Appendices: Additional exercises for critical thinking and clinical reasoning
Extra Critical Thinking Questions
Ghazal Sokhanran; Samuel Lam; Kristen Danielle Go; and Jennifer Kong
In this appendix you will find a series of extra critical thinking questions that relate back to all the knowledge you have learned till this point, and they require you to apply the critical thinking skills and methods to solve them
Heart Failure chapter
- Compare the anatomy and function of the right and left sides of the heart. Speculate on some possible defects in the heart that could lead to diseases. Hint: they don’t have to be actual disease, don’t even name disease, just speculate. Eg. Hypertrophy on the left side of heart (the muscle tissue gets too large on the left side)
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Pathophysiology Physiological manifestations (e.g. chamber volume, cardiac output) EXAMPLE: LV is abnormally thick Reduced LV filling volume –> decr ejection fraction [1] Reduced volume in pulmonary circulation & left heart LA is enlarged with abnormally thin walls [2] [3] Superior & Inferior Vena Cava are distended with excess volume, low cardiac output [4] LV is enlarged with thin walls & decr CO, murmur is heard during systole - What do you think would happen if the aortic valve doesn’t work properly? For each of the following scenarios, explain what: i) would would the effect be on cardiac output (i.e. volume ejected into the aorta)? ii) leftover volume after systole (i.e. end systolic volume)? iii) preload (i.e. volume filling the ventricle).
- What respiratory changes (if any) would someone with L-sided heart failure experience? How does this compare with R-sided heart failure? Are these difference enough for you to make a “diagnosis”?[8]
- Which would have a greater impact on overall perfusion of the body: concentric vs eccentric hypertrophy? [9]
Acute Kidney Injury Chapter
Metastatic Melanoma Chapter
Diabetes Mellitus Chapter
Emphysema & Pneumonia Chapters
Cirrhosis Chapter
- RV has reduced contractility or pulmonary valve won't open fully ↵
- pulmonary circulation will be overfilled with fluid in alveolar space ↵
- right heart can't contract and eject ↵
- aortic valve can't close fully and volume falls back into LV ↵
- ai.reduced ejection fraction (i.e. less volume ejected); aii) incr end systolic volume in LV' aiii) reduced filling volume entering LV ↵
- bi.reduced ejection fraction (i.e. less volume ejected); bii) incr end systolic volume in LV' biii) reduced filling volume entering LV ↵
- ci.reduced ejection fraction (i.e. less volume ejected); cii) incr end systolic volume in LV' ciii) reduced filling volume entering LV ↵
- 4. L-sided heart failure has blood backed up to pulmonary circulation which the fluid will push into the alveoli (pulmonary edema) causing coughing and dyspnea. Right sided heart failure will have less blood going to the pulmonary circulation and a backup of blood going to the SVC & IVC ↵
- The key here is how the hypertrophy affects ejection fraction (EF). If there is reduced filling volume, as with concentric hypertrophy, there would be reduced EF. However, eccentric hypertrophy will preserve filling volume but will have decreased contractile function as the walls thinning causing loss of function. So concentric hypertrophy with reduced EF has a greater impact on cardiac output until eccentric hypertrophy loses its contractile function. ↵
