Cardiology

Question 1

Eisenmenger’s syndrome

Answer 1

Reversal of a L-to-R shunt in a congenital heart defect due to pulmonary hypertension

• Original murmur may
• Cyanosis
• Clubbing
• RVF
• Haemoptysis, embolism

Question 2

Atropine

Answer 2

Anti-cholinergic drug; muscarinic acetylcholine rec. antagonist
Rx - organophosphate poisoning

S/E

• tachycardia
• mydriasis
• dry mouth
• hypohidrosis
• constipation
• urinary retention

Question 3

Monroe-Kellie Doctrine

Answer 3

Control of ICP by altering brain, CSF, and blood

https://basicmedicalkey.com/wp-content/uploads/2016/08/DA3C34FF1.jpg

Question 4

Hydralazine

Answer 4

Arteriolar vasodilator
Rx for hypertensive emergency
Increases cGMP to released NO to relax smooth muscle

Question 5

External Carotid Artery branches

Answer 5

(Order in which they branch off)
Some (sup thyroid)
Attendings (Ascending Pharyngeal)
Like (Lingual)
Freaking (Facial)
Out (Occipital)
Potential (Post auricular)
Medical (Maxillary)
Students (Sup temporal)

Question 6

Kussmaul’s sign

Answer 6

Paradoxical rise in JVP during inspiration seen in constrictive pericarditis.

Question 7

Pulsatile hepatomegaly (‘bouncing up and down periodically’ ) is a sign of …

Answer 7

Tricuspid regurgitation

Question 8

Tricuspid Regurgitation signs

Answer 8

pan-systolic murmur
prominent/giant V waves in JVP
pulsatile hepatomegaly
left parasternal heave

Question 9

Apolipoprotein involved in atherosclerosis

Answer 9

ApoB100

Under normal circumstances, macrophages uptake lipids into their cytoplasm via ApoB100. When LDL becomes oxidised in the pathology of atherosclerosis, macrophages uptake it via a different ‘scavenger’ receptor. Unlike the B100 receptor, there is no negative feedback involved in this scavenger receptor, so that excess lipid is taken up, leading to the production of so-called foam cells.

Question 10

Which two types of infections are you most likely to be at risk from because of heart failure?

Answer 10

Chest infections

Ulcerated cellulitic legs

Question 11

Spot Diagnosis: Complete Heart Block

Answer 11

Lightheadedness 
Old age
Mild bibasal crepitations 
Bilateral peripheral pitting oedema
Low resting HR (e.g 40bpm)
ECG - Dissociation of P and QRS
JVP - Canon a waves

Question 12

Dipyridamole

Answer 12

Antiplatelet used in stroke patients intolerant of clopidogrel

Non-specific phosphodiesterase inhibitor (enzyme that normally break down cAMP)
Decreases cellular uptake of adenosine thus increases plasma conc.

Question 13

Amiodarone MoA

Answer 13

Class III antiarrhythmic - primarily blocks voltage-gated K+ channels
Rx of atrial, nodal and ventricular tachycardias
Inhibits repolarisation and hence prolongs AP
Secondary action: Blocks voltage-gated Na+ channels

Question 14

Amiodarone S/E

Answer 14

thyroid dysfunction: hypothyroidism, hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
'slate-grey' appearance
thrombophlebitis and injection site reactions
bradycardia
lengths QT interval

Question 15

Heparin

Answer 15

activates anti-thrombin III

Question 16

Clopidogrel

Answer 16

P2Y12 inhibitor

Question 17

Abciximab

Answer 17

glycoprotein IIb/IIIa inhibitor

Question 18

Dabigatran

Answer 18

direct thrombin inhibitor

Oral anticoag
For prophylaxis of DVT after knee/hip replacement or prophylaxis of stroke for those with risk factors
S/E Major bleeding, caution with reduced kidney function

Question 19

Rivaroxaban

Answer 19

direct factor X inhibitor

Question 20

ECG - Hypokalaemia

Answer 20

Prominent U waves

+ ST depression, slightly prolonged PR, slightly peaked P

Question 21

ECG - Hypothermia

Answer 21

J waves

Question 22

ECG - Wolff Parkinson White syndrome

Answer 22

Delta waves

Question 23

XRay - Egg-on-side hear appearance

Answer 23

Transposition of the great arteries

Question 24

Apple green birefringence with polarised light

Answer 24

Amyloidosis