blood flow

Question 1

A 22-year-old woman presents to A+E with abdominal pain and fever. She reports the pain started generalised, but is now worse in the RIF. Her blood pressure is 85/55, HR 119.

What type of shock does she have?

Answer 1

septic shock

Question 2

a greater than 50% rise in serum creatinine within past week

Answer 2

definition of AKI

Question 3

what is ohms law

Answer 3

voltage( pd between two points- equivalent to bp) = current(flow from point A-B, how much blood gets pushed around each min) x resistance(hinderance to flow-blood vessels on blood)

Question 4

voltage =

Answer 4

current x resistance

Question 5

blood pressure

Answer 5

cardiac output x stroke volume

Question 6

starling cure

Answer 6

the more the heart is stretched the stronger it contracts ( preload)
this increases stroke volume to a point before it decreases
less circulation means less stretch which means less powerful contraction
high HR can also lead to less stretching( less time to fill) and so lead to reduced output)

Question 7

flow =

Answer 7

pressure change x vessel radius^4
all divided by
blood viscosity x vessel length

Question 8

regulation of blood flow can be neurological
humoral
local - auto regulation and active hyperaemia

Answer 8

true

Question 9

the autonomic system regulates bp by what hormones

Answer 9

adrenaline and noradrenaline

Question 10

humoral - renin

what things increase the blood pressure and what things decrease it

Answer 10

aldosterone - keeps sodium in and potassium out
adrenaline - larger blood volume and flow
ADH - acts in kidney stored in psotiero pituitary
angiotensin II -

ANP and BNP - decrease it as dilate the kidney made in the heart

Question 11

active hyperaemia

Answer 11

local mechanism of increasing blood flow to tissues/organs to meet metabolic demna

oxygen and ph decrease
pco2 , lactare , temperate and adenosine ( k) increase

NO release in vascular wall

Question 12

A 58-year-old man is brought to ED by ambulance. He is drowsy and confused, with a temperature of 38.4 degrees, HR 112, BP 90/72, and sats of 86%. His chest x-ray is shown. Over the next few hours, his urine output drops considerably.

What is the diagnosis?
What organisms are most likely responsible?
What SIX things does the patient need?

Answer 12

pneumonia - septic shock

strep pneumoniae

sepsis 6 
check 
lactate 
urine output 
blood cultures 

give
antibiotic
Iv fluid
oxgen

Question 13

sepsis 6

Answer 13

check
lactate
urine output
blood cultures

give
antibiotic
Iv fluid
oxgen

Question 14

A 69-year-old man presents with progressive breathlessness and dizziness, especially on exertion. On examination he has normal observations, with an ejection systolic murmur, and a slow rising pulse.

What is the likely diagnosis?
How do we investigate it?
What treatment options are there?

Answer 14

aortic stenosis

ECHO

valve replacement - surgery and balloon

Question 15

A 25-year-old man is involved in a road traffic collision, when his bike collides with a car. He has multiple broken bones, and has lost a considerable amount of blood. His blood pressure is low, heart rate high, and temperature low.

how are we gonna manage

Answer 15

give blood

Question 16

major haemorrhage protocol

Answer 16

stop bleeding

replace the lost blood or avoid lethal triad

Question 17

lethal triad during bleeding

Answer 17

hypothermia - make warm
acidosis - give oxygen and blood - ABG
coagulapthy - give platelets

Question 18

inadequate blood flow systemic

Answer 18

Brain
Confusion
Drowsiness
Reduced consciousness
Kidneys
Reduced urine output
AKI
Heart
Angina
Reduced cardiac function
Muscles
Lactate production  acidosis  increased respiratory rate
Gut
Reduced gut function
Liver
Ischaemic hepatitis

Question 19

A 62-year-old man with a history of obesity and hypertension presents with chest pain. He looks unwell and is very sweaty. His ECG is shown below.

What is the diagnosis?
What treatment does he need now?
What medications will he most likely be given afterwards?

Answer 19

STEMI

PCI

ACEi 
beta blockers 
spironolactone 
antiplateltss 
statins

Question 20

A 72 year old smoker with a history of MI’s and strokes presents to his GP with painful calves. He reports pain when he walks that improves with rest. His feet feel cold and his pedal pulses are week

What is the most likely diagnosis?
What are the risk factors for this condition?
What are the treatment options?

Answer 20

intermittent claudication - painful in both legs

smoking

stop smoking
surgery and vasodilators

peripheral vascular disease - narrowing of barterers leading to reduced blood flow and apparent during increased activity causing ischaemic pain and deep ache - intermittent claudication

RF - diabetes, hyperlipidemiam and hypercholesterstromia

Question 21

A 54 year old woman is brough in by ambulance. She has developed slurred speech, and her face looks droopy. A CT-scan is normal. The symptoms developed 6 hours ago.

What is the most likely diagnosis?
What is the immediate management?
What further imaging is required?

Answer 21

stroke

IV injection of ( recombinant tissue plasminogen activator) tPA - ischemic stroke

CTHead

Question 22

inadequate blood flow - local

Answer 22

Brain (e.g. stroke)
Weakness
Confusion
Slurred speech
Heart (e.g. heart attack)
Myocyte death
Reduced cardiac function
Kidneys (e.g. renal artery stenosis)
AKI
Gut (e.g. mesenteric thrombosis)
Gut ischaemia
Perforation
Sepsis
Limb (e.g. peripheral arterial disease)
Cold, pulseless, painful limb
Ischaemia and necrosis