Cardiac Week 1 and 2 Flashcards
Topic 1: Anatomy - Q1: What are the contents of the thoracic cavity?
A: Mediastinum: Contains the heart, thymus, trachea, esophagus, and major vessels. Pleural Cavities: Contain the lungs and pleural membranes. [cite: 1, 2]
Topic 1: Anatomy - Q2: What are the boundaries and divisions of the mediastinum?
A: Boundaries : Superior: Thoracic inlet. Inferior: Diaphragm. Anterior: Sternum. Posterior: Vertebral column. Lateral: Pleural cavities. Divisions : Superior mediastinum, and inferior mediastinum (further divided into anterior, middle, and posterior). [cite: 3, 4]
Topic 1: Anatomy - Q3: What are the contents of each division of the mediastinum?
A: Superior Mediastinum: Thymus, great vessels, trachea, esophagus, thoracic duct, vagus and phrenic nerves. Inferior Mediastinum: Anterior : Fat, lymph nodes, thymic remnants. Middle : Heart, pericardium, roots of great vessels, phrenic nerves. Posterior : Esophagus, descending aorta, azygos veins, thoracic duct, sympathetic trunks. [cite: 5, 6, 7, 8]
Topic 1: Anatomy - Q4: Describe the structure, blood supply, and innervation of the pericardium.,
A: Structure : Fibrous Pericardium: Outer layer that protects and anchors the heart. [cite: 9, 10] Serous Pericardium: Divided into parietal and visceral layers with a pericardial cavity containing lubricating fluid. [cite: 11] Blood Supply : Pericardiophrenic artery, branches of bronchial and esophageal arteries. [cite: 12] Innervation : Phrenic nerve, vagus nerve, and sympathetic trunks. [cite: 12]
Topic 1: Anatomy - Q5: What are the functions of the pericardium?
,A: Protects the heart. Reduces friction with pericardial fluid. [cite: 13, 14] Prevents overdistension of the heart. Anchors the heart in place. [cite: 14]
Topic 1: Anatomy - Q6: Describe the structure and great vessels of the heart.
A: Structure : Four chambers (right atrium, right ventricle, left atrium, left ventricle), valves (tricuspid, mitral, pulmonary, aortic), and layers (endocardium, myocardium, epicardium). [cite: 15] Great Vessels : Superior and inferior vena cava. Pulmonary arteries and veins. Aorta. [cite: 15, 16]
Topic 1: Anatomy - Q7: Describe the branches and distribution of the coronary arteries.
A: Right Coronary Artery : Branches into right marginal artery and posterior interventricular artery, supplying the right atrium, right ventricle, and parts of the left ventricle and interventricular septum. [cite: 17, 18] Left Coronary Artery : Branches into the circumflex artery and anterior interventricular artery (LAD), supplying the left atrium, left ventricle, and anterior interventricular septum. [cite: 19]
Topic 1: Anatomy - Q8: Explain the direction of blood flow in the heart.
,A: Deoxygenated blood: Body → Right atrium → Right ventricle → Lungs. [cite: 20, 21, 22] Oxygenated blood: Lungs → Left atrium → Left ventricle → Body. [cite: 21, 22]
Topic 1: Anatomy - Q9: Compare the structure of the right and left sides of the heart.
A: Right Side: Thinner walls, pumps deoxygenated blood to the lungs (low pressure). [cite: 23, 24, 25] Left Side: Thicker walls, pumps oxygenated blood to the body (high pressure). [cite: 24, 25]
Topic 2: Clinically Relevant Anatomy - Q1: Describe the location and position of the heart and its chambers.
A: Location : In the thoracic cavity, within the mediastinum, posterior to the sternum and resting on the diaphragm. [cite: 26, 27] Orientation : Apex points downward, forward, and to the left (at 5th intercostal space). [cite: 28]
Topic 2: Clinically Relevant Anatomy - Q2: Describe the location and position of the major vessels.
