Physiology & Shock

Question 1

Define sinus rhythm

Answer 1

Heart controlled by the SA node

Question 2

Put in order:

Purkinje fibres, A/P fascicles, Bundle of His, AVN, bundle branches, SAN

Answer 2

SAN > AVN > Bundle of His > bundle branches > Purkinje fibres > A/P fascicles

Question 3

Vagal tone:
parasympathetic or sympathetic?
what does it act on?
what does it do?

Answer 3

Parasympathetic action on SAN + AVN at rest, increases AVN delay

Question 4

Sympathetic supplies what part of the hearts? What is its function?

Answer 4

To beta adrenoceptors in SAN + AVN + myocardium

Increases HR + contraction

Question 5

B1 adrenoceptors where

B2 adrenoceptors where

Answer 5

B1 heart

B2 GI/resp/kidney

Question 6

Define stroke volume

Answer 6

Volume ejected by each ventricle per beat

Question 7

Define cardiac output

Answer 7

Volume ejected per minute

CO = SV X HR

Question 8

Ventricles contract in ____ and relax in ____

Answer 8

Contract systole, relax diastole

Question 9

AV valves shut when…

Answer 9

AV valves shut when ventricular pressure greater than atrial pressure

Question 10

S3 or S4 - which is always pathological and which is physiological in a young person?

Answer 10

S4 always pathological

S3 physiological in a young person

Question 11

Heart gets perfusion during diastole or systole

Answer 11

Diastole

slower heart rate = more diastole

Question 12

Formula for maximum heart rate

Answer 12

220 - age

Question 13

Coronary arteries arise from …

Answer 13

Aorta

Question 14

Pulmonary circulation is low or high resistance

Answer 14

Low resistance

Question 15

Formula for MAP

Answer 15

MAP = (2X diastolic + systolic) / 3

MAP = diastolic + 1/3(systolic -diastolic)

Question 16

Where are baroreceptors

Answer 16

In carotid sinus and aortic arch

Question 17

Function of atrial natriuretic peptide

Answer 17

Decreases BP vasodilates

Question 18

RAAS

• What is the rate limiting step?
• Renin is released from _____, it stimulates the release of _____ from _____, which stimulates the release of _____. _____ converts _____ to _____, which stimulates the release of _____ from the _____
• Function

Answer 18

The rate limiting step is renin release
Renin is released from KIDNEY, it stimulates the release of ANGIOTENSINOGEN from LIVER, which stimulates the release of ANGIOTENSIN 1. ACE converts ANGIOTENSIN 1 to ANGIOTENSIN 2, which stimulates the release of ALDOSTERONE from the ZONA GLOMERULOSA OF THE ADRENAL
Function to >BP (by retaining Na and increasing plasma volume)

Question 19

ADH

• Where is it made?
• What is it also called?
• Function?

Answer 19

Hypothalamus
Vasopressin
Concentrates urine to increase BP

Question 20

Name the drug
Side effects include dry cough and teratogenicity
Contraindicated in severe CKD

Answer 20

ACEI eg lisinopril

Question 21

Angiotensin receptor blockers are teratogens - T or F

Answer 21

True

Question 22

Atenolol, metoprolol, propranolol, bisoprolol
Which are B1 selective?
Which are B1 + B2 non-selective?

Answer 22

Atenolol B1 selective
Metoprolol B1 selective
Propranolol B1 + B2
Bisoprolol B1 selective

Question 23

B-blockers are contraindicated in ____ and known to worsen ____

Answer 23

B-blockers are contraindicated in ASTHMA and known to worsen DIABETES

Question 24

Hypokalaemia is a side effect of which antihypertensive?

Answer 24

Loop diuretics

Question 25

Which antihypertensive functions by blocking sodium reabsoprtion?

Answer 25

Thiazide diuretics

Question 26

What is the mechanism of spironolactone?

Answer 26

Potassium sparing aldosterone receptor antagonist

Question 27

Which antihypertensives have gynaecomastia as a side effect?

Answer 27

Spironolactone and digoxin

Question 28

Avoid calcium channel blockers in heart failure except which one ...

Answer 28

Amlodipine

Question 29

Why can't verapamil be combined with a BB?

Answer 29

Both slow heart rate

Question 30

Name 4 calcium channel blockers

Answer 30

Amlodipine, nifedipine, verapamil, diltiazem

Question 31

Ankle oedema is a common side effect of antihypertensives that ...

Answer 31

Vasodilate - such as nifedipine

Question 32

Grey skin and hypothyroidism are side effects of which drug?

Answer 32

Amiodarone

Question 33

Atropine mechanism

Answer 33

Inhibits muscarinic M2 receptors that decrease HR - to increase HR

Question 34

Aspirin mechanism

Answer 34

Antiplatelet - cyclooxygenase inhibitors - that produces thromboxane A2

Question 35

In what type of shock would you see J waves on an ECG?

Answer 35

Hypothermia

Question 36

Name 3 causes of obstructive shock

Answer 36

PE Cardiac tamponade Tension pneumothoax

Question 37

MIs and arrhythmias cause _____ shock due to decreased contractility, a drug to combat this is a _____

Answer 37

MIs and arrhythmias cause CARDIOGENIC shock due to decreased contractility, a drug to combat this is a INOTROPE

Question 38

Spinal cord injuries cause ____ shock due to decreased ____ drive

Answer 38

Spinal cord injuries cause NEUROGENIC shock due to decreased SYMPATHETIC drive

Question 39

Bleeding, vomiting and burns can all cause what type of shock?

Answer 39

Hypovolaemic shock

Question 40

What are the 3 components of Virchow's triad

Answer 40

Endothelial injury Venous stasis / turbulent flow Hypercoagulability