Syllabus · Historical · V4 (2023) · Body Fluids and Electrolytes
I1 · Physiology of Body Fluids and Electrolytes
I1.iii · Physiology of Body Fluids and Electrolytes
Describe the distribution, regulation and physiological importance of sodium, chloride, potassium, magnesium, calcium, and phosphate ions.
Written examination
SAQ history
Calcium Regulation
4 exam appearances
a) Outline the distribution of calcium in the body and provide the normal range of plasma calcium concentration (20% of marks).
b) Outline the regulation of plasma calcium (50% of marks).
c) Outline other physiological factors that may influence plasma calcium concentration (30% of marks).
74.7%
Outline the distribution of calcium in normal plasma (20% of marks). Describe the hormonal control of the calcium concentration in the plasma (80% of marks)
53%
Outline the regulation of plasma calcium concentration. Outline the mechanism of action of biphosphonates for the management of hypercalcaemia.
33%
Electrolytes — Calcium
1 exam appearance
Outline the role of calcium in the body (70% of marks). Outline the differences between calcium chloride and calcium gluconate solutions (30% of marks).
33%
Electrolytes — Hyperkalaemia ECG
1 exam appearance
Describe the electrocardiographic (ECG) changes seen with hyperkalaemia. (30% of marks) Outline the pharmacologic principles of drugs used in the management of severe hyperkalemia. (70% of marks)
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Electrolytes — Hyperkalaemia Treatment
1 exam appearance
Describe the mechanism of actions and duration of effect of drugs used to lower potassium in hyperkalaemia.
55%
Electrolytes — Magnesium
2 exam appearances
Outline the distribution, clearance and physiologic functions of magnesium in the body.
36%
Outline the distribution, clearance and physiologic functions of magnesium in the body
20%
Electrolytes — Phosphate
1 exam appearance
Outline the distribution, absorption, elimination, regulation and physiological role of phosphate.
29%
Electrolytes — Potassium & Hyperkalaemia
1 exam appearance
Describe the determinants of serum potassium. Outline the consequences of acute hyperkalaemia.
43%
Electrolytes — Potassium Flux
1 exam appearance
Electrolytes — Potassium Regulation
2 exam appearances
Magnesium Sulfate
5 exam appearances
Sodium Bicarbonate
1 exam appearance
Renal Tubular Physiology — Potassium Handling
3 exam appearances
Describe renal handling of potassium (60% of Marks), including physiological factors that may influence it (40% of Marks).
33%
Describe renal handling of potassium (60% marks), including factors that may influence it (40% marks).
33%
Renal Tubular Physiology — Sodium Handling
3 exam appearances
Describe how the kidney handles sodium. (50 marks) What factors influence urinary sodium excretion (50 marks)
22%
Oral examination
VIVA history
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2026A · VIVA 4
Relevant examiner prompt
Following a period of starvation, why do electrolytes become deranged with reintroduction of calories?
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2026A · VIVA 5
Relevant examiner prompts
Explain the effect of high serum potassium on the ventricular action potential?
How is the SA node action potential changed by high serum potassium?
Relate those changes in the action potential to the changes on the ECG (in hyperK)?
How does iv calcium help in this situation?
How is digoxin toxicity affected by serum potassium level?
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2024B · Day 1 · VIVA 4
This VIVA will examine calcium physiology and pharmacology. How does the body handle calcium, including its absorption, elimination and distribution?
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2024A · Day 2 · VIVA 4
This VIVA will examine your potassium physiology and pharmacology. Beginning at the glomerulus, describe how potassium is handled along the nephron? (Image removed from report.)
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2023B · Day 2 · VIVA 3
This viva will examine cellular physiology. What are the concentrations of sodium potassium and chloride in the extracellular and intracellular fluid of a skeletal myocyte? (Image removed from report.)
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2023B · Day 2 · VIVA 4
This viva will examine renal potassium handling and channel physiology. How is potassium handled at the numbered sites? (Image removed from report.)
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2023A · Day 1 · VIVA 5
This VIVA will examine oxygen measurement and sodium channel physiology. In what ways can oxygen tension or concentration be measured?
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2019B · Day 2 · VIVA 1
This viva will explore your knowledge of renal physiology and diuretics. Describe how sodium is handled in the nephron.
