CENTRAL CONNECTICUT STATE UNIVERSITY
Department of Biology
M.S. Biological Sciences: Anesthesia Program
COMPREHENSIVE EXAM QUESTIONS – Plan B
Exams will in late August and early September of 2017.
Attached are questions for your oral comprehensive exam. This is a part of the capstone experience (culminating experience) required for your masters degree. Master’s degree Capstone experiences are to provide opportunities for analysis and integration of materials in your field of study.
Use the questions provided to help you do an extensive review of the materials that you have had in BIO 517 Advanced human anatomy, physiology, and pathophysiology; BIO 518 Advanced pathophysiology and applied physiology; BIO 528 Advanced pharmacology; and BIO 530 Immunology. (Integration of CHEM 550 Basic organic and biochemistry into these courses is also expected). To prepare for the oral comprehensive exam, we suggest that you do the following:
Write out answers to each question.
a. use your lecture notes and textbooks
b. list key points; draw flow diagrams and graphs
c. be sure that you know why or how certain mechanisms work
d. apply the questions to the functioning of a whole individual as well as to cellular or subcellular mechanisms
e. write out your own answers, do not rely on “canned” answers from upper classmen or peers
During some exams we have received numerous incorrect answers in significant
areas because people studied from “canned” notes that were incorrect.
After you have developed your own answers to questions, then you should to work with others.
a. determine whether you left out key points
b. practice verbally answering questions with classmates
PRACTICE, PRACTICE, PRACTICE
a. write out answers without looking at notes
b. verbally answer questions without looking at notes
Set yourself a schedule for answering the questions. Be sure to leave yourself time to practice
answering questions. Past experiences with students have shown that one week or one month of
studying is NOT insufficient preparation.
Dr. Rollin and Dr. Jackson are available for questions or review in areas of physiology.
Dr. Rollin is available for questions or review of immunology. We suggest that you outline
answers to questions, then groups of students can make an appointment.
Dr. Rollin: 860-832-2659; Email:
Dr. Jackson: 860-832-2650; Email:
CENTRAL CONNECTICUT STATE UNIVERSITY
Department of Biology
M.S. Biological Sciences: Anesthesia Program
COMPREHENSIVE EXAM QUESTIONS – Plan B
HUMAN ANATOMY, PHYSIOLOGY AND PATHOPHYSIOLOGY QUESTIONS
(Revised Jan, 2014)
Cell Physiology, Electrophysiology, and Muscles
1. Discuss active and passive transport through cell membranes.
a. What is diffusion? Facilitated diffusion?
b. Discuss the Fick Equation for diffusion.
c. Describe osmosis. How is osmosis different from diffusion?
2. Discuss the Nernst potential and its role in the membrane potential.
3. Discuss how the resting membrane potential is maintained. What is the role of the sodium-potassium pump?
4. Discuss differences in the generation of the action potential for skeletal muscle, smooth muscle, ventricular cardiac muscle, sinus nodal tissue, and neurons.
5. Compare and contrast skeletal muscle contraction, cardiac muscle contraction, and smooth muscle contraction.
6. Describe the neuromuscular junction, including mechanisms involved in the release of neurotransmitters from presynaptic membrane and the electrical and chemical events occurring at the postsynaptic membrane as a result of the type of the neurotransmitter released.
7. Discuss glycolysis. What are the products of glycolysis and where does glycolysis occur?
8. Discuss the citric acid cycle.
a. What are the products?
b. What are the products of the electron transport chain?
c. Where is CO2 produced?
d. Where is O2 used?
Thermoregulation
1. Discuss the regulation of body temperature during heat challenge and during cold.
2. Discuss thermoregulation in infants and the elderly.
Endocrine System
1. What hormones regulate metabolism and how do they work?
2. Discuss the roles of the hypothalamus, pituitary, and gonads in the hormonal regulation of puberty (male/female), ovulation, menstruation, pregnancy and parturition.
3. Discuss the factors that control GH secretion, and the effects of normal, excess or inadequate GH production (include in your answer the roles of GH-RH, somatostatin, and somatomedins).
4. Discuss the functions and regulation of the pancreas, thyroid gland, adrenal glands and parathyroid glands.
5. Discuss diseases involving the pancreas, thyroid glands, adrenal glands and parathyroid glands.
Renal System
1. Describe the processes of glomerular filtration, tubular reabsorption, secretion and excretion.
a. Describe how we produce a concentrated urine.
b. How is flow in the renal system autoregulated?
2. Discuss secretion and functions of ADH.
3. Discuss the renin-angiotensin-aldosterone system in terms of the kidney and peripheral vasculature changes.
4. Discuss renal clearance equations.
Acid-base balance
1. Discuss roles of the respiratory and renal systems in acid-base balance and the causes/treatments/compensations for persons with metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis.
