View source for 2017B

<span id="2017-2nd-sitting"></span>
== 2017 (2nd sitting) ==



<span id="question-1"></span>
=== Question 1 ===



<span id="question-1"></span>
==== Question ====

Compare and contrast the pharmacology of ibuprofen and paracetamol.



<span id="example-answer-1"></span>
==== Example answer ====









<span id="examiner-comments-1"></span>
==== Examiner comments ====

<blockquote>65% of candidates passed this question.

This was a standard compare and contrast question of common analgesic pharmacology and it<br />
was generally well answered. The use of a table ensured all areas were covered including<br />
class, indications, pharmaceutics, mode of action, pharmacodynamics, pharmacokinetics and<br />
adverse effects. The uncertain nature (and possibilities) of the mechanism of action of<br />
paracetamol was alluded to in better responses.

Details of the comparative pharmacokinetics were often lacking. Answers should have included<br />
a comment on first-pass effect, the significance of the difference in protein binding and the<br />
details of metabolism, particularly paracetamol. Metabolism limited to &quot;hepatic metabolism and<br />
renal excretionâ€ gained no marks as better responses were more detailed and clearer about the<br />
differences between the two drugs. Knowledge of metabolism at therapeutic doses and the<br />
effect of overdose were expected. Better answers included potential interactions with other<br />
drugs (e.g. warfarin) and contraindications to the use of these drugs.
</blockquote>


<span id="online-resources-for-this-question-1"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-1 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b01/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-01.pdf CICM Wrecks]
* [https://partone.litfl.com/paracetamol.html Part One - Paracetamol] and [https://partone.litfl.com/cox_inhibitors.html Part One - Ibuprofen]



<span id="similar-questions-1"></span>
==== Similar questions ====

* ? None





<span id="question-2"></span>
=== Question 2 ===



<span id="question-2"></span>
==== Question ====

Outline the daily nutritional requirements, including electrolytes, for a normal 70 kg adult.



<span id="example-answer-2"></span>
==== Example answer ====









<span id="examiner-comments-2"></span>
==== Examiner comments ====

<blockquote>21% of candidates passed this question

The provision of nutrition is a core skill in ICU. An understanding of its key elements enables prescription and modification. However, most answers lacked detailed information which is available in the standard texts. Better responses outlined the caloric requirements including each major element (water, carbohydrate, fat and protein) along with the caloric values and potential sources. Essential amino acids, fatty acids, fat and water-soluble vitamins were expected. A list of the requirements for major electrolytes and some of the trace elements were expected. Some candidates seemed to confuse calories, kilocalories and kilojoules.

Some answers did not provide the nutritional requirements, as asked, but instead discussed the<br />
fate of the nutrients; hence did not score marks. Candidates are reminded to read the question<br />
carefully. 
</blockquote>


<span id="online-resources-for-this-question-2"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-2 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b02/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-02.pdf CICM Wrecks]



<span id="similar-questions-2"></span>
==== Similar questions ====

* Question 9, 2020 (2nd sitting)







<span id="question-3"></span>
=== Question 3 ===



<span id="question-3"></span>
==== Question ====

Describe the factors that determine the filtered load of a substance at the renal glomerulus.



<span id="example-answer-3"></span>
==== Example answer ====









<span id="examiner-comments-3"></span>
==== Examiner comments ====

<blockquote>67% of candidates passed this question

A good place to start was with the correct equation for a filtered load and a description of the<br />
components. Better answers described the components and how they differ and change over<br />
the glomerulus. Many candidates usefully based answers around the Starling forces.

A summary of factors including the role of plasma concentration, protein binding, molecular size<br />
and charge was required to pass. Many answers gave examples for the effects of size and<br />
charge and relate endocrine responses to specific alterations in arteriolar tone and how this<br />
affected filtration. A detailed discussion of cardiovascular and endocrine responses to<br />
hypovolaemia was not required.

Some candidates confused clearance with filtered load. Candidates are reminded to write<br />
legibly - especially where subscripts and Greek letters are used. Directional arrows (if used)<br />
should correlate with text.
</blockquote>


<span id="online-resources-for-this-question-3"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-3 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b03/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-03.pdf CICM Wrecks]



<span id="similar-questions-3"></span>
==== Similar questions ====

* Question 13, 2009 (1st sitting)
* Question 4, 2016 (1st sitting)





<span id="question-4"></span>
=== Question 4 ===



<span id="question-4"></span>
==== Question ====

Describe how interstitial fluid recirculates to the vascular system.