A: Aorta: Ascends, arches over the heart, descends into the thorax and abdomen. [cite: 29, 30, 31] Pulmonary Trunk: Exits the right ventricle and splits into pulmonary arteries. [cite: 31] Superior/Inferior Vena Cava: Drain blood into the right atrium. [cite: 31]
Topic 2: Clinically Relevant Anatomy - Q3: Identify the relevant areas for palpation in the cardiovascular system.
A: Carotid artery (neck). Radial/ulnar arteries (wrist). [cite: 32, 33] Apical impulse (5th intercostal space). Femoral and popliteal arteries. [cite: 33]
Topic 2: Clinically Relevant Anatomy - Q4: Identify the sites for auscultation of the heart.
A: Aortic valve: Right 2nd intercostal space. Pulmonary valve: Left 2nd intercostal space. Tricuspid valve: Left 4th intercostal space near sternum. [cite: 34, 35] Mitral valve: Left 5th intercostal space, midclavicular line. [cite: 35]
Topic 3: Cardiac Cycle - Q1: What are the phases of the cardiac cycle?
A: Atrial Systole : Atria contract, filling the ventricles. [cite: 36] Ventricular Systole : Isovolumetric contraction (pressure builds, valves closed). [cite: 36, 37] Ventricular ejection (blood exits via semilunar valves). [cite: 37] Diastole : Isovolumetric relaxation (pressure drops). Ventricular filling (passive flow). [cite: 37]
Topic 3: Cardiac Cycle - Q2: Describe the relationship between blood volume
A: Blood moves from high-pressure to low-pressure areas. Valves prevent backflow (AV valves into atria; semilunar valves into ventricles). [cite: 38, 39]
Topic 4: The Heart as a Pump - Q1: Describe the structure of the myocardium.
A: Composed of cardiac muscle cells (cardiomyocytes) . [cite: 40, 41, 42] Arranged in spiral or circular bundles for contraction efficiency. [cite: 41, 42] Contains intercalated discs (gap junctions and desmosomes) for synchronized contraction. [cite: 42]
Topic 4: The Heart as a Pump - Q2: Describe the structure and function of cardiomyocytes.
A: Cylindrical, striated muscle cells with a central nucleus. Rich in mitochondria for high energy demands. [cite: 43, 44] Interconnected by intercalated discs, allowing electrical and mechanical continuity. [cite: 44]
Topic 4: The Heart as a Pump - Q3: Explain cardiac output and its determinants.
A: Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV). [cite: 45] Determinants: Heart rate (sympathetic and parasympathetic regulation). [cite: 45, 46] Stroke volume (preload, afterload, and contractility). [cite: 46]
Topic 4: The Heart as a Pump - Q4: Discuss the factors affecting venous return.
A: Muscle pump action. Intrathoracic pressure changes (respiration). [cite: 46, 47] Venous valve function. Blood volume and venous tone. [cite: 47]
Topic 5: A Closer Look at Valves - Q1: Discuss the anatomy and histology of the atrioventricular and semilunar valves.
A: Atrioventricular (AV) Valves : Tricuspid (right), Mitral (left). [cite: 47, 48, 49] Supported by chordae tendineae and papillary muscles . [cite: 48, 49] Semilunar Valves : Pulmonary (right ventricle), Aortic (left ventricle). [cite: 49] Pocket-like cusps prevent backflow. [cite: 49]
Topic 5: A Closer Look at Valves - Q2: Discuss the physiology and function of the atrioventricular and semilunar valves.
A: AV valves: Prevent backflow from ventricles to atria during systole. [cite: 50, 51] Semilunar valves: Prevent backflow from arteries into ventricles during diastole. [cite: 51]
Topic 5: A Closer Look at Valves - Q3: What generates heart sounds?
A: S1 (“lub”): Closure of AV valves at the start of systole. [cite: 52, 53] S2 (“dub”): Closure of semilunar valves at the start of diastole. [cite: 53]
Topic 5: A Closer Look at Valves - Q4: Explain the consequences of insufficient valvular function.
