Cardiac Week 2

Question 1

Topic 1: Anatomy of Blood Vessels - Q1: Identify the major arteries/ veins/ and lymphatic supply throughout the body.

Answer 1

A:Major Arteries : Aorta/ carotid arteries/ subclavian arteries/ renal arteries/ femoral arteries. [cite: 1/ 2/ 3] Major Veins : Superior vena cava (SVC)/ inferior vena cava (IVC)/ jugular veins/ femoral veins/ renal veins. [cite: 1/ 2/ 3] Lymphatics : Thoracic duct/ lymph nodes near major vessels. [cite: 1/ 2/ 3/ 4]

Question 2

Topic 1: Anatomy of Blood Vessels - Q2: Describe the physical and functional features of conducting arteries/ distributing arteries/ small arteries/ and arterioles.

Answer 2

A:Conducting Arteries : Large elastic arteries (e.g./ aorta); expand and recoil to maintain blood flow during diastole. [cite: 4/ 5/ 6] Distributing Arteries : Medium muscular arteries; regulate blood flow to specific organs. [cite: 4/ 5/ 6] Small Arteries/Arterioles : Smooth muscle regulates resistance; critical for blood pressure control. [cite: 4/ 6/ 7]

Question 3

Topic 1: Anatomy of Blood Vessels - Q3: Describe the physical and functional features of venules/ medium veins/ and large veins.

Answer 3

A:Venules : Small/ collect blood from capillaries. [cite: 7/ 8] Medium Veins : Contain valves to prevent backflow. [cite: 7/ 8/ 9] Large Veins : Thick walls/ large lumen (e.g./ IVC/ SVC). [cite: 7/ 9]

Question 4

Topic 1: Anatomy of Blood Vessels - Q4: Compare and contrast histological features of arterial and venous walls.

Answer 4

A:Arteries : Thick tunica media with elastic fibers; narrow lumen. [cite: 10/ 11] Veins : Thin tunica media; wider lumen; valves present. [cite: 10/ 11]

Question 5

Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q1: Explain the relationship between pressure/ volume/ resistance/ and flow through a tube.

Answer 5

A:Flow = Pressure difference ÷ Resistance. [cite: 12/ 13] High pressure or low resistance increases flow. [cite: 12/ 13]

Question 6

Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q2: Discuss cardiac preload and afterload/ and the factors affecting them.

Answer 6

A:Preload : Volume of blood in ventricles at end-diastole; affected by venous return and ventricular compliance. [cite: 14/ 15] Afterload : Resistance the ventricles must overcome; determined by arterial pressure and vascular resistance. [cite: 15/ 16]

Question 7

Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q3: Discuss the determinants of cardiac output.

Answer 7

A:Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV). [cite: 17] Influenced by preload/ contractility/ afterload/ and heart rate. [cite: 17]

Question 8

Topic 3: Mean Arterial Pressure - Q1: Define mean arterial pressure (MAP).

Answer 8

A:MAP = Diastolic Pressure + (1/3 × Pulse Pressure). [cite: 18/ 19]

Question 9

Topic 3: Mean Arterial Pressure - Q2: Identify and define the parameters contributing to MAP.

Answer 9

A:Cardiac Output (CO) : Heart rate × Stroke volume. [cite: 19/ 20/ 21] Total Peripheral Resistance (TPR) : Resistance in systemic vasculature. [cite: 19/ 20/ 21] Stroke Volume (SV) : Volume of blood pumped per heartbeat. [cite: 20/ 21] Heart Rate (HR) : Beats per minute. [cite: 20/ 21]

Question 10

Topic 3: Mean Arterial Pressure - Q3: Describe how a change in each parameter alters blood pressure.

Answer 10

A:↑ CO or TPR → ↑ MAP. [cite: 22] ↓ CO or TPR → ↓ MAP. [cite: 22/ 23]

Question 11

Topic 3: Mean Arterial Pressure - Q4: Identify factors that alter these parameters and describe how blood pressure is subsequently affected.