<span id="example-answer-4"></span>
==== Example answer ====









<span id="examiner-comments-4"></span>
==== Examiner comments ====

<blockquote>10% of candidates passed this question

Candidates had a limited understanding of this area of the syllabus. It was expected that answers would describe important concepts including the anatomy of venous structures, valves and lymphatics, permeability and factors which influence permeability. A description of hydrostatic forces, other pressures involved, and the role of osmotic and electric forces were required. 
</blockquote>


<span id="online-resources-for-this-question-4"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-4 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b04-describe-how-interstitial-fluid-recirculates-to-the-vascular-system/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-04.pdf CICM Wrecks]



<span id="similar-questions-4"></span>
==== Similar questions ====

* ? None







<span id="question-5"></span>
=== Question 5 ===



<span id="question-5"></span>
==== Question ====

Compare and contrast unfractionated heparin with low molecular weight heparin. 



<span id="example-answer-5"></span>
==== Example answer ====

{|
! Name
! HMWH (heparin)
! LMWH (enoxaparin)
|-
| '''Class'''
| Anticoagulant
| Anticoagulant
|-
| '''Indications'''
| Prophylactic and therapeutic anticoagulation (e.g. AF, DVT, PE, ACS etc)
| Prophylactic and therapeutic anticoagulation (e.g. AF, DVT, PE, ACS etc)
|-
| '''Pharmaceutics'''
| MW = 5,000-25,000 Da Clear solution for injection
| MW = 5,000 Daltons Clear solution for injection
|-
| '''Routes of administration'''
| IV, SC
| SC (main), can also be given IV
|-
| '''Dose'''
| Prophylactic: 5,000 IU BD-TDS Therapeutic: infusion (APTT target)
| Therapeutic: 1mg/kg BD or 1.5mg/kg OD Prophylactic: 20-40mg OD
|-
| pKA
| 
| 
|-
| '''Pharmacodynamics'''
| 
| 
|-
| MOA
| Heparin binds to antithrombin 3 &gt; conformational change &gt; increases affinity for inactivating thrombin (factor IIa) and Factor Xa
| Enoxaparin binds to AT-3 &gt; conformational change &gt; increases affinity for inactivating factor Xa (and weakly factor IIa - 4x less activity)
|-
| Effects
| Anticoagulation
| Anticoagulation
|-
| Side effects
| HAEM: increased risk of haemorrhage, bruising, HITTS (higher than LMWH)
| HAEM: increased risk of haemorrhage, bruising, HITTS (lower than HMWH)
|-
| '''Pharmacokinetics'''
| 
| 
|-
| Onset
| Immediate (IV), 30 mins (SC)
| Peak effect 3-4 hrs post SC injection
|-
| Absorption
| PO bioavailability - 0% <br />
Variable SC absorption - less predictable response
| PO bioavailability - 0% <br />
 &gt;90% bioavailability post SC injection
|-
| Distribution
| VOD = 0.1L/kg Lipid solubility: low Protein binding: high Does not cross BBB / placenta
| VOD = 4.3L <br />
Protein binding: does not bind to heparin binding proteins
|-
| Metabolism
| Reticuloendothelial system
| Minimal hepatic metabolism
|-
| Elimination
| Renal elimination (very minimal) - hence preferred in renal failure<br />
 T 1/2 = 1 hrs
| Renal elimination of active and inactive metabolites <br />
 T 1/2 = 6-12 hours
|-
| '''Special points'''
| Reversal: protamine (1mg = 100IU) - 100% Monitoring: APTT level
| Reversal: protamine (&lt;75% efficacy) Monitoring: Anti-Xa level
|}



<span id="examiner-comments-5"></span>
==== Examiner comments ====

<blockquote>68% of candidates passed this question.

This question was generally well answered and lent itself well to a tabular format. Expected information included an approximation of the molecular weights / significance of the differences in size and therefore its mechanism of action. Other pertinent areas to mention included pharmacokinetic differences and its use in renal failure, side effect profiles, monitoring, predictability of response and reversibility for the two agents. 
</blockquote>


<span id="online-resources-for-this-question-5"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-5 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b05/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-05.pdf CICM Wrecks]
* [https://partone.litfl.com/anticoagulants.html#id Part One, LITFL]



<span id="similar-questions-5"></span>
==== Similar questions ====

* Question 20, 2018 (2nd sitting)
* Question 2, 2008 (1st sitting)
* Question 20, 2009 (2nd sitting)





<span id="question-6"></span>
=== Question 6 ===



<span id="question-6"></span>
==== Question ====

Describe the effects of Ventilation/Perfusion (V/Q) inequality on the partial pressure of oxygen (PaO2) in arterial blood. 



