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MBBS1 Thorax > John Palmer's Chest Pain > Flashcards

John Palmer's Chest Pain Flashcards

1
Q

What must FXa be bound to to contribute to coagulation?

A

FVa

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2
Q

What are the symptoms of heart failure mostly attributable to?

A

Decreased venous drainage

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3
Q

What did the CAST trial show?

A

Class I anti arrhythmics will not improve survival when used prophylactically

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4
Q

What does increased preload do to cardiac contractility?

A

Increased contractility

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5
Q

What does 2 P waves per QRS on an ECG reflect?

A

2nd degree heart block e.g. 2:1 type, Mobitz 2

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6
Q

Why does exercise increase cardiac contractility?

A

Increased sympathetic stimulation

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7
Q

How can cardiovascular risk factors be described?

A

Synergistic

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8
Q

Which ligand binds to the P2Y12 receptor?

A

ADP

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9
Q

Which vector does aVR correspond to?

A

Right arm

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10
Q

At what speed does endocardium to epicardium conduct at?

A

0.3 m/s

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11
Q

What does the PR interval reflect the function of?

A

AV node

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12
Q

What pumps most of the calcium out of the cell in relaxation?

A

the NCX (Ca2+:3Na+) antiporter

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13
Q

Which vector does lead II correspond to?

A

Right arm to left leg

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14
Q

Which cell mediates plaque rupture in atherosclerotic plaque?

A

Macrophages

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15
Q

What do class III anti-arrhythmic drugs do?

A

Prolongs AP and refractory period

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16
Q

During isovolumetric relaxation which valves are open and which are shut?

A

All valves are shut

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17
Q

How does fondaparinux work?

A

Inhibits FXa via activation of antithrombin

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18
Q

Name a clot buster

A

Streptokinase

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19
Q

What is atrial fibrillation a risk factor for?

A

Thromboembolism

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20
Q

Why may people not adhere to post-MI treatment?

A

Anexity and depression

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21
Q

Which thrombi should be treated with anti-platlet drugs?

A

Arterial

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22
Q

What does prothrombinase consist of?

A

FXa and FVa

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23
Q

Give two class II anti-arrhythmic drugs.

A

Atenolol and B blockers

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24
Q

What is abciximab?

A

A GPIIb-IIIa inhibitor

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25
Q

What does the law tell us?

A

What we must do and not do

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26
Q

What does article 2 of the Human Right’s Act 1998 give everyone the right to?

A

Life

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27
Q

Give two class I anti-arrhythmic drugs.

A

Fast Na+ channel blockers and flecainamide

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28
Q

Where do eosinophils often migrate to?

A

The GI tract

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29
Q

What does ventricular tachycardia result in?

A

Fulminant heart failure

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30
Q

What is congestive heart failure?

A

When left heart failure leads to right heart failure

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31
Q

What is orthopenoea?

A

Pulmonary oedema on lying down

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32
Q

Why might someone who is having a heart attack be breathless?

A

Cardiac output is low

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33
Q

What percentage of artery must be occluded for it to be significant occlusion?

A

70%

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34
Q

How many people over 70 have heart failure?

A

10%

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35
Q

What do basophils contain?

A

Pro-inflammatory granules

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36
Q

At what speed does the AV node conduct at?

A

0.05 m/s

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37
Q

How much fluid flows through capillaries per day?

A

4000L

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38
Q

Which leads are the chest leads?

A

V1, V2, V3, V4, V5, V6

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39
Q

What direction is lead I in if left is 0 degrees and we are moving clockwise?

A

0 degrees

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40
Q

Which of ticagrelor and clopidogrel prevents cardiovascular events better?

A

Ticagrelor

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41
Q

What do type 2 atheromatous lesions contain?

A

Smooth muscle cells

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42
Q

Which way will increasing contractility move the cyclic graph of volume against pressure of the cardiac cycle?

A

Upwards because the pressure in the heart is increasing

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43
Q

What is a first line drug for heart failure treatment?

A

ACE inhibitor

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44
Q

How do B1 receptors increase contractility?

A

By increasing the slow inward current

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45
Q

How many wires and leads are there in a standard ECG?

A

10 wires and 12 leads

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46
Q

How do platlets bind to Von Willebrand factor?

A

Via GP1B

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47
Q

Which cardiac murmer can be caused by incompetence of the semi lunar valves?

A

Heard after the second heart sound

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48
Q

When is an inverted T wave normal?

A

In V1

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49
Q

Which ligand binds to the GPIIb/IIIa receptor?