Answer 11

A:Factors: Autonomic regulation/ blood volume/ vascular tone. [cite: 23/ 24] Effect: Adjusted MAP (↑ or ↓). [cite: 23/ 24]

Question 12

Topic 3: Mean Arterial Pressure - Q5: Explain basal vascular tone.

Answer 12

A:Continuous partial contraction of smooth muscle; influenced by sympathetic nervous system and local factors. [cite: 24/ 25]

Question 13

Topic 4: Extrinsic Regulators of Arterial Smooth Muscle - Q1: Describe the primary role of extrinsic regulators on arterial smooth muscle.

Answer 13

A:Control vascular tone to regulate blood flow and blood pressure. [cite: 26/ 27]

Question 14

Topic 4: Extrinsic Regulators of Arterial Smooth Muscle - Q2: Explain how each extrinsic regulator affects arterial smooth muscle and blood pressure.

Answer 14

A:Sympathetic Nervous System : Vasoconstriction → ↑ BP. [cite: 28/ 29] Adrenaline/Noradrenaline : Vasoconstriction; ↑ BP. [cite: 28/ 29] Histamine : Vasodilation; ↓ BP. [cite: 28/ 29] Angiotensin II : Vasoconstriction; ↑ BP. [cite: 29/ 30] Vasopressin : Vasoconstriction; ↑ BP. [cite: 29/ 30] Vasodilator Nerves : Relaxation; ↓ BP. [cite: 30/ 31] ANP : Vasodilation; ↓ BP. [cite: 30/ 31]

Question 15

Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q1: Describe the primary role of intrinsic regulators on arterial smooth muscle.

Answer 15

A:Regulate local blood flow based on tissue needs. [cite: 31/ 32]

Question 16

Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q2: Explain how each intrinsic regulator affects arterial smooth muscle and blood pressure.

Answer 16

A:O2 : Vasoconstriction in systemic circulation; vasodilation in lungs. [cite: 33/ 34] CO2 : Vasodilation → ↑ local blood flow. [cite: 33/ 34] Lactic Acid : Vasodilation → ↑ local blood flow. [cite: 34/ 35] Adenosine : Vasodilation → ↑ local blood flow. [cite: 34/ 35] Nitric Oxide : Vasodilation; ↓ BP. [cite: 35/ 36] Endothelin-1 : Vasoconstriction; ↑ BP. [cite: 35/ 36]

Question 17

Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q3: Describe autoregulation and its factors at various locations.

Answer 17

A:Heart : Maintains flow during pressure changes. [cite: 36/ 37] Brain : Regulates flow based on CO2 levels. [cite: 36/ 37] Kidneys : Adjusts based on filtration needs. [cite: 37/ 38] Lungs : Responds to O2 levels. [cite: 37/ 38] Skeletal Muscle : Adjusts based on demand. [cite: 38/ 39] Skin : Responds to temperature. [cite: 38/ 39]

Question 18

Topic 6: Short-Term Regulation of Blood Pressure - Q1: Identify the location of baroreceptors and describe their function.

Answer 18

A:Locations: Carotid sinus/ aortic arch. [cite: 39/ 40] Function: Detect pressure changes and adjust autonomic output. [cite: 39/ 40]

Question 19

Topic 6: Short-Term Regulation of Blood Pressure - Q2: Describe the role of the autonomic nervous system in short-term BP regulation.

Answer 19

A:Sympathetic activation: ↑ BP. [cite: 41/ 42] Parasympathetic activation: ↓ BP. [cite: 41/ 42]

Question 20

Topic 6: Short-Term Regulation of Blood Pressure - Q3: Explain the baroreceptor reflex and its role in short-term BP control.

Answer 20

A:Pressure change detected → Signal to medulla → Adjusts HR/ vascular tone. [cite: 42/ 43]

Question 21

Topic 7: Medium-Long Term Regulation of Blood Pressure - Q1: Identify the structures involved in the renin-angiotensin-aldosterone system (RAAS).