<span id="example-answer-6"></span>
==== Example answer ====









<span id="examiner-comments-6"></span>
==== Examiner comments ====

<blockquote>48% of candidates passed this question

Overall answers lacked sufficient detail on a core area of respiratory physiology. Answers expected included a description of V/Q ratios throughout the lungs and an explanation of how V/Q inequality lowers PaO2.
</blockquote>


<span id="online-resources-for-this-question-6"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-6 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b06/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2014-2-5-vq-po2-pco2-changes.pdf CICM Wrecks]
* [https://partone.litfl.com/shunt.html Part One, LITFL]



<span id="similar-questions-6"></span>
==== Similar questions ====

* Question 6, 2008 (1st sitting)
* Question 5, 2014 (2nd sitting)





<span id="question-7"></span>
=== Question 7 ===



<span id="question-7"></span>
==== Question ====

 Compare and contrast the sympathetic and parasympathetic nervous systems.



<span id="example-answer-7"></span>
==== Example answer ====









<span id="examiner-comments-7"></span>
==== Examiner comments ====

<blockquote>75% of candidates passed this question

This question was generally well answered A table or diagram lent structure to the answer. More complete answers included details on the function, anatomy, a description of the pre- and post-ganglionic fibres, ganglia, receptors and neurotransmitters involved. 

Whilst most commented on â€˜fight or flightâ€™ for the SNS and â€˜rest and digestâ€™ for the PNS, no candidate observed that the SNS is a diffuse physiological accelerator and that the PNS acts as a local brake. No candidate included the fact that the SNS supplies viscera and skin whilst the PNS only supplies the viscera. Many candidates failed to make reference to the fact that the postganglionic SNS receptor is G protein coupled and the PNS postganglionic receptor is Gcoupled on muscarinic receptors but operates an ion channel when nicotinic. 

Candidates may have scored higher if they had provided a little more detail in their answers. 
</blockquote>


<span id="online-resources-for-this-question-7"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-7 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b07/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-07.pdf CICM Wrecks]
* [https://partone.litfl.com/autonomic_nervous_system.html Part One, LITFL]



<span id="similar-questions-7"></span>
==== Similar questions ====

* ? None





<span id="question-8"></span>
=== Question 8 ===



<span id="question-8"></span>
==== Question ====

Classify calcium channel antagonists and give one example of each class (30% of marks). Describe the pharmacology of Nimodipine including important drug interactions (70% of marks). 



<span id="example-answer-8"></span>
==== Example answer ====









<span id="examiner-comments-8"></span>
==== Examiner comments ====

<blockquote>19% of candidates passed this question

The classification was done well. Most candidates demonstrated that they had a structure for a â€œdrugâ€ question, but were often challenged to fill in the detail of that structure and failed to deliver enough content to secure a pass. Many candidates wrote a generic answer for calcium channel blockers instead of the specifics of nimodipine. 

Frequently the pharmacokinetic data recounted was incorrect. Candidates failed to distinguish between absorption and bioavailability. The difference between oral and intravenous dosing was often omitted. Few answered the section on important drug interactions.
</blockquote>


<span id="online-resources-for-this-question-8"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-8 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b08-classify-calcium-channel-antagonists-and-give-one-example-of-each-class-30-of-marks-describe-the-pharmacology-of-nimodipine-including-important-drug-interactions-70-of-marks/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2011-2-17-ca-channel.pdf CICM Wrecks]
* [https://partone.litfl.com/calcium_channel_blockers.html Part One, LITFL]



<span id="similar-questions-8"></span>
==== Similar questions ====

* Question 17, 2011 (2nd sitting)
* Question 2, 2014 (1st sitting)







<span id="question-9"></span>
=== Question 9 ===



<span id="question-9"></span>
==== Question ====

Briefly outline the formation, absorption, distribution, role and composition of cerebrospinal fluid



<span id="example-answer-9"></span>
==== Example answer ====









<span id="examiner-comments-9"></span>
==== Examiner comments ====

<blockquote>44% of candidates passed this question

The question spelt out very specific areas of CSF physiology to outline and the marks were evenly distributed among these areas. The candidates who did not pass this question usually did not provide enough detailed information. Details of the production and absorption of CSF were commonly lacking. The majority of candidates correctly described the composition of CSF; indicating whether a particular variable was higher or lower than in plasma, scored less marks than more specific information. 
</blockquote>