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2019B · Day 3 · VIVA 6
This viva will test your knowledge of potassium. How is total body potassium regulated?
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2019A · Day 1 · VIVA 6
This viva is about renal function, including fluid and chloride clearance. Define renal clearance and describe how we measure glomerular filtration.
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2018A · Day 2 · VIVA 8
This viva will examine adreno-receptors, second messengers and calcium. Classify adreno-receptors and their secondary messenger systems.
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2017B · Day 1 · VIVA 5
This viva will test your knowledge of respiratory physiology and the renal handling of sodium. Describe the oxygen cascade – from the atmosphere to the tissues (in a normal healthy adult) using appropriate PO2 values.
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2017B · Day 2 · VIVA 1
This viva will test your knowledge of renal physiology and potassium. Briefly outline the functions of the kidney.
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2017B · Day 2 · VIVA 4
This viva is about cardiovascular physiology and calcium. Define afterload and list the components.
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2016A · Day 1 · VIVA 1
This viva tested knowledge of cardiovascular physiology. It discussed cardiac output, stroke volume, sarcomere length myocardial contractility, the role of calcium and then related pharmacology of drugs that increase cardiac contractility including catecholamines and digoxin.
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2015B · VIVA 4
This Viva tested knowledge of the physiology of calcium and related pharmacology. It explored the role of calcium on the cardiac myocyte and the bodies’ regulation of calcium.
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2014A · VIVA 2
This Viva tested knowledge of renal physiology and diuretic pharmacology. It explored nephron structure and function, sodium handling and diruretic pharmacology.
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2013B · VIVA 6
This Viva tested knowledge of on the physiology of calcium and the pharmacology of calcium channel antagonists. Although some candidates performed well, there was generally a lack of sufficient knowledge of the control of calcium.
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2012B · VIVA 4
This viva will examine knowledge of Calcium. Consider the normal levels of calcium in blood and factors which affect it. Subsequent discussion focused on calcium physiology and pharmacology of verapamil.
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2011A · VIVA 7
This Viva will test your knowledge of renal physiology and potassium regulation Q 1. Briefly outline the functions of the kidney? This viva tested, briefly, knowledge of renal function, as well as covering hyperkalaemia in some depth. Candidates had a general knowledge related to hyperkalaemia, but struggled to explain the cardiac consequences as they related to the cardiac action potential and as they reflected upon the ECG.
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2009A · VIVA 8
In this viva you will be asked to discuss cell membrane physiology and electrolyte disturbances. Draw a cell membrane. A detailed syllabus has been developed and forms the foundation for the knowledge base for the JFIC Primary Examination. All questions are sourced directly from that syllabus and candidates should have a sound understanding of those topics, and confidence to express their understanding of the subject material in both written and oral form. The candidates should be able to integrate and express basic physiological and pharmacological principles as to how the relate to various scenarios relevant to Intensive Care practice. Candidates would find it valuable to develop strategies and standard formats to answer typical questions, eg compare and contrast the pharmacology of Drugs X and Y. Candidates are also strongly encouraged to use accurate and labelled figures and tables wherever possible to help display their knowledge and to describe basic principles. Dr Gill Bishop Chair Primary Examination Committee Circulation: Board of Joint faculty Panel of Examiners Supervisors of Intensive Care Training Course Supervisors Regional Education Offices Registered Trainees
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2008B · VIVA 6
The initial information given to the candidates was - This viva will mostly cover pharmacology and physiology of insulin. Describe the primary function of insulin. This viva explored the candidates’ knowledge in relation to the following points Structure, mechanism of action and physiology of natural insulin Insulin preparations Pathophysiology of re-feeding syndrome Examination feedback: Candidates knowledge in relation to the physiology of insulin was good and much stronger than their knowledge in relation to the pharmacology of the different insulin preparations. It is important that candidates have a good understanding of the pharmacology of insulin preparations as well as remain up to date with changes in those preparations. Candidates also struggled with describing the basic elements, in particular the changes to electrolytes, associated with the re-feeding syndrome.
Sources: objective text from the relevant CICM syllabus; historical SAQ and VIVA wording from CICM examiner reports.