Blood Pressure

Question 1

MAP (Mean Arterial Pressure) =

Answer 1

CO (cardiac output) x TPR (total peripheral resistance)

Question 2

MAP is measures in

Answer 2

mmHg

Question 3

If MAP is too high =

Too low =

Answer 3

hypertension
fainting (syncope)

Question 4

Inputs to medullary CVS centres are:

Answer 4

1. cardiopulmonary baroreceptors
2. central chemoreceptors
3. muscle chemoreceptors
4. joint receptors
5. higher centres

Question 5

Angiotensin II causes

Answer 5

arteriolar constriction

increased TPR

Question 6

Aldosterone causes

Answer 6

increase Na+ reabsorption

increased plasma volume

Question 7

Vasopressin is an

Answer 7

antidiuretic horome

Question 8

Vasopressin causes

Answer 8

arteriolar constriction
increased TPR
increased Na+ excretion
decreased blood volume

Question 9

Atrial and brain natriuretic peptide both cause

Answer 9

arteriolar dilation
decreased TPR
increase Na+ secretion
decreased blood volume

Question 10

The effect of standing on BP causes an increase in

Answer 10

hydrostatic pressure

pooling of blood in legs/feet

Question 11

The effect of standing on BP causes a decrease in

Answer 11

VR, EDV, preload, SV, CO , MAP, baroreceptor firing rate

Question 12

The reflex response decreases

Answer 12

vagal tone

so, increase in HR and CO

Question 13

The reflex response increases

Answer 13

sympathetic tone

so, increase in HR and CO

Question 14

The reflex response also increases three other things:

Answer 14

contractility (in turn SV and CO) 
venoconstriction (in turn VR, EDV, SV and CO) 
arteriolar constriction (in tun TPR)

Question 15

The valsalva manoeuvre =

Answer 15

forced expiration against a closed glottis

Question 16

Long term control of BP controlled by ______ and what three hormone systems?

Answer 16

plasma volume by the kidney

renin-angiotensin-aldosterone system
antidiuretic factor (ADH, vasopressin)
atrial natriuretic peptide

Question 17

Functions of the kidney include

Answer 17

excretion of waste
maintaining ion balance
regulation of pH, osmolarity, plasma volume

Question 18

A very permeable collecting duct =

Answer 18

small volume of hypo-osmotic urine

Question 19

A very impermeable collecting duct =

Answer 19

large volume of hyper-osmotic urine

Question 20

The release of ADH triggers an increase in _________ and a decrease in __________

Answer 20

osmolarity of interstitial fluid

blood volume

Question 21

What does ADH do?

Answer 21

increases permeability of collecting duct to water
(reduces diuresis, increases plasma volume)

vasoconstriction, therefore increasing MAP

Question 22

Where is atrial natriuretic peptide produced?

What happens when it is released?

Answer 22

myocardial cells in atria

increased distension of atrium

Question 23

The function of ANP is to

Answer 23

increase secretion of Na+
inhibit release of renin
act on medullary centres to reduce MAP

Question 24

Name 4 drug treatments for hypertension

Answer 24

Ca2+ channel antagonists
B-adrenogenic receptor antagonists
Thiazide diuretics
Angiotensin converting enzyme inhibitors

Question 25

What is an atheroma/atherosclerosis?

Answer 25

formation of focal elevated lesion (plaques) in intimate of large and medium sized vessels

Question 26

The consequences of atheroma include

Answer 26

ischaemia angina myocardial infacrtion (by ischaemia) complications by thromboembolism

Question 27

In a complicated atheroma, the following can happen

Answer 27

haemorrhage into plaque (calcification) thrombosis plaque rupture/fissuring

Question 28

Hypercholesterolaemia causes

Answer 28

plaque formation and growth in absence of any other risk factors

Question 29

Hyperlipidaemia may be due to

Answer 29

``` drug relations diabetes obesity alcoholism total cholesterol (HDL and LDL) ```

Question 30

Physical signs of hyperlipidaemia include

Answer 30

discolouration of eyes | fatty lumps on knuckles/achilles or in skin/around eyes

Question 31

Major risk factors of atheroma include

Answer 31

