Pathophysiology revision - SECTION 1: GENERAL PRINCIPLES

Question 1 of 42

1

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Cell membranes are composed of mainly proteins and phospholipids. ( Phospholipids, Proteins, Ion channels, Lipids ) have a glycerol backbone that is ( hydrophilic (water-loving), hydrophobic (water-hating), soluble ) and fatty acid tails which are ( hydrophobic (water-hating), hydrophillic (water-loving), soluble ). Proteins are embedded in the phospholipid bilayer and play an important role by forming ( ion channels, fatty acid tails, diffusion trails )

Explanation

Question 2 of 42

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The process by which MOLECULES move from areas of high concentration to low concentration until evenly spread is known as

Select one of the following:

diffusion
osmosis
active transport
Boyle's Law

Explanation

Question 3 of 42

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The process by which WATER moves from an area of high concentration to an area of low concentration is known as:

Select one of the following:

osmosis
diffusion
active transport
Henry's Law

Explanation

Question 4 of 42

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Two solutions with equal osmolarities are said to be ( iso-osmotic, osmolaric, bi-osmolar, in aquatic equilibrium ). If two solutions have different measures osmolarities, the solution with the higher osmolarity is said to be ( hyper-osmotic, hypo-osmotic, super-osmotic, minor-osmotic ) and that with lower osmolarity is said to be ( hypo-osmotic, hyper-osmotic, super-osmotic, minor-osmotic ).

Explanation

Question 5 of 42

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An isotonic soloution ( will have no change in cell volume, will cause cells to shrink, will cause cells to swell ). A hypertonic solution ( will cause cells to shrink, will cause cells to swell, will have no change in cell volume ). A hypotonic solution ( will cause cells to swell, will have no change in cell volume, will cause cells to shrink )

Explanation

Question 6 of 42

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The process by which molecules can be moved from an area of low concentration to high is known as ( active transport, diffusion, osmosis, Collapsing pressure ). This uphill movement requires ( energy in the form of ATP, a differential pressure, a group of enzymes, lipid molecules )

Explanation

Question 7 of 42

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You are on the scene of a farm accident. The patient is trapped in heavy machinery with a prolonged extrication. In addition to having several other serious injuries, the patient has sustained multiple lacerations on the forearms that appear to be grossly contaminated with manure, dirt and other debris. After properly assessing and stabilizing the patient, you are then required to irrigate the lacerations while the rest of the team works to extricate the patient. What fluid would be most appropriate for irrigation?

Select one of the following:

Sterile hypertonic (3% saline)
Sterile isotonic (0.9% saline)
Sterile hypotonic (5% dextrose in water)
Sterile colloid solution (25% albumin)
Plain tap water

Explanation

Question 8 of 42

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Which of these statements is false?

Select one of the following:

Lipid insoluble drugs are readily absorbed into the cell membrane
Passive diffusion is the most common process by which drugs cross cell membranes
Diffusion of drugs into cell membranes generally occurs in the direction of high concentration to an area of low concentration
Uphill” (low to high concentration) transport of drugs across cell membranes occurs through the process of active transport and requires energy
Active transport ATPase pumps move move drugs from areas of low concentration to high concentration

Explanation

Question 9 of 42

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Water comprises of approximately ( 60%, 70%, 50%, 40% ) of total body weight in males and ( 50%, 60%, 70%, 80% ) in females. Obese individuals tend to have ( 25-30%, 35-40%, 15-20%, 5-10% ) less body water and newborns will comprise of ( 75-80%, 65-70%, 55-60%, 45-50% ) body water

Explanation

Question 10 of 42

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Water in the body is divided into ( intracellular, intramuscular, intrafiberous, intraglobular ) (first space), ( intravascular, intracardiac, intralunar, intracirculatory ) (second space) and ( extravascular, extracirculatory, extralumbar, extrasynovial ) (interstitial, third space) compartments. ( 40%, 30%, 20%, 10% ) of total body water is found in the cells, 5% is found ( intravascular, intracardiac, intralunar, intracirculatory ) and ( 15%, 20%, 25%, 10% ) is contained in the interstitiam

Explanation

Question 11 of 42

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One law which relates best to the movement of fluids through the capillaries is ( Starling’s Law, Boyle's Law, La Places' Law, Charles' Law ). This explains the distribution of fluids from a high pressure to a low pressure

Explanation

Question 12 of 42

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( 0.9% Saline, 25% saline, 5% dextrose, tap water ) and ( Ringer’s Lactate, 25% saline, 5% dextrose, tap water ) are both considered to be istonic solutions and used to provide immediate expansion of circulatory volume. However, because of their tonicity, they will eventually distribute into the third space therefore, expanding ( interstitial, intracellular, intravascular ) rather than ( intravascular, interstitial, intracellular ) volume. ( 5% dextrose, 0.9% saline, 25% saline, Ringer's Lactate ) is considered a hypotonic solution and can be used to keep a cannulated vein open.