2. Discuss the carbonic acid formation and dissociation and the components of the Henderson-Hasselbach Equation.
Water balance
1. Discuss the hormones that are responsible for water balance during dehydration and how they work.
2. Discuss the hormones released during volume overload and what they do.
Nervous system
1. Compare the conduction of the action potential in myelinated and non-myelinated axons. What is salutatory conduction?
2. Discuss the difference between metabotropic and ionotropic receptors.
3. Describe how the following neurotransmitter receptors work. Describe the neurotransmitters that act on them, any agonists and antagonists, the ions that they control, whether they are ionotropic or metabotropic, and an intracellular mechanisms that they regulate:
a. GABA receptor
b. Nicotinic and Muscarinic receptors
c. β adrenergic and α adrenergic receptors
d. Glutamate receptors
4. Describe an EPSP and an IPSP.
a. What are their functions?
b. How are they different from an action potential?
c. Discuss the concepts of spatial and temporal summation.
5. Discuss the anatomical and physical properties of the major components of the central nervous system.
6. Describe the somatic sensory pathways.
a. How are tactile sensations detected? Discuss types of sensory transduction.
b. Describe the Dorsal Column- Medial Lemniscal system.
c. Describe the Anterolateral system.
d. Describe how pain, thermal, and headache sensations are transmitted to the CNS.
7. Describe the mechanisms involved in the release of neurotransmitters from the presynaptic membrane, along with the electrical and chemical events occurring at the postsynaptic membrane as a result of the type of neurotransmitter released.
8. Describe the cranial nerves anatomically and physiologically.
9. Compare the subdivisions of the autonomic nervous system anatomically, physiologically and pharmacologically.
Heart and Cardiovascular System
1. Discuss how hormones affect vascular tone. Which receptors and signaling mechanisms are used?
2. Discuss how preload, afterload, contractility and heart rate influence cardiac performance.
3. Discuss the role of peripheral resistance in the control of circulatory flow rate and mean arterial pressure.
4. Discuss the physiologic system responsible for the Frank-Starling Law of the Heart.
5. Discuss the baroreceptor reflexes anatomically and physiologically.
6. Identify the major waveforms of the ECG with physiological events occurring in the heart.
7. Discuss the ionic mechanism of rhythmicity in the SA node.
a. How do autonomic neurotransmitters or hormones influence the SA node?
8. What are the ionic events of a ventricular action potential?
9. Discuss the relationship between ventricular end-diastolic pressure and stroke work and the effect of ionotropic influences upon it.
10. Describe the relationship between HR, SV and CO.
11. What factors are involved in acute, long term, and local blood flow regulation?
12. Discuss the relationship between blood flow, blood pressure and resistance in the circulation.
13. Discuss the fetal circulation and what happens to it after birth
Respiratory system
1. Discuss how changes in pulmonary compliance are related to lung diseases?
2. List the normal values for lung volumes and capacities and describe how they are determined.
3. Define Boyle’s, Charles’, Dalton’s, Graham’s and Henry’s Laws.
4. Describe what happens during a forced expiration? What is air trapping and where is air trapped?
5. Discuss the transport of oxygen and carbon dioxide by the blood. Indicate in your answer:
a. Factors that modify the affinity of Hb for oxygen ( i.e., acidity, organic phosphates,
b. temperature)
c. Factors that modify the carbon dioxide dissociation curve ( i. e., Bohr effect, Haldane effect).
6. Discuss the diffusion of oxygen and carbon dioxide across the alveolar-capillary membrane from physiological and pathophysiological points of view.
7. Describe and account for the composition of alveolar gas compared to atmospheric gas.
8. Discuss the location and operation of central, neural and peripheral respiratory control systems and how they function to maintain normal arterial blood gas values.
Department of Biology
M.S. Biological Sciences: Anesthesia Program
COMPREHENSIVE EXAM QUESTIONS – Plan B
Oral Comprehensive Questions in Applied Physiology & Pathophysiology
(Revised January 2017)
Cardiovascular
Describe the cardiac cycle in terms of normal flow-volume loops and the alterations caused by different clinical situations including valve diseases.
Explain the phasic nature of coronary artery perfusion and the coronary pressure equation: AoDP – LVEDP. Explain clinical situations that alter coronary perfusion e.g. heart rate, coronary spasm, thrombi
Discuss in detail hemodynamic and cardiac monitoring including
· 12-lead EKGs (rhythm, presence of Q wave and ST changes in ischemia, injury and infarction detection)
· central venous pressure and pulmonary artery pressure monitoring.
Define and discuss in detail the five cardiovascular variables that can be measured and manipulated by clinicians:
· preload (include Frank Starling Law, interventricular radius)
· afterload (include systemic vascular resistance, interventricular pressure)
· contractility (include inotropy, ejection fraction)
· rate
· rhythm (include examples e.g. atrial fibrillation, PVCs)
Discuss in detail myocardial oxygen supply and demand. Include clinical examples of alterations, clinical diagnosis and management. Including the effects of
· heart rate, diastolic time
· coronary artery diameter
· oxygen content
· wall tension, LaPlace’s Law
· contractility
· muscle mass
· arterial oxygen content
· LVEDP and AoDP
Discuss Law of LaPlace as related to the heart, myocardial oxygen demand, wall tension, wall thickness,
Discuss the Poiseuille’s Law as it relates to blood flow, resistance, radius, viscosity, pressure. Give clinical examples.
