Cardiology and antiplatelets

Question 1

Antiplatelet therapy as secondary prevention for angina? 1st and 2nd line

Answer 1

1st line: aspirin 75

2nd line: clopi 75

Question 2

Anti platelet therapy for Secondary prevention in medically managed ACS

Answer 2

12 months of DAPT - aspirin + ticagrelor 90mg BD

Question 3

Secondary prevention for stroke/TIA

Answer 3

clopidogrel alone, lifelong

Question 4

Secondary prevention for PVD?

Answer 4

clopidgorel alone

Question 5

ticagrelor vs clopidogrel vs prasugrel vs aspirin - list in order of highest to lowest bleeding risk

Answer 5

ticagrelor and prasugrel - higher bleeding risk
clopidogrel
aspirin - lowest bleeding risk

Question 6

Pt with PMH of AFib (on apixaban) presents with STEMI, suitable for PCI. what drug treatment would you offer?

If this patient wasn’t on apixaban, what drug treatment would you offer?

Answer 6

As well as PCI - give aspirin 300mg STAT + clopidogrel (as on a DOAC) - otherwise give prasugrel

Question 7

In suspected NSTEMI - what scoring system would you use for risk? what score is deemed low vs medium/high risk

Answer 7

GRACE
low risk <=3%
medium high risk >3%

Question 8

Acute medical therapy in NSTEMI

Answer 8

aspirin 300mg STAT + ticagrelor

BUT if on a DOAC already or high bleeding risk:
aspirin 300mg STAT + clopidogrel

Question 9

Secondary prevention following an MI. in a patient who needs anticoagulation for AF, if they had PCI? if they didn’t have PCI?

Answer 9

If they had PCI : clopidogrel for up to 12 months

If they didn’t have PCI: aspirin for up to 12 months

Question 10

Preferred drug treatment to start in a pt who has had an MI and subsequently developed LVF? when would you start this?

Answer 10

MRA eg spironolactone

Start 3-14 days post MI

Question 11

At what BP is stage 2 hypertension based off avg ABPM?

Answer 11

150/95

Question 12

Indication for ACEi/ARB as 1st line mx of HTN

Answer 12

<55yo or T2DM

Question 13

Indication for CCB as 1st line mx of HTN

Answer 13

> 55yo + no T2DM or black

Question 14

What clinic BP would you consider commencing antihypertensives without doing ambulatory/home BP monitoring?

Answer 14

180/120

Question 15

2 types of oesophageal spasm?

Answer 15

diffuse (uncoordinated contraction) and nutcracker (coordinated but high amplitude)

Question 16

ECG changes in hyperkalaemia

Answer 16

tented T waves
flatted P waves
QRS broadening
ST depression

Question 17

ECG in hypokalaemia

Answer 17

U waves
ST depression
flat T waves

Question 18

ECG in hypercalcemia

Answer 18

short QT

Question 19

ECG in hypocalcemia

Answer 19

prolonged QT

Question 20

Key ECG feature in hypothermia?

Answer 20

J wave (notch at the junction btw QRS and ST segment)

Question 21

CHolestyramine MoA

Answer 21

bile acid sequestrant

Question 22

at what age should all DM patients be commenced on a statin

Answer 22

40yo

Question 23

alternative to statin recommended for dyslipidaemia

Answer 23

ezetimibe

Question 24

what ecg changes would make you suspect posterior STEMI?

Answer 24

horizontal ST depression in V1-3

Question 25

what valve problem often arised post MI due to papillary muscle rupture?

Answer 25

mitral regurgitation

Question 26

management of angina - after bB and CCBs, what are the 4 other options?

Answer 26

ISMN nicorandil ivabradine ranolazine

Question 27

what is the clinic BP in stage 1, stage 2 and stage 3 hypertension

Answer 27

1) 140/90 2)160/100 3) 180/120

Question 28

at what average home BP would you diagnose stage 2 hypertension

Answer 28

>150/95 (stage 1 is >135/85)

Question 29

Mobitz Type I vs type II

Answer 29

Type I - she's getting later and later pr interval gradually prolongs until QRS is dropped altogether type II - just doesn't turn up at all! p wave followed by no QRS. PR interval length is constant.

Question 30

Renal causes of Hypertension

Answer 30

- Chronic pyelonephritis - Glomerulonephritis - Diabetic nephropathy - Renal artery stenosis - PCKD

Question 31

2 complications of PCI via femoral artery? how do they present?

Answer 31

femoral pseudoaneurysm - bruit in femoral mass, reduced pulses in distal limb retroperitoneal bleed - flank pain and bruising

Question 32

ecg changes in HOCM

Answer 32

sinus bradycardia LVH right or left axis deviation

Question 33

which cholesterol lowering medication is safe in pregnancy

Answer 33

none!

Question 34

ECG finding in brugada syndrome

Answer 34

cove shaped ST segment elevation and deep T wave inversion in V1-3

Question 35

which vessels correspond with: ii, III, aVF aVL, V5, V6 V1, V2

Answer 35

Right : ii III aVF Left anterior descending: V1, V2 Left circumflex: aVL, V5, V6

Question 36

which pt group is acei/arb 1st line for hypertension

Answer 36

<55 or T2DM

Question 37

which lipid lowering therapy predisposes to gallstones?

Answer 37

cholestyramine

Question 38

aortic dissection - how does presentation of aortic arch vs descending aorta differ

Answer 38

aortic arch --> like MI. note if it affects aortic root can cause MI descending aorta --> scapular pain

Question 39

what is pulsus paradoxus

Answer 39

exaggerated decrease of BP on inspiration causes --> severe COPD, PE, constrictive pericarditis, tamponade, acute asthma

Question 40

what med do you give after thrombolysis for STEMI

Answer 40

heparin infusion

Question 41

in pts post MI, with reduced LVEF, what drug should you start?

Answer 41

spironolactone (though this should be started after ACEI/ARB has been established)