A

Fibrinogen

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50
Q

What do inotropic agents do?

A

Increase contractility

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51
Q

What is the typical hydrostatic pressure gradient along a capillary?

A

25 mmHg, higher at arterial end

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52
Q

What is the magnitude of a voltage on an ECG a reflection of?

A

The vector of depolarisation in the direction of the lead

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53
Q

How do neutrophils produce energy?

A

Anaerobic glycolysis

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54
Q

What does a type 4 atheromatous lesion have?

A

A fibrous cap

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55
Q

What do anti-coagulants do?

A

Prevent growth of a thrombosis

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56
Q

What are If channels?

A

Funny current channels

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57
Q

What causes the depolarisation upstroke in the cardiac action potential?

A

Voltage gated sodium channels

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58
Q

Where do haemopoietic stem cells derive from originally?

A

Mesenchyme

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59
Q

What do class I anti-arrhythmic drugs do?

A

Terminate re-entry arrhythmias and slow conduction through conducting system

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60
Q

What is happening in ventricular filling?

A

AV valves are open and blood is forced into ventricle but cannot leave as the aortic and pulmonary valves are shut

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61
Q

What does warfarin do?

A

Inhibits Vit K dependent epoxide reductase activity,

which modifies FVII, FIX, FX, and prothrombin (FII) during synthesis in liver

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62
Q

How does anti-thrombin work as an anti-coagulant?

A

Inactivates factors IIa, IXa, XIa, XIIa when not in clot

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63
Q

Which factors are activated in amplification of coagulation?

A

V and VIII

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64
Q

What is the most common form of myocardial infarction?

A

Transmural

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65
Q

How many patients with newly identified heart failure survive at least 3 months?

A

75%

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66
Q

What does article 8 of the Human Right’s Act 1998 give everyone the right to?

A

Self determination

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67
Q

Which heart sound can indicate raised EDP?

A

S3-S4 gallop rhythm

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68
Q

What does increased mean arterial pressure cause?

A

Increased afterload

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69
Q

How many people in UK have heart failure?

A

650,000

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70
Q

What combo of drugs should be used in heart failure?

A

ACE i and B blocker

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71
Q

What do platelets release when activated?

A

ADP, TXA2, serotonin

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72
Q

Which way will increasing afterload move the cyclic graph of volume against pressure of the cardiac cycle?

A

To the right as there is high EDP therefore high filling

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73
Q

Which vector does aVF correspond to?

A

Left leg

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74
Q

What percentage of UK women over 75 have CHD?

A

25%

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75
Q

Which drug induces early after depolarisations?

A

Procainamide

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76
Q

How do platelets stick together?

A

By fibrinogen binding

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77
Q

When do neutrophils die?

A

After phagocytosing a single pathogen

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78
Q

How does GTN work?

A

Metabolised to NO which relaxes veins and venules to decrease CVP and LVEDP so therefore decreases CO and O2 demand by Starling’s law

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79
Q

What is the ejection fraction usually in systolic heart failure?

A

Less than 45%

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80
Q

What kind of nucleus does a basophil have?

A

Bilobed nucleus

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81
Q

Which is the rhythm lead?

A

Lead II

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82
Q

How does Warfarin work?

A

Antagonises vitamin K

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83
Q

Which ligand binds to the intergrin A2 B1 receptor?

A

Collagen

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84
Q

Which adrenergic receptors does carvedilol antagonise?

A

A1, B1, B2

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85
Q

What is the plane of detection for the leads of Einthoven’s triangle?

A

Oblique

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86
Q

According to Starling’s law what must be equal on the left and right sides of the heart?

A

Stroke volume

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87
Q

What is the shape of a platelet?

A

A biconvex disc

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88
Q

How do NO and prostaglandin work as anti-coagulants?

A

Inhibit platelet aggregation and activation

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89
Q

By how much does chronic stress increase risk of CHD?

A

100%

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90
Q

What coagulation factor is thrombin?

A

FII

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91
Q

What kind of nucleus does a erythrocyte have?

A

No nucelus

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92
Q

What is the PR interval?

A

The time from beginning of P wave to the beginning of the Q wave

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93
Q

What does no P waves on an ECG reflect?

A

Atrial fibrillation

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94
Q

What is the length of the QRS complex?

A

80 ms

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95
Q

Which are the anti-platelet drugs?

A

Aspirin, clopidogrel, ticagrelor, abciximab

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96
Q

Which ligand binds to the GP1B receptor?

