Blood flow, abnormal local variations and clinical presentations

Question 1

22 y/o woman with abdominal pain and fever, pain started generalised and now worse in RIF, BP is 85/55 HR 119

Answer 1

Septic shock

50% rise of serum creatinine in last week is acute kidney injury

Question 2

Mechanism of septic shock and example

Answer 2

Driven by vasodilation due to systemic inflammation - e.g. bacteraemia

Question 3

Mechanism of cariogenic shock and example

Answer 3

Poor cardiac output due to pump failure = low BP

E.g. heart failure and bradycardia

Question 4

Neurogenic shock mechanism and e.g.

Answer 4

Excessive P/s or deficient S response

e.g. blood loss

Question 5

Hypovolemic shock and sx

Answer 5

Reduced blood volume = reduced pump efficacy and pressure

Blood loss is e.g.

Question 6

Anaphylactic shock mechanism and e.g.

Answer 6

Massive histamine and IgE response = inflammation

Anaphylaxis is e.g.

Question 7

Obstructive shock mechanism and e.g.

Answer 7

Blockage in major vessel = increased BP

E.g. includes aortic stenosis and PE

Question 8

Ohm’s law calculations

Answer 8

• Blood pressure = blood flow (cardiac output) x peripheral resistance
• Cardiac output = heart rate x stroke volumr
• BP = heart rate x stroke volume x peripheral resistance

Question 9

Why is noradrenaline essential in times of stress?

Answer 9

Constricts non-essential vessels e.g. GIT but dilates essential vessels = higher BP

Question 10

58 y/o man is drowsy and confused, temp is 38.4, HR 112, BP 90/72, sats 86%

Answer 10

CAP by streptococcus pneumonia and sepsis

SEPSIS 6 = BUFALO

Question 11

Breathlessness and dizziness on exertion, O/E normal obs with ejection systolic murmur and slow rising pulse

Answer 11

Aortic stenosis
Diagnose echocardiography
Treat valve replacement t

Question 12

STEMI treatment

Answer 12

PCI (Stent)

ACEi (ramipril), B blockers, aldosterone antagonist etc

Question 13

Pain in both calves, feet are cold and weak pedal pulses

Answer 13

Intermittent claudication (In DVT would be one leg)
Manage with reducing risk factors, exercise and analgesia

Question 14

Timeframe of TIA

Answer 14

Lasts less than 24h

Question 15

How do the different strokes appear on CT?

Answer 15

Ischaemic acute stroke would initially look normal on CT

Strokes only show on CT after a few dyas

Haemorrhagic stroke is visible on CT straight away

Question 16

How do you manage ischaemic stroke?

Answer 16

If within 4/5 hours use thrombolysis and if not use anti platelets