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Hypertension - 15 Marks University Question ke liye Diagrams

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DIAGRAM 1 - RAAS Pathway (MOST IMPORTANT - 4 marks value)

Liver → Angiotensinogen
           ↓ (Renin - kidney se)
       Angiotensin I
           ↓ (ACE - lung capillaries mein)
       Angiotensin II
        ↙           ↘
Adrenal cortex    Direct vasoconstriction
(Aldosterone)           ↓
     ↓              BP ↑ (peripheral resistance ↑)
Na+ & H2O retention
     ↓
Blood volume ↑
     ↓
BP ↑

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DIAGRAM 2 - Sites of Action of Antihypertensive Drugs (4 marks value)

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DIAGRAM 3 - Baroreceptor Reflex Arc (3 marks value)

Carotid sinus baroreceptors (↑BP sensed)
     ↓ Sensory fiber
Nucleus tractus solitarius (brainstem)
     ↓ Inhibitory interneurons
Vasomotor center
     ↓ ↓ Sympathetic discharge
Autonomic ganglion
     ↓ Motor fibers
Sympathetic nerve endings → α/β receptors
     → Vasodilation + ↓ HR → BP normalizes

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DIAGRAM 4 - Classification / Staging Table (2 marks - easy marks)

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DIAGRAM 5 - Pathophysiology Flowchart (2 marks - agar time ho)

Primary Causes                Secondary Causes
(Essential HTN >90%)          (Renovascular, Endocrine)
         ↓                           ↓
↑ Cardiac Output + ↑ TPR (Total Peripheral Resistance)
         ↓
     BP = CO × TPR ↑
         ↓
Target Organ Damage:
├── Heart → LVH, IHD, Heart failure
├── Brain → Stroke, Hypertensive encephalopathy
├── Kidney → Nephrosclerosis, CKD
├── Eye → Hypertensive retinopathy
└── Arteries → Atherosclerosis, Aortic dissection

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Exam Strategy - 15 Marks Answer Structure

• Diagrams ke saath labels aur arrows clearly likho - ek label missing = marks cut
• Har diagram ke neeche "Fig:" ke saath ek line title likho
• RAAS aur drug sites diagram - dono milake banao agar ek hi page mein fit ho, warna alag alag
• BP formula BP = CO × TPR zaroor likho - examiner notice karta hai

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Shock - 15 Marks University Question ke liye Diagrams

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DIAGRAM 1 - Classification of Shock (MOST IMPORTANT - 4 marks)

                        SHOCK
                   (↓ O2 delivery)
         _______________↓________________
        |          |          |          |
  DISTRIBUTIVE  CARDIOGENIC  HYPOVOLEMIC  OBSTRUCTIVE
        |          |          |          |
  Septic shock    MI         Hemorrhage  Tension PTX
  Anaphylaxis    Arrhythmia  GI bleed    Cardiac tamponade
  Neurogenic     Myocarditis Burns       Pulmonary embolism
  Burn shock     Valvular    DKA         Aortic dissection
  Adrenal crisis             Diarrhea

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DIAGRAM 2 - Hemodynamic Profile Table (EXAMINER FAVOURITE - 3 marks)

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DIAGRAM 3 - Pathophysiology / O2 Delivery Flowchart (3 marks)

DO2 = CO × CaO2
       |         |
   HR × SV   Hb × 1.34 × SaO2
    |
Preload/Contractility/Afterload

          ↓ DO2  (any cause)
               ↓
    Aerobic → Anaerobic metabolism
               ↓
    Pyruvate → LACTATE (↑ lactate = marker of shock)
               ↓
    ATP ↓  →  Na+/K+ ATPase fails
               ↓
    Cell swelling → Ca2+ influx → Phospholipases activate
               ↓
    Cellular death → Organ dysfunction
               ↓
    MODS (Multi-Organ Dysfunction Syndrome)

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DIAGRAM 4 - Stages of Shock (3 marks)

STAGE 1: COMPENSATED SHOCK (Preshock)
├── Body compensates: ↑HR, ↑SVR, ↑ADH, ↑RAAS
├── No overt organ dysfunction
├── Mild ↑ Lactate only
└── REVERSIBLE with treatment

         ↓ (if untreated)

STAGE 2: DECOMPENSATED SHOCK (True Shock)
├── Compensatory mechanisms overwhelmed
├── Hypotension (SBP <90 or MAP <65 mmHg)
├── Signs: oliguria, AMS, cold peripheries
└── STILL REVERSIBLE with aggressive treatment

         ↓ (if untreated)

STAGE 3: IRREVERSIBLE SHOCK
├── Permanent organ dysfunction
├── MODS develops
├── Death despite treatment
└── NOT reversible

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DIAGRAM 5 - Compensatory Mechanisms in Shock (2 marks - bonus diagram)

↓ BP / ↓ CO  (any shock type)
        ↓
   3 Compensatory Systems activate:
   
   1. Sympathetic NS:
      ↑ Heart rate + ↑ Contractility + Vasoconstriction (↑SVR)
   
   2. RAAS:
      ↓ Renal perfusion → ↑ Renin → ↑ Ang II → ↑ Aldosterone
      → Na+ & H2O retention → ↑ Blood volume
   
   3. ADH (Vasopressin):
      Released from posterior pituitary
      → Water retention → ↑ Blood volume + Vasoconstriction
   
   Result: Attempt to restore MAP and tissue perfusion

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Exam Strategy - 15 Marks Answer Structure

• DO2 = CO × CaO2
• CO = HR × SV
• MAP = DBP + 1/3(SBP - DBP) → Shock mein MAP < 65 mmHg
• Lactate > 2 mmol/L = tissue hypoperfusion

• Distributive shock mein CO ↑ hota hai - yeh unique point diagram mein circle karke highlight karo
• Septic shock = Distributive + Lactate > 2 + vasopressor required (newest Sepsis-3 definition)
• Hemodynamic table ZAROOR banana - bahut marks milte hain aur easy bhi hai
• Stages diagram ke saath clinical features likho (oliguria, altered sensorium, cold extremities)