E3.i · Diuretics

This viva will explore your knowledge of renal physiology and diuretics. Describe how sodium is handled in the nephron.

This viva will examine the pharmacology of diuretics. Demonstrate the mechanism of action of diuretics along the nephron. (Image removed from report.)

This viva will examine liver physiology and diuretics. Describe the blood supply of the liver.

This viva tested knowledge of physiology related to renal clearance and the pharmacology of diuretic agents.

This viva tested knowledge of renal physiology and the pharmacology of diuretics. It discussed the functions of the kidney, GFR and factors that influence plasma creatinine.

This Viva tested knowledge of renal physiology and related pharmacology. It explored understanding about acid base balance, renal handling of bicarbonate and moved on to the pharmacology of diuretics.

This Viva tested knowledge on intravenous fluids. It explored understanding about colligative properties, anion gap and moved on to the pharmacology of frusemide.

This Viva tested knowledge of renal physiology and diuretic pharmacology. It explored nephron structure and function, sodium handling and diruretic pharmacology.

This Viva tested knowledge of renal physiology and pharmacology. It began by asking what the normal Glomerular Filtration Rate (GFR) is and what the determinants of GFR are. It also explored knowledge of glomerular-tubular feedback, the counter current system and diuretics. Although most candidates had a good knowledge of GFR and its determinants, fewer were as confident to recall the actual values or to apply that physiology to scenarios like hypovolaemia. Some candidates struggled to explain the counter current mechanism, in particular the “multiplier” effect. Mechanism of action of diuretics was well answered.

This Viva will explore your knowledge of fluids and colligative properties. What is in a bag of 0.9% Saline? Subsequent questions explored knowledge of osmolality, osmolarity, mannitol, colligative properties of fluids, anion gap, classification of diuretics and mechanism of actions.

This Viva will examine liver physiology and diuretics. During this Viva candidates were asked about the functions of the liver, liver drug metabolism, blood supply and the physiological consequences of cirrhosis upon liver blood flow. Candidates were also asked about frusemide, frusemide associated biochemical disturbances

The initial information given to the candidates was – This viva will test your knowledge about the use of diuretics, pharmacokinetics and dynamics. And Use of drugs during a cardiac arrest. Candidates were asked to explain mechanism of action of diuretics, in particular frusemide. Candidates were also tested upon the basis that various vasoactive drugs (eg adrenaline and vasopressin) are used in cardiac arrest, in particular their mechanism of action and routes of administration.

a period of prolonged vomiting. An arterial blood gas analysis was performed on room air, revealing the following findings. pH 7.59 (7.35 – 7.45) PaCO2 58 mmHg (35 – 45) PaO2 72 mmHg (90 – 110) HCO3- 59 mmol/L (22 – 32) Interpret the findings. This viva tested the candidate’s knowledge of renal physiology related to the control of urinary pH, effects of acetazolamide and frusemide upon metabolic acid base state and respiratory response to metabolic acid base changes. The main points expected for a pass were knowledge of : • Respiratory response to changes in metabolic acid base. Use of correctly labelled graph or common formulae • Renal handling of H+ at the proximal and distal tubules. • Mechanism of HCO3- reabsorption and regeneration • Urinary buffers such as phosphate, ammonia and glutamine • Mechanism of frusemide associated metabolic alkalosis • Affect of acetazolamide on HCO3- The use of illustrations greatly assisted candidates to answer questions within this viva Syllabus : D1-2e, D2a and B1c-2a & b Reference : Textbook of Medical Physiology by A. C Guyton & J. E Hall.