Answer 21

A:Kidneys : Release renin. [cite: 44/ 45] Liver : Produces angiotensinogen. [cite: 44/ 45] Lungs : Contain ACE (angiotensin-converting enzyme). [cite: 44/ 45] Adrenal Cortex : Releases aldosterone. [cite: 44/ 45]

Question 22

Topic 7: Medium-Long Term Regulation of Blood Pressure - Q2: Describe the primary role of RAAS.

Answer 22

A:Maintains blood pressure and fluid balance by regulating vasoconstriction and sodium retention. [cite: 46/ 47]

Question 23

Topic 7: Medium-Long Term Regulation of Blood Pressure - Q3: Sequentially describe the processes involved in the RAAS system.

Answer 23

A:Renin converts angiotensinogen to angiotensin I. [cite: 47/ 48/ 49] ACE converts angiotensin I to angiotensin II. [cite: 47/ 48/ 49] Angiotensin II causes vasoconstriction and stimulates aldosterone release. [cite: 47/ 48/ 49] Aldosterone promotes sodium and water retention. [cite: 48/ 49]

Question 24

Topic 7: Medium-Long Term Regulation of Blood Pressure - Q4: Describe how changes in RAAS alter blood pressure.

Answer 24

A:Overactive RAAS → Hypertension due to increased vasoconstriction and fluid retention. [cite: 49/ 50/ 51] Underactive RAAS → Hypotension due to decreased vascular resistance and fluid loss. [cite: 49/ 50/ 51]

Question 25

Topic 7: Medium-Long Term Regulation of Blood Pressure - Q5: Explain how salt intake affects RAAS.

Answer 25

A:High salt intake suppresses renin release. [cite: 51/ 52] Low salt intake stimulates renin release. [cite: 51/ 52]

Question 26

Topic 8: Hypertension - Q1: Define hypertension and discuss the types of hypertension.

Answer 26

A:Definition : Persistent systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg. [cite: 53/ 54] Types : Primary (essential) hypertension: No identifiable cause (~90–95% of cases). [cite: 55/ 56] Secondary hypertension: Due to an underlying condition (e.g./ renal disease/ endocrine disorders). [cite: 55/ 56]

Question 27

Topic 8: Hypertension - Q2: Describe the epidemiology and risk factors of hypertension.

Answer 27

A:Epidemiology : Common in adults/ higher prevalence with age. [cite: 57/ 58] Risk factors : Obesity/ sedentary lifestyle/ high salt intake/ stress/ genetics. [cite: 57/ 58]

Question 28

Topic 8: Hypertension - Q3: Describe the pathophysiology of essential hypertension.

Answer 28

A:Increased vascular resistance due to endothelial dysfunction/ reduced nitric oxide/ and increased sympathetic tone. [cite: 58/ 59]

Question 29

Topic 8: Hypertension - Q4: Define hypertensive crisis and discuss its pathogenesis.

Answer 29

A:Definition : Severe BP elevation (≥180/120 mmHg) with potential end-organ damage. [cite: 60/ 61] Pathogenesis : Sudden vasoconstriction/ arterial injury/ and ischemia. [cite: 60/ 61]

Question 30

Topic 9: Diagnosis of Hypertension - Q1: Discuss the classification and stages of hypertension.

Answer 30

A:Normal : <120/80 mmHg. [cite: 61/ 62/ 63] Elevated : Systolic 120–129 mmHg/ diastolic <80 mmHg. [cite: 61/ 62/ 63] Stage 1 : Systolic 130–139 mmHg or diastolic 80–89 mmHg. [cite: 62/ 63] Stage 2 : Systolic ≥140 mmHg or diastolic ≥90 mmHg. [cite: 62/ 63/ 64]

Question 31

Topic 9: Diagnosis of Hypertension - Q2: Discuss the clinical manifestations of hypertension.

Answer 31

A:Often asymptomatic ("silent killer"). [cite: 64/ 65] Symptoms: Headache/ dizziness/ visual changes/ chest pain in advanced cases. [cite: 64/ 65]

Question 32

Topic 9: Diagnosis of Hypertension - Q3: Discuss the diagnosis of hypertension.

