1:A2, natural frequency 1/period

Measurement

Sarcomere MSK 2

CBF vs pCO2 Increase of pCO2 by 1mmHg will increase CBF by 25ml or 4%. Demonstrate this by marking pCO2 50 as 1000mls/min

Neuro 1

CBF vs pO2 Neuro

CBF vs CPP 60 - 160 straight Neuro

Context Sensitive Half Times Y: CSHT (mins) 0 - 300

X: inf dur (hrs) 0 -9,

Diaz>Fent>Thio>Midaz>Alfent>Prop>Remifent

Pharm 1

Sourced Key Points Subject Revised MarkedGraph

�2

Concentration vs Time following a BolusAUC can be used to calculated clearance

Cmax peak concentration

Tmax time of peak concentration

T1/2 time to reach 50% max concentration from Tmax

Time constant

Time to reach 37% max concentration

Vd Calculated from t1/2 (assuming first order kinetics and 1 compartment)

Pharm 1

Quantal (all or nothing) dose response curve (semi-log scale)

A population has been studied. y: %responding, x: Log dose (mg), left therapeutic effect - ED50, right lethal effect LD50.

Pharm 2

IV Bolus of Thiopentone Blood -> Vessel Rich -> Muscle -> Fat

Pharm

Graded dose-response curve (semi-log scale) Y: drug effect (%), X: Log Drug concentration (mg/ml), a single subject has been studied, Emax at 100%, 50% on y, EC50 on x

Pharm

Graded dose-response curve (linear scale) • Y: drug effect (%), X: Drug concentration (mg/ml), a single subject has been studied, 0.5 on y, EC50 on x

Pharm

Dose response (potency) Increased potency shifts curve to the left

Pharm

Dose response (Intrinsic activity) Y: %response, x: log10 dose, full, partial(decreased Emax), inverse agonist and antagonist

Pharm

Dose response (efficacy) Decrease efficacy decreases Emax

Pharm

Dose response (competitive vs non-competitive antagonist)

Competitive shifts curve to the right, non-competitive decreases Emax

Pharm

Spirometry Trace in Pregnancy Pregnancy 2

First Breaths Y:TLC, x:pressure, high pressure -> low pressure

Pregnancy

Sourced Key Points Subject Revised MarkedGraph

�3

Double Bohr Effect Same set up as O2 dissociation curve

Maternal p50 26, shifts right

Fetal p50 18, shifts left

Pregnancy

Creatinine Clearance vs Remaining Nephrons Renal 1

Nephron + Blood Supply Renal

Tidal Breathing See VIVA43 Resp 1 1

Pulmonary Vascular Resistance Curve PVR on y, %TLC on x, 2x curves - alveolar, extra alveolar, added to make total, minimal at FRC

Resp 1 1

Lung Static Compliance Curves Resp 1

Lung Pressure Volume Loop (Dynamic Compliance) Resp 1

Fowler’s Method 2 Graphs - %N2 at mouth vs time, Volume expired vs time. Calculation of anatomical dead space.

Resp 1

Flow Volume Loop y: flow, x: volume, TLC left, RV right, effort dependent upstroke, independent downstroke, complete loop with inspiration

Resp 1

CO2 Dissociation y: CO2 ml/100ml, x: pCO2, 2 points 48/40, 52/45, 2 lines, bottom is arterial blood

Resp 1

Closing Capacity vs Age Key ages 44, 75 Resp 1

Sourced Key Points Subject Revised MarkedGraph

�4

Blood flow in the lung y: rib no, x: flow Resp 1

Airways Resistance versus Lung Volume Resp 1

Work vs Resp Rate work in kg.m/min on y, resp rate on x, 2x curves elastic/non elastic work, added to make 3rd curve - total work

Resp 2

Ventilation vs pO2 Minimal influence at physiological PaO2

Resp 2

Ventilation vs pCO2 Slope 2 l/min/mmHg Resp 2

V/Q Ratio Y: (left) V/Q ratio 3.3, 1.0, 0.63, x: base->apex, 3 lines: perfusion (steep), ventilation, V/Q ratio (exponential)

Resp 2

Spirometry Tidal breathing, max inspiration, max expiration, tidal breathing.

