Week 3

Question 1

Why is blood flow in capillaries slow?

Answer 1

Allow adequate time for exchange

Question 2

What can pass through the pores of the capillary wall?

Answer 2

Small water soluble substances
Na, K, glucose, amino acids

Question 3

What can pass through the endothelial cells of the capillary wall?

Answer 3

Lipid soluble substances
O2, CO2

Question 4

How are exchangeable proteins transported across the capillary wall?

Answer 4

Vesicular transport

Question 5

What law of diffusion does movement of gas and solutes follow?

Answer 5

Fick’s Law

Question 6

What is net filtration pressure?

Answer 6

Forces favouring filtration - forces opposing filtration

Question 7

What is Kf?

Answer 7

Filtration coefficient

Question 8

What forces favour filtration?

Answer 8

Capillary hydrostatic pressure
Interstitial fluid osmotic pressure

Question 9

What forces oppose filtration?

Answer 9

Capillary osmotic pressure
Interstitial fluid hydrostatic pressure

Question 10

What does a positive net filtration pressure favour?

Answer 10

Filtration

Question 11

What does a negative filtration pressure favour?

Answer 11

Reabsorption

Question 12

Would filtration or reabsorption be favoured at the arteriolar end?

Answer 12

Filtration

Question 13

Would filtration or reabsorption be favoured at the venular end?

Answer 13

Reabsorption

Question 14

What happens to fluid that accumulates in the interstitium?

Answer 14

Lymphatic system helps to drain

Question 15

Is resistance higher or lower in the pulmonary circulation than systemic?

Answer 15

Lower

Question 16

What is oedema?

Answer 16

Accumulation of fluid in interstitial space

Question 17

Does lung compliance increase or decrease in pulmonary oedema?

Answer 17

Decrease

Question 18

In HF is the RAAS upregulated or downregulated and what does this result in?

Answer 18

Upregulated
More fluid retention

Question 19

What signs may be seen in R ventricular failure?

Answer 19

Peripheral oedema

Question 20

Why is angina affected by the cold?

Answer 20

Cold causes vasoconstriction and increases afterload of the heart

Question 21

What are the acute coronary syndromes?

Answer 21

Unstable angina
NSTEMI
STEMI

Question 22

What immediate deadly arrhythmia may occur in a STEMI?

Answer 22

Ventricular fibrillation

Question 23

What HF can be caused after STEMI?

Answer 23

L due to scar tissue affecting pumping

Question 24

What features may be seen on a STEMI ecg?

Answer 24

ST elevation
T wave inversion

Question 25

What ecg changes are needed to diagnose a STEMI?

Answer 25

>1mm ST elevation in 2 adjacent limb leads or >2mm elevation in at least 2 continuous precordial leads or New onset bundle branch block with associated symptoms

Question 26

Give examples of thrombolysis medications?

Answer 26

Streptokinase tpa

Question 27

What are the absolute contraindications to thrombolytic therapy?

Answer 27

Previous haemorrhagic stroke Stroke within 6 months CNS damage or neoplasm Active internal bleeding Aortic dissection Recent major surgery or trauma Known bleeding disorder

Question 28

What is the early treatment for STEMI patients?

Answer 28

Aspirin 300mg Clopidogrel 600mg Morphine Anti-emetic GTN if BP <90 Angioplasty or thrombolysis

Question 29

What is the travel time for PCI over thrombolysis?

Answer 29

90 minutes

Question 30

What structural complications can result from MI?

Answer 30

Cardiac rupture Ventricular septal defect Mitral valve regurgitation Left ventricular aneurysm Mural thrombus Acute pericarditis Dressler's syndrome

Question 31

What functional complications can occur after MI?

Answer 31

Acute ventricular failure Cardiogenic shock HF

Question 32

What is the KILLIP classification used in?

Answer 32

In hospital mortality following MI

Question 33

What may be seen in an NSTEMI ECG?