Answer 32

A:Multiple BP measurements over time. [cite: 65/ 66/ 67] Ambulatory BP monitoring. [cite: 65/ 66/ 67] Assessment for end-organ damage (e.g./ ECG/ urine analysis). [cite: 65/ 66/ 67]

Question 33

Topic 10: Pharmacology of Antihypertensives - Q1: Outline the management of hypertension.

Answer 33

A:Lifestyle modifications. [cite: 67/ 68] First-line medications: ACE inhibitors/ ARBs/ β-blockers/ calcium channel blockers/ thiazide diuretics. [cite: 67/ 68]

Question 34

Topic 10: Pharmacology of Antihypertensives - Q2: Describe the mechanism of action of common antihypertensives.

Answer 34

A:ACE Inhibitors : Block conversion of angiotensin I to angiotensin II. [cite: 68/ 69/ 70/ 71] ARBs : Block angiotensin II receptors. [cite: 68/ 69/ 70/ 71] β-blockers : Reduce heart rate and contractility. [cite: 68/ 69/ 70/ 71] Calcium Channel Blockers : Reduce vascular smooth muscle contraction. [cite: 68/ 69/ 70/ 71] Thiazide Diuretics : Increase sodium and water excretion. [cite: 68/ 69/ 70/ 71]

Question 35

Topic 10: Pharmacology of Antihypertensives - Q3: Outline the management of hypertensive emergency.

Answer 35

A:IV antihypertensives (e.g./ nitroprusside/ labetalol). [cite: 71/ 72] Gradual BP reduction to prevent ischemia. [cite: 71/ 72]

Question 36

Topic 11: Complications of Hypertension and Lifestyle Modification - Q1: Discuss the complications of hypertension.

Answer 36

A:Cardiovascular: Left ventricular hypertrophy/ heart failure/ atherosclerosis. [cite: 72/ 73/ 74] Cerebral: Stroke/ hypertensive encephalopathy. [cite: 72/ 73/ 74] Renal: Chronic kidney disease. [cite: 73/ 74] Ocular: Hypertensive retinopathy. [cite: 73/ 74]

Question 37

Topic 11: Complications of Hypertension and Lifestyle Modification - Q2: Briefly explain the pathophysiology of complications.

Answer 37

A:Atherosclerosis : Endothelial damage → plaque formation. [cite: 74/ 75/ 76/ 77/ 78] Aortic Dissection : Weakening of arterial walls. [cite: 74/ 75/ 76/ 77/ 78] Left Ventricular Hypertrophy : Increased workload → myocardial thickening. [cite: 74/ 75/ 76/ 77/ 78] Heart Failure : Chronic pressure overload → pump failure. [cite: 74/ 75/ 76/ 77/ 78] Stroke : Vessel rupture or occlusion. [cite: 74/ 75/ 76/ 77/ 78] Nephropathy : Glomerular damage → proteinuria. [cite: 74/ 75/ 76/ 77/ 78] Retinopathy : Vascular damage → vision loss. [cite: 74/ 75/ 76/ 77/ 78]

Question 38

Topic 11: Complications of Hypertension and Lifestyle Modification - Q3: Discuss lifestyle modifications to promote healthy blood pressure.

Answer 38

A:Weight loss/ reduced salt intake/ regular exercise/ DASH diet/ stress reduction/ smoking cessation. [cite: 78]

Question 39

Regarding hormonal control of the cardiovascular system, which of the following statements is correct? a. Adrenaline/epinephrine causes vasodilatation in skeletal muscle by acting on β 1 receptors. b. Angiotensin-converting enzyme is predominately found in the vascular bed of thegastrointestinal tract. c. Antidiuretic hormone is released when arise in osmolarity is detected. d. Renin is converted to angiotensin I by angiotensinogen. e. Adrenaline is secreted from the adrenal cortex.

Answer 39

c. Antidiuretic hormone is released when arise in osmolarity is detected. Increased plasma osmolarity will stimulate antidiuretic hormone release.