A: Regurgitation: Backflow of blood due to incomplete valve closure. Stenosis: Narrowing of valve, increasing resistance to flow. [cite: 54]
Topic 6: Cardiac Conduction Pathway - Q1: Identify the structures involved in the cardiac conduction pathway.
A: Sinoatrial (SA) node. Atrioventricular (AV) node. [cite: 54, 55, 56] Bundle of His. Right and Left Bundle Branches. Purkinje fibers. [cite: 56]
Topic 6: Cardiac Conduction Pathway - Q2: Describe the spread of electrical activity across the heart.
A: SA node initiates impulse → spreads to atria → AV node delays conduction → travels via Bundle of His and bundle branches → Purkinje fibers stimulate ventricles. [cite: 56, 57]
Topic 6: Cardiac Conduction Pathway - Q3: Discuss the functions of the SA node, AV node, and Purkinje fibers
A: SA node: Pacemaker, initiates electrical impulses (~60–100 bpm). [cite: 58, 59] AV node: Delays conduction to allow atrial contraction. [cite: 59] Purkinje fibers: Ensure rapid conduction for coordinated ventricular contraction. [cite: 60]
Topic 7: Excitation-Contraction Coupling - Q1: Describe the phases of an action potential in cardiomyocytes.
A: Resting Membrane Potential: Stable potential before excitation. Depolarization: Sodium influx rapidly increases voltage. Plateau Phase: Calcium influx sustains contraction. [cite: 60, 61, 62] Repolarization: Potassium efflux restores resting potential. [cite: 62]
Topic 7: Excitation-Contraction Coupling - Q2: How do these electrical events correlate to mechanical heart functions?
A: Depolarization triggers contraction. [cite: 62, 63] Plateau phase corresponds to sustained contraction for blood ejection. [cite: 63] Repolarization allows relaxation and filling. [cite: 63]
Topic 7: Excitation-Contraction Coupling - Q3: What triggers cardiac myocyte contraction?
A: Action potential opens voltage-gated calcium channels → calcium influx triggers sarcoplasmic reticulum calcium release → actin-myosin interaction → contraction. [cite: 63, 64]
Topic 7: Excitation-Contraction Coupling - Q4: Describe the characteristics of ventricular action potential.
A: Longer duration (~200 ms). [cite: 65, 66] Plateau phase due to calcium influx, important for sustained contraction. [cite: 66]
Topic 7: Excitation-Contraction Coupling - Q5: Describe the characteristics of pacemaker action potential.
A: Spontaneous depolarization (automaticity). [cite: 66, 67] No true resting potential. Key ions: Sodium, potassium, calcium. [cite: 67]
Topic 8: Autonomic Control of the Cardiac Conduction Pathway - Q1: Discuss cardiac innervation and conduction pathway.
A: Sympathetic nerves: Increase heart rate and contractility. Parasympathetic (vagus) nerves: Decrease heart rate. Autonomic control influences conduction speed and rhythm. [cite: 68, 69]
Topic 8: Autonomic Control of the Cardiac Conduction Pathway - Q2: Describe the role of the sympathetic nervous system in cardiac conduction.
A: Releases noradrenaline . [cite: 70, 71] Increases SA node firing rate, conduction velocity, and force of contraction. [cite: 71]
Topic 8: Autonomic Control of the Cardiac Conduction Pathway - Q3: Describe the role of the parasympathetic nervous system in cardiac conduction.
A: Releases acetylcholine . [cite: 72, 73] Slows SA node firing, reduces heart rate, and prolongs conduction time. [cite: 73]
Topic 8: Autonomic Control of the Cardiac Conduction Pathway - Q4: Enumerate the factors influencing the cardiac conduction pathway.
