1
Q
What is vascular resistance?
A
force within the circulatory system opposing the flow of blood
2
Q
What is laminar flow?
What is turbulent flow?
A
laminar: flow of a substance (blood) through a tube (blood vessel) parallel to
the tube’s edges (vessel walls) whereby velocity increases towards
the centre of the lumen
turbulent: disorganised flow of substance (blood) through a tube (blood vessel)
in a wide variety of antegrade and retrograde velocities simultaneously
3
Q
What is the Poiseuille Hagen Formula?
A
formula expressing the relationship between flow, viscosity and tube (blood vessel) radius
most important take away = SMALL CHANGES TO RADIUS HAVE A BIG IMPACT ON FLOW
4
Q
What is Laplace’s Law?
A
tension on the wall of a cylinder (blood vessel) is equal to the product of transmural pressure and radius divided by wall thickness
most important implication: EXPLAINS WHY CAPILLARIES DO NOT RUPTURE DESPITE HAVING VERY THIN WALLS - the smaller the radius of a vessel, the less tension is required to withstand internal pressure
5
Q
Flow of blood/fluid is affected by what?
A
pressure
- fluids from from high to low pressure
resistance
- high resistance reduces flow
6
Q
Blood flow through vessels is what?
Where is velocity the highest and lowest?
A
laminar
- flow is organised and parallel to the cylinder (blood vessel) walls
velocity is highest in the centre of the lumen and lowest where blood is in contact with the cylinder (blood vessel) walls
velocity = distance substance is displaced over time
7
Q
Blood flow is __1__ until it reaches a __2__ at which point flow will become __3__.
A
- LAMINAR
(flow of blood through blood vessel parallel to vessel walls, whereby velocity increases towards the centre of the lumen, flow is organised) - CRITICAL VELOCITY (velocity at which a fluid will switch from laminar to turbulent flow)
- TURBULENT (disorganised flow of blood through blood vessels in a wide variety of antegrade and retrograde velocities simultaneously)
8
Q
What is velocity?
What is it affected by?
A
distance substance is displaced over time
- flow rate through a vessel
- cross-sectional area of that vessel
9
Q
Where is the largest total cross-sectional area? What does that mean in regards to velocity?
A
at the level of capillaries
means that lowest velocity is within the capillaries
10
Q
Turbulent flow is triggered by a substance reaching what?
What is turbulent flow?
A
critical velocity
disorganised flow of a substance (blood) through a tube (blood vessel) displaying a wide variety of high velocities - creates NOISE which can be heard on auscultation, high velocities can be ANTEGRADE AND RETROGRADE
11
Q
What is turbulence impacted by?
A
- diameter of the tube
- viscosity of the substance
12
Q
How does increased viscosity and decreased diameter impact turbulence?
A
increased viscosity decreases the chance of flow becoming turbulent
decreased diameter increased the chance of flow becoming turbulent
13
Q
What is viscosity?
A
the degree to which a fluid resists deformation
high viscosity = low flow
14
Q
What is viscosity in the blood produced by?
A
FRICTION BETWEEN MOLECULES AND CELLS
- ++ molecules/cells = ++ viscosity
- increased haematocrit = ++ viscosity
COMPRESSIBILITY OF CELLS
- ++ rigidity = ++ viscosity e.g hereditary spherocytosis
COMPOSITION OF PLASMA
- e.g conditions leading to increased IG concentration
15
Q
- What can a turbulent flow cause?
- Where do turbulent flows usually occur?
- When are they more likely to occur?
A
- can damage endothelium and increase risk of atherogenesis
- at arterial bifurcations and curvatures = increased plaque formation
- after a constriction (stenosis)
16
Q
What is the key point about Poiseuille Hagen’s Formula?
A
that radius has a huge impact on flow and resistance
small increase in diameter = massively increases FLOW
small decrease in diameter = massively increases RESISTANCE
17
Q
In regards to Poiseuille Hagen’s formula, what would a small increase in diameter cause?
What would a small decrease in diameter cause?
A
small increase: increase flow
small decrease: increase resistance
18
Q
Why are arterioles very effective at increasing flow or resistance?
A
- smooth muscle in their walls
- very large total area
(very effective at controlling blood supply to organs)
19
Q
What is Critical Closing Pressure?
A
the intravascular pressure below which a blood vessel collapses and blood flow stops, because the surrounding tissue pressure and vascular smooth muscle tone overcome the luminal pressure
(minimum pressure needed to keep a vessel open - if blood pressure falls below this, the vessel shuts and flow stops even though pressure isnt zero)
20
Q
Capillary walls are 1 cell thick. Why do they not rupture?