A

vWF

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97
Q

What is happening in the ejection phases?

A

The aortic and pulmonary valves open and blood is ejected into aorta and pulmonary valve

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98
Q

What initiates amplification of coagulation?

A

Thrombin

99
Q

What is the plane of detection for the chest leads?

A

Transverse

100
Q

What kind of nucleus does a lymphocyte have?

A

Large circular nucleus that fills the cell

101
Q

Which drug induces delayed after depolarisations?

A

Digitoxin

102
Q

What direction is lead III in if left is 0 degrees and we are moving clockwise?

A

120 degrees

103
Q

How fast do atria beat in atrial flutter?

A

300 bpm

104
Q

During isovolumetric contraction which valves are open and which are shut?

A

All valves are shut

105
Q

What are megokaryocytes precursors of?

A

Platelets

106
Q

What type of cell is a neutrophil?

A

Granulocyte

107
Q

What does cholesterol in atheromatous plaques form?

A

Crystals

108
Q

During atrial systole which valves are open and which are shut?

A

The atrio-ventricular valves are open and the aortic and pulmonary valves are shut

109
Q

What is the daily net movement of fluid from microvasculature to interstitium?

A

8L

110
Q

What regulates capillary pressure gradients?

A

Changes in arteriole resistance

111
Q

Which ligand binds to the GPV1 receptor?

A

Collagen

112
Q

How do chronotropic agents increase heart rate?

A

Increasing If current

113
Q

What are the most common risk factors for heart failure?

A

MI and HT

114
Q

Which cells release tissue plasminogen activator?

A

Damaged endothelial cells

115
Q

Is cardiac muscle more or less sensitive to stretch than skeletal muscle?

A

More sensitive to stretch

116
Q

At what heart rate will a ventricular cell take over as cardiac pacemaker?

A

30 bpm

117
Q

Do B blockers improve symptoms or mortality in heart failure?

A

Both

118
Q

What direction is lead II in if left is 0 degrees and we are moving clockwise?

A

60 degrees

119
Q

What will be lower than normal in a failing heart?

A

Stroke volume

120
Q

What percentages of WBCs are lymphocytes?

A

40-70%

121
Q

Which are the anti-coagulation drugs?

A

Heparin, warfarin

122
Q

What does chronic stress cause the release of?

A

Catecholamines

123
Q

What is a normal haemocrit?

A

40%

124
Q

In initiation of coagulation what does tissue factor bind to?

A

FVII

125
Q

Where would a thrombus which is mainly a product of coagulation be found?

A

In a vein

126
Q

Which channels bring SA nodes to threshold?

A

If channels only

127
Q

What can’t cardiac muscle produce regarding action potentials?

A

A summation of action potentials

128
Q

How do the action potentials of the epicardium and endocardium compare?

A

It is shorter in the epicardium

129
Q

What percentages of patients only show partial response to clopidogrel?

A

33%

130
Q

Which leads are bipolar?

A

I, II, III

131
Q

What is happening in isovolumetric contraction?

A

Ventricles are in systole but valves are yet to open so no volume changes, preparing to push blood forcefully out into aorta and pulmonary artery

132
Q

What does tenase consist of?

A

FVIIIa and FIXa

133
Q

What do cardiac glycosides cause?

A

Decreased removal of Ca2+ from the cell

134
Q

What direction is aVL in if left is 0 degrees and we are moving clockwise?

A

-30 degrees (+300)

135
Q

What type of cell is a NK cells?

A

Lympocyte

136
Q

What is the infarct caused by diffuse stenosis without thrombus or embolism known as?

A

Subendocardial

137
Q

How does tissue factor pathway inhibitor work as an anti-coagulant?

A

Combines with and inactivates FXa

138
Q

What direction is aVR in if left is 0 degrees and we are moving clockwise?

A

-180 degrees (+210)

139
Q

How does ivabradine decrease the work of the heart?

A

Inhibits If (current of pacemaker potential in SAN) to decrease O2 demand and increase supply

140
Q

What do P2Y12 antagonists prevent?

A

Platelet aggregation

141
Q

What proportion of the UK population has CHD?

A

4%

142
Q

What does PR intervals that progressively increases until a QRS complex is missed on an ECG reflect?

A

Wenckebach-type 2nd degree heart block

143
Q

What causes the plateau phase of the cardiac action potential?

A

The open state of L-type calcium channels

144
Q

What do verapamil and amlodipine do?