A: Autonomic nervous system activity. Hormones (e.g., adrenaline). Electrolyte levels (potassium, calcium). Drugs (e.g., beta-blockers, calcium channel blockers). [cite: 74, 75] Ischemia or infarction affecting conduction tissue. [cite: 75]
Are you able to describe the proper electrical conductance (in the correct order ) through the heart?
AV node -> SA node -> Bundle if his -> Bundle branches -> Purkinje fibers
b.
SA node -> AV node -> Bundle if his -> Purkinje fibers -> Bundle branches ->
c.
SA node -> AV node -> Bundle if his ->Bundle branches -> Purkinje fibers
This is the correct order of electrical conductance through the heart
d.
SA node -> AV node -> Bundle branches -> Bundle if his -> Purkinje fibers
SA node -> AV node -> Bundle if his -> Bundle branches -> Purkinje fibers
During your Emergency Medicine rotation, you see a patient where physical examination reveals ananxious, diaphoretic patient with unstable vital signs and hypoxemia. He denies any medical problemsbut admits to daily use of cocaine, including intranasal cocaine approximately 30 minutes ago. Thinking about some of the effects of cocaine use on the body, which of the following is true?
a.
QRS prolongation
b.
heart failure as a main issue
c.
decreased binding to Na channels
d.
increased Phase 0 depolarization
QRS prolongation
All cardiac valves are normally closed during which of the following phases of cardiac cycle?
a.
Ventricular filling
b.
Isovolumetric relaxation
Semilunar valves close after ejection and atrioventricular valves are still closed from the end of previous diastole
c.
Systolic ejection
d.
Atrial contraction
b.
Isovolumetric relaxation
In which structure of the nervous system would damage cause increased parasympathetic activity?
a.
Nucleus solitarius
b.
Cardiac decelerator centre
c.
Dorsal motor nucleus of the vagus
d.
Rostral ventrolateral medulla (RVLM)
d.
Rostral ventrolateral medulla (RVLM)
When describing the general phases of the cardiac myocyte action potential, which phase has rapiddepolarisation due to a transient increase of Na conductance into the cell?
a.
Phase 4
b.
Phase 2
c.
Phase 3
d.
Phase 1
e.
Phase 0
e.
Phase 0
Closure of the aortic and pulmonary valves produces which heart sound?
a.
S4
b.
S3
c.
S2
d.
S1
c.
S2
Which of the following best describes the structure of the myocardium?
a.
Connective tissue providing elasticity to the heart chambers
b.
Striated muscle tissue arranged in a branching pattern
c.
Smooth muscle tissue that contracts involuntarily
d.
A single layer of epithelial cells lining the heart chambers
b.
Striated muscle tissue arranged in a branching pattern
The repolarization phase of the cardiac action potential depends upon which type of channels?
a.
Sodium potassium pumps
b.
Potassium channels
c.
Fast sodium channels
d.
Slow calcium channels
e.
Both fast sodium channels and slow calcium channels
b.
Potassium channels
In terms of anatomical relations, which of the following is correct?
a.
The lung is inferior to the heart
b.
The diaphragm is superior to the mediastinum
c.
The apex of the heart is anterior to its base
d.
Sternum is superior to the heart
e.
The aorta is superficial to the sternum
c.
The apex of the heart is anterior to its base
Which of the following structures separates the diaphragmatic surface of the heart from the base?
a.
The coronary sulcus
b.
The right ventricle
c.
The left atrium
d.
The anterior interventricular groove
e.
The posterior interventricular groove
a.
The coronary sulcus
Which of the following best describes the histological structure of the atrioventricular valves?
a.
Composed mainly of dense connective tissue with a central core of endocardium
b.
Characterized by a thin layer of endothelial cells overlying a thick myocardial layer
c.
Contains a fibrous skeleton that provides attachment sites for cardiac muscle
d.
Composed of three parts: collagen with some elastic fibres leaflets; fine, strong fibrous ligaments and papillary muscles
e.
Predominantly made of cardiac muscle tissue for enhanced contractility
d.