Resp 2

Shunt Derivation Total O2 flux = shunt flux + non shunted flux

Resp 2

O2 Dissociation Resp 2

Capnograph y: pCO2, x: time, Phase 1 Inspiratory baseline, Phase 2 expiratory upstroke (mixed alveolar/deadspace), phase 3 Expiratory plateau (mostly alveolar gas), Phase 4 Inspiratory downstroke

Resp

Statistical Errors Table Stats 2

Sourced Key Points Subject Revised MarkedGraph

�5

2x2 Contingency Table Derive sensitivity, specificity, PPV, NPV

Stats

TIVA 1 1

Shunt Equation 1 1

Measurement of RAW 1

Measurement of Closing Volume 1

CSF Absorption and Formation 1

Clarke Electrode 1

Changes in Maternal Blood Volume 1

Blood flow in coronary arteries 1

Odds Ratio RR = (a/a+b)/(c/c+d). OR = ad/bc 1

Standard Normal Distribution y: frequency, x: standard deviation 1

Sourced Key Points Subject Revised MarkedGraph

�6

SNP Metabolism 1

Clotting Cascade (Classic) 1

Cell Based Coagulation 1

Propofol Bolus 2

O2 Cascade

Sourced Key Points Subject Revised MarkedGraph

�7

Sourced Key Points Subject Revised MarkedGraph

�8

Sourced Key Points Subject Revised MarkedGraph

�9

BETA BLOCKERS Receptor selectivity

Non-selective for B1 and B2 receptors Propanolol

Cardio-selective for B1 receptors Metoprolol

Atenolol

Esmolol

Mixed alpha and beta antagonists Carvedilol

Labetolol

Intrinsic sympathomimetic activity

Not Present Sotalol

Atenolol

Metoprolol

Propanolol

Esmolol

Present Timolol

Acebutolol

Membrane stabilising effects

Present Timolol

Propanolol

CALCIUM CHANNEL BLOCKERS

Molecular structure

Pheny-alkyl-amines Verapamil

Di-hydro-pyridines Nifedipine

Benzo-thiamines Diltiazem

ACE INHIBITORS Molecular structure

Sulfhydryl-containing agents Captopril

Dicarboxylate-containing agents Ramipril

Phosphate-containing agents Fosinopril

DIURETICS Mechanism of action

Osmotic Mannitol

Carbonic Anhydrase Inhibitors Acetazolamide

Loop Frusemide

Thiazides Hydrochlorothiazide

Potassium Sparing Amiloride

Aldosterone Antagonists Spirinolactone

IV ANAESTHETIC AGENTS Drug groups

Barbituates Thiopentone

Phenobarbitone

Chloral Hydrate

Phenols Propofol

Phencyclidine derivatives Ketamine

Benzodiazepines Midazolam

Opiates Fentanyl

Alpha-2 agonists Dexmedetomidine

Imidazoles Etomidate

Speed of onset

Rapidly acting Thiopentone

Propofol

Etomidate

Slower acting Ketamine

Benzodiazepines

Opioids

NEUROMUSCULAR BLOCKERS

Depolarising vs Non Depolarising

Depolarising Suxamethonium

Non depolarising - Aminosteroids Rocuronium

Vecuronium

Pancuronium

Non depolarising - Isoquinolines Atracurium

Cisatracurium

ANTICHOLINESTERASES Complex formation

Easily reversible enzyme complex Edrophonium

Carbamylated enzyme complex Neostigmine

Pyridostigmine

�1

Physostigmine

Formation of stable enzyme complex Organo-phosphates

LOCAL ANAESTHETICS Molecular Structure – Link between aromatic ring and the amine

Esters Procaine

Cocaine

Amides Lignocaine

Bupivacaine

Levobupivacaine

Ropivacaine

OPIOIDS Structure Naturally Occurring (Penanthrenes) Papaverine

Morphine

Codeine

Semisynthetic Opioids Di-acetyl-morphine (heroin)