Explanation

Question 13 of 42

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Colloid solutions include 5% and 25% albumin and hetastarch. They are used to ( increase plasma volume, increase glucose concentration, decrease lactate, decrease extracellular pressure ) in the blood vessels as the large molecules can not pass through membranes as easily as crystalloids

Explanation

Question 14 of 42

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You are called to the scene of a motor vehicle accident. The patient is a 23 year old male with extensive multi-system trauma including lower extremity amputation with active bleeding. Vital signs are as follows: BP 90/palpation, HR 122, RR 24. Which IV fluid should be used?

Select one of the following:

5% dextrose
0.9% saline
0.45% saline
Lactated Ringers solution
5% dextrose in Lactated Ringer’s solution

Explanation

Question 15 of 42

1

What would happen if a colloid solution was used to treat a patient who had experienced an amputation?

Select one of the following:

Lactate formation would be promoted, leading to a build-up of toxic substrates
The fluid would distribute to the interstitial space since the osmotic pressure would be decreased
Fluid would be absorbed into the blood vessels because the osmotic pressure would increase
The intravascular volume would become further depleted
The patient would not be able to receive crystalloid fluids because they are incompatible with colloids

Explanation

Question 16 of 42

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An example of when not to use 5% dextrose fluid is (check all that apply):

Select one or more of the following:

Resuscitation of a paediatric patient
Critically ill patients
Without Thiamine in known alcoholics
Hypoglycemic patient in insulin shock

Explanation

Question 17 of 42

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The partial pressure of Oxygen (P02) roughly ( 100 mmHg, 80 mmHg, 50 mmHg, 40 mmHg ) in the atmosphere and ( 40mmHg, 30 mmHg, 50 mmHg, 20 mmHg ) in the pulmonary arties. The partial pressure of Carbon Dioxide (PC02) in the atmosphere is roughly ( 40mmHg, 50 mmHg, 30 mmHg, 20 mmHg ) and ( 45mmHg, 55 mmHg, 35 mmHg, 50 mmHg ) in the pulmonary arteries coming from the right ventricle. Hence, oxygen is diffused into the returning pulmonary vein and carbon dioxide diffuses out into the atmosphere

Explanation

Question 18 of 42

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Oxygen is normally carried around the body bound to ( haemoglobin, fatty cells, protine molecules, macrophages ). The ( percent saturation (SP02), haemosaturated pressure gradient, red blood cell count, fluid distribution curve ) describes the amount of oxygen molecules bound to haemoglobin

Explanation

Question 19 of 42

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A shifting of the oxygen dissociation curve to the ( right, left, upwards segment, downwards segment ) decreases haemoglobin’s affinity for oxygen. This makes it easier for haemoglobin to release oxygen but may lead to hypoxia due to the molecule being less willing to carry it. Acidotic patients have curves shifted to the right as a “protective” mechanism, so the body can offload O2 rapidly when it needs (Bohr Effect). This also effects people at high altitude

Explanation

Question 20 of 42

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A shifting of the oxygen dissociation curve to the ( left, right, upwards gradient, downwards gradient ) increases haemoglobins affinity for oxygen. Examples of this include carbon monoxide poisoning, increase in PH and decrease in temperature

Explanation

Question 21 of 42

1

What causes hypoxia? (tick all that apply):

Select one or more of the following:

Decreased P02
Hypoventilation
Ventilation-perfusion inequality
Shunting
Decreased oxygen carrying capacity

Explanation

Question 22 of 42

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CO2 is transported to the lungs by ( plasma, lipids, proteins, active transport ) and ( red blood cells, white blood cells, macrophages, free floating lipids ) via the bicarbonate buffer system. C02 is transformed into bicarbonate by the carbonic anhydrase enzyme

Explanation

Question 23 of 42

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Which of the following can cause a shift of the oxygen-haemoglobin dissociation curve to the right?

Select one or more of the following:

Metabolic acidosis
High fever
Living at high altitude
Strenuous Exercise
Respiratory Alkalosis

Explanation

Question 24 of 42

1

All of the following are known mechanisms for the development of hypoxia except:

Select one of the following:

Living at high altitude
Hyperventilation
Severe anaemia
Pulmonary embolism
Heart chamber defects

Explanation

Question 25 of 42

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Which of the following is FALSE with regards to pulse oximetry?