<span id="online-resources-for-this-question-9"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-9 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b09/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2015-1-16-csf-physiology.pdf CICM Wrecks]
* [https://partone.litfl.com/csf.html Part One, LITFL]



<span id="similar-questions-9"></span>
==== Similar questions ====

* Question 22, 2007 (1st sitting)
* Question 6, 2008 (2nd sitting)
* Question 2, 2013 (1st sitting)
* Question 16, 2015 (1st sitting)
* Question 24, 2017 (1st sitting)
* Question 15, 2018 (2nd sitting)
* Question 11, 2019 (1st sitting)
* Question 166, 2020 (1st sitting)





<span id="question-10"></span>
=== Question 10 ===



<span id="question-10"></span>
==== Question ====

Compare and contrast two methods of measuring cardiac output.



<span id="example-answer-10"></span>
==== Example answer ====









<span id="examiner-comments-10"></span>
==== Examiner comments ====

<blockquote>35% of candidates passed this question

Good answers began with a definition of cardiac output. For each method, it was expected that<br />
candidates discuss the theoretical basis, equipment, advantages and disadvantages / sources<br />
of error and limitations. Additional marks were awarded when an attempt was made to compare<br />
and contrast the two methods (often helped by the use of a table).
</blockquote>


<span id="online-resources-for-this-question-10"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-10 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b10/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-10.pdf CICM Wrecks]
* [https://partone.litfl.com/cardiac-output.html Part One, LITFL]



<span id="similar-questions-10"></span>
==== Similar questions ====

* ? None







<span id="question-11"></span>
=== Question 11 ===



<span id="question-11"></span>
==== Question ====

Describe the pharmacology of propofol



<span id="example-answer-11"></span>
==== Example answer ====









<span id="examiner-comments-11"></span>
==== Examiner comments ====

<blockquote>76% of candidates passed this question.

A structured approach proved a good basis to answer this question. It was expected candidates<br />
would outline the uses such as anaesthesia, more prolonged sedation or possible additional roles in patients with seizures or head injuries. Discussion of the presentation and pharmaceutics, including a comment on antibacterial preservatives or lack thereof was expected. The mechanism of action should have been described. It was expected candidates could provide an indication of the usual dose (and how it differs in the more unwell / elderly patient population). A maximal rate and possible toxicity was expected.

A discussion on the pharmacodynamics by major organ systems was expected and credit was given for additional comments about hyperlipidaemia, urine colour changes or metabolic alterations. It was expected that candidates would mention propofol infusion syndrome at some point in their answer with some mention of clinical features or pathophysiology.

The important aspects of its pharmacokinetics should have been mentioned (high protein binding, large volume of distribution, termination of effect by redistribution, hepatic metabolism, context sensitive half life). A mention of adverse effects would complete the answer.
</blockquote>


<span id="online-resources-for-this-question-11"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-11 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b11/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2015-2-14-propofol-pharmacology.pdf CICM Wrecks]
* [https://partone.litfl.com/propofol.html#id Part One, LITFL]



<span id="similar-questions-11"></span>
==== Similar questions ====

* Question 14, 2015 (2nd sitting)
* Question 21, 2013 (2nd sitting)
* Question 5, 2012 (2nd sitting)
* Question 10, 2008 (2nd sitting)





<span id="question-12"></span>
=== Question 12 ===



<span id="question-12"></span>
==== Question ====

Compare and contrast aspirin and clopidogrel



<span id="example-answer-12"></span>
==== Example answer ====









<span id="examiner-comments-12"></span>
==== Examiner comments ====

<blockquote>68% of candidates passed this question

Both of these commonly used agents are level A in the syllabus and thus a high level of detail was expected. Marks were awarded in the following areas - pharmaceutics, mechanism of action, pharmacokinetics (PK) and side effects. For the PK parameters a general description rather than exact values was sufficient (i.e. â€˜high protein bindingâ€™ rather than â€˜98% protein boundâ€™). It was expected that candidates would mention the fact that clopidogrel is a pro-drug and the factors which influence its conversion to the active form. Additional marks were awarded for well-structured answers which attempted a comparison between the two drugs (helped by the use of a table).
</blockquote>


<span id="online-resources-for-this-question-12"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-12 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b12-compare-and-contrast-aspirin-and-clopidogrel/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-12.pdf CICM Wrecks]
* [https://partone.litfl.com/antiplatelets.html Part One - Clopidogrel] and [https://partone.litfl.com/cox_inhibitors.html Part One - Aspirin]