A
T = P x r (law of laplace)
T = wall tension
P = transmural pressure (inside vs outside)
r = radius of vessel
capillary walls are thin but capillaries also have a tiny radius so even if pressure inside is significant, multiplying it by a very small r means the tension in the wall is very low
low wall tension = little risk of rupture
21
Q
Which vessels are Capacitance? What does this mean?
A
veins - they can hold large volumes of blood with only a small rise in pressure
22
Q
What does “systolic pressure” refer to?
What does “diastolic pressure” refer to?
A
systolic: arterial pressure at systole
diastolic: arterial pressure at diastole
23
Q
What does “pulse pressure” refer to?
What does “mean pressure” refer to?
A
pulse pressure: difference between systolic and diastolic BP
mean pressure: average pressure throughout cardiac cycle
24
Q
What are the different types of vessels?
What are the 2 major cell types?
A
25
Where is endothelium found in vessels?
What does the endothelium respond to?
between circulating blood and tunica media/adventitia
respond to flow changes, stretch, inflammatory mediators, vasoactive mediators
26
List 4 facts in regards to vascular smooth muscle.
- regulates BP
- muscle cells have K, Ca, Cl channels
- contraction via myosin light chain mechanism
- prolonged contractions contributes to vascular tone
27
Prolonged contractions of vascular smooth muscle contributes to what?
vascular tone
28
What are the 3 layers that make an artery?
What makes up each of these layers?
adventitia
- connective tissue - external elastic lamina
media
- smooth muscle
intima
- endothelium
- connective tissue - internal elastic lamina
29
Larger diameter vessels have more __1__ than smaller arterioles.
elastic tissue
30
Arterioles have less __1__ and more __2__. This makes them a major site of __3__.
1. elastic tissue
2. smooth muscle
3. resistance
31
What makes arterioles a major site of resistance?
the fact that they have less elastic tissue and more smooth muscle
32
Label the image.
33
Fill in the blanks.
34
How big are capillaries?
How big are the walls of capillaries? What are they composed of?
What must RBCs do to fit in capillaries?
about 5um in diameter (just wide enough for a RBC to squeeze through)
only 1um thick - composed of a single endothelial cell sitting on a basement membrane
deform into a parachute shape
35
What secrete vasoactive substances and help regulate capillary blood flow and repair?
pericytes
36
What are the channels between arterioles and capillaries called? What do they contain?
metarterioles - few smooth muscle cells
37
What is at the start of each capillary to control whether blood enters a capillary bed or bypasses it?
precapillary sphincter
38
What are pericytes?
specialised cells that wrap around endothelial cells of capillaries and venules throughout the body
they secrete vasoactive substances and help regulate capillary blood flow and repair
39
What are metarterioles?
What is the function of capillary sphincter?
channels between arterioles and capillaries with a few smooth muscle cells
the sphincters constrict or relax to control whether blood enters a capillary bed or bypasses it
40
What are the 3 different types of capillary structures and where can you find them?
1. normal/continuous
- junctions between endothelial cells allow passage of molecules up to 10 nm
- skeletal/cardiac/smooth muscle beds
2. fenestrated
- 20-100nm
- kidneys, intestinal villi, endocrine glands
3. sinusoidal
- allows large proteins through
- liver, bone marrow, spleen
41
What is the purpose of lymphatics?
Vessels usually join together and drain into the what?
collect plasma that collects in interstitial space after leaving the capillaries
into the right and left subclavian veins
42
List 4 properties of lymphatics.
- contains valves
- no fenestration
- no tight intercellular connections
- little basal lamina
43
Label the image.
44
How are large veins distinguished from arteries? (histology)
large veins have the following:
- irregular lumen
- thinner tunica media
- less smooth muscle
45
In large limb veins, there are __1__ formed by __2__ of the __3__.
These prevent __4__ and assist __5__ return against __6__.
1. valves
2. folds
3. tunica intima
4. backflow
5. venous
6. gravity
46
In regards to vasculogenesis, what give rise to capillaries?