Buprenorphine

Oxycodone

Synthetic Opioids (Phenyl-piperidines) Pethidine

Fentanyl

Alfentanyl

Remifentanil

Methadone

Intrinsic Activity

Full agonist Morphine

Partial agonist Buprenorphine

Agonist-antagonist Pentazocine

Antagonist Naloxone

NSAIDS COX Specificity

Non-specific COX inhibitors Aspirin

Ibuprofen

Paracetamol

Indometacin

Preferential COX-2 inhibitors Meloxicam

Specific COX-2 inhibitors Parecoxib

Chemical Structure

Salicylates Aspirin

Propionic acid Ibuprofen

Oxicams Meloxicam

Acetic Acids Indomethacin

Coxibs Parecoxib

Reverisibility

Irreversible Aspirin

NON-OPIOID ANALGESIA Mechanism of action

NSAIDs Paracetamol

Ibuprofen

Anticonvulsants Gabapentin

Pregabalin

NMDA Receptor Antagonists Ketamine

Mono-amine potentiators Amitryptiline

Tramadol

Alpha-2 Agonists Dexmetetomidine

Anti-gout Allopurinol

Colchicine

DRUGS THAT INCREASE GASTRIC PH

Mechanism of Action

Proton Pump Inhibitor Pantoprazole

Histamine 2 Receptor Antagonists Ranitidine

Antacids Inorganic Compounds

Muscarinic blockers pirenzipine

Prostaglandin E2 analogues Misoprostil

HCl Buffer Sucralfate

�2

ANTI-EMETICS Mechanism of Action

Serotonin antagonist Ondansetron

Tropisetron

Granisitron

Dopamine antagonist Metoclopramide

Droperidol

Prochlorperazine

Anticholinergics Hyoscine

Atropine

Antihistamines Cyclizine

Promethazine

Steroids Dexamethasone

Others GABA potentiators

Canabinoid

Propofol

Alpha 2 agonists

Opioid Receptor Blockers

Neurokinin 1 Antagonists

ORAL HYPOGLYCAEMICS Chemical Structure/Mechanism of Action

Biguanides Metformin

Sulphonylureas Gliclazide

Thiazolidinediones (Glitazones) Rosiglitazone

Alpha glucosidase inhibitors Acarbose

Meglitinides Repaglinidine

ANTIHYPERTENSIVES Mechanism of action

Centrally acting drugs Clonidine

Alpha methyldopa

Adrenoreceptor antagonist

Alpha blockers Prazosin

Phenoxybenzamine

Phentolamine

Beta blockers Metoprolol

Mixed Antagonist Labetolol

Carvedilol

Direct vasodilators

Calcium channel antagonist Nimodipine

Nitric Oxide Glyceryl Trinitrate

Sodium Nitroprusside

Other Hydralazine

Renin-Angiotensin Pathway

ACE inhibitors Captopril

Angiotensin II receptor blockers Telmisartan

Losartan

Potassium channel activators Nicorandil

Minoxidil

Diuretics Frusemide

Amiloride

IV FLUIDS Partical Types

Crystalloids 0.9% saline

Hypertonic saline

RRT fluids

Hartmann’s

Glucose

Plasmalite

Colloids Starches

Gelatins

Dextrans

�3

Blood Products Whole Blood

Albumin

Platelets

BENZODIAZAPINES Duration of Action

Short (<12hrs) Midazolam

Intermediate (12-24hrs) Lorazepam

Long (>24hrs) DiazepamANTIDEPRESSANTS Mechanism of Action Tricyclic antidepressants Amitriptyline

Selective serotonin seuptake inhibitors ParoxetineSerotonin-noradrenaline reuptake inhibitors VenlafaxineMonoamine oxidase inhibitors Phenelzine

ANTIPSYCHOTICS Development First Generation Haloperidol

ChlorpromazineSecond Generation Olanzapine

Risperidone

Clozapine

Quetiapine

LithiumANTICONVULSANTS Drug Group Benzodiazepines Midazolam

ClonazepamBarbituates Phenobarbitone

ThiopentoneSalts of Carboxylic Acid Sodium ValproateHydantoins PhenytoinImino-stilbenes CarbemazepineGABA analogues Gabapentin

PregabalinTriazines LamotrigineRacetams Leviracetam

ANTI-PARKINSON DRUGS Mechanism of Action Dopamine Precursor LevodopaPeripheral DOPA-decarboxylase inhibitor CarbidopaSynthetic dopamine agonists Bromicriptine

DRUGS THAT AFFECT COAGULATION

Anti-Coagulants Anti-Platelet drugs Aspirin

Clopidogrel

Dipyridamole

Tirofiban

AbciximabHeparins Heparin

EnoxaparinOral Anticoagulants Warfarin

Dabigatran

RivaroxibanFibrinolytics Tenecteplase

rTPAOther Hirudin

Citrate

Fondaparinux

Haemostatic Drugs Anti-Fibrinolytics Aminocaproic Acid

Tranaxemic Acid

AprotoninFactor Replacement Fresh Frozen Plasma

Cryoprecipitate

Prothrombinex

Factor VIIa

�4

Factor VIII

Factor IXReversing Agents Vitamin K

ProtamineBlood Products Platelets

Fresh Frozen PlasmaANTI-PLATELET DRUGS Mechanism of Action Cyclo-oxygenase-1 inhibitors Aspirin

