CV System and Shock - A Christmas Quiz

1. As the children's letters have been flooding in amidst soaring supply chain costs in the North Pole, Santa has been getting increasingly stressed. He has been getting generalised headaches for three weeks and was diagnosed with hypertension and started on medication for this. Despite triple antihypertensive therapy, his BP remains elevated. Blood tests reveal an elevated serum renin level. Which of the following medications affects the level of this hormone directly?

• Captopril
• Furosemide
• Metoprolol
• Amlodipine
• Valsartan

2. Rudolph is working with Lapland's cardiovascular physiology department to improve his fitness for his Christmas Eve exertions. They are monitoring his heart rate to optimise his training regime. Following a strenuous treadmill test, his heart rate increases from 54 BPM to 182 BPM. Which of the following best describes the changes in stroke volume during the treadmill test?

• Increased venous return from the muscles, reduces preload, and increases stroke volume
• Increased venous return from the muscles, increases preload, and increases stroke volume
• Increased venous return from the muscles, increases preload, and reduces stroke volume
• Reduced venous return from the muscles, increases preload, and increases stroke volume
• Reduced venous return from the muscles, reduces preload, and reduces stroke volume

3. Santa is getting old (St. Nicholas was born in 280 AD). He has recently seen the North Pole's GP complaining of dizziness upon standing, who referred him for an ECHO scan. This found a left ventricular ejection fraction of 35%. What is the most likely cause of these signs and symptoms?

• Atrial dysfunction
• Atrioventricular node dysfunction
• Diastolic dysfunction
• Systolic and diastolic dysfunction
• Systolic dysfunction

4. Tis the night before Christmas. Mrs Claus is feeling really rough and attends Lapland ED with severe CP, dyspnoea & vomiting. She has a history of heart failure with preserved ejection fraction. On examination, pedal oedema is present, and crepitations are heard at both lung bases. An ECG shows findings suggestive of MI. Which of the following correlates with Mrs Claus's condition?

• Decreased cardiac output and decreased pulmonary capillary wedge pressure
• Decreased cardiac output and decreased right atrial pressure
• Decreased cardiac output and increased right atrial pressure
• Increased cardiac output and decreased systemic vascular resistance
• Increased cardiac output and increased right atrial pressure

5. During his Christmas Eve journey, Santa develops central crushing chest pain that radiates down his left arm and into his jaw. He can barely hold onto the sleigh's reins. Fortunately, he is delivering presents to children on SGH's paediatrics ward, where an ECG is performed. There is ST-elevation in leads I, aVL, and V4-V6. Which artery is most likely to be occluded?

• LAD
• Left circumflex artery
• Sinoatrial nodal branch
• RCA
• Right marginal artery

6. You are asked to see a patient in ED who has developed sudden onset chest pain and dyspnoea having just been shocked to witness Father Christmas delivering presents to children in the hospital. You review the patient's ECG, and due to changes within a certain section, urgently arrange for transfer to the cath lab. Which underlying process does the ECG section in question represent?

• Sino-atrial node firing
• Period between ventricular depolarisation & repolarisation
• Ventricular repolarisation
• Atrial depolarisation
• Atrioventricular node function

7. Santa is in poor 'elf. He has Type 2 diabetes and is referred to the vascular clinic with a chronic cold purple left leg which used to only cause pain when exercising. He now complains of leg pain at rest lasting the past week. During a peripheral vascular exam, it is discovered that he has no palpable popliteal, posterior tibial or dorsalis pedis pulses on his left leg and a weak posterior tibial and dorsalis pedis pulse on his right leg. His ABPI (Ankle-Brachial-Pressure-Index) is 0.56. What would be the most suitable next step in his treatment at this stage in his disease?

• Change lifestyle factors
• Put on aspirin and a statin
• Percutaneous transluminal angioplasty
• Surgical bypass of the femoral artery
• Amputation preserving the knee

8. Santa loses control of his sleigh in a blizzard over Southampton and crashes. Dasher suffers a crush injury to his right hind leg and loses a lot of blood. Which one of the following will not decrease?

• Cardiac Output
• Renin secretion
• Firing of carotid baroreceptors
• Firing of aortic baroreceptors
• Blood pressure

9. Following the same sleigh crash, Prancer is struggling to breathe. He is brought into ED in an ambulance and is tachycardic, hypotensive and stops breathing shortly after arriving to the hospital. The doctors examine him and suspect shock. Which of the following is a cause of obstructive shock due to an interference in ventricular filling?

• Pulmonary embolism
• Anaphylactic shock
• Tension pneumothorax
• Chemical burns
• Myocardial infarction

10. Santa presents to the emergency department 30 minutes after sustaining severe burns when his beard caught fire as he descended a chimney with a lit fire. There are large areas affected by full-thickness burns. There is significant oedema. On examination his heart rate is 124/min and his blood pressure is 92/48 mmHg. What is the most likely cause for his vital signs?

• Neurogenic shock
• Secondary infection
• Severe pain
• Smoke inhalation
• Third space fluid loss