What is the most relevant factor involved?
angioblasts
(mesoderm -> some mesodermal cells differentiate into angioblasts, angioblasts = endothelial cell precursors)
VEGF - key signalling molecule that tells mesodermal cells to become angioblasts and then endothelial cells
47
What is the role of VEGF?
vascular endothelial growth factor:
- angioblast differentiation
- proliferation and migration of endothelial cells
- formation of primitive vascular tubes
48
How do we maintain forward flow of blood during diastole?
arterial recoil
during systole (ventricular contraction)
- left ventricle contracts and ejects blood into aorta
- aortic wall stretches because contains lots of elastic laminae
- this STRETCHING = STORES ENERGY
during diastole (ventricular relaxation)
- ventricle relaxes and semilunar valve closes
- stretched ARTERIAL WALLS RECOIL
- RECOIL = SQUEEZES BLOOD FORWARD maintaining pressure and flow through arteries even when heart is not actively pumping
49
What would happen without arterial recoil?
- blood would only move in spurts during systole - tissue would get uneven blood supply
- recoil smooths out flow = more continuous perfusion = perfusion would not be continuous
50
With regards to arterial recoil, the energy is stored in walls of large arteries in the form of what?
This is possible due to what?
tension
elastic laminae
51
Pressure = __?__ x __?__
An increase in __1__ or __2__ would __3__ pressure.
flow x resistance
1. flow
2. resistance
3. increase
52
Diastolic pressure increases until when?
At this point it falls again due to what?
middle age
loss of elasticity
BP is lower in women than men prior to 55-65
53
What is the definition of hypertension?
What is afterload and what is its relevance here? (mention LV)
sustained elevation of arterial BP
pressure left ventricle must overcome to eject blood into the aorta, in HTN systemic arterial pressure is elevated - means that LV must generate more pressure during systole to open the aortic valve and eject blood = AFTERLOAD IS INCREASED
LV adapts to this chronic pressure overload by getting thicker - thicker walls reduce wall stress (Laplace's Law)
54
What is occurring in each steps?
55
Venous circulation is aided by what 2 factors?
thoracic pump
muscle pump
56
In regards to the thoracic pump, what creates negative pressure?
What flattens during inspiration and what occurs when this happens?
inspiration (-ve pressure transmitted to great veins)
diaphragm flattens during inspiration:
- increased intra-abdominal pressure
- valves in limb veins force blood up to the heart
57
What are the veins in limbs compressed by?
- skeletal muscle contraction
- arterial pulsation
58
What prevent backflow and force blood to move towards the heart?
valves
59
What is the purpose of valves?
prevent backflow and force blood to move towards heart
60
If standing still pressure in lower limb increases and blood pools, what two things will occur?
reduced venous return and therefore reduced cardiac output
61
In regards to lower limb pressure, what would reduce venous return and therefore reduce cardiac output?
standing still pressure increasing in lower limb and blood pooling
62
Varicose veins are due to what?
What is the consequence of this?
incompetent valves
stasis and oedema
63
What is the purpose of the lymphatic circulation?
lymphatic system is a network of vessels that helps return excess fluid from tissues back into the bloodstream, and also plays a role in immune defence
normally interstitial fluid efflux > influx in capillaries:
- efflux: fluid moving out of the capillaries into the tissue (interstitial space)
- influx: fluid moving back into the capillaries from the tissues
MORE FLUID LEAVES CAPILLARIES THAN RETURNS - theres always a bit of fluid leftover in the tissues - that extra fluid is collected by lymphatic vessels preventing oedema
(lymphatic system = acts like a drainage system for the body)
64
What does the lymph contain?
water
proteins
lipids
immune cells
65
What percentage of protein enters circulation via lymph?
25-50%
66
What happens to the lymph as it moves through the lymphatic vessels?
How does the lymph eventually return to the bloodstream?
gets filtered via lymph nodes
drains into the right and left subclavian veins
67
What are the 2 types of vessels in lymphatic circulation?
List the key things about each.
INITIAL LYMPHATIC VESSELS
- no valves or smooth muscle
- found in places like intestines and skeletal muscles
- fluid pushed into these vessels by muscle contractions and pulsation
- drain into collecting vessels
COLLECTING LYMPHATIC VESSELS (bigger)
- have valves and smooth muscles
- use peristaltic contractions
- skeletal muscle contractions help squeeze these vessels
68
Identify which vessels the images are showing and their key features.
69
What does incompetent lymphatic vessels lead to?
- impaired lymphatic outflow
- interstitial fluid build up
- inflammation of stagnant interstitial fluid builds up
- scarring and fibrosis results
70
What does the image show?
stages of lymphoedema if left untreated
71
There is a common complication of axillary lymph node chain clearance in which surgery?
breast cancer surgery
72
Breast cancer surgery may lead to which complication involving the lymphatics?
axillary lymph node chain clearance
73
In systemic circulation, flow is determined by what?
