F5.ii · Pulmonary Circulation

This viva tested knowledge of cardiovascular physiology and pharmacology, the Frank Starling mechanism, venous return and stroke volume. It went on to discuss cardiac output measurement and the pharmacology of milrinone, West’s zones of the lung and pulmonary vascular resistance.

This Viva will discuss the pharmacology and the physiology related to the pulmonary artery pressure. Q1. What is the normal pulmonary artery pressure, and which factors will increase the pulmonary artery pressure? Subsequent questions asked about factors that increase pulmonary artery pressure, drugs used to treat pulmonary hypertension and their mechanism of action, advantages of NO over other drugs, how pulmonary artery pressure may be measured at the bed side, how to determine Pulmonary Vascular Resistance.

The initial information given to the candidates was - This Station will explore aspects of respiratory physiology and related measurement. This Chest Xray shows complete collapse of the Left Lung. What patho-physiological processes might contribute to Hypoxia in this patient? This viva explored the candidates’ knowledge in relation to the following points Describe ventilation and perfusion to the lung and illustrate their relationship Significance of high and low V/Q Shunt and mechanisms to limit hypoxia, effect of supplemental oxygen Pulmonary Vascular Resistance Pulse Oximetry, principles of measurement, limitations (A digital reproduction of a CXR was displayed – but candidates were not expected to make any clinical interpretation of the CXR and were provided with the CXR findings and diagnosis) Examination feedback: Candidates used graphs to illustrate their discussions with good effect. Areas of weakness was in understanding and explaining the limitations of the pulse oximetry. 3 ( 100%) candidates passed this questions 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 Arthas Flabouris Deputy Chair Primary Examination Committee Circulation: Board of Joint faculty Panel of Examiners Supervisors of Intensive Care Training Course Supervisors Regional Education Offices Registered Trainees