Select one of the following:

The saturation of oxygen can be measured within a 3% margin of error
An SP02 of 100% corresponds to a P02 of 70
Pulse oximetry is a useful adjunct in assessing oxygen transport
Patients with hypovolemia, hypotension and anaemia can still be monitored with a pulse oximeter
Pulse oximetry can reveal unsuspected hypoxemia in cases of carbon monoxide poisoning

Explanation

Question 26 of 42

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You are called to the scene to intubate a pulseless, apneic patient. After intubation, you notice fogging in the ET tube, breath sounds and absence of abdominal distension. What else would confirm a proper tube placement?

Select one of the following:

A chest x-ray
Pulse oximetry
A yellow colour change on a colormetric end-tidal C02 detector
Presence of breath sounds heard over the trachea
An arterial blood gas

Explanation

Question 27 of 42

1

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The autonomic nervous system has three essential divisions which are the ( sympathetic, symphonic, adregenic, systemic ), ( parasympathetic, parasymphonic, parametabolic, paranervous ) and ( enteric, enerdrenic, energetic, enertonic ) systems. These all control and regulate cardiac muscle, smooth musle and various glands.

Explanation

Question 28 of 42

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In the autonomic nervous system, the neurons from each division connect outside the central nervous system in cell clusters known as ( ganglia, gang junctions, neuronic junctions, central nervous buffers )

Explanation

Question 29 of 42

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Ganglia which are located in the innervated organs; neurons exiting from the craniosacral division; pre-ganglionic neurons being longer than post-ganglionic nerons – all describe the ( parasympathetic, sympathetic, enteric ) nervous system

Ganglia which are located closer to the spinal chord; neurons which leave the CNS at the thoracolumbar division; pre-ganglionic neurons being shorter than post-ganglionic neurons – all describe the ( sympathetic, parasympathetic, enteric ) nervous system

Explanation

Question 30 of 42

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Neurotransmitters function as chemical bridges to relay signals from neuron to neuron . In both sympathetic and parasympathetic divisions, the major neurotransmitter is ( acetylcholine, epinephrine, cortisol, glutamate ). In postganglionic fibres leading to innervated tissue, ( acetylcholine, epinephrine, norepinephrine, seratonin ) acts as the main neurotransmitter for the parasympathetic system while ( norepinephrine, epinephrine, acetylcholine, seratonnin ) is released in the sympathetic system.

Explanation

Question 31 of 42

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In pre-hospital care, many of the medications administered work at the receptor level of the sympathetic and parasympathetic divisions of the autonomic nervous system. These receptors are either ADRENERGIC which include Alfa and Beta receptors or CHOLINERGIC which include nicotinic and muscarinic receptors.

( Alpha-1, Alpha-2 ) and ( Beta-1, Beta-2 ) receptors produce an excitatory response.

( Alfa-1, Alfa-2 ) and ( Beta-1, Beta-2 ) receptors usually produce an inhibitory/relaxing response.

( Alfa-1, Alfa-2, Beta-1, Beta-2 ) receptors are usually located on smooth muscle and are sensitive to norepinephrine and epinephrine

( Alfa-1, Alfa-2, Beta-1, Beta-2 ) receproes are usually located in smooth muscle as well as in platelets and fat cells

( Alfa-1, Alfa-2, Beta-1, Beta-2 ) receptors are located primarily in the heart

( Alfa-1, Alfa-2, Beta-1, Beta-2 ) receptors are located in vascular smooth muscle, gastrointestinal tract and bronchial smooth muscle

( Nicotonic, Muscarinic ) receptors are found at the neurotransmitter junction and in autonomic ganglia. They allow the cells to exchange sodium and potassium and produce excitation when stimulated

( Muscarinic, Nicotonic ) receptors are located in the heart and smooth muscles. They cause an inhibitory response in the heart but an excitatory reponse in the smooth muscle

Explanation

Question 32 of 42

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The study of pharmacokinetics attempts to define the dynamics of drug behaviour in the body. The biological fate of a drug after it has been administered depends on four essential processes which are defined as:

- The rate and quality of a drug that is introduced into the body (( Absorbtion, Quantification, pharmalocation, injestion ))

- The movement or temporary storage of a drug (( distribution, movement, placement, deliverance ))

- The process of chemical conversion of the original drug to metabolite (( metabolism, transformation, conversion, depletion ))

- Removal of the drug from the body (( elimination, extraction, vacation, evacuation ))

Explanation

Question 33 of 42

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Solubility, rate of dissolution, presence of other drugs, obesity or anything which affects the gastrointestinal tract all effect the ( absorption, distribution, metabolism, elimination ) of drugs.

