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SAQ/SBA questions > SAQ > Flashcards

SAQ Flashcards

1
Q

A healthy 20-year-old male presents for a routine check-up. During the physical examination, you are tasked with performing cardiac auscultation.

1.Briefly describe the normal heart sounds (S1 & S2) in terms of their timing, location, and characteristics. (1 point)

A

S1 - closure of the atrioventricular valves (tricuspid and mitral valves) following atrial systole as the pressure in the ventricles is greater than atria. Low-pitched “lib” sound. Heard best at the apex

S2- closure of the semi-lunar valves (aortic and pulmonary valves) following ventricular systole as the pressure in the great vessels is greater than the ventricles. High-pitched “dub”. Heard best at the base.

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2
Q

A healthy 20-year-old male presents for a routine check-up. During the physical examination, you are tasked with performing cardiac auscultation.

2.Using anatomical landmarks, identify the four main valve areas where you would auscultate for heart sounds. (2 points)

A

Aortic = 2nd intercostal space, just to right of sternum
Pulmonary = 2nd intercostal space, left of sternum
Tricuspid= 5th intercostal space, left of sternum
Mitral = 5th intercostal space, left midclavicular line

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3
Q

A healthy 20-year-old male presents for a routine check-up. During the physical examination, you are tasked with performing cardiac auscultation.

3.Explain the physiological events occurring in the heart that generate each of the normal heart sounds. (2 points)

A

S1 = closure of atrioventricular valves
S2 = closure of semi-lunar valves

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4
Q

A 30-year-old woman with no significant medical history presents to the emergency department with chest pain radiating down her left arm. Based on her symptoms and initial tests, you suspect a potential cardiac issue.

1.Describe the origin and course of the two main coronary arteries (left main and right coronary artery) arising from the aorta. (2 points)

A

Arise from the ascending aorta- left and right aortic sinus
Run in left and right atrioventricular grooves
Left main coronary artery branches to form left anterior descending (with diagonal branches) and circumflex artery
Right main coronary artery branches to farm posterior interventricular artery and right marginal artery

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5
Q

A 30-year-old woman with no significant medical history presents to the emergency department with chest pain radiating down her left arm. Based on her symptoms and initial tests, you suspect a potential cardiac issue.

2.Briefly explain the main territories supplied by the left main coronary artery and its branches. (2 points)

A

Left main coronary artery: Supplies the interventricular septum, anterior and lateral walls of the left ventricle, and the left papillary muscle.

LAD: Supplies the anterior and anteroseptal walls of the left ventricle.

Circumflex: Supplies the lateral wall of the left ventricle.

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6
Q

A 30-year-old woman with no significant medical history presents to the emergency department with chest pain radiating down her left arm. Based on her symptoms and initial tests, you suspect a potential cardiac issue.

3.Why is the left main coronary artery considered the “widowmaker”? (1 point)

A

Supplies the majority of the left side of the heart - left ventricular output
As well as SAN

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7
Q

A 30-year-old woman with no significant medical history presents to the emergency department with chest pain radiating down her left arm. Based on her symptoms and initial tests, you suspect a potential cardiac issue.

4.If the right coronary artery were blocked, which specific regions of the heart would be most likely affected? (2 points)

A

Right atrium
AV node
Right ventricle
Inferior wall of left ventricle

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8
Q

During a routine check-up, a 25-year-old athlete with no known medical history exhibits a slightly irregular heartbeat on your physical examination. You decide to investigate further.

1.Briefly describe the components of the cardiac conduction system, starting from the pacemaker to the ventricles. (2 points)

A

SAN —> atria —> AVN —> bundle of His —> left and right bundle branches —> purkinje fibres —> ventricles

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9
Q

During a routine check-up, a 25-year-old athlete with no known medical history exhibits a slightly irregular heartbeat on your physical examination. You decide to investigate further.

2.What key structures are responsible for delaying the electrical signal before ventricular contraction? Explain the physiological purpose of the delay in electrical signal conduction after the atria. (2 points)

A

AVN delays the contraction in order to allow complete contraction of the atria before the ventricles contract so that all blood moves into the ventricles.

Physiology:
Fewer pacemaker cells in the AV node
Fewer gap junctions
Fewer FAST Na+ channels

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10
Q

During a routine check-up, a 25-year-old athlete with no known medical history exhibits a slightly irregular heartbeat on your physical examination. You decide to investigate further.

3.Describe the differences in conduction velocities of different structures within the heart. (2 points)

A

Fastest = purkinje fibres 2-4 m/s
•Allows strong ejection
Slowest = AVN 0.1-0.5 m/s
•Allows adequate ventricular filling

Speed is dependent on:
•Ion movement in/out
•Interconnectedness – number of gap junctions

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11
Q

A 40-year-old patient presents with high blood pressure (150/90 mmHg) and reports experiencing occasional dizziness. You suspect changes in blood flow and pressure dynamics might be contributing to their symptoms. Based on your understanding of basic cardiovascular physiology, answer the following questions:

1.Briefly explain Ohm’s Law (with equation) and its application to blood flow in the circulatory system. (1 point)

A

Flow = pressure gradient /resistance

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12
Q

A 40-year-old patient presents with high blood pressure (150/90 mmHg) and reports experiencing occasional dizziness. You suspect changes in blood flow and pressure dynamics might be contributing to their symptoms. Based on your understanding of basic cardiovascular physiology, answer the following questions:

2.Define stroke volume and give its equation (1 point)

A

Stroke volume = EDV - ESV
Volume of blood pumped out of heart per beat

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13
Q

A 40-year-old patient presents with high blood pressure (150/90 mmHg) and reports experiencing occasional dizziness. You suspect changes in blood flow and pressure dynamics might be contributing to their symptoms. Based on your understanding of basic cardiovascular physiology, answer the following questions:

3.Calculate the pulse pressure for this patient using the provided blood pressure values. (1 point)

A

60 mmHg

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14
Q

State Pouiselle’s equation

A

(8 x viscosity x length)/ (pi x r^4)

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15
Q

What is the equation for Mean Arterial Pressure?

