Cardiac Physiology Quiz

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Questions and Answers

Which phase of the cardiac action potential is characterized by the closure of calcium channels and the efflux of potassium?

  • Phase 4
  • Early repolarization
  • Phase 0
  • Phase 3 (correct)

During the cardiac cycle, which ECG component reflects the electrical activity associated with the delay in the AV node?

  • T wave
  • QRS complex
  • P wave
  • PR interval (correct)

What is the primary ionic event during the depolarization phase of a cardiac cell?

  • Efflux of calcium ions.
  • Influx of sodium ions. (correct)
  • Efflux of sodium ions.
  • Influx of potassium ions.

Where are the autorhythmic cells primarily located that act as the main pacemaker?

<p>SA Node (B)</p> Signup and view all the answers

Which of the following correctly describes the ionic movement associated with the resting state of a cardiac cell?

<p>Potassium ions entering the cell. (A)</p> Signup and view all the answers

Which of the following best describes the physiological consequence of a tension pneumothorax?

<p>Reduced lung expansion due to air or fluid accumulation in the pleural space. (D)</p> Signup and view all the answers

What is the primary function of the central chemoreceptors in the medulla oblongata?

<p>To respond to changes in the partial pressure of carbon dioxide in the blood. (A)</p> Signup and view all the answers

How does the administration of opiate-based pain relief affect the respiratory system during general anaesthesia?

<p>It impairs the respiratory system's ability to respond to changing oxygen demands. (C)</p> Signup and view all the answers

In a patient with restrictive lung disease, which of these statements best describes the change in lung compliance and its consequence?

<p>Decreased compliance, increasing the pressure needed for lung inflation and potentially causing inadequate oxygenation. (D)</p> Signup and view all the answers

Which effect does the Trendelenburg position have on a patient's breathing?

<p>It compresses the lungs due to abdominal contents pushing against the diaphragm, restricting its movement and impeding lung expansion. (D)</p> Signup and view all the answers

Which of the following medications is MOST appropriate for treating hypotension not directly associated with cardiac arrest?

<p>Metaraminol (A)</p> Signup and view all the answers

A patient is experiencing a severe anaphylactic reaction. In addition to administering oxygen and IV adrenaline, which of the following is the MOST appropriate immediate treatment?

<p>Intravascular volume replacement (A)</p> Signup and view all the answers

During treatment of malignant hyperthermia, what is the PRIMARY purpose of inserting activated charcoal filters on the inspiratory and expiratory limbs of the circuit?

<p>To remove any remaining vaporized anesthetic agents (A)</p> Signup and view all the answers

A patient with a known history of asthma develops bronchospasm after receiving an anesthetic. What is the MOST appropriate IMMEDIATE intravenous medication to administer?

<p>Salbutamol (D)</p> Signup and view all the answers

Which medication is used specifically for local anaesthetic toxicity, particularly in severe cases presenting with cardiovascular collapse?

<p>Intralipid (D)</p> Signup and view all the answers

Which medication is BEST suited to reverse the effects of a non-shockable cardiac arrest?

<p>Adrenaline (C)</p> Signup and view all the answers

Which ethical principle is MOST directly concerned with ensuring fair and equitable distribution of care during an emergency?

<p>Justice (D)</p> Signup and view all the answers

In a situation where a patient is unconscious and requires immediate medical intervention, under what ethical circumstance can a healthcare provider typically proceed without explicit consent?

<p>If implied consent can be assumed due to the emergency. (D)</p> Signup and view all the answers

When assessing a patient's capacity to provide informed consent, what is the MOST critical factor that must be satisfied?

<p>The patient has been given sufficient information and opportunity to consider. (B)</p> Signup and view all the answers

What is the primary legal distinction between a 'red form' and a 'purple form' in the context of Do Not Attempt Resuscitation (DNAR) orders?

<p>A red form signifies that the DNAR agreement was made with the patient, doctors, and family, while purple forms are often just the patients advanced directive. (A)</p> Signup and view all the answers

According to the content, in what specific circumstance might a person's autonomy, regarding medical decisions, be justifiably overridden or removed?

<p>When they have a mental illness that impairs their decision making capacity. (B)</p> Signup and view all the answers

During a major haemorrhage, which physiological response is NOT a direct compensatory mechanism?