A

Block Ca2+ entry into smooth and cardiac muscle so decrease force, relax arterial vessels so decrease TPR and O2 demand

145
Q

What is an issue with GTN?

A

Tolerance builds up due to formation of reactive oxygen species inhibiting ALDH-2

146
Q

How long do neutrophils survive in the circulation?

A

5 days

147
Q

What does PR upstroke, delta wave, on an ECG reflect?

A

Accessory pathway from atria to ventricles

148
Q

Which pathogen are eosinophils important in destroying?

A

Parasites

149
Q

How does rivaroxaban work?

A

Directly inhibits FXa

150
Q

What does nicorandil do?

A

K+ channel agonist, opens K+ channels in vascular smooth muscle cells to cause cell hyperpolarisation, vasodilation so decrease TPR and decrease O2 demand

151
Q

What happens to ventricles during heart failure?

A

Ventricles dilate

152
Q

During rapid and reduced ejection phase which valves are open and which are shut?

A

AV valves are shut and the aortic and pulmonary open to allow blood to be pushed out

153
Q

What should the ejection fraction of a healthy person be?

A

55-75%

154
Q

How does heart failure cause oedema?

A

Venous pressure is increased

155
Q

What type of cell is a monocyte?

A

Agranulocyte/ mononuclear cell

156
Q

Which leads are augmented and unipolar?

A

aVL, aVR, aVF

157
Q

What metabolises glyceryl trinitrate (GTN)?

A

ALDH-2

158
Q

What do eosinophil granules contain?

A

Basic, cytotoxic proteins

159
Q

By how much will a cardiac rehabilitation programme reduce CHD mortality?

A

25%

160
Q

How does heart failure ultimately cause death?

A

Cardiac arrhythmia

161
Q

Name an irreversible P2Y12 antagonist.

A

Clopidogrel

162
Q

What is happening in isovolumetric relaxation?

A

Full diastole of the heart, atria fill with blood slowly to prepare for next cardiac cycle

163
Q

What does heparin inhibit?

A

Factors XIIa, XIa, Xa, IXa and IIa (thrombin)

164
Q

What is the extracellular matrix of blood made of?

A

Plasma

165
Q

What does streptokinase activate?

A

Plasminogen

166
Q

Where does the bundle of Kent run in WPW?

A

Right ventricle to right atrium

167
Q

What is the length of the QT interval?

A

300-450 ms

168
Q

What do class IV anti-arrhythmic drugs do?

A

Slows conduction in AV node, slows ectopic pacemakers and reduces AV node excitability

169
Q

In stenotic valvular disease what causes heart failure?

A

Increased afterload

170
Q

What type of cell is a T cell?

A

Lympocyte

171
Q

How much air in the blood stream would kill someone?

A

300 ml

172
Q

How does unfractioned heparin work?

A

Inhibits FXa and thrombin via activation of antithrombin

173
Q

What differentiates reticulocytes from mature erthrocyte in regards to staining?

A

RNA stains differently

174
Q

How does aspirin work?

A

Irreversibility binds COX and inhibits platelet aggregation

175
Q

What is the hydrostatic pressure in the interstitum?

A

0 mmHg

176
Q

What is the length of the PR interval?

A

120-200 ms

177
Q

What is the diameter of a lymphocyte?

A

6-9 micro metres

178
Q

What do statins inhibit?

A

HMG-CoA reductase

179
Q

According to Starling’s law what does the energy released in contraction depend on?

A

The cardiac fibre length

180
Q

When do latent pacemakers increase in automaticity?

A

In ischaemia

181
Q

Which act informs the treatment of people ages 16 and over that lack capacity to consent for treatment?

A

The Mental Capacity Act 2005

182
Q

Which anti-arrhythmic drugs slows heart rate in atrial fibrillation without affecting contractility?

A

Digitoxin

183
Q

How does dabigatran work?

A

Directly inhibits thrombin

184
Q

What percentage of heart failure is systolic?

A

70%

185
Q

What are delayed rectifier channels?

A

K+ channels

186
Q

What causes heart failure after myocardial infarction?

A

Ventricular dilation

187
Q

Which vector does lead III correspond to?

A

Left arm to left leg

188
Q

What determines cardiac output?

A

Central venous pressure

189
Q

What is the preferred immediate treatment for myocardial thrombus?

A

Cardiac cathertisation

190
Q

How do B blockers help angina symptoms?

A

By blocking sympathetic stimulation of heart to decrease force and HR so decrease O2 demand, increase coronary blood supply so increase O2 supply

191
Q

What kind of nucleus does a monocyte have?