Answer 33

ST depression T wave inversion May be normal

Question 34

What troponins are specific to the heart?

Answer 34

Troponin I and T

Question 35

What anti platelet therapy is used after a stent?

Answer 35

Dual anti platelet therapy

Question 36

What conditions other than MI may raise troponin?

Answer 36

CCF HTN crisis Renal failure PE Sepsis CVA Pericarditis/ myocarditis

Question 37

What are the 2 types of HF?

Answer 37

Heart failure with reduced ejection fraction Heart failure with preserved ejection fraction

Question 38

What is the most useful diagnostic test in HF?

Answer 38

Echocardiography

Question 39

What type of echo tends to be used in HF?

Answer 39

Transthoracic

Question 40

What blood test may be used in identifying HF?

Answer 40

BNP

Question 41

What value would be a normal Nt-proBNP?

Answer 41

<400

Question 42

What BNP value would suggest standard echo waitlist and what would suggest urgent?

Answer 42

Standard: 400 - 2000 Urgent: >2000

Question 43

What conditions can lead to HF?

Answer 43

HTN Diabetes Coronary heart disease Tachy arrhythmias Dilated cardiomyopathy

Question 44

What is a normal ejection fraction?

Answer 44

>50%

Question 45

What is ivabradine?

Answer 45

SGLT2 inhibitor

Question 46

Does ivabradine work in AF?

Answer 46

No

Question 47

What impact does ivabradine have on HR?

Answer 47

Slows

Question 48

What are the 4 pillars of HF treatment?

Answer 48

ARNI BB MRA SGLT2i

Question 49

What does ectopy mean in relation to arrhythmia?

Answer 49

Single beats

Question 50

In SVT where does the arrhythmia originate?

Answer 50

Above the ventricle - SAN, Atria, AVN, His

Question 51

What may be seen in ECG of SVT?

Answer 51

Rapid P wave or 'f' waves of AF Narrow WRS

Question 52

What are the common types of SVT?

Answer 52

Atrial - AF, atrial flutter, ectopic atrial tachycardia Bradycardia - Sinus bradycardia, sinus pauses

Question 53

What occurs in AF?

Answer 53

Atrial depolarisation random and fast losing all meaningful contractions AV node blocks so ventricles much lower rate

Question 54

Where does ventricular tachycardia originate from?

Answer 54

Ventricular myocardium (common) Fascicles of the conduction system (uncommon)

Question 55

What does the QRS look like in ventricular tachycardia?

Answer 55

Wide QRS

Question 56

What does the ECG look like in ventricular tachycardia?

Answer 56

QRS rapid, wide and distorted T waves large with deflections opposite the QRS complexes Usually regular ventricular rhythm Usually no visible P waves PR interval not measurable

Question 57

What is the cardiothoracic ratio?

Answer 57

Maximum diameter of the heart divided by maximum diameter of the thorax Normal >50%

Question 58

What type of x-ray will exaggerate the heart size?

Answer 58

AP

Question 59

What are the 4H and 4T causes of cardiac arrest?

Answer 59

Hypoxia, hypovolaemia, hypothermia, hypokalaemia/ hyperkalaemia Tension pneumothorax, tamponade, toxins, thrombus

Question 60

What depth should chest compressions reach?

Answer 60

At least 5cm no more than 6cm

Question 61

What rhythms are shockable?

Answer 61

Ventricular fibrillation Pulseless ventricular tachycardia

Question 62

Is asystole a shockable rhythm?

Answer 62

No

Question 63

What drugs are given in line with defibrillation?

Answer 63

Amiodarone after 3 shocks Adrenaline every 3-5 minutes

Question 64

How is adrenaline given in non-shockable rhythm?

Answer 64

Immediately and repeated every 3-5 minutes

Question 65

When should CPR be terminated?

Answer 65

Valid and relevant advanced directive Obvious mortal injury/ irreversible death Safety threat to ALS provider Persistent asystole >20 mins despite ALS without reversible cause identified