3. Oxford clinic handbook physiology

Question 1

What can be done to assist someone in giving up smoking

Answer 1

Advantages and motivational interviewing
invite the patient to quit on a date where stress will be low
Throw away all smoking accessories
Nicotine gum/patches
Vareniciline- nicotine receptor ppartial agonist
Bupropion- antidepressant, stops cravings

Question 2

What may cause palpitations of the heart?

Answer 2

Ectopic beats
Tachycardia
AF, SVT, VT
Thyrotoxytoxycosis
Anxiety
Phraemochromyctoma

Question 3

What is the Aberdeen way of reading an ECG?

Answer 3

A- Any electrical actvitiy
R- Rate
I- Irregular or regular QRS?

B- Broad or narrow QRS?
A- Atrial acitivity present?
R- Relationship between atria and ventricles

Question 4

How does atrial fibrillation present on an ECG?

Answer 4

P wave is messed up

Question 5

What are the varies degrees of heart block?

Answer 5

1st degree heart block- Prolonged PR interval 
2nd degree (Mobitz I)- PR becomes loner and longer until QRS is missed
2nd degree (Mobitz II)- QRS are often missed
3rd degree (complete)- No impulses passed from atrium to ventricles

Question 6

What does an inverted T wave/ Elevated ST segment tell you?

Answer 6

Nothing if there is no clinical indication

V1-3-Right bundle branch block, black or child(normal)
V2-5- Anterior ischemia, Subarachnoid heamorrhage,
V4-6-Lateral ischemia, Left bundle branch block
II,III, AvF- inferior ischemia

Question 7

How do you assess left bundle branch block on an ECG?

Answer 7

Wide QRS (W pattern) in V1
M pattern in V6

WiLLiaM= left bundle branch block

Question 8

How do you assess right bundle branch block on an ECG?

Answer 8

M pattern in V1
W shape in V6 (very difficult to see)

MaRRoW- Right bundle branch block

Question 9

What ECG changes are seen in pulmonary hypertension?

Answer 9

Right axis deviation
Positive QRS complexes in lead 1
ST depression and T wave inversion in V1-V3
Peaked Pwaves suggesting right atrial hypertrophy

Question 10

What cardiac imaging modalities are available to use?

Answer 10

CXR- (heart fialure, positioning)

ECHO- Moving heart picture (valves,

Cardiac CT- (e.g. angiography)

Cardiac MR- myocardial diseases

Nuclear imaging- assessing CABG status

Question 11

What can echocardiography be used for?

Answer 11

Quantification of global LV function
Estimating right heart haemodynamics
Valve disease
Congenital heart disease
Endocarditis
Pericardial effusion

Question 12

What are the various procedures that can be carried out via cardiac catheterization

Answer 12

Inject radiopaque contrast for cardiac imaging
Perform angioplasty, valvoplasty, cardiac biopsies.
Electrophysiology studioes and radiofrequency ablations
Perform intravascular ultrasound or echocardiography

Question 13

What is PCI (percutanous coronary intervention)

Answer 13

A type of angioplasty used to stent coronary vessels.

Primary PCI is the term used when this is performed on people with acute coronary symptoms

Question 14

What are the different type of antiplatelet drugs available?

Answer 14

Aspirin- irreversibly acetylates cyclo-oxygenase (stop platelet aggregation)

ADP receptor agonists(Clopidpogrel)-(stop platelet agg)

glycoprotein IIb/IIIa antagonists- tirofaban, s.p.a

Question 15

What are the different types of anticoagulant drugs available?

Answer 15

DOAC- apixibam, dabigatran
Warfarin
LMWH (dalteparin),

Question 16

How do beta blockers work?

What are betablockers suffix

Answer 16

Block B adrenoreceptors, antagonizing the sympathetic nervous system.

End in olol

Question 17

How do ACE inhibitors work?

What is important to do when taking ACE inhibitors

What are ace inhibitors suffix

Answer 17

Block the formation of angiotnesin II

monitor renal function closely when on these

End in -pril

Question 18

What are the different types of diuretics?

Answer 18

Loop diuretics- (furosemide) stop Na/Cl transporters exploiting loop of henle

Thiazide and thiazide like- (indapamide) blocki na/cl transporters in distal tubule

Potassium sparing diuretics- (spironolactone) directly block aldosterone receptors

Question 19

Explain the mode of aciton of calcium channel blockers?

What is the suffix of choice for CCB’s?

Answer 19

Block L type calcium channels either peripherally (dihydropyridines) or centrally (non-dihydropyridines)

-ipine

Question 20

How does digoxin work?

What are the negative effects of digoxin?

Answer 20

blocks the sodium/potassium pump to slow heart rate

toxicity is bad. can cause cardiac arrhythmia’s or N+V, abdo pain, vomiting.

Question 21

What are statins mode of action?

Answer 21

Inhibit the HMG-COA reductase enzyme lowering the synthesis of LDL cholesterol. e.g. simvisatin