<span id="similar-questions-12"></span>
==== Similar questions ====

* Question 3, 2013 (2nd sitting)
* Question 20, 2015 (2nd sitting)





<span id="question-13"></span>
=== Question 13 ===



<span id="question-13"></span>
==== Question ====

Compare and contrast the pharmacology of intravenous fentanyl and morphine



<span id="example-answer-13"></span>
==== Example answer ====









<span id="examiner-comments-13"></span>
==== Examiner comments ====

<blockquote>68% of candidates passed this question

Good candidates produced a well-structured answer and highlighted the differences between the two drugs. It was important to include the dose, potency, time course of effect of both agents, and differences in pharmacokinetic and pharmacodynamic effects. Candidates should have specific knowledge of these important drugs. Many candidates failed to focus the question on intravenous fentanyl and intravenous morphine as asked. No marks were given for information about other routes of administration.
</blockquote>


<span id="online-resources-for-this-question-13"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-13 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b13-compare-and-contrast-the-pharmacology-of-intravenous-fentanyl-and-morphine/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-13.pdf CICM Wrecks]
* [https://partone.litfl.com/opioids.html#id Part One, LITFL]



<span id="similar-questions-13"></span>
==== Similar questions ====

* Question 12, 2016 (2nd sitting)
* Question 16, 2011 (1st sitting)





<span id="question-14"></span>
=== Question 14 ===



<span id="question-14"></span>
==== Question ====

Explain the mechanisms responsible for the cell resting membrane potential (60% of marks) and describe the Gibbs Donnan effect (40% of marks)



<span id="example-answer-14"></span>
==== Example answer ====









<span id="examiner-comments-14"></span>
==== Examiner comments ====

<blockquote>35% of candidates passed this question.

A good answer included a definition of the resting membrane potential and a clear description of<br />
the factors that determine it. Explanation of these factors should have included a detailed description of the selective permeability of the membrane, electrochemical gradients and active transport mechanisms. Answers should demonstrate awareness of the Nernst equation and the Goldman-Hodgkin-Katz equation. These were often confused, sometimes with the GibbsDonnan effect. Descriptions of the Gibbs-Donnan effect generally lacked detail and understanding. The better answers included a definition and discussed in detail the influence of non-diffusible ions (intracellular proteins) on the distribution of diffusible ions
</blockquote>


<span id="online-resources-for-this-question-14"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-14 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b14-explain-the-mechanisms-responsible-for-the-cell-resting-membrane-potential-60-of-marks-and-describe-the-gibbs-donnan-effect-40-of-marks/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-14.pdf CICM Wrecks]
* [https://partone.litfl.com/transport_across_cell_membranes.html Part One, LITFL]



<span id="similar-questions-14"></span>
==== Similar questions ====

* ? none





<span id="question-15"></span>
=== Question 15 ===



<span id="question-15"></span>
==== Question ====

List the properties of an ideal inotrope (50% of marks). How does adrenaline compare to these ideal properties (50% of marks)?



<span id="example-answer-15"></span>
==== Example answer ====









<span id="examiner-comments-15"></span>
==== Examiner comments ====

<blockquote>98% of candidates passed this question

Many candidates scored very highly on this core topic. It was expected information be included<br />
on pharmaceutics, cost, availability and compatibilities. Relevant pharmacokinetics (onset/offset, titratability) and pharmacodynamics (including relevant receptors, nuances of haemodynamic effects e.g. effect on diastolic pressure and regional perfusion) should have been detailed. Adverse effects and safety profile (e.g. use in pregnancy, therapeutic index) should also have been included. Good answers were structured and highlighted differences with specific facts and data
</blockquote>


<span id="online-resources-for-this-question-15"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-15 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b15-list-the-properties-of-an-ideal-inotrope-50-of-marks-how-does-adrenaline-compare-to-these-ideal-properties-50-of-marks/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-15.pdf CICM Wrecks]
* [https://partone.litfl.com/adrenergic_drugs.html Part One, LITFL]



<span id="similar-questions-15"></span>
==== Similar questions ====

* Question 18, 2012 (2nd sitting)





<span id="question-16"></span>
=== Question 16 ===



<span id="question-16"></span>
==== Question ====

Classify and describe adverse drug reactions with examples of each.