<p>Decreased respiratory rate (D)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial intervention after confirming a major haemorrhage?

<p>Activating the major haemorrhage protocol (C)</p> Signup and view all the answers

A patient with a major haemorrhage is not responding to standard treatments. Which haematological condition from Box A requires urgent liaison with a haematologist?

<p>Warfarin overdose (B)</p> Signup and view all the answers

According to the provided guidelines, what is the target level for fibrinogen in a patient experiencing major haemorrhage?

<blockquote> <p>1.0 g/L (A)</p> </blockquote> Signup and view all the answers

A 10 year-old child, weighing 30kg, requires a bolus dose of 10% calcium chloride for a major haemorrhage. What is the correct dose?

<p>$6$ mL (C)</p> Signup and view all the answers

In a non-obstetric major haemorrhage, what is the correct IV infusion rate for tranexamic acid (TXA) post bolus, according to the guidelines?

<p>1g IV bolus, then 1g IV infusion over the next 8 hours (D)</p> Signup and view all the answers

Which of these drug options will assist in stabilising the clotting process during a major haemorrhage?

<p>Tranexamic Acid (TXA) (D)</p> Signup and view all the answers

A patient experiencing a major haemorrhage with a low platelet count. What blood product will directly address this?

<p>Platelets (A)</p> Signup and view all the answers

Which zone of a burn injury is characterized by decreased tissue perfusion and the potential for it to become irreversible?

<p>Zone of stasis (C)</p> Signup and view all the answers

What is the primary systemic response that begins when a burn affects approximately 30% of the body's tissue area?

<p>Release of cytokines and inflammatory mediators (A)</p> Signup and view all the answers

What physiological change underlies the peripheral and splanchnic vasoconstriction observed in burn patients?

<p>Release of catecholamines, vasopressin, and angiotensin (A)</p> Signup and view all the answers

What is the primary respiratory consequence for a burn patient experiencing bronchospasm?

<p>Increased airway resistance (D)</p> Signup and view all the answers

Why does insulin resistance occur in burn patients?

<p>Release of adrenaline causing cell's inability to bind to insulin (C)</p> Signup and view all the answers

What is the primary purpose of aggressive enteral feeding in burn patients?

<p>To decrease catabolism (A)</p> Signup and view all the answers

What is the underlying cause of the lethal triad in burn patients?

<p>Loss of volume leading to decreased oxygen and increased lactic acid (B)</p> Signup and view all the answers

Which of the following is a primary concern regarding burns around the mouth?

<p>Potential for airway swelling and obstruction (A)</p> Signup and view all the answers

Why is it important to replace lost fluid volume with warmed IV fluids in burn patients?

<p>To maintain blood pressure and prevent hypothermia (A)</p> Signup and view all the answers

What is the significance of arterial blood gas (ABG) monitoring in burn patients?

<p>To evaluate blood's acidity and oxygenation levels (D)</p> Signup and view all the answers

Which of the following is the PRIMARY antibody involved in the pathophysiology of anaphylaxis?

<p>Immunoglobulin E (IgE) (B)</p> Signup and view all the answers

During anaphylaxis, a large release of histamine causes vasodilation which has what effect on blood pressure?

<p>Decreases blood pressure (C)</p> Signup and view all the answers

What is the primary effect of histamine on the bronchioles during an anaphylactic reaction?

<p>Bronchoconstriction and increased mucus production (C)</p> Signup and view all the answers

Which of the following most accurately describes the cardiovascular changes associated with severe anaphylaxis?

<p>Decreased blood pressure and tachycardia (C)</p> Signup and view all the answers

Which of these mediators is responsible for increased vascular permeability in anaphylaxis?

<p>Histamine and platelet-activating factor (D)</p> Signup and view all the answers

What is the primary rationale for administering intramuscular adrenaline (epinephrine) during anaphylactic shock?

<p>To cause vasoconstriction (D)</p> Signup and view all the answers

What type of fluid is used via a bolus during anaphylaxis and why?

<p>Crystalloid fluids ONLY, to increase intravascular volume (C)</p> Signup and view all the answers

How does the loss of intravascular volume directly impact the cardiovascular system during anaphylaxis?

<p>Decreased cardiac output and myocardial damage (A)</p> Signup and view all the answers

In the context of anaphylaxis, which of the following processes contributes most directly to airway obstruction?