What circulations are part of the "special" circulation, and what makes them special?
by a pressure gradient and resistance
- pulmonary
- coronary
- cerebral
- cutaneous
= they have other factors contributing to flow
74
What are the major differences between the systemic and pulmonary circulations?
systemic:
- high pressure, high resistance
- thick muscular vessels
- auto-regulated blood flow to organs
pulmonary circulation:
- low pressure, low resistance (protect alveoli from bursting)
- very compliant vessels
- no auto-regulation = main mechanism is HPV
- heavily influenced by gravity and breathing mechanics
75
State the typical pressures in different regions of the pulmonary circulation and compare it to the systemic mean arterial pressure.
76
What is meant by V/Q matching?
What is the optimal ratio?
V(entilation) = volume of air received by given part of the lungs (how much fresh air is reaching a given part of the lungs)
Q(perfusion) = volume of blood received by given part of the lung (how much blood is reaching that same part)
optimal ratio: 1:1
77
What do the following ratios indicate:
1. V/Q <1
2. V/Q >1 (where would you see this?)
3. V/Q >0.5
What does the V/Q ratio basically indicate?
1. more blood than air (blood flow is okay but alveoli arent ventilated well)
2. more air than blood - PE (airs gets in but blood supply is reduced)
3. below normal but not extreme - indicates ventilation is present but relatively reduced compared to perfusion
basically how well the lungs are matching airflow (ventilation) to blood flow (perfusion)
78
What is Hypoxic Pulmonary Vasoconstriction?
What is the mechanism/pathway by which this helps match V/Q ratio?
reflex contraction of pulmonary smooth muscle in response to hypoxia - part of lung is poorly ventilated and blood vessels constrict to redirect blood to better-ventilated areas
decreased ventilation -> hypoxia -> HPV -> reduced perfusion in poorly ventilated areas = helps match V/Q ration (blood follows air)
79
What pulmonary mechanism helps match V/Q ratio?
HPV
80
Give an example of a condition where HPV helps match the V/Q ratio.
COPD - HPV helps shunt blood away from bad alveoli
81
What can chronic HPV lead to and how?
cor pulmonale
widespread vasoconstriction -> pulmonary hypertension -> right heart strain -> cor pulmonale
82
Why does a normal V/Q ratio not equal a normal V + Q?
because if V and Q both drop by half, ratio would be 1 which appears as normal but overall gas exchange would be reduced = hypoxemia
83
What are the four classic Starling forces that govern movement of fluid across capillary walls?
hydrostatic (Pc)= pushes fluid out of capillaries
oncotic (πc) = plasma proteins pull fluid back in
interstitial hydrostatic (Pi) = resists filtration (usually low so resists movement of fluid into tissues)
interstitial oncotic (πi)= pulls fluid out (proteins in interstitial space pull fluid out of capillary)
84
What is the net fluid movement across capillaries determined by?
net filtration = (Pc - Pi) - (πc - πi)
(capillary hydrostatic pressure - interstitial hydrostatic pressure) MINUS (capillary oncotic - interstitial oncotic)
85
How do Starling forces normally act in systemic capillaries?
Pc = capillary hydrostatic
Pi = oncotic
πc = interstit al hydrostatic
πi = interstitial oncotic
86
How are pulmonary capillaries different from systemic capillaries in terms of Starling forces?
pulmonary hydrostatic pressure is much lower than systemic hydrostatic pressure
plasma oncotic pressure is the same, about -25mmHg
CREATES DELICATE BALANCE IN LUNGS - EVEN A SMALL RISE IN CAPILLARY HYDROSTATIC PRESSURE CAN EXCESS FILTRATION
87
Why is there a delicate balance of hydrostatic and interstitial pressure in pulmonary capillaries?
because too much hydrostatic pressure can cause pulmonary oedema
88
Why does left-sided heart failure make the lungs particularly vulnerable to oedema?
because pulmonary hydrostatic pressure is normally kept low and the margin is very small
left sided heart failure would increase pulmonary venous pressure, hydrostatic pressure would overwhelm oncotic pressure = interstitial fluid would spill in alveoli which would lead to pulmonary oedema
89
What organ has the highest O2 consumption and extraction rate?
heart
90
How much CO does the myocardium receive in comparison to the brain? Why?