Question 40

Which of the following is true of the baroreceptor reflex? a. Baroreceptors in the carotid body are innervated by the glossopharyngeal nerve. b. Decreased loading of baroreceptors increases venous tone by reducing parasympatheticactivity. c. It is central to the long-term regulation of blood pressure d. Constriction of cutaneous arterioles brought about by the baroreceptor reflex can be overcome by thermoregulatory changes in vascular tone. e. Increased stretch in the arterial wall causes a decrease in baroreceptor firing.

Answer 40

d. Constriction of cutaneous arterioles brought about by the baroreceptor reflex can be overcome by thermoregulatory changes in vascular tone. The baroreceptor reflex is important in the cutaneous circulation if the temperature is neutral but can be overcome if there is peripheral vasodilation due to high temperature

Question 41

Which of the following best describes the anatomical feature that distinguishes arteries from veins? a. Veins possess semilunar valves throughout their length to facilitate blood flow to the tissues b. Veins are responsible for the oxygenation of blood, which is why they have thinner walls compared to arteries c. Arteries typically have higher blood pressure, necessitating thicker, more elastic walls than veins d. Arteries have thinner walls than veins, allowing for higher rates of gas exchange e. Arteries contain a single layer of smooth muscle, whereas veins are composed of multiple layers, including a thick tunica adventitia

Answer 41

Arteries typically have higher blood pressure, necessitating thicker, more elastic walls than veins Arteries have thicker, more elastic walls than veins to handle the higher pressure of blood flow

Question 42

A 40-year-old female has a blood pressure of 300/200 mmHg. Without further information, what is theclinical classification? a. Secondary hypertension b. Surgical hypertension c. Benign hypertension d. Essential hypertension e. Emergency hypertension

Answer 42

e. Emergency hypertension Acute, severe elevation of blood pressure (>220/130) most likely associated with objective findings of acute end-organ damage

Question 43

It is important to have a commanding knowledge of the properties and adverse effects of the commonly used antihypertensive agents. Below is a list of adverse effects seen with different classes of antihypertensive agents, together with some important properties of selected agents. Which of the below antihypertensive agents would you be cautious about using if your hospitalized patient is having a hard time regulating their electrolytes? a. Thiazide diuretics —hypercholesterolaemia, hyperglycaemia, thrombocytopenia and gout b. Angiotensin II receptor blockers —similar to ACE inhibitors but cough is less common c. Calcium channel blockers —headaches, sweating, palpitations and ankle oedema d. Beta-blockers —bradycardia, postural hypotension, depression and cold peripheries e. ACE inhibitors —angio-oedema, cough, postural hypotension, hyperkalaemia, progression of renal failure and first-dose hypotension

Answer 43

e. ACE inhibitors —angio-oedema, cough, postural hypotension, hyperkalaemia, progression of renal failure and first-dose hypotension

Question 44

A 55-year-old female presents to your clinic complaining of a headache. During a physical examinationshe is found to have an arterial blood pressure of 190/120 mmHg. What would direct the attention tothe diagnosis of malignant hypertension in this case? a. There is positive family history of ischemic heart disease b. She does not exercise c. Her diastolic blood pressure is recorded more than 100 mmHg on the next visit d. There is a history of smoking for more than 3 years e. There is evidence of rapidly progressive end organ damage  Malignant hypertension is often associated with acute end-organ damage, including the eyes

Answer 44

e. There is evidence of rapidly progressive end organ damage Malignant hypertension is often associated with acute end-organ damage, including the eyes

Question 45

After a mild hemorrhage, compensatory responses initiated by the baroreceptor reflex keeps bloodpressure at or close to its normal value. Which one of the following values is less after compensationthan it was before the hemorrhage? a. Ventricular contractility b. Coronary blood flow c. Venouscompliance d. Heart rate e. Total peripheral resistance

Answer 45

c. Venous compliance Baroreceptor reflex after bleeding will lead to sympathetic stimulation resulting in venous constriction as a result of decreased venous compliance to allow for increased venous return