<p>Mucus production and vascular swelling (D)</p> Signup and view all the answers

What is the primary function of mast cells in anaphylaxis?

<p>To release histamine and inflammatory mediators (C)</p> Signup and view all the answers

Flashcards

Autonomy in healthcare

The patient's right to make their own decisions about their healthcare.

Beneficence

The principle of doing good and acting in the patient's best interest.

Non-maleficence

The principle of avoiding harm to the patient.

Advanced directive

A legal document that outlines a patient's wishes for medical treatment in the event they are unable to make decisions for themselves.

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Purple form (DNAR)

A form used to document a Do Not Attempt Resuscitation (DNAR) order.

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Energy equation

The equation that represents the process of aerobic respiration where glucose and oxygen are converted into energy (ATP), carbon dioxide (CO2), and water (H2O).

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Respiratory acidosis

A condition where there is an increase in the partial pressure of carbon dioxide (CO2) in the blood due to a decrease in the efficiency of the respiratory system to eliminate CO2.

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Pressure gradient for breathing

The pressure inside the lungs must be lower than atmospheric pressure so that air can flow into the lungs.

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Lung compliance

The ability of the lungs to expand and contract easily. It reflects how easily the lungs can be inflated.

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Bronchospasm/Asthma

A condition where the bronchioles in the lungs narrow, making it difficult to breathe.

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What is Laryngospasm?

A condition where the larynx narrows abnormally. Prolonged laryngospasm can lead to barotrauma and complications, such as pulmonary edema or blood in the lungs.

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What is Anaphylaxis?

An immediate and severe allergic reaction that involves a release of histamine and serotonin. Symptoms include hives, swelling, and difficulty breathing.

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What is Local Anaesthetic Toxicity?

A severe reaction to local anesthetics, characterized by changes in mental status, cardiovascular collapse, and potentially life-threatening arrhythmias. It can happen shortly after or even some time after injection.

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What is Tachycardia?

A condition marked by an extremely rapid heart rate. Treatment might involve fluids, magnesium, or medications like amiodarone or labetalol.

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What is Bradycardia?

A condition where the heart rate is abnormally slow. Can be treated with medications like atropine or adrenaline in emergencies.

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What is Malignant Hyperthermia?

A rare but serious condition characterized by a rapid rise in body temperature, muscle rigidity, and potentially fatal complications like rhabdomyolysis. Treatment involves dantrolene, and cooling measures.

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What is the body's response to major haemorrhage?

The body's response to blood loss, characterized by increased heart rate, vasoconstriction, and reduced blood pressure. The body is compensating for the lack of circulating volume.

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What is the major haemorrhage protocol?

A group of interventions aimed at stabilising a patient experiencing a major haemorrhage. It includes measures like early recognition, calling for help, blood product transfusion, and controlling bleeding sources.

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What is major haemorrhage?

This term refers to a life-threatening condition that occurs when a patient experiences a sudden and significant blood loss. This can lead to shock and potential organ damage.

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Why is active patient warming essential in major haemorrhage?

A critical component of major haemorrhage management. It involves measures to prevent heat loss and maintain the patient's core temperature. This is crucial for proper clotting and preventing complications.

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What is the lethal triad in major haemorrhage?

A collection of factors, including hypothermia, acidosis, and coagulopathy, that often occur together in major haemorrhage. These factors can worsen bleeding and increase the risk of complications.

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What is tranexamic acid (TXA)?

A drug used to prevent the breakdown of blood clots, thus helping to control bleeding in cases of major haemorrhage.

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What is fresh frozen plasma (FFP)?

A blood product containing clotting factors, which is administered to help control bleeding in patients with major haemorrhage.

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What are platelets, and why are they important in major haemorrhage?

A blood product containing platelets, which are essential for blood clotting. They are administered to patients with major haemorrhage to help stop the bleeding.

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What is the SA Node?

Autorhythmic cells responsible for initiating and regulating the heartbeat. They are located in the right atrium and act as the 'pacemaker' of the heart.

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What is the AV Node?

Autorhythmic cells found near the bottom of the right atrium that help to slow down electrical signals before they reach the ventricles. This ensures proper coordination between atrial and ventricular contractions.