A

DP + 1/3(SP - DP)

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16
Q

Where are central chemoreceptors located?

A

Medulla

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17
Q

What is the equation for calculating Heart Rate?

A

Cardiac output/ stroke volume

18
Q

Describe the composition of blood.

A

55% plasma
45% cellular - RBC - 44%, WBC - 1%

19
Q

What would an absent P wave on an ECG be a sign of?

A

Atrial fibrillation

20
Q

What is the unique characteristic of cardiac muscle?

A

Myogenic
Presence of intercalated discs between muscle fibres

21
Q

Briefly describe foetal circulation.

A

Maternal circulation ->
umbilical vein (oxygenated blood) ->
ductus venosus - >
IVC - >
RA ->
LA/RV ->
aorta ->
umbilical artery (deoxygenated
blood) ->
maternal circulation

22
Q
  1. A 14 year old patient is rushed to A and E with pear drop breath and severe loss of consciousness. As a known type 1 diabetic, they are confirmed to be in a state of diabetic ketoacidosis.
    a. Diabetes mellitus is a lack of insulin production or action on peripheral tissue. What is the function of insulin and where is it secreted from? (2 marks)
A

Secreted from beta cells in islets of langerhans in pancreas
Increase uptake of glucose into liver and muscle cells -Glycogenesis

23
Q

b. Name the main rate limiting step in glycolysis, including the enzyme involved. (3 marks)

A

Conversion of fructose-6-phosphate to fructose 1,6, bisphosphate by phosphofructokinase-1

24
Q

List the 2 steps requiring ATP in glycolysis (2 marks)

A

Conversion of glucose to glucose-6-phosphate
Conversion of fructose-6-phosphate to fructose-1,6-bisphosphate

25
Q

Ketoacidosis occurs when there is excessive gluconeogenesis which the body doesn’t need. Fatty acids are metabolised to glucose via what process before entering the Krebs’ cycle as acetyl coA? (2 marks)

A

Beta-oxidation

26
Q
  1. Sally presents to you, her GP, with retrosternal chest pain which is worse on lying down and is associated with dyspepsia and heartburn. You think she has GORD. Before you diagnose her, you take a sample from her larynx and pharynx to run under the microscope.
    a. What epithelium lines the oesophagus in a normal physiological human? (3 marks)
A

Stratified squamous non-keratinising epithelium

27
Q

You also examine the epithelium of the larynx and this reveals pseudostratified ciliated columnar epithelium. Name one region in the abdomen you may find this type of epithelium. (1 mark)

A

Surface epithelium of ovaries in females

28
Q

M etaplasia occurs when one cell type morphs into another. In severe GORD, normal oesophageal epithelium transforms into simple columnar epithelium of the stomach. What is this complication known as? (1 mark)

A

Barrett’s oesophagus

29
Q

Name 3 types of cell junction (3 marks)

A

Tight junctions
Gap junctions
Desmosomes

30
Q

Epithelium rests on a basement membrane. What type of collagen is the basement membrane made from? (1 mark)

A

Type 4

31
Q

In what tissue may you histologically find intercalated discs? (1 mark)

A

Cardiac muscle

32
Q
  1. A hypertensive patient with a BP reading 155/100 presents to his GP.
    a. The RAAS system is heavily involved in BP maintenance. Where is renin produced from? (2 marks)
A

Principal cells of the juxtaglomerular apparatus in the kidney

33
Q

Name 3 effects of the RAAS system (3 marks)

A

Activates aldosterone release
Activates ADH secretion
Increases sympathetic nervous system stimulation

34
Q

Where is aldosterone released from? (2 marks)

A

Zona glomerulosa in adrenal cortex

35
Q

Where is the site of greatest peripheral resistance to systemic blood flow? (1 mark)

A

Arterioles

36
Q

Write the equation for cardiac output (2 marks)

A

Heart rate x stroke volume

37
Q
  1. A 76 year old smoker presents for a routine checkup in her COPD management. She is sent for spirometry testing and a chest X ray.
    a. What term best describes this definition; ‘The maximum air one can exhale after a maximal inhalation’ (1 mark)
A

Vital capacity

38
Q

COPD patients may have respiratory failure which is often type 2 respiratory failure. How would you define this? (2 marks)

A

Low PaO2
High PaCO2

39
Q

A chest X ray shows hyperinflated lungs with a non-deviated trachea. At what vertebral level does the trachea bifurcate into left and right main bronchi? (1 mark)

A

T4/T5

40
Q

Later on you see another patient; an 8 year old asthmatic.
d. Asthmatics usually have episodes of worsening symptoms, often caused by allergens. Which Ig subclass mediates allergic reactions? (1 mark)

A

IgE

41
Q

Alveolar pneumocytes are either type 1 or type 2. Type 1 forms the exchange surface between the alveoli and capillaries. What is the function of type 2 pneumocytes and state the equation involving alveolar air flow and radius. (2 marks)

A

Produce surfactant
P = 2T/r

42
Q

Gell and Coombs’ classification is used to define hypersensitivity reactions. Define (in simple terms) what a type 2, type 3 and type 4 hypersensitivity reaction is. (3 marks)

A

Type 2 - antigen-antibody complex formation
Type 3 - immune complex deposition
Type 4- delayed T cell mediated hypersensitivity

SAQ/SBA questions (2 decks)

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