<span id="example-answer-16"></span>
==== Example answer ====

'''Adverse drug reaction'''

* Noxious or unintended effect associated with drug administration at a normal dose
** This is different from an adverse drug event which is the occurrence of any untoward event following administration of a drug (thus all ADRs are ADEs)
* Risk factors: extremes of age, polypharmacy, genetic variability (e.g. CYP enzymes), concurrent illness (renal, liver, cardiac impairment), pregnancy 



'''Classification of adverse drug reactions'''

{|
! Reaction type
! Mechanism
! Features
! Example/s
! Management
|-
| Type A<br />
'Augmented'
| Related to the pharmacological action of the drug (dose related)
| - Common<br />
- Predictable<br />
- Low mortality
| - Bleeding related to administration of anticoagulants (e.g. heparin)
| Reduce or withhold
|-
| Type B<br />
'Bizarre'
| Non-dose related (any exposure &gt; reaction)
| - Rare<br />
- Unpredictable<br />
- Not related to action of drug<br />
- High mortality
| Anaphylaxis to penicillin's
| Withhold and avoid future use
|-
| Type C<br />
'Chronic'
| Due to the cumulative dose received (dose and time related)
| - Uncommon
| Adrenal suppression with prolonged course of corticosteroids.
| Reduce or withhold (may need to happen over time)
|-
| Type D<br />
'Delayed'
| Does not appear for a prolonged period after exposure (time related)
| - Uncommon <br />
- Usually also dose related
| Tardive dyskinesia from long term use of typical antipsychotics
| Can be intractable
|-
| Type E<br />
'End of treatment'
| Withdrawal reactions from drug cessation
| - Uncommon<br />
- Fast onset
| Seizures from abrupt withdrawal of benzodiazepines or alcohol
| Reintroduce + withdraw slowly
|-
| Type F<br />
'Failure'
| Unexpected failure or decrease in efficacy
| - Common<br />
- Dose related
| Ineffectiveness of clopidogrel (non metabolisers)
| Increase dosage / alternative therapy
|}



<span id="examiner-comments-16"></span>
==== Examiner comments ====

<blockquote>44% of candidates passed this question.<br />
Candidates should have provided a definition of adverse drug reactions and then a classification. There are at least two widely accepted systems for classification, either was acceptable; though candidates often switched between both which led to a less structured answer. The WHO classification is comprehensive and logical, though both Rang and Dale and Goodman and Gilman also have sections on this topic. Common errors were the citing of examples with the incorrect mechanism, describing only drug interactions rather than all adverse reactions and focussing the answer on the 4 hypersensitivity reactions which could only score a low mark. Some candidates confused drug errors with adverse reactions
</blockquote>


<span id="online-resources-for-this-question-16"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-16 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b16-classify-and-describe-adverse-drug-reactions-with-examples-of-each/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2012-1-14-advers-drug-reaction.pdf CICM Wrecks]



<span id="similar-questions-16"></span>
==== Similar questions ====

* Question 14, 2012 (2nd sitting)





<span id="question-17"></span>
=== Question 17 ===



<span id="question-17"></span>
==== Question ====

Define and explain damping, resonance, critical damping and optimum damping.



<span id="example-answer-17"></span>
==== Example answer ====









<span id="examiner-comments-17"></span>
==== Examiner comments ====

<blockquote>25% of candidates passed this question

Concise definitions were required with a clear explanation of the underlying physical principles.<br />
The response time of the system, degree of overshoot, effect on amplitude, noise and ability to<br />
faithfully reproduce frequencies relative to the natural resonant frequency were important considerations.<br />
Many candidates interpreted the question as relating to arterial lines and a detailed discussion<br />
of the components and characteristics of an intra-arterial catheter and transducer system did not<br />
attract marks. 
</blockquote>


<span id="online-resources-for-this-question-17"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-17 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b17/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2015-1-12-resonance-and-damping.pdf CICM Wrecks]



<span id="similar-questions-17"></span>
==== Similar questions ====

* Question 12, 2020 (1st sitting)
* Question 24, 2012 (2st sitting)
* Question 12, 2015 (1st sitting)





<span id="question-18"></span>
=== Question 18 ===



<span id="question-18"></span>
==== Question ====

Draw and numerically label, on a spirogram, the lung volumes and capacities of a 30 kg child.



<span id="example-answer-18"></span>
==== Example answer ====









<span id="examiner-comments-18"></span>
==== Examiner comments ====

<blockquote>87% of candidates passed this question.

