Hypertension And Shock

Question 1

Where can blood pressure be regulated?

Answer 1

Heart
Kidneys
Vasculature

Question 2

Treatment of hypertension

Answer 2

Diuretics
Vasodilators eg alpha 1 R antagonist/ calcium blockers
ACE inhibitors - block angiotensin II and reduce aldosterone release
Beta blockers (phasing out)

Question 3

What is blood pressure in hypertension?

Answer 3

Over 140/90

Question 4

What is hypovolaemic shock?

Answer 4

Loss of circulating volume

Question 5

After what blood loss will someone start to show signs of hypovolaemic shock

Answer 5

Reduction by 20-30%

Question 6

Give some causes of hypovolaemic shock.

Answer 6

Hyponatraemia
Vomiting
Diarrhoea
Burns
Haemorrhage

Question 7

Where are baroreceptors found?

Answer 7

Arch of aorta

Carotid sinus

Question 8

What are the signs and symptoms of hypovolaemic shock?

Answer 8

Cold and clammy
Tachycardia
Weak pulse

Question 9

What is the long term consequence of SNS stimulation in hypovolaemic shock?

Answer 9

Activation of the RAAS

ADH release

Question 10

What effect does increased TPR have in hypovolaemic shock?

Answer 10

Impairs tissue perfusion (increase in vasodilator metabolites can override this)
Reduced hydrostatic pressure
Internal transfusion

Question 11

What is anaphylactic shock?

Answer 11

A form of distributive shock caused by an allergic reaction

Question 12

What chemical mediators can be released in anaphylactic shock?

Answer 12

Leukotrienes
Bradykinin
Histamine
Prostaglandins
Cytokines

Question 13

What affect does histamine have in anaphylactic shock?

Answer 13

Decreased arterial blood pressure

Reduced TPR

Question 14

What are the signs and symptoms of anaphylactic shock?

Answer 14

Dyspnea
Collapse
Tachycardia
Red and warm extremities
Fast and pounding pulse

Question 15

How do you treat anaphylactic shock?

Answer 15

Adrenaline

Question 16

What is toxic shock?

Answer 16

A form of distributive shock caused by sepsis.

Question 17

What bacterial and endogenous chemicals contribute to the symptoms of toxic shock?

Answer 17

Endotoxin
TNF alpha
IL-1

Question 18

What are the symptoms of toxic shock?

Answer 18

Tachycardia
Warm and red extremities
Strong pulse

Question 19

How can you treat toxic shock?

Answer 19

Antibiotics

Fluid resuscitation with colloid

Question 20

Give a cause of mechanical shock

Answer 20

Cardiac tamponade

Pulmonary embolism

Question 21

What are the symptoms of mechanical shock

Answer 21

Dyspnoea
Chest pain
Raised JVP
Bulging neck veins
Tachycardia

Question 22

What are the pressures in the right and left atria in mechanical shock caused by a pulmonary embolism?
(high or low)

Answer 22

Right - high

Left - low

Question 23

What are the pressures in the right and left atria in mechanical shock caused by cardiac tamponade?
(high or low)

Answer 23

Right - high

Left - high

Question 24

How would you treat cardiac tamponade?

Answer 24

Pericardiocentesis beneath the xiphoid process

Question 25

What is cardiogenic shock?

Answer 25

Inability of the heart to eject enough blood

Question 26

Give some causes of cardiogenic shock

Answer 26

Ventricular tachycardia
Bradycardia
MI which damages the left ventricle
Acute worsening of heart failure

Question 27

How can cardiogenic shock cause oliguria?

Answer 27

Pressure is too low to filter blood through the kidneys