``` smoking hypertension diabetes mellitus being male being old ```

Question 32

The two steps in the formation of an atheromatous plaque are:

Answer 32

1. injury to endothelial lining of artery | 2. chronic inflammation/healing response of vascular wall to this injury

Question 33

Stenosis of 50-75% of lumen =

Answer 33

stable angina (reversible tissue ischaemia)

Question 34

Very severe stenosis of lumen =

Answer 34

unstable angina (ischaemic pain at rest)

Question 35

Total Occlusion of the lumen in the following areas leads to what? 1. coronary artery 2. carotid or cerebal arteries 3. ileal, femoral, popliteal arteries

Answer 35

1. myocardial infarct 2. stroke 3. lower limb gangrene

Question 36

Gradual dilation of a great vessel is caused by

Answer 36

the media beneath the atheromatous plaque being gradually weakened

Question 37

How to control risks of atheroma

Answer 37

``` Stop smoking Control of BP Weight-loss Regular exercise Dietary modifications ```

Question 38

Drug control in people at risk of atheroma

Answer 38

Cholesterol lowering drugs (aspirin) or surgical options

Question 39

What does aspirin do?

Answer 39

inhibits platelet aggregation to decrease risk of thrombosis on established atheromatous plaques

Question 40

How can BP vary during the day?

Answer 40

Physical stress Mental stress Exercise

Question 41

Stage 1 Hypertension is defined by

Answer 41

Clinical BP 140/90 mmHg or more ABPM average 135/85 mmHg or more

Question 42

Stage 2 Hypertension is defined by

Answer 42

Clinical BP of 180 mmHg or more ABPM average 150/95 mmHg or more

Question 43

Stage 3 Hypertension is defined by

Answer 43

Clinical systolic BP is 180 mmHg or more Clinical diastolic BP is 110mmHg or more

Question 44

Primary Hypertension makes up how many of total cases?

Answer 44

95%

Question 45

The 5% of secondary causes of hypertension include?

Answer 45

chronic renal disease renal artery disease endocrine disease (Cushing's, Chron's)

Question 46

The activation of the sympathetic nervous system produces

Answer 46

vasoconstriction reflex tachycardia increased cardiac output

Question 47

Factors affecting blood pressure include

Answer 47

``` age genetics/family history weight (and birth weight) alcohol/salt intake environment (stress) race ```

Question 48

To treat hypertension in a young person, what would be used?

Answer 48

high renin (A) = ACE inhibitor/ARB

Question 49

To treat hypertension in an elderly person, what would be used?

Answer 49

low renin (C or D) = calcium channel blocker or thiazide-type diuretic

Question 50

What are the contraindications of angiotensin converting enzyme inhibitors?

Answer 50

renal artery stenosis renal failure hyperkalaemia

Question 51

What adverse drug reactions can ACEIs cause?

Answer 51

``` cough first dose hypotension taste disturbance renal impairment angioneurotic oedema ```

Question 52

How to calcium channel blockers work?

Answer 52

vasodilate block L type calcium channels reduce cardiac output

Question 53

Contraindications of Ca2+ channel blockers?

Answer 53

acute MI heart failure bradycardia

Question 54

Adverse drug reactions of Ca2+ channel blockers?

Answer 54

flushing headache ankle oedema indigestion/reflux oesophagitis

Question 55

Thiazide-type diuretics are used in

Answer 55

first line treatment in Afro-Caribbeans | combo with any other antihypertensive drug

Question 56

Thiazide-type diuretics work by

Answer 56

blocking reabsorption of Na+ | enhance urinary sodium loss

Question 57

Thiazide-type diuretics can cause

Answer 57

impotence | gout