The myocardium receives the CO from which arteries? What do these arise from?
myocardium: about 5% CO
- from RCA and LCA -> arise from SINUSES OF VALSALVA
brain: about 15% CO = brain is a larger size and a CONSISTENTLY HIGH METABOLISM because of GREY MATTER - neurons cannot store fuel and need a constant supply of energy
91
What is the main artery in the heart? What does it branch into and what does it supply?
LCA = main artery
divides into the left circumflex artery and left anterior descending artery
supplies: left ventricle, left atrium, most of IV septum
92
What does the RCA supply?
right ventricle, part of IV septum, BOTH ATRIA
93
Which arteries supply the heart with oxygenated blood?
RCA and LCA
(which branch directly from the ascending aorta just above the aortic valve)
94
During which phase of the cardiac cycle does perfusion of the heart mostly occur and why?
perfusion mostly occurs during diastole because in systole the coronary vessels are compressed
95
What does Basal Flow mean?
What is this maintained by in the heart?
the relatively high resting level of blood flow through the coronary arteries
maintained largely by NO released from the vascular endothelium
NO diffuses into smooth muscle -> activates guanylate cyclase = increase cGMP = relaxation = vasodilation
RESULT = coronary arteries stay "tonically dilated" so even at rest the myocardium has a high flow of oxygenated blood
96
Why does the myocardium have a high basal flow?
the myocardium's resting blood flow/basal flow is high because endothelial cells are constantly producing NO which keeps the coronary vessels dilated
97
Through which factors is coronary circulation regulated?
METABOLIC
- adenosine, CO2, K+, H+, No = vasodilation
MYOGENIC MECHANISM
- increased intraluminal pressure = arteriolar constriction
- decreased IL pressure = arteriolar dilation
AUTONOMIC CONTROL
- a1 receptors = vasoconstriction
- b receptors = vasodilation
- parasympathetic (vagus nerve) = vasodilation
98
The 'Circle of Willis' refers to which circulation in the body?
What is it formed by and why does it act as a 'safety net'?
Which arteries arise from this?
cerebral circulation
formed by anastomosis of the BASILAR ARTERY (posterior circulation) and the INTERNAL CAROTID ARTERIES (anterior circulation)
collateral flow if one major vessel is narrowed/blocked
- anterior cerebral artery
- middle cerebral artery
- posterior cerebral artery
99
What is formed by anastomosis of the basilar artery and internal carotid arteries?
circle of willis
100
Where do the anterior cerebral, middle cerebral and posterior cerebral arteries arise from?
circle of willis
101
Where are cerebral arteries found and what do they give rise to? Where do these arteries run?
cerebral arteries run on the brain surface in the subarachnoid space - they give rise to PIAL arteries which run within the pia mater (closely applied to the brain surface)
102
What arteries come off the Pial arteries and what do they supply?
parenchymal (penetrating) arteries which supplies deep structure
103
List the differences between Pial and Parenchymal arteries.
PIAL
- extrinsic innervation (outside brain)
sources:
- perivascular innervation (nerves around vessels)
- superior cervical ganglion (sympathetic)
- sphenopalatine/otic ganglia (parasympathetic)
- trigeminal ganglion (sensory)
FUNCTION: control diameter of surface arteries = modulates overall blood delivery into brain
PARENCHYMAL
- intrinsic innervation
sources:
- subcortical neurones
- locus coreuleus
- raphe nucleus
- basal forebrain
- local cortical interneurons
DO NOT DIRECTLY HUG THE ARTERIES - INFLUENCE ASTROCYTES WHICH THEN SIGNAL TO VESSELS
104
What are pial arteries and what type of innervation do they receive?
What is their function?
surface arteries on the brain, supplies mainly by extrinsic innervation from outside the brain
to regulate large-scale blood inflow into the brain from the surface
105
What are the main sources of innervation for pial arteries?
106
What are parenchymal arteries, and what type of innervation do they receive?
What is their primary target?
What is their functional role?
penetrating vessels within brain tissue, supplied mainly by intrinsic innervation from inside the brain
arteriole-associated astrocytes which then influence vessel tone
to match local neuronal activity with blood flow - neurovascular coupling
107
Which arteries target astrocytes?
parenchymal (penetrating) arteries
108
Which arteries receive their innervation from intrinsic supply?
Which arteries receive their innervation extrinsic supply?
parenchymal arteries
pial arteries
109
What are the main sources of innervation for parenchymal arteries?