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What does the QRS complex represent in an ECG?

Represents the electrical activity of the ventricles as they contract. It's the largest wave on an ECG and is characterized by the 'QRS complex'.

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What is the resting membrane potential of a cardiac cell?

The resting state of a cardiac cell where the inside of the cell is negatively charged compared to the outside. This creates a potential difference, essential for the heart to function properly.

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What is Depolarization in a cardiac cell?

The process by which a cardiac cell is stimulated to generate an electrical impulse. This involves sodium ions rushing into the cell, causing it to become positively charged.

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Anaphylaxis

A severe, life-threatening allergic reaction characterized by widespread vasodilation, bronchoconstriction, and increased vascular permeability. It can manifest with symptoms affecting multiple organ systems, including the skin, respiratory system, cardiovascular system, and gastrointestinal system.

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Immunoglobulin E (IgE)

A type of antibody that plays a crucial role in allergic reactions. Its binding to allergens triggers the release of histamine and other inflammatory mediators from mast cells.

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Mast cells

Specialized cells found in tissues that contain histamine and other inflammatory mediators. When activated by IgE, they release these mediators, contributing to the symptoms of anaphylaxis.

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Histamine

A chemical released by mast cells during anaphylaxis. It causes vasodilation (blood vessel widening), bronchoconstriction (airway narrowing), and increased vascular permeability (leakiness of blood vessels).

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Allergen

A substance that causes an allergic reaction, such as pollen, food, insect stings, or pet dander.

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Crystalloid fluid bolus

A rapid infusion of a fluid to increase the blood volume. It may be used to treat anaphylaxis by increasing the circulating volume.

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Vasodilation

The widening of blood vessels, which can lead to a decrease in blood pressure (hypotension).

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Bronchoconstriction

The narrowing of the airways in the lungs, which can cause difficulty breathing (wheezing, stridor, and dyspnea).

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Increased vascular permeability

The leakage of fluid from blood vessels into surrounding tissues, which can lead to swelling.

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Intramuscular (IM) injection

The process of administering medication directly into a muscle, usually in the thigh or upper arm.

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Zone of Coagulation

The most damaged area of a burn, characterized by irreversible cell death and impaired circulation. This zone is where blood clots form.

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Zone of Stasis

This zone of a burn is characterized by reduced blood flow and tissue perfusion. It's potentially reversible, but can also turn into the irreversible zone if not treated properly.

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Zone of Hyperemia

This zone of a burn is characterized by increased blood flow due to inflammation. This zone has the potential to recover.

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Systemic Response to Burns

This occurs when burns affect at least 30% of the body's surface area, triggering the release of cytokines and inflammatory mediators that increase capillary permeability.

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Hypovolemic/Distributive Shock in Burns

A condition that occurs due to the loss of fluids following a burn, leading to a decrease in blood pressure and oxygen carrying capacity, potentially resulting in hypovolemic shock or distributive shock.

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Bronchospasm in Burn Patients

An important complication of burns, leading to airway obstruction and compromised breathing. It can occur due to the release of cytokines and inflammation in the airways.

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Hypermetabolism in Burns

A critical metabolic change following a burn, where the body increases its metabolic demands due to the loss of tissues. This can lead to malnutrition and catabolism.

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Insulin Resistance in Burns

A common complication of burns, characterized by a decrease in the body's ability to utilize insulin. It's caused by the release of adrenaline, which prevents the body from efficiently taking in glucose from the bloodstream.

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Fluid Resuscitation Formula for Burns

Parkland Formula

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Arterial Blood Gases (ABGs) in Burns

This is a measure of the amount of oxygen in the blood, and it's critical to monitor in burn patients due to their increased oxygen demand and potential for respiratory compromise.

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Study Notes

Four Main Ethical Principles

  • Autonomy
  • Justice
  • Non-maleficence
  • Beneficence

Emergency and Complex Care

  • Best Interest
  • Autonomy
  • Consent - verbal, written or implied
  • Informed Consent - Competent, sufficient information, able to ask questions, given opportunity to consider
  • No intent to harm
  • Jehovah's intent to harm

Lacks Capacity

  • Do everything possible to help them understand

DNR - Purple Form/Red Form

  • Advanced directive - what they don't want
  • Red form - agreed with patient and doctor/family

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