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  • Question 1 - A 28-year-old patient is intubated and has a central venous catheter inserted after...

    Incorrect

    • A 28-year-old patient is intubated and has a central venous catheter inserted after being diagnosed with septic shock. You keep track of her central venous pressure.

      The normal value for central venous pressure is which of the following?

      Your Answer: 5-12 cmH 2 O

      Correct Answer: 0-8 cmH 2 O

      Explanation:

      The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).

      At the conclusion of expiration, the CVP should be measured with the patient resting flat. The catheter’s tip should be at the intersection of the superior vena cava and the right atrium. An electronic transducer is installed and zeroed at the level of the right atrium to measure it (usually in the 4th intercostal space in the mid-axillary line).
      CVP is a good predictor of preload in the right ventricle. Hypovolaemia is indicated by a volume challenge of 250-500 mL crystalloid eliciting an increase in CVP that is not sustained for more than 10 minutes.

      CVP is influenced by a number of factors, including:
      Mechanical ventilation (and PEEP)
      Pulmonary hypertension
      Pulmonary embolism
      Heart failure
      Pleural effusion
      Decreased cardiac output
      Cardiac tamponade
      CVP is reduced by the following factors:
      Distributive shock
      Negative pressure ventilation
      Hypovolaemia
      Deep inhalation

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      60.5
      Seconds
  • Question 2 - On reviewing the ECG of a patient with a history of intermittent palpitations,...

    Correct

    • On reviewing the ECG of a patient with a history of intermittent palpitations, you observe prolonged QT interval.

      Which of these can cause prolongation of the QT interval on the ECG?

      Your Answer: Erythromycin

      Explanation:

      Syncope and sudden death due to ventricular tachycardia, particularly Torsades-des-pointes is seen in prolongation of the QT interval.

      The causes of a prolonged QT interval include:
      Erythromycin
      Amiodarone
      Quinidine
      Methadone
      Procainamide
      Sotalol
      Terfenadine
      Tricyclic antidepressants
      Jervell-Lange-Nielsen syndrome (autosomal dominant)
      Romano Ward syndrome (autosomal recessive)
      Hypothyroidism
      Hypocalcaemia
      Hypokalaemia
      Hypomagnesaemia
      Hypothermia
      Rheumatic carditis
      Mitral valve prolapse
      Ischaemic heart disease

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      18.1
      Seconds
  • Question 3 - You evaluate a 80-year-old man who has a history of persistent heart failure...

    Incorrect

    • You evaluate a 80-year-old man who has a history of persistent heart failure and discover that he has generalised oedema.

      Which of the following claims regarding capillary hydrostatic pressure (P c) is false?

      Your Answer: P c is the main driver for pushing fluid out of the capillary bed

      Correct Answer: P c increases along the length of the capillary, from arteriole to venule

      Explanation:

      The capillary hydrostatic pressure (Pc) is normally between 15 and 30 millimetres of mercury. Pc Decreases along the capillary’s length, mirroring the arteriolar and venule pressures proximally and distally.
      Pc is determined by the ratio of arteriolar resistance (RA) to venular resistance (RV).

      When the RA/RV ratio is high, the pressure drop across the capillary is modest, and Pcis is close to venule pressure.

      When the ratio of RA/RV is low, the pressure drop across the capillary is considerable, and Pcis is close to arteriolar pressure.

      Pcis closer to the venule pressure and thus more responsive to changes in venous pressure than arteriolar pressure when RA/RV is high.

      Pcis the major force behind fluid pushing out of the capillary bed and into the interstitium.
      It is also the most variable of the forces affecting fluid transport at the capillary, partly because sympathetic-mediated arteriolar vasoconstriction varies.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      581
      Seconds
  • Question 4 - Where:
    Capillary hydrostatic pressure is (P c)Hydrostatic pressure in the interstices is (P I...

    Correct

    • Where:
      Capillary hydrostatic pressure is (P c)Hydrostatic pressure in the interstices is (P I )
      Plasma oncotic pressure is (π p)Interstitial oncotic pressure is (π i)

      Which of the following formulas best represents fluid flow at the capillary bed?

      Your Answer: Volume / min = (P c - P i ) - (π p - π i )

      Explanation:

      Starling’s equation for fluid filtration describes fluid flow at the capillary bed.
      Filtration forces (capillary hydrostatic pressure and interstitial oncotic pressure) stimulate fluid movement out of the capillary, while resorption forces promote fluid movement into the capillary (interstitial hydrostatic pressure and plasma oncotic pressure). Although the forces fluctuate along the length of the capillary bed, overall filtration is achieved.

      At the capillary bed, there is fluid movement.

      The reflection coefficient (σ), the surface area accessible (S), and the hydraulic conductance of the wall (Lp) are frequently used to account for the endothelium’s semi-permeability, yielding:
      Volume / min = LpS [(Pc- Pi) –  σ(πp– πi)]
      Volume /min = (Pc-Pi) – (πp–πi) describes the fluid circulation at the capillaries.
      Where:
      Pc= capillary hydrostatic pressure
      Pi= interstitial hydrostatic pressure
      πp= plasma oncotic pressure
      πi= interstitial oncotic pressure

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      16.3
      Seconds
  • Question 5 - The ECG of a patient presenting with a history of intermittent palpitations has...

    Correct

    • The ECG of a patient presenting with a history of intermittent palpitations has a prolonged QT interval.

      Which of these can cause prolongation of the QT interval on the ECG?