Composed of three parts: collagen with some elastic fibres leaflets; fine, strong fibrous ligaments and papillary muscles
The T wave of the electrocardiogram occurs during which phase of the cardiac cycle?
a.
Isovolumetric relaxation
b.
Rapid ventricular ejection
c.
Atrial systole
d.
Reduced ventricular ejection
e.
Isovolumetric contraction
d.
Reduced ventricular ejection
ECG Wave Cardiac Cycle Phase Event
P wave Atrial systole Atrial depolarization
QRS complex Isovolumetric contraction & rapid ventricular ejection Ventricular depolarization & onset of systole
T wave Reduced ventricular ejection Ventricular repolarization
End of T wave Isovolumetric relaxation Completion of repolarization, onset of diastole
Which of the following is true when differentiating between the pacemaker (SA, AV node) and non-pacemaker (cardiac muscle) AP?
a.
AP Cardiac muscle can occur in cardiac muscles other than SA & AV
b.
AP Cardiac muscle driven by funny current Na channels
c.
AP Cardiac muscle has three phases
d.
AP SA Node has no automaticity
a.
AP Cardiac muscle can occur in cardiac muscles other than SA & AV
AP SA Node
-AP Cardiac muscle
Occur in pacemaker cells
-Occur in cardiac muscles other than SA and AV
Driven by funny current Na channels
-Driven by stimulus, no funny current
Unstable RMP (-50 to -90 mV)
-Stable RMP -90 mV
Only 3 phases
-4 phases
Automaticity is possible
-No automaticity
Feature Pacemaker AP (SA, AV Nodes) Non-Pacemaker AP (Cardiac Muscle)
Location SA node, AV node Atria, ventricles, Purkinje fibers
Resting Membrane Potential Unstable (~-60mV, drifts up) Stable (~-90mV)
Phase 4 (Initiation) Driven by funny current (If, Na⁺) Maintains resting potential
Depolarization (Phase 0) Ca²⁺ influx (L-type channels) Na⁺ influx (fast sodium channels)
Phases Three phases (4, 0, 3) Five phases (4, 0, 1, 2, 3)
Repolarization (Phase 3) K⁺ efflux K⁺ efflux
Automaticity Present (spontaneous depolarization) Absent (requires stimulus)
Which of the following regarding anatomy of the heart is true?
a.
The apex is formed by the right ventricle
b.
The ascending aorta is entirely outside the pericardial sac
c.
The right atrium is posterior to the left atrium
d.
The right coronary artery supplies art of left ventricle
e.
The left coronary artery supplies right atrium
d.
The right coronary artery supplies part of left ventricle
When the left ventricular stroke volume is 40 ml/beat and the heart rate is 80 beats/minutes, thecardiac output is?
Select one:
a.
2 Litres/minute
b.
5 Litres/minute
c.
6 Litres/minute
d.
3.2 Litres/minute
e.
4.5 Litres/minute
d.
3.2 Litres/minute
Cardiac output= SV X HR. 40 x 80= 3.2 L/min
Topic 1: Anatomy of Blood Vessels - Q1: Identify the major arteries/ veins/ and lymphatic supply throughout the body.
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]
Topic 1: Anatomy of Blood Vessels - Q2: Describe the physical and functional features of conducting arteries/ distributing arteries/ small arteries/ and arterioles.
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]
Topic 1: Anatomy of Blood Vessels - Q3: Describe the physical and functional features of venules/ medium veins/ and large veins.
A:Venules : Small/ collect blood from capillaries. [cite: 7/ 8] Medium Veins : Contain valves to prevent backflow. [cite: 7/ 8/ 9] Large Veins : Thin walls/ large lumen (e.g./ IVC/ SVC). [cite: 7/ 9]
Topic 1: Anatomy of Blood Vessels - Q4: Compare and contrast histological features of arterial and venous walls.
