C6.i · V/Q Relationships & West Zones

This VIVA will examine respiratory physiology. The following diagram represents the West zones of the upright healthy lung. Describe this model of pulmonary blood flow distribution.

This viva will examine respiratory physiology. Using the diagram describe the regional variability of ventilation and perfusion in the lung. (Image removed from report.)

This viva will explore your knowledge and understanding of respiratory physiology and pharmacology. Use the diagram below to demonstrate regional variability of ventilation and perfusion through the upright lung. (Image removed from report.)

This viva will explore your understanding of respiratory physiology. Describe the V/Q ratios throughout the lung in the erect position for a healthy individual.

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 information is from a patient with a pulmonary embolism FIO2 0.5 PaO2 100mmHg PaCO2 20mmHg Calculate the A-a gradient.

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