This core respiratory physiology topic was well answered by most candidates. Candidates generally were able to draw a spirogram. A common omission was inspiratory capacity. 
</blockquote>


<span id="online-resources-for-this-question-18"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-18 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b18/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-18.pdf CICM Wrecks]



<span id="similar-questions-18"></span>
==== Similar questions ====

* ? none





<span id="question-19"></span>
=== Question 19 ===



<span id="question-19"></span>
==== Question ====

Describe the physiology of a vasovagal syncope



<span id="example-answer-19"></span>
==== Example answer ====









<span id="examiner-comments-19"></span>
==== Examiner comments ====

<blockquote>41% of candidates passed this question

Generally, there was a lack of knowledge about this topic with many candidates confusing vasovagal syncope with a Valsalva or orthostatic hypotension. A â€œvasovagalâ€ is from excessive autonomic reflex activity in contrast to orthostatic hypotension which is a failure of the autonomic reflex response.<br />
A good place to start was with a description of vasovagal syncope, also known as neurocardiogenic syncope. It is benign, self-limiting and caused by an abnormal or exaggerated autonomic response to various stimuli (which should have been listed). The mechanism should have been described including the various receptors involved
</blockquote>


<span id="online-resources-for-this-question-19"></span>
==== Online resources for this question ====

<ul>
<li><p>[https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-19 Deranged Physiology]</p></li>
<li><p>[https://jennysjamjar.com.au/year/17b/17b19-describe-the-physiology-of-a-vasovagal-syncope/ Jenny's Jam Jar]</p></li>
<li><p>[https://cicmwrecks.files.wordpress.com/2019/04/2017-2-19.pdf CICM Wrecks]</p>
<p></p></li></ul>

<span id="similar-questions-19"></span>
==== Similar questions ====

* ? None





<span id="question-20"></span>
=== Question 20 ===



<span id="question-20"></span>
==== Question ====

Outline the functions of the liver



<span id="example-answer-20"></span>
==== Example answer ====









<span id="examiner-comments-20"></span>
==== Examiner comments ====

<blockquote>86% of candidates passed this question

This is a very straightforward question testing breadth of knowledge rather than depth. It was<br />
well answered by the majority of candidates. 
</blockquote>


<span id="online-resources-for-this-question-20"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-20 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b20/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-20.pdf CICM Wrecks]
* [https://partone.litfl.com/functions_of_the_liver.html#id Part One, LITFL]



<span id="similar-questions-20"></span>
==== Similar questions ====

<ul>
<li><p>Question 22, 2017 (1st sitting)</p></li>
<li><p>Question 4, 2013 (2nd sitting)</p></li>
<li><p>Question 12, 2011 (2nd sitting)</p>
<p></p></li></ul>



<span id="question-21"></span>
=== Question 21 ===



<span id="question-21"></span>
==== Question ====

Describe and compare the action potentials from cardiac ventricular muscle and the sinoatrial node.



<span id="example-answer-21"></span>
==== Example answer ====









<span id="examiner-comments-21"></span>
==== Examiner comments ====

<blockquote>95% of candidates passed this question

This topic was well understood and answered by most candidates. Some candidates had a good knowledge base but missed out on potential marks by failing to compare and contrast. A diagram outlining the various phases was a useful way to approach the question.
</blockquote>


<span id="online-resources-for-this-question-21"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-21 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b21/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2013-1-19-ap-generation-and-conduction-prevention-of-arrhythmia.pdf CICM Wrecks]
* [https://partone.litfl.com/exams/2020A/2020A10.html Part One, LITFL]



<span id="similar-questions-21"></span>
==== Similar questions ====

* Question 1, 2020 (2nd sitting)
* Question 23, 2010 (2nd sitting)
* Question 19, 2013 (1st sitting)
* Question 11, 2016 (2nd sitting)





<span id="question-22"></span>
=== Question 22 ===



<span id="question-22"></span>
==== Question ====

Define bioavailability. Outline the factors which affect it.



<span id="example-answer-22"></span>
==== Example answer ====









<span id="examiner-comments-22"></span>
==== Examiner comments ====

<blockquote>33% of candidates passed this question

Many candidates did not specify that bioavailability describes the proportion/fraction of drug<br />
reaching the systemic circulation (to differentiate from the portal circulation). Some candidates considered only factors impacting absorption from the GI tract or stated that bioavailability related only to orally administered drugs. Candidates failed to provide an equation, or got equations or graphs wrong. Nearly all candidates failed to provide a comprehensive list of factors affecting bioavailability.
</blockquote>


<span id="online-resources-for-this-question-22"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-22 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b22-define-bioavailability-outline-the-factors-which-affect-it/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2020/08/2017-2-22.pdf CICM Wrecks]



<span id="similar-questions-22"></span>
==== Similar questions ====

* Question 15, 2020 (1st sitting)





<span id="question-23"></span>
=== Question 23 ===



<span id="question-23"></span>
==== Question ====

Outline the anatomy of the internal jugular vein relevant to central venous line cannulation (80% of marks). Include important anatomical variations (20% of marks).