A:Arteries : Thick tunica media with elastic fibers; narrow lumen. [cite: 10/ 11] Veins : Thin tunica media; wider lumen; valves present. [cite: 10/ 11]
Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q1: Explain the relationship between pressure/ volume/ resistance/ and flow through a tube.
A:Flow = Pressure difference ÷ Resistance. [cite: 12/ 13] High pressure or low resistance increases flow. [cite: 12/ 13]
Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q2: Discuss cardiac preload and afterload/ and the factors affecting them.
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]
Topic 2: Pressure/ Volume/ Resistance/ and Flow - Q3: Discuss the determinants of cardiac output.
A:Cardiac Output (CO) = Heart Rate (HR) × Stroke Volume (SV). [cite: 17] Influenced by preload/ contractility/ afterload/ and heart rate. [cite: 17]
Topic 3: Mean Arterial Pressure - Q1: Define mean arterial pressure (MAP).
A:MAP = Diastolic Pressure + (1/3 × Pulse Pressure). [cite: 18/ 19]
Topic 3: Mean Arterial Pressure - Q2: Identify and define the parameters contributing to MAP.
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]
Topic 3: Mean Arterial Pressure - Q3: Describe how a change in each parameter alters blood pressure.
A:↑ CO or TPR → ↑ MAP. [cite: 22] ↓ CO or TPR → ↓ MAP. [cite: 22/ 23]
Topic 3: Mean Arterial Pressure - Q4: Identify factors that alter these parameters and describe how blood pressure is subsequently affected.
A:Factors: Autonomic regulation/ blood volume/ vascular tone. [cite: 23/ 24] Effect: Adjusted MAP (↑ or ↓). [cite: 23/ 24]
Topic 3: Mean Arterial Pressure - Q5: Explain basal vascular tone.
A:Continuous partial contraction of smooth muscle; influenced by sympathetic nervous system and local factors. [cite: 24/ 25]
Topic 4: Extrinsic Regulators of Arterial Smooth Muscle - Q1: Describe the primary role of extrinsic regulators on arterial smooth muscle.
A:Control vascular tone to regulate blood flow and blood pressure. [cite: 26/ 27]
Topic 4: Extrinsic Regulators of Arterial Smooth Muscle - Q2: Explain how each extrinsic regulator affects arterial smooth muscle and blood pressure.
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]
Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q1: Describe the primary role of intrinsic regulators on arterial smooth muscle.
A:Regulate local blood flow based on tissue needs. [cite: 31/ 32]
Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q2: Explain how each intrinsic regulator affects arterial smooth muscle and blood pressure.
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]
Topic 5: Intrinsic Regulators of Arterial Smooth Muscle - Q3: Describe autoregulation and its factors at various locations.
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]
Topic 6: Short-Term Regulation of Blood Pressure - Q1: Identify the location of baroreceptors and describe their function.
A:Locations: Carotid sinus/ aortic arch. [cite: 39/ 40] Function: Detect pressure changes and adjust autonomic output. [cite: 39/ 40]
Topic 6: Short-Term Regulation of Blood Pressure - Q2: Describe the role of the autonomic nervous system in short-term BP regulation.
A:Sympathetic activation: ↑ BP. [cite: 41/ 42] Parasympathetic activation: ↓ BP. [cite: 41/ 42]
Topic 6: Short-Term Regulation of Blood Pressure - Q3: Explain the baroreceptor reflex and its role in short-term BP control.
A:Pressure change detected → Signal to medulla → Adjusts HR/ vascular tone. [cite: 42/ 43]
Topic 7: Medium-Long Term Regulation of Blood Pressure - Q1: Identify the structures involved in the renin-angiotensin-aldosterone system (RAAS).
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]
Topic 7: Medium-Long Term Regulation of Blood Pressure - Q2: Describe the primary role of RAAS.
A:Maintains blood pressure and fluid balance by regulating vasoconstriction and sodium retention. [cite: 46/ 47]
Topic 7: Medium-Long Term Regulation of Blood Pressure - Q3: Sequentially describe the processes involved in the RAAS system.