      Your Answer: Hypomagnesaemia

      Explanation:

      The causes of a prolonged QT interval include:

      Hypomagnesaemia
      Hypothermia
      Hypokalaemia
      Hypocalcaemia
      Hypothyroidism
      Jervell-Lange-Nielsen syndrome (autosomal dominant)
      Romano Ward syndrome (autosomal recessive)
      Ischaemic heart disease
      Mitral valve prolapse
      Rheumatic carditis
      Erythromycin
      Amiodarone
      Quinidine
      Tricyclic antidepressants
      Terfenadine
      Methadone
      Procainamide
      Sotalol

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      14.1
      Seconds
  • Question 6 - The term cardiac output refers to the amount of blood pumped by the...

    Incorrect

    • The term cardiac output refers to the amount of blood pumped by the heart in one minute. The rate in women is around 5 L/min, whereas in men is somewhat higher, around 5.5 L/min.

      Which of the equations below best describes cardiac output?

      Your Answer: Stroke volume x total peripheral resistance

      Correct Answer: Stroke volume x heart rate

      Explanation:

      Cardiac output (CO) is calculated by multiplying stroke volume (SV) by heart rate (HR):
      CO = HR x SV

      As a result, both stroke volume and heart rate are exactly proportional to cardiac output. There will be an increase in cardiac output if the stroke volume or heart rate increases, and a reduction in cardiac output if the stroke volume or heart rate lowers.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      28.9
      Seconds
  • Question 7 - Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is...

    Correct

    • Metabolic hyperaemia harmonizes local blood flow with local O2 demand. If there is an increase in metabolic rate, the production of vasoactive metabolites increases. These metabolites act locally on the surrounding arterioles, causes vasodilation and an increase blood supply.

      Which of these metabolites is the most potent vasodilator in skeletal muscle?

      Your Answer: K +

      Explanation:

      Hyperaemia is the process where the body adjusts blood flow to meet the metabolic needs of different tissues in health and disease. Vasoactive mediators that take part in this process include K+, adenosine, CO2, H+, phosphates and H2O2. Although the mechanism is not clear, all these mediators likely contribute to some extent at different points.

      Specific organs are more sensitive to specific metabolites:
      K+ and adenosine are the most potent vasodilators in skeletal muscles

      CO2 and K+ are the most potent vasodilators in cerebral circulation.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      34.2
      Seconds
  • Question 8 - At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts...

    Correct

    • At rest, skeletal muscle accounts for between 15-20% of cardiac output and accounts for around 50% of body weight. This can increase to nearly 80% of cardiac output during exercise. Skeletal muscle circulation is highly controlled and has a number of specialized adaptations as a result of this high degree of disparity during exercise, in combination with the diversity in the size of skeletal muscle around the body.

      What is the primary mechanism for boosting skeletal muscle blood flow during exercise?

      Your Answer: Metabolic hyperaemia

      Explanation:

      In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.

      Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.

      The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      244.5
      Seconds
  • Question 9 - The cutaneous circulation's principal role is thermoregulation. This process is aided by the...

    Correct

    • The cutaneous circulation's principal role is thermoregulation. This process is aided by the existence of arteriovenous anastomoses.

      Which of the following anatomical areas has the greatest number of arteriovenous anastomoses?

      Your Answer: Pinna of the ear

      Explanation:

      Short vessels called arteriovenous anastomoses (AVAs) link tiny arteries and veins. They have a large lumen diameter. The strong and muscular walls allow AVAs to completely clog the vascular lumen, preventing blood flow from artery to vein (acting like a sphincter). When the AVAs open, they create a low-resistance connection between arteries and veins, allowing blood to flow into the limbs’ superficial venous plexuses. There is no diffusion of solutes or fluid into the interstitium due to their strong muscle walls.

      AVAs are densely innervated by adrenergic fibres from the hypothalamic temperature-regulation centre. High sympathetic output occurs at normal core temperatures, inducing vasoconstriction of the AVAs and blood flow through the capillary networks and deep plexuses. When the temperature rises, sympathetic output decreases, producing AVA vasodilation and blood shunting from the artery to the superficial venous plexus. Heat is lost to the environment as hot blood rushes near to the skin’s surface.
      AVAs are a specialized anatomical adaptation that can only be found in large quantities in the fingers, palms, soles, lips, and pinna of the ear.

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      91.6
      Seconds
  • Question 10 - A trauma victim who has been intubated is tachycardic, hypotensive, and has a...

    Correct

    • A trauma victim who has been intubated is tachycardic, hypotensive, and has a poor urine output. You feel she is dehydrated and decide to use a central venous catheter to help you manage her. As part of this, you keep an eye on the waveform of central venous pressure (CVP).

      Which of the following cardiac cycle phases corresponds to the CVP waveform's 'a wave'?

      Your Answer: End diastole

      Explanation:

      The pressure measured in the right atrium or superior vena cava is known as central venous pressure (CVP). In a spontaneously breathing subject, the usual CVP value is 0-8 cmH2O (0-6 mmHg).

      The structure of the CVP waveform is as follows:
      The CVP’s components are listed in the table below:
      Component of the waveform
      The cardiac cycle phase.
      mechanical event
      mechanical event Diastole 
      Atrial contraction
      a wave 
      C  wave 
      v wave
      Early systole
      The tricuspid valve closes and bulges 
      Late Systole 
      Filling of the atrium with systolic blood 
      x descent
      y descent
      Mid systole
      Relaxation of the atrium 
      Early diastole
      Filling of the ventricles at an early stage

    • This question is part of the following fields:

      • Cardiovascular Physiology
      • Physiology
      32.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Physiology (7/10) 70%
Physiology (7/10) 70%
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