Blood flow, diffusion and active transport all rate to the ( distribution, absorption, metabolism, elimination ) of a drug.

The process by which most drugs are converted in the liver is the ( metabolism, distribution, absorption, elimination ) of a drug

The kidneys, lungs, liver and body fluids are all responsible for the ( elimination, distribution, metabolism, absorption ) of a drug.

Explanation

Question 34 of 42

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The rate in which a drug is excreted from the body is known as its ( half life, elimination time, destruction segment, split point ). This is the amount of time it takes to remove 50% of the drug and generally ( 6, 4, 8, 2 ) of these are required to remove 98% of the drug. ( 10, 8, 12, 9 ) of these completely eliminate the drug

Explanation

Question 35 of 42

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The amount of drug in systemic circulation is usually a fraction of the original dose – this is known as ( bioavailability, half life, drug dose percentage, pharmainventory ). For drugs given IV, this is approximately ( 100%, 90%, 50%, 40% ) and those given oraly depends on the four essential processes of drugs. Over time, this will equal the rate of elimination and this is known as the ( steady state, half life, bioavailability, pharmavailability ) which usually takes ( 4, 6, 8, 10 ) half lives to achieve.

Explanation

Question 36 of 42

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The action by which drugs are removed or partially metabolised by the liver after being absorbed by the gastrointestinal tract is known as the ( first pass hepatic effect, hepatic re-directive, hepatic metabolite confirmation, hepatic elimination drive ). Drugs which are particularly affected by this process are aspirin, ( morphine, adderall, Amoxicillin, Suprophen ) and propranolol

Explanation

Question 37 of 42

1

You are called to a remote location to asses a paediatric patient with an accidental ingestion of one tablet of his mother’s pain medication (drug X). En route to hospital, you read an information file on drug X. The half life is listed as 1 hour. When would 98% of the drug be eliminated from the patient’s body?

Select one of the following:

2 hours
4 hours
6 hours
8 hours
24 hours

Explanation

Question 38 of 42

1

Which of the following medications used in emergency care has the most extensive first pass hepatic effect?

Select one of the following:

Amioderone
Epinephrine
Furosemide
Diazapam
Morphene

Explanation

Question 39 of 42

1

Drugs must be particularly carefully administered to patients with which of the following medical conditions? (tick all that apply)

Select one or more of the following:

Heart failure
Hyperthyroidism
Hypothyroidism
Cirrhosis
Hypoglycaemics
Rhumatoid Arthritis

Explanation

Question 40 of 42

1

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The relationship between pressure and volume is ( Boyle’s Law, Charles' Law, Dalton's Law, Henry's Law, Starling's Law, La Places' Law ). This related to the ventilation of the lungs and movement of air into/out of them.

The relationship between temperature and volume is ( Charles’ Law, Boyle's Law, Dalton's Law, Henry's Law, Starling's Law, La Places' Law ). This relates to the warming of air through the sinuses in order to increase volume. If you breathe in cold air, there is less volume.

Illustrating that the pressure of gas is directly related to the number of moles and that total pressure of the mixture of gasses is equal to the sum of them (PA + PB + PC) is ( Dalton’s Law, Boyle's Law, Charles' Law, Henry's Law, Starling's Law, La Places' Law ). This relates to climbers ascending heights where the partial pressure of oxygen is lower and hence, creates hypoxia.

The principle that all gases are soluble in liquids relates to ( Henry’s Law, Boyle's Law, Charles' Law, Dalton's Law, Starling's Law, La Places' Law ). More gas dissolves at high pressure and hence, as the pressure decreases that gas will begin to expand back into the blood stream. If this happens too quickly, organs will suddenly depressurise, collapse and sudden death will occur. The bends relates to Nitrogen expanding into the joints causing pain as well as CO2 expanding out and causing the blood to become foamy.

Both ( Henry’s Law, Boyle's Law, Charles' Law ) and ( Starling’s Law, Dalton's Law, La Places' Law ) relate to the gaseous exchange in the alveoli.

( La Places’ law, Boyle's Law, Charles' Law, Dalton's Law, Henry's Law, Starling's Law ) explains how a decreasing radius within the alveoli relates to an increased collapsing pressure due to surface tension as well as the need for surfactant.