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]
Topic 7: Medium-Long Term Regulation of Blood Pressure - Q4: Describe how changes in RAAS alter blood pressure.
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]
Topic 7: Medium-Long Term Regulation of Blood Pressure - Q5: Explain how salt intake affects RAAS.
A:High salt intake suppresses renin release. [cite: 51/ 52] Low salt intake stimulates renin release. [cite: 51/ 52]
Topic 8: Hypertension - Q1: Define hypertension and discuss the types of hypertension.
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]
Topic 8: Hypertension - Q2: Describe the epidemiology and risk factors of hypertension.
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]
Topic 8: Hypertension - Q3: Describe the pathophysiology of essential hypertension.
A:Increased vascular resistance due to endothelial dysfunction/ reduced nitric oxide/ and increased sympathetic tone. [cite: 58/ 59]
Topic 8: Hypertension - Q4: Define hypertensive crisis and discuss its pathogenesis.
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]
Topic 9: Diagnosis of Hypertension - Q1: Discuss the classification and stages of hypertension.
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]
Topic 9: Diagnosis of Hypertension - Q2: Discuss the clinical manifestations of hypertension.
A:Often asymptomatic (“silent killer”). [cite: 64/ 65] Symptoms: Headache/ dizziness/ visual changes/ chest pain in advanced cases. [cite: 64/ 65]
Topic 9: Diagnosis of Hypertension - Q3: Discuss the diagnosis of hypertension.
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]
Topic 10: Pharmacology of Antihypertensives - Q1: Outline the management of hypertension.
A:Lifestyle modifications. [cite: 67/ 68] First-line medications: ACE inhibitors/ ARBs/ β-blockers/ calcium channel blockers/ thiazide diuretics. [cite: 67/ 68]
Topic 10: Pharmacology of Antihypertensives - Q2: Describe the mechanism of action of common antihypertensives.
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]
Topic 10: Pharmacology of Antihypertensives - Q3: Outline the management of hypertensive emergency.
A:IV antihypertensives (e.g./ nitroprusside/ labetalol). [cite: 71/ 72] Gradual BP reduction to prevent ischemia. [cite: 71/ 72]
Topic 11: Complications of Hypertension and Lifestyle Modification - Q1: Discuss the complications of hypertension.
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]
Topic 11: Complications of Hypertension and Lifestyle Modification - Q2: Briefly explain the pathophysiology of complications.
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]
Topic 11: Complications of Hypertension and Lifestyle Modification - Q3: Discuss lifestyle modifications to promote healthy blood pressure.
A:Weight loss/ reduced salt intake/ regular exercise/ DASH diet/ stress reduction/ smoking cessation. [cite: 78]
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.
c.
Antidiuretic hormone is released when arise in osmolarity is detected.
Increased plasma osmolarity will stimulate antidiuretic hormone release.
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.
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
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
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
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
e.
Emergency hypertension
Acute, severe elevation of blood pressure (>220/130) most likely associated with objective findings of acute end-organ damage
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
e.
ACE inhibitors —angio-oedema, cough, postural hypotension, hyperkalaemia, progression of renal failure and first-dose hypotension
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
e.
There is evidence of rapidly progressive end organ damage
Malignant hypertension is often associated with acute end-organ damage, including the eyes
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
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
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
e.
Angiotensin I toAngiotensin II
ACE inhibitors stop action of ACE to convert Angiotensin I to angiotensin II
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
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
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
d.
Hematocrit
Hematocrit reflect blood viscosity, if it decreases resistance is decreased and allow to increase blood flow to the organ
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
c.
Angiotensin II
Angiotensin II is a potent vasoconstrictor
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
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
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
e.
Obesity
Obesity is a modifiable risk factor for hypertension
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
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
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
b.
Increases aldosterone secretion and increases vasoconstriction
It is a powerful vasoconstrictor and stimulates adrenal glands to produce aldosterone
