1. Haemodynamic disorders

Question 1

Oedema

Answer 1

An abnormal increase in interstitial fluid

Question 2

Causes of Oedema

Answer 2

Increased hydrostatic pressure 
Salt and H20 retention
Reduced plasma oncotic pressure
Inflammation
Lymphatic obstruction

Question 3

Generalised Oedema

Answer 3

Fluid in serous cavities >5L (pleural, pericardial, peritoneal)

Question 4

3 Causes of generalised Oedema

Answer 4

Congestive heart failure
Hypoproteinaemia (low protein content)
Nutritional oedema

Question 5

Localised Oedema

Answer 5

Pulmonary and cerebral oedema

Question 6

4 Causes of localised oedema

Answer 6

Left heart failure
Inflammation
Venous hypertension
Lymphatic obstruction

Question 7

Pulmonary oedema

Answer 7

Normally plasma oncotic pressure is > hydrostatic pressure in pulmonary capillaries
Left heart failure increases hydrostatic pressure in pulmonary capillary bed
Fluid accumulates 1st in interstitial space and then eventually spills into alveolar spaces

Question 8

Main symptom of pulmonary oedema

Answer 8

Breathlessness (worse when lying flat)

Question 9

2 Causes of Cerebral Oedema

Answer 9

Vasogenic: Increased permeability of capillaries and venules
Cytotoxic: Derangement of sodium-potassium membrane pump e.g. ischaemic strokes

Question 10

Thrombosis

Answer 10

Abnormal blood clot formation in the circulatory system

Question 11

3 Causes of Thrombosis

Answer 11

Endothelial injury
Stasis or turbulent blood flow
Blood hyper coagulability

Question 12

What are the Primary causes of hypercoaguability?

Answer 12

Genetic:
Factor V mutation
Protein C deficiency

Question 13

What are the Secondary causes of hypercoaguability?

Answer 13

Acquired:
Obesity
Cancer
Stasis 
Age
Use of oral contraceptive pill

Question 14

Venous thrombi mainly form in…

Answer 14

Deep leg veins

Question 15

2 Key contributory factors to venous thrombi

Answer 15

Stasis

Hypercoaguablilty

Question 16

Most important potential complication of venous thrombi

Answer 16

Pulmonary embolism

Question 17

What does narrowing of artery by thrombus cause?

Answer 17

Ischaemia of tissue supplied by artery

Question 18

What does complete blockage of artery by thrombus cause?

Answer 18

Infarction of tissue supplied by artery

Question 19

4 Fates of Thrombi

Answer 19

Propagation
Embolisation
Dissolution
Organisation and re-canalisation

Question 20

Thrombi come to clinical attention when they

Answer 20

Obstruct arteries or veins

Embolise

Question 21

Embolus

Answer 21

abnormal material within circulatory system that is carried in blood to a site distant from its point of origin

Question 22

Rare types of embolic material

Answer 22

Air
Fat
Amniotic fluid
Tumour

Question 23

Infarct

Answer 23

An area of ischemic necrosis caused by occlusion of arterial supply or venous drainage

Question 24

Red Infarct

Answer 24

Result of Venous occlusion

Often in loose tissue with dual circulation e.g. Lung

Question 25

White Infarct

Answer 25

Result of Arterial occlusion | Often in solid organs e.g. Spleen, Kidney

Question 26

Pulmonary thromboembolism: | What does emboli lodging in a major pulmonary artery cause?

Answer 26

Instantaneous death

Question 27

Pulmonary thromboembolism: | What does emboli lodging in medium sized arteries present with?

Answer 27

Breathlessness

Question 28

Pulmonary thromboembolism: | What does emboli lodging in small arteries cause?

Answer 28

Subtle symptoms of breathlessness, chest pain and dizziness

Question 29

Haemorrhage

Answer 29

Extravasation of blood due to vessel rupture

Question 30

What are the causes of Haemorrhage?

Answer 30

Trauma | Intrinsic disease of a vessel

Question 31

Define Shock

Answer 31

Systemic hypotension due to reduced circulatory volume or reduced cardiac output

Question 32

What is the cause of Hypovolaemic Shock?

Answer 32

Fluid loss >1L of blood

Question 33

Cardiogenic Shock

Answer 33

Heart can't pump enough blood to meet body’s demands

Question 34

What is the cause of Cardiogenic shock?

Answer 34

Acute myocardial infarction

Question 35

Systemic inflammatory response syndrome (SIRS) is characterised by 2 or more of the following:

Answer 35

Temperature >38 C or < 36 C Tachycardia >90 bpm Respiratory rare >20 breaths/min or PaCO2 <4.3KPa WBC >12 x109/ L or >10% immature blasts

Question 36

What is Sepsis?

Answer 36

SIRS + infection

Question 37

What is Septic Shock?

Answer 37

Severe sepsis + hypoperfusion despite adequate fluid resuscitation, or the use of vasopressors/inotropes to maintain blood pressure

Question 38

What is Severe Sepsis?

Answer 38

Sepsis + organ hypoperfusion

Question 39

What is the cause of Neurogenic Shock?

Answer 39

Sudden loss of signals from sympathetic nervous system that maintain normal muscle tone in blood vessel walls