110
Which arteries are responsible for neurovascular coupling and how?
parenchymal arteries
they target arteriole-associated astrocytes which regulate vessel tone which results in neurovascular coupling = means that active neurons receive more blood
111
Why does systemic circulation have high pressure and high resistance but pulmonary has low pressure and low resistance?
systemic:
- needs to deliver blood to the entire body, including against gravity = requires strong, muscular arteries which causes high pressure and resistance
pulmonary:
- only pumps blood a short distance (heart -> lungs -> heart)
- delicate alveoli must not be damaged = vessels are thin, wide and floppy = low pressure and low resistance
112
What does autoregulated blood flow to organs mean?
that organs like the brain, kidney and heart can adjust their own blood vessel diameter to keep blood flow steady despite changes in systemic blood pressure
113
What does 'compliant vessels' mean?
Where are they found? Why is it necessary to have compliant vessels there?
compliance = ability to stretch easily when pressure changes
pulmonary vessels are very compliant = they can accommodate large changes in blood volume without big changes in pressure = helps keep pulmonary pressures low and protects alveoli
114
Why are lungs better perfused at the base rather than the apex?
gravity: blood pools at lung bases = more blood flow = increase in hydrostatic pressure in vessels = capillaries wide open
at apex = very little blood flow = low hydrostatic pressure
115
Why is systemic mean arterial pressure much higher than pulmonary?
systemic circulation needs to drive blood through long, high-resistance vessels to every organ
pulmonary only needs to push blood through short, low-resistance vessels
116
117
Asthma can result in hypoxia. How is this different from COPD?
asthma: airway obstruction is patchy and variable (widespread) = widespread V/Q mismatch = hypoxia
COPD: chronic damage to alveoli and airways = poorly ventilated areas -> HPV initially helps (but long term leads to pulmonary hypertension and cor pulmonale)
118
What is Cor Pulmonale?
right sided HF caused by pulmonary hypertension
119
Why may alveoli collapse at the apex of lungs?
because gravity reduces pulmonary arterial and venous pressure so much that alveolar pressure may exceed vessel pressure = vessels may collapse
120
What are the 'West's Zones'?
zone 1 = apex
- alveolar pressure > arterial > venous = little/no blood flow
zone 2 = middle
- arterial > alveolar > venous = flow depends on arterial-alveolar difference
zone 3 = base
- arterial > venous > alveolar = continous flow
121
Label the image.
122
What is cerebral blood flow mainly regulated by?
metabolic products:
- CO2 + O2
- pH
- lactate
- K+
123
What are the components of Cushing's Triad?
- widened pulse pressure
- bradycardia
- disordered breathing
124
What is Cushing's reflex? What are the steps involved?
a physiological reaction to raised ICP
1. SOL -> increased ICP
- raised ICP compressed cerebral vessels = increased vascular resistance = decreased cerebral blood flow (CBF)
2. decreased CBF -> ischaemia
- medulla senses low perfusion = triggers sympathetic outflow = raises systemic BP to try to maintain cerebral perfusion
= RESULTS IN WIDENED PULSE PRESSURE
3. bradycardia occurs later on
4. INCREASED ICP = BRAINSTEMSTEM HERNIATION = DISORDERED BREATHING / CARDIAC ARREST
125
low viscosity and high velocity
turbulence index increases with velocity and vessel diameter but decreases with viscosity
126
nothing
127
128
129
130
131
132
133
134
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137
138
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140
141
Med Term 3
flashcards
Decks in class (44)
# Cards
-
HPD 154
-
HPD 272
-
HPD 343
-
HDP 4 and 5101
-
HPD 6 and 7100
-
HDP 8 and 970
-
HSD 10 and 1184
-
HSD 11.265
-
Urinary System 1140
-
Urinary 2112
-
Urinary 368
-
Urinary 463
-
Urinary 551
-
Urinary 697
-
Urinary 789
-
Urinary 8137
-
Urinary 963
-
Urinary 1066
-
CVS 1129
-
CVS 294
-
CVS 390
-
CVS 465
-
CVS 589
-
CVS 6141
-
CVS 7112
-
CVS 8106
-
CVS 986
-
CVS 1063
-
CVS 1181
-
Respiratory 1132
-
Respiratory 2135
-
Respiratory 3115
-
Respiratory 480
-
Respiratory 5156
-
Respiratory 672
-
Respiratory 771
-
Respiratory 876
-
Respiratory 9112
-
Respiratory 10103
-
Respiratory 11117
-
OSCE practise15
-
ECGs117
-
PASSMED10
-
TERM 3 REVISION737
