FRCS Surgical Physiology & Pharmacology 2

Question 1

What is the acid-base disturbance in a patient who has been vomiting profusely with gastric losses?

Accepted Answer

Metabolic alkalosis with respiratory compensation (hypoventilation)

Answer

Loss of gastric HCl through vomiting results in metabolic alkalosis (loss of H+ and Cl−). The kidneys compensate by retaining HCO3− and excreting less acid. Hypochloraemia and hypokalaemia accompany the alkalosis. Respiratory compensation (hypoventilation to retain CO2) is limited.

Question 2

A patient develops bronchospasm, hypotension, and urticaria 10 minutes after induction of anaesthesia. What is the first-line treatment?

Accepted Answer

IV adrenaline 0.5mg IM (1:1000)

Answer

Anaphylaxis management requires adrenaline 0.5mg IM (1:1000) as the first-line treatment. Adrenaline reverses bronchoconstriction (beta-2 effect), causes vasoconstriction (alpha-1 effect), and reduces histamine release. IV fluids, antihistamines, and corticosteroids are secondary measures.

Question 3

What does the term 'oxygen delivery' (DO2) represent and how is it calculated?

Accepted Answer

Cardiac output × arterial oxygen content — represents the rate of oxygen delivery to tissues

Answer

Oxygen delivery (DO2) = cardiac output (CO) × arterial oxygen content (CaO2), where CaO2 = (Hb × 1.34 × SaO2) + (0.003 × PaO2). Normal DO2 is approximately 1000 mL/min. Reduced DO2 from any combination of low CO, low haemoglobin, or low SaO2 leads to tissue hypoxia.

Question 4

What is the mechanism of action of morphine?

Accepted Answer

Binds to mu opioid receptors, reducing pain transmission and altering pain perception

Answer

Morphine exerts its analgesic effects primarily through mu (μ) opioid receptor agonism in the CNS (brain and spinal cord), reducing the transmission and perception of pain. It also acts on peripheral mu receptors. Mu receptor activation causes analgesia, sedation, respiratory depression, and constipation.

Question 5

A patient with a tension pneumothorax develops cardiovascular collapse. What is the immediate management before chest drain insertion?

Accepted Answer

Needle decompression via 2nd intercostal space, midclavicular line

Answer

Tension pneumothorax is a clinical emergency causing cardiovascular collapse from mediastinal shift and compression of the contralateral lung and great vessels. Immediate needle decompression (14G cannula, 2nd ICS, MCL or 4th-5th ICS, anterior axillary line) relieves pressure. Chest X-ray must not delay treatment.

FRCS Part A Practice Test

FRCS Part A Practice Test

FRCS Surgical Physiology & Pharmacology 2