A

Horseshoe shaped nucleus

192
Q

Name an ARB (angiotension receptor blocker)

A

Valsartan

193
Q

What activates prothrombin?

A

FXa

194
Q

How does digitoxin increase intracellular Ca2+ in myocytes?

A

Increases intracellular Na+

195
Q

Where are erythroid precursor cells found?

A

Bone marrow

196
Q

What kind of nucleus does a megakaryocyte have?

A

Multi nucleated

197
Q

At what speed do Purkinje fibres conduct at?

A

4 m/s

198
Q

What direction is aVF in if left is 0 degrees and we are moving clockwise?

A

90 degrees

199
Q

Which heart sound would indicate delayed conduction?

A

Split S1 as that is conduction from atria to ventricles

200
Q

What is a normoblast the precursor of?

A

Erthrocyte

201
Q

What forms the blood brain barrier?

A

Capillary endothelium

202
Q

What is pitting oedema a sign of?

A

Elevated venous pressure

203
Q

Which fibrillation results in sudden death?

A

Ventricular fibrillation

204
Q

Where does haemopoiesis take place in the early embryo?

A

Liver

205
Q

Give two class IV anti-arrhythmic drugs.

A

Diltiazem and slow-inward L-type Ca+ channel blockers

206
Q

Which vector does lead I correspond to?

A

Right arm to left arm

207
Q

What does no correspondence between P waves and QRS complexes on an ECG reflect?

A

Complete heart block

208
Q

Do loop diuretics improve symptoms or mortality in heart failure?

A

Symptoms

209
Q

Name a direct FXa inhibitor

A

Rivaroxaban

210
Q

How is GTN administered?

A

Patches

211
Q

What does erythropoietin promote?

A

Growth and division of normoblasts

212
Q

How long after an infarct does ventricular rupture usually occur?

A

10 days

213
Q

What do platelet dense granules contain?

A

Serotonin

214
Q

What do class II anti-arrhythmic drugs do?

A

Inhibits effect of adrenaline

215
Q

When are fibrinolytics used?

A

To lyse a clot

216
Q

After reaching threshold which channels control the upstroke of the SA node action potential?

A

L-type calcium channels

217
Q

Give two class III anti-arrhythmic drugs.

A

Amiodarone and delayed-rectifier K+ channel blockers

218
Q

What is the main pharmacological strategy to deal with angina of effort?

A

Decrease blood O2 demand

219
Q

Which vector does aVL correspond to?

A

Left arm

220
Q

What kind of nucleus does a neutrophil have?

A

Multi lobed nucleus

221
Q

What is the normal percentage of circulating red blood cells that are reticulocytes?

A

1%

222
Q

What type of cell is a basophil?

A

Granulocyte

223
Q

What is an arterial infarct without bacterial contamination called?

A

White, bland infarct

224
Q

At what speed do the atria conduct at?

A

1 m/s

225
Q

What is the diameter of a normal platlet?

A

3 micro metres

226
Q

What is claudication?

A

Muscle pain on exercise

227
Q

What is the current model of coagulation known as?

A

The cell-based model

228
Q

During rapid and reduced ventricular filling which valves are open and which are shut?

A

AV open, pulmonary and aortic shut

229
Q

What is preload determined by?

A

Central venous pressure

230
Q

Which thrombi are platelet rich?

A

Pale thrombi

231
Q

How is heparin activity tested?

A

Measure partial thromboplastin time

232
Q

What does long PR interval on an ECG reflect?

A

1st degree heart block

233
Q

What is the diameter of a normal erythrocyte?

A

7 micro metres

234
Q

Which factor causes cross-linking of fibrin?

A

XIIIa

235
Q

What does an M pattern for the QRS complex likely to indicate?

A

Bundle branch block

236
Q

What initiates cardiac contraction in atrial fibrillation?

A

The AV node

237
Q

Which of clopidogrel and aspirin reduces mortality more?

A

Clopidogrel

238
Q

Which channels determinate heart rate?

A

Potassium channels and If channels

239
Q

Where do newly produced blood cells first enter?

A

Through a sinusoid

240
Q

How does heparin work as an anti-coagulant?

A

Activates anti-thrombin

241
Q

Where do symptoms of weakness in heart failure come from?

A

Increased arterial vasoconstriction

242
Q

Is splitting of the second heart sound always pathological?

A

No

243
Q

What is the INR?

A

Prothrombin time

MBBS1 Thorax (6 decks)

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