1. BAMS Cardio/Resp

Question 1

Angina and PVD

1. Describe angina
2. Describe the two types
3. List common symptoms
4. Describe acute treatment and preventative treatment
5. What is PVD
6. Give some symptoms
7. How is it managed preventatively?

Answer 1

1. Narrowing of one/more coronary arteries, reducing blood supply and oxygen concentration to heart
2. Stable - worse with exercise/exertion; relieved at rest
   Unstable - no precipitating factor
3. Chest pain, may radiate to arm/jaw/back
4. Acute - 2x GTN puffs (sublingual). 400mcg/actuation. 15l/min O2 via non-rebreathing mask
   Preventative - aspirin, antihypertensives, lifestyle changes
5. ‘Angina’ of the tissues (lower limbs) due to atheroma in femoral/popliteal vessels
6. Limb claudication, relieved with rest
7. Similar to angina - aspirin, antihypertensives, lifestyle changes

Question 2

Cyanosis and MI

1. What is the definition of cyanosis?
2. What are the 2 types?
3. Describe the differences between the two types
4. What is a key feature of cyanosis?
5. List some key MI symptoms
6. How would you manage this acutely?
7. Give some types of post-MI medications that can be used for long-term management

Answer 2

1. > 5g/dl deoxygenated haemoglobin in blood
2. Central, peripheral
3. Central - underlying pathology. Core, lips, gums, tongue, mucous membranes
   Peripheral - environmental. Extremities (fingers, toes)
4. Finger clubbing, blue/purple discolouration
5. Pale, nausea, sweating, central crushing chest pain, may radiate
6. Call 999, make patient comfortable, chew aspirin (300mg dispersible tablet), 15l/min O2 via non-rebreathing mask
7. Antiplatelets/anticoagulants, beta-blockers, ACE inhibitors, stains, diuretics, Ca-channel blockers

Question 3

Hypertension and HF

1. Define
2. List 3 risk factors
3. List 2 symptoms
4. Describe non-drug treatment options
5. List 3 drug treatment options
6. List the 3 types of HF
7. Give 2 signs of 2 types
8. How can HF be treated

Answer 3

1. BP > 140/90mmHg
2. Age, race, obesity, alcohol, family history, pregnancy, stress, drugs
3. Headaches, TIAs
4. Lifestyle changes
5. Aspirin, beta-blocker, ACE inhibitors, thiazide diuretics, Ca-channel blockers
6. Right, left, congestive
7. Right - raised JVP, ascites, swollen ankles
   Left - dyspnoea, tachycardia, hypotension
8. Treat cause, diuretics, ACE inhibitors, nitrates, inotropes
   Not beta-blockers or steroids

Question 4

Cardio Drugs

1. List 3 antiplatelets and describe their action
2. List 4 anticoagulants and describe their action and management of patients on these
3. What do statins do?
4. What do beta-blockers do?
5. What do diuretics do?
6. What do nitrates do?
7. What do Ca-channel blockers do?
8. What do ACE inhibitors do?

Answer 4

1. Aspirin - inhibit platelet aggregation (prevent platelet plug formation)
   Clopidogrel - inhibit ADP-induced aggregation
   Dipyridamole - inhibit platelet phosphodiesterase
2. Warfarin - inhibits vit K-dependent synthesis of clotting factors (FI, II, V, VI, X). Measured by INR (measures extrinsic and common coagulation pathways). Determines the clotting tendency of blood, in the measure of warfarin dosage, liver damage, and vitamin K status. Get checked ideally 24hrs before extraction – ensure stable for 72hrs before this
   If >4.0 (SDCEP – NHS GGC is >3.5) cannot extract teeth
   Apixiban/rivaroxiban - FX inhibitor. Miss/delay morning dose
   Dabigatran - direct thrombin inhibitor. Miss morning dose
   Heparin - activates AT, which inactivates thrombin and FX. Consult with GP/haem
3. Lower cholesterol (inhibit synthesis in liver)
4. Reduce heart muscle excitation, prevent HR increase, reduce heart efficiency
5. Increase salt and water loss (RAAS)
6. Venodilators, reduce PR, dilate collateral coronary artery supply
7. Block calcium channels, lowering BP
8. Inhibit ACE (prevent Ang I to Ang II conversion), reduce BP and salt and water retention

Question 5

Asthma and COPD

1. Definition of asthma
2. What is the triad mechanism of asthma?
3. Give 3 symptoms
4. What might trigger asthma?
5. List the 5 steps in asthma treatment
6. What is COPD?
7. What causes COPD?
8. How can COPD be managed?

Answer 5

1. Reversible airflow obstruction
2. Airway smooth muscle construction
   Mucosal inflammation/oedema
   Increased mucosa secretion
3. Cough, wheeze, dyspnoea
4. Infections, environment, cold air, exercise
5. Occasional beta-agonist
   Low-dose inhaled steroid or sodium cromoglycate/nedocromil
   High-dose inhaled steroid
   Long-acting beta-agonist, theophylline, anti-muscarinic drugs
   Oral steroid
6. Mixed airway reversible obstruction and destructive lung disease
   Combination of asthma and emphysema
7. Smoking, environmental lung damage
8. Smoking cessation, long-acting bronchodilator, steroids, oxygen support, pulmonary rehabilitation therapy

Question 6

Cystic Fibrosis, Resp failure, sleep apnoea, lung tumours

1. What is CF?
2. Give 3 symptoms
3. Give 4 management methods
4. Describe differences between 2 types of resp failure
5. What is sleep apnoea?
6. What are the 2 types?
7. How is it managed?
8. Give 3 signs of lung tumours

Answer 6

1. Inherited recessive disorder, CFTR gene (chromosome 7) anomaly. Over-production of sticky solid mucus
2. Productive cough, prolonged diarrhoea, poor weight gain, repeated chest infections
3. Physio, exercise, medications (bronchodilators, antibiotics, steroids, DNases), transplantation
4. Type 1 - hypoxaemia. Failure of oxygenation.
   PaO2 <8kPa or when SaO2 <90%.
   Leads to poor alveolar ventilation, diffusion abnormality, VQ mismatch
   Type 2 - hypercapnia. Failure of ventilation
   PaO2 >6.7kPa .
   Only in acute respiratory failure
5. Airway obstruction during sleep >10s
6. Obstructive (loss of airway muscle tone)
   Central
7. CPAP

8. Cough
Haemoptysis
Pneumonia
Dysphagia
SVC obstruction
Recurrent laryngeal nerve palsy (hoarseness)

Question 7

Resp Drugs

1. What colour of inhaler is first line for asthma (short-acting beta-agonist)?
2. What colour of inhaler is for a long-acting beta-agonist?
3. What colour of inhaler is for first line steroids?
4. What colour of inhaler is for second line steroids?
5. What do beta-agonists do?
6. What do steroids do?
7. What do anticholinergics do?
8. What do theophyllines do?

Answer 7

1. Blue - short-acting
2. Green - long-acting
3. Brown
4. Orange/pink
5. Improve airway potency, reduce bronchoconstriction
6. Reduce bronchial wall inflammation (immunosuppression)
7. Bronchial dilation, reduce mucus secretion
8. Improve gas exchange, relax bronchial smooth muscle, increase HR and BP, anti-inflammatory