Question 46

A 41-year-old female with long standing hypertension presents to your clinic. She has been onAngiotensin converting enzyme (ACE) Inhibitors for two years. This medication works by inhibitingwhich one of the following steps? a. Angiotensin I + Renin to Angiotensinogen b. Renin to Angiotensinogen c. Angiotensinogen to Angiotensin II d. Angiotensinogen to Angiotensin I e. Angiotensin I to Angiotensin II

Answer 46

e. Angiotensin I toAngiotensin II ACE inhibitors stop action of ACE to convert Angiotensin I to angiotensin II

Question 47

It is important to have a commanding knowledge of the properties and adverse effects of thecommonly used antihypertensive agents. Below is a list of adverse effects seen with different classes ofantihypertensive agents, together with some important properties of selected agents. Which of thebelow antihypertensive agents would you be cautious about in a patient that has uncontrolleddiabetes? a. ACE inhibitors —angio-oedema, cough, postural hypotension, hyperkalaemia, progression of renal failure and first-dose hypotension. b. Calcium channel blockers —headaches, sweating, palpitations and ankle oedema c. Angiotensin II receptor blockers —similar to ACE inhibitors but cough is less common d. Beta-blockers —bradycardia, postural hypotension, depression and cold peripheries e. Thiazide diuretics —hypercholesterolaemia, hyperglycaemia, thrombocytopenia and gout

Answer 47

e. Thiazide diuretics —hypercholesterolaemia, hyperglycaemia, thrombocytopenia and gout Your concern is the risk factor of hyperglycaemia from a thiazide diuretic with a patient who already had hyperglycaemia from uncontrolled diabetes

Question 48

Blood flow through an organ would be increased by decreasing which of the following parameters? a. Number of open arteries b. Arterial pressure c. Diameter of veins d. Hematocrit e. Diameter of artery

Answer 48

d. Hematocrit Hematocrit reflect blood viscosity, if it decreases resistance is decreased and allow to increase blood flow to the organ

Question 48

Systemic arteriolar constriction may result from an increase in local concentration of which of the following compounds? a. Nitric oxide b. Beta agonist c. Angiotensin II d. Arial natriuretic peptide (ANP) e. Hydrogen ion

Answer 48

c. Angiotensin II Angiotensin II is a potent vasoconstrictor

Question 49

Which type of vessel or location has the lowest velocity of flow in the systemic (peripheral) circuit? a. Arterioles b. Large arteries c. Aorta d. Capillaries e. Veins

Answer 49

d. Capillaries The capillaries have the lowest velocity of flow in the systemic circuit. This reduced flow rate is essential for allowing sufficient time for the exchange of gases, nutrients, and waste products between blood and tissues

Question 50

You have just diagnosed a 45-year-old man with essential hypertension. Which of the following is a modifiable risk factor for hypertension? a. Age b. Ethnicity c. Gender d. Family size e. Obesity

Answer 50

e. Obesity Obesity is a modifiable risk factor for hypertension

Question 50

Thinking about the positive inotropic effects of sympathetic stimulation on the heart and how theyincrease cardiac output, which of the following is correct? a. leads to a decrease in intracellular calcium levels and increased contractility b. deactivates the cyclic AMP (cAMP) second messenger system c. decreases heart rate, which also decreases cardiac output d. decreases the release of norepinephrine e. binds to β1-adrenergicreceptors on cardiac myocytes  this is one of the responses to positive inotropic effects of sympathetic stimulation on the heart and how it increases cardiac output

Answer 50

e. binds to β1-adrenergicreceptors on cardiac myocytes this is one of the responses to positive inotropic effects of sympathetic stimulation on the heart and how it increases cardiac output

Question 51

What is the mechanism of action of angiotensin II? a. Increases bradykinin secretion and increases potassium serum levels b. Increases aldosterone secretion and increases vasoconstriction c. Increases stroke volume and heart rate d. Increases bradykinin secretion and decreases potassium serum levels e. Decreases aldosterone secretion and increases vasoconstriction

Answer 51

b. Increases aldosterone secretion and increases vasoconstriction It is a powerful vasoconstrictor and stimulates adrenal glands to produce aldosterone