Describe cardiac pathophysiology including
· heart failure
· coronary artery disease, myocardial ischemia/infarction, coronary syndrome,
· hypertension
· cardiogenic shock
· valvular diseases including aortic and mitral stenosis, aortic and mitral regurgitation
Explain the changes in circulation that occur at birth; discuss basic pathophysiologic alterations of congenital heart disease including patent ductus arteriosus, tetralogy of Fallot, atrial septal defect, ventricular septal defect. Identify flow patterns of right to left versus left to right shunts and their effects on cardiac output, and oxygenation.
Pulmonary
Define ventilation, respiration, normal patterns, definitions, deadspace (anatomic, physiologic, alveolar) vs. shunt units, tidal volume, diaphragmatic performance, control of ventilation, lung zones, perfusion versus ventilation (VQ matching)
Discuss oxygen tension in the atmosphere (PO2), conducting airways, alveoli (PAO2) and arteries (PaO2). Explain the oxyhemoglobin dissociation curve. Explain how oxygen is carried in blood
Discuss in detail oxygen content (CaO2), oxygen delivery (DaO2), arterial (SaO2) versus venous (SvO2) oxygen saturation measurements and utilization, clinical management and equations/calculations.
Explain flow volume curves and loops, arterial blood gases, and how they are affected by various obstructive (e.g. asthma) and restrictive (e.g. obesity) lung diseases.
Explain the alveolar gas equation. Explain all the oxygen equations including respiratory quotient. Discuss clinical applications.
Discuss in detail the five causes of hypoxemia:
· V/Q mismatching
· Hypoventilation
· Low FiO2
· Diffusion abnormalities
· Right to left shunting.
· Give examples, do calculations, discuss clinical management.
Discuss in detail A-a gradients. Explain the shunt graph including the relationship between FiO2 and PaO2.
Explain in detail the clinical diagnosis and management of hypoxemia, hypoxia, and respiratory failure.
Explain hypoxic pulmonary vasoconstriction.
Contrast cardiogenic and non-cardiogenic pulmonary edema. Discuss ARDS.
Explain pneumothorax, tension pneumothorax, obstructive versus restrictive disease – give examples. Discuss the pathophysiology of asthma, its diagnosis, and its clinical management. Discuss pulmonary embolism. Discuss pulmonary hypertension. Discuss lung cancer. Discuss obstructive sleep apnea, perioperative risk assessment, STOPBANG scoring, and its clinical management.
Explain the differences in a child’s pulmonary system including compliance, oxygen consumption, and pediatric pathophysiology such as upper versus lower airway obstructions, croup versus epiglottitis, stridor, sleep apnea, aspiration of foreign bodies, scoliosis
Renal
Compare acute versus chronic renal failure in terms of
· signs & symptoms
· serum and urine lab tests
· time course, progression/stages
· etiology
· reversibility
· risk factors
· clinical management
With respect to chronic renal failure, explain the
· causes
· manifestations of chronic renal failure on all body systems
Explain why NSAIDs and morphine are contraindicated in chronic renal insufficiency.
Explain why ACEi are potentially beneficial in management of chronic renal failure.
Neurologic
Describe the arterial supply to the brain (Circle of Willis) and spinal cord.
Discuss the pressure dynamics in the brain including the relationship between:
· cerebral blood flow, and ICP, MAP, PO2, PCO2
· mean artery pressure (MAP) and intracranial pressure (ICP)
· normal and abnormal ICP; brain, CSF and blood, Cushing’s Triad
Explain clinical recognition and management of increased ICP including:
· the Monroe Kellie Hypothesis; ICP vs. ICV; herniation
· normal blood flow values
· autoregulation
· abnormal states e.g. hydrocephalus, cerebral edema
Compare early signs of an elevated ICP to late signs and discuss the clinical management to prevent herniation.
Explain the anatomy and physiology of spinal vertebrae, spinal nerve roots and plexuses (including the cervical, brachial, lumbar and sacral plexi).
Explain the consequences of different levels of spinal cord damage in terms of sensory, motor and autonomic deficits. Explain dermatomes and myotomes in detail as they relate to both spinal cord trauma or disease and spinal or epidural anesthesia.
Define pain, pain pathways, explain tolerance, physical dependence, addiction. Explain the pathophysiology of pain including transmission, neuromodulation, endorphins, opioid receptors, types of pain, treatment of pain.
Discuss sleep apnea.
Contrast seizures and convulsions. Explain factors that alter seizure thresholds.
Outline neurological disorders: Alzheimer’s, Huntington’s, Parkinson’s, traumatic brain injury (outline the Glasgow Coma Scale), epidural and subdural hematomas, spinal cord injuries, spinal shock, autonomic hyperreflexia, CVAs, aneurysms, multiple sclerosis, Guillian Barre, Amyotrophic Lateral Sclerosis, Myasthenia Gravis.
Musculoskeletal
Briefly define rhabdomyolysis; osteomyelitis; osteoarthritis; ankylosing sponylitis; scoliosis.
Discuss muscular dystrophies including Duchenne Muscular Dystrophy and its importance in anesthesia.