Platelet phospho-diesterase inhibitors DipyridamolePlatelet ADP receptor inhibitors ClopidogrelGP IIb/IIIa receptor antagonist Tirofiban

AbciximabORAL ANTICOAGULANTS Mechanism of Action Vitamin K epoxide reductase inhibitor Warfarin

Direct thrombin inhibitor DabigatranDirect Factor Xa inhibitor Rivaroxiban

ANTI - FIBRINOLYTICS Source Natural AprotoninSynthetic Tranaxemic Acid

Aminocaproic AcidDRUGS USED TO TREAT ASTHMA Drug Groups Bronchodilators Salbutamol

Corticosteroids Prednisolone

Hydrocortisone

BudesonideGases Oxygen

HelioxMast Cell Stabilisers Adrenaline

BRONCHODILATORS Mechanism of Action Beta Agonists Sabutamol

Salmeterol

AdrenalineAntimuscarinics Ipratropium

TiotropiumPhosphodiesterase Inhibitors TheophyllineLeukotriene antagonist MontelukastOther Magnesium

Ketamine

VolatilesCORTICOSTEROIDS Route Oral Prednisolone

IV Hydrocortisone

Methylprednisolone

DexamethasoneInhaled Budesonide

FluticasonePULMONARY VASODILATORS Mechanism of Action Guanylyl Cyclase activators Nitric Oxide

Prostacyclin Derivatives IlloprostPhosphodiesterase 5 Inhibitors SildenofilEndothelin receptor antagonist Bosentan

SitaxentanINSULIN Duration of Action Very rapid acting Lispro

Novo RapidRapid acting ActrapidIntermediate acting ProtaphaneLong acting Ultralente

GlargineMixed preparations Mixtard

ANTI-FUNGALS Chemical Structure Polyenes Amphotericin

�5

NystatinAzoles Fluconazole

MiconazoleEchinocandidins Caspofungin

ANTI-VIRALS Mechanism of Action Prevent entry of virus MaravirocInhibit nucleic acid synthesis Acyclovir

Gancyclovir

NRTIs

NNRTIsInhibit protein synthesis RitonovirPrevent viral release Oseltamivir

ANTIBIOTICS Mechanism of Action Inhibit cell wall synthesis Beta-lactams

VancomycinInhibit protein synthesis

Ribosome 50s Linezolid

Macrolides (Azithromycin)Ribosome 30s Aminoglycosides

(Gentamicin)Tetracyclines (Doxycycline)

Inhibit nucleic acid synthesis or function

Inhibit DNA gyrase Quinolones (Ciprofloxacin)

Inhibit folate synthesis BactrimCreate free radicals Metronidazole

NitrofurantoinOXYTOCICS Molecule type Oxytocin derivatives Oxytocin

Ergot alkaloid ErgometrineProstaglandins PG F2 alpha

TOCOLYTICS Mechanism of Action Beta Agonists SalbutamolCalcium channel blockers NifedipineNSAIDs IndomethacinOther Glyceryl Trinitrate

Magnesium

VolatilesCHEMOTHERAPEUTICS Mechanism of Action Alkylating agents Cyclophosphamide

Antimetabolites MethotrexateCytotoxic antibiotics DoxorubicinPlant alkaloids VincristineHormonal agents TamoxifenMonoclonal antibodies Alemtuzumab

LAXATIVES Mechanism of Action Bulking agents MetamucilFaecal softeners Docusate

GlycerineOsmotic laxatives LactuloseStimulants Senna

ANTITHYROID DRUGS Mechanism of Action Thyroid peroxidase inhibitor Carbimazole5' Deiodinase inhibitor Propylthiouracil

LIPID LOWERING DRUGS Molecule type HMG-CoA reductase inhibitor AtorvastatinFibrates GemfibrozilDecrease intestinal fat absorbtion Ezetimibe

Orlistat

�6

VIVA Number Subject Times Reviewed

1

2

3

4

5

6

7

8 Maternal Physiology 1

9

10

11

12

13

14

15

16 Calcium Physiology 1

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

VIVA Number

�1

33

34

35

36

37

38

39

40

41

42

43

44

45

46

Subject Times ReviewedVIVA Number

�2