<span id="example-answer-23"></span>
==== Example answer ====



Internal jugular vein

* Originates at the jugular bulb (confluence of the inferior petrosal and sigmoid sinus')
* Exits skull via the jugular foramen with CN IX, X, XI
* Descends inferolaterally in the carotid sheath (initially posterior &gt; lateral to carotid artery with descent)
* Terminates behind the sternal end of the clavicle where it joins with the subclavian vein to form the brachiocephalic vein
* Tributaries: facial, thyroid, pharyngeal, lingual veins
* Usually larger on the right



Relations

* Anterior to IJV: SCM, lymph nodes, CN XI
* Posterior to IJV: scalene muscles, lung pleura, lateral mass C1, vagus (poster-medial)
* Inferior/at termination: pleura (which extends ~2cm above clavicle)
* Medial: vagus, carotid artery



Variations

* Stenosis, complete occlusion, aneurysms, absence 
* Variation in relation to carotid (e.g. anterior) in up to 1/4 cases



Ultrasound anatomy

* Often lateral to carotid (not always) and often larger than carotid
* Unlike carotid: Non pulsatile, thin walled, compressible
* Doppler flows can also be helpful. 



Surface anatomy

* Identify triangle between the clavicle and two heads of SCM
* Palpate carotid
* Puncture lateral to carotid artery at 30 degree angle
* Aim caudally towards ipsilateral nipple



<span id="examiner-comments-23"></span>
==== Examiner comments ====

<blockquote>14% of candidates passed this question.

Good answers were structured including origin, termination, tributaries, relationships, surface<br />
anatomy and common variations.<br />
Factual inaccuracies were common and there was confusion about the relations of the internal<br />
jugular vein. Many candidates did not mention the changing relationship between the internal<br />
jugular and the carotid artery as they travel through the neck or the changes that result from<br />
repositioning for insertion. Many candidates also forgot to mention surface anatomy and a<br />
number talked about ultrasound and views used for insertion of central lines. Common<br />
omissions included the origin, tributaries, relationship with the correct cranial nerves and the fact<br />
that it is usually larger on the right. Almost nobody mentioned the relationship to the pleura.
</blockquote>


<span id="online-resources-for-this-question-23"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-23 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b23/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2019/04/2017-2-23.pdf CICM Wrecks]
* [https://partone.litfl.com/internal_jugular_vein.html Part One, LITFL]



<span id="similar-questions-23"></span>
==== Similar questions ====

* Question 8, 2021 (2nd sitting)
* Question 18, 2014 (1st sitting)





<span id="question-24"></span>
=== Question 24 ===



<span id="question-24"></span>
==== Question ====

What is functional residual capacity (30% of marks)? Describe two methods of measuring functional residual capacity (70% of marks).



<span id="example-answer-24"></span>
==== Example answer ====









<span id="examiner-comments-24"></span>
==== Examiner comments ====

<blockquote>59% of candidates passed this question

Most candidates could state 2 methods of measuring FRC. Some candidates (especially for<br />
nitrogen wash out) failed to provide enough information e.g. statements such as &quot;if the amount<br />
of nitrogen is measured then FRC can be derived&quot; were insufficient to score many marks.
</blockquote>


<span id="online-resources-for-this-question-24"></span>
==== Online resources for this question ====

* [https://derangedphysiology.com/cicm-primary-exam/past-papers/2017-paper-2-saqs/question-24 Deranged Physiology]
* [https://jennysjamjar.com.au/year/17b/17b24/ Jenny's Jam Jar]
* [https://cicmwrecks.files.wordpress.com/2017/04/2015-2-4-functional-residual-capacity.pdf CICM Wrecks]
* [https://partone.litfl.com/volumes_and_capacities.html Part One, LITFL]



<span id="similar-questions-24"></span>
==== Similar questions ====

* Question 2, 2020 (2nd sitting)
* Question 15, 2010 (2nd sitting)
* Question 4, 2015 (2nd sitting)
* Question 8, 2017 (1st sitting)
* Question 24, 2017 (2nd sitting)