Explanation

Question 41 of 42

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The body usually maintains a PH of around ( 7.4, 7.0, 7.9, 6.8 ). Control of the acid-base balance is through the lungs, kidneys and buffer system.

Lungs – ( fast response, slow response, takes days/hours, instantaneous, works in seconds )

Kindeys – slow response, takes days to work and several hours to respond

Buffer system – ( instantaneous, works in seconds, reasonably fast response, slow response )

Explanation

Question 42 of 42

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Decreased ability to breathe due to severe chronic lung disease leads to ( respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis ) and is corrected by increasing ( excretion of acid in the urine, excretion of alkali in the urine, breathing rate to retain C02, breathing rate to rid C02 )

Hyperventilation due to anxiety leads to ( respiratory alkalosis, respiratory acidosis, metabolic alkalosis, metabolic acidosis ) and is corrected by increased ( excretion of alkali in the urine, excretion of acid in the urine, breathing rate to retain C02, breathing rate to reduce C02 )

Loss of stomach acid due to vomiting leads to ( metabolic alkalosis, metabolic acidosis, respiratory acidosis, respiratory alkalosis ) and is corrected by decreased ( breathing rate to retain CO2, breathing rate to expel C02, excretion of acid in the urine, excretion of alkaline )

Increased acid production due to DKA leads to ( metabolic acidosis, metabolic alkalosis, respiratory acidosis, respiratory alkalosis ) and is corrected by increased ( breathing rate to decrease C02, breathing rate to retain C02, excretion of acid in the urine, excretion of alkaline in the urine )

	Created by Kaylee Garrick over 4 years ago

Revision for section one of the red book

Pathophysiology revision - SECTION 1: GENERAL PRINCIPLES

Question 1 of 42

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Explanation

Question 2 of 42

The process by which MOLECULES move from areas of high concentration to low concentration until evenly spread is known as

Select one of the following:

Explanation

Question 3 of 42

The process by which WATER moves from an area of high concentration to an area of low concentration is known as:

Select one of the following:

Explanation

Question 4 of 42

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Explanation

Question 5 of 42

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Explanation

Question 6 of 42

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Explanation

Question 7 of 42

Select one of the following:

Explanation

Question 8 of 42

Which of these statements is false?

Select one of the following:

Explanation

Question 9 of 42

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Explanation

Question 10 of 42

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Explanation

Question 11 of 42

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One law which relates best to the movement of fluids through the capillaries is Starling’s Law Boyle's Law La Places' Law Charles' Law( Starling’s Law, Boyle's Law, La Places' Law, Charles' Law ). This explains the distribution of fluids from a high pressure to a low pressure

Explanation

Question 12 of 42

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Explanation

Question 13 of 42

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Explanation

Question 14 of 42

You are called to the scene of a motor vehicle accident. The patient is a 23 year old male with extensive multi-system trauma including lower extremity amputation with active bleeding. Vital signs are as follows: BP 90/palpation, HR 122, RR 24. Which IV fluid should be used?

Select one of the following:

Explanation

Question 15 of 42

What would happen if a colloid solution was used to treat a patient who had experienced an amputation?

Select one of the following:

Explanation

Question 16 of 42

An example of when not to use 5% dextrose fluid is (check all that apply):

Select one or more of the following:

Explanation

Question 17 of 42

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Explanation

Question 18 of 42

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Explanation

Question 19 of 42

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Explanation

Question 20 of 42

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A shifting of the oxygen dissociation curve to the left right upwards gradient downwards gradient( left, right, upwards gradient, downwards gradient ) increases haemoglobins affinity for oxygen. Examples of this include carbon monoxide poisoning, increase in PH and decrease in temperature

Explanation

Question 21 of 42

What causes hypoxia? (tick all that apply):

Select one or more of the following:

Explanation

Question 22 of 42

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Explanation

Question 23 of 42

Which of the following can cause a shift of the oxygen-haemoglobin dissociation curve to the right?

Select one or more of the following:

One law which relates best to the movement of fluids through the capillaries is ( Starling’s Law, Boyle's Law, La Places' Law, Charles' Law ). This explains the distribution of fluids from a high pressure to a low pressure

A shifting of the oxygen dissociation curve to the ( left, right, upwards gradient, downwards gradient ) increases haemoglobins affinity for oxygen. Examples of this include carbon monoxide poisoning, increase in PH and decrease in temperature

In the autonomic nervous system, the neurons from each division connect outside the central nervous system in cell clusters known as ( ganglia, gang junctions, neuronic junctions, central nervous buffers )