cardio amk

Question 1

how to assess a patients stroke score risk

Answer 1

CHAD2DS2 - VASc score

Question 2

what should be offered in first line for reducing stroke risk in AF

Answer 2

DOACs - direct oral anticognualtns - rivaroxaban - patients with AF are at increase risk of stroke due to atrial emboli

anticoagulants slow down clotting reducing fibrin formation and prevent clot formation and growth
anti-platlet drugs like aspirin prevent platelets from clumping together and prevent clot formation and growth

Question 3

what is atorvastatin

Answer 3

statin

Question 4

what INR

Answer 4

prothrombin time

The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin

Question 5

A 61-year-old woman visits her GP to review her anginal medication. She is concerned about her condition and asks about what has caused the narrowing of her coronary arteries.

Which of the following is a change which occurs in the process of atherosclerosis?

Phagocytosis of HDLs by macrophages, forming foam cells

Infiltration of the tunica externa by LDL particles

Fatty infiltration of the subendothelial space

Hypertrophy of the arterial layers

Increased nitric oxide bioavailability

Answer 5

Fatty infiltration occurs at the subendothelial space

Atherosclerosis is a complex process which develops over a number of years. A number of changes can be seen:
initial endothelial dysfunction is triggered by a number of factors such as smoking, hypertension and hyperglycaemia
this results in a number of changes to the endothelium including pro-inflammatory, pro-oxidant, proliferative and reduced nitric oxide bioavailability
fatty infiltration of the subendothelial space by low-density lipoprotein (LDL) particles
monocytes migrate from the blood and differentiate into macrophages. These macrophages then phagocytose oxidized LDL, slowly turning into large ‘foam cells’. As these macrophages die the result can further propagate the inflammatory process.
smooth muscle proliferation and migration from the tunica media into the intima results in formation of a fibrous capsule covering the fatty plaque.

Question 6

3 arterial blood supplies of the thymus

Answer 6

Superior thyroid artery (1st branch of external carotid)
Inferior thyroid artery (from thyrocervical trunk)
Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)

Question 7

at what level does the right phrenic nerve cross the diaphragm

Answer 7

T8

Question 8

STEMI in leads II, III, avF

hat infarction and artery

Answer 8

inferior myocardial infarction

right coronary artery

Question 9

st elevation seen in V1,2

Answer 9

anteroseptal defect

LAD

Question 10

V3,4

Answer 10

anterior RCA/LAD

Question 11

I , AVL V5,6

Answer 11

lateral

circumflex artery

Question 12

bundle branch blocks through what structure

Answer 12

bundle of his
MARROW
WILLIAM - left

Question 13

if hypertension with typ2 or

under 55 and not black without type 2 what do you prescribe

Answer 13

first line ACEi or ARB

then either or or add thiazide or CCB

Question 14

if ages 55 or over or black without T2D

Answer 14

CCB first line

then ACEi or ARB or thiazide

Question 15

enalapril is an ACEi how does it work and side effects

Answer 15

stimulate dilation of BV by inhaibiting production of angiotensin II
dry cough due to increased bradykinin

Question 16

amplodipine is a CCB and prevents entry for smooth muscle calcium and muscle contractions and slow deep at SA node what are the side effects

Answer 16

headaches and flushing feeling with swollen ankles

Question 17

losartan is an ARB - angiotensin blocker by backing receptors especially AT1 found in heart and blood vessels
side effects

Answer 17

severe N+ V
confusion
dizziness - side effect strongest on first dose especially if taking a diuretic

hyperkalaemia

Question 18

coronary arteries arise form the ascending aorta. on the right the subclavian and carotid arise from the brachiocephalic on theft

Answer 18

subclavian and carotid arise from arch of the aorta singularly

Question 19

atrial blood pressure formula

Answer 19

DBP + 1/3 ( SBP - DBP)

Question 20

AGT2 is vasoconstrictor of the efferent arterioles what does Ace work

Answer 20

lungs

Question 21

if someone has acute heart failure and is not responding to treatment what should be considered

Answer 21

CPAP

normally for heart failure give loop diuretics plus oxygen and vasodilators ( hypotension side effect)
respiratory failure give CPAP
in cardiogenic shock give inotropic agents e.g. dobutamine

Question 22

renin secreted by what cells

Answer 22

juxtaglomerular cells

Question 23

what factors stimulate renin secretion

Answer 23

erect posture 
hypotension 
hyponatrraemia 
SNS
catcholamines 

factors that reduce renin secretion are beta blockers(by inhibiting β1-adrenergic receptors located on JG cells.) and NSAIDs (Cyclooxygenase inhibition by NSAIDs results in two results; first, they decrease distal sodium delivery by reducing glomerular filtration and enhancing salt absorption by the nephron; second, by inhibiting macula densa PGs production they reduce renin release.)

Question 24

origin of IVC

Answer 24

L5

Question 25

level the aorta bifurcates into the left and right common iliac

Answer 25

L4

Question 26

Intercristal plane

Answer 26

L4 - level of highest point of iliac crest

Question 27

Intertubercular plane

Answer 27

level of L5 body

Question 28

subcostal margin

Answer 28

Lowest margin of 10th costal cartilage

Question 29

bosentan is used to treat primary pulmonary hypertension what does it do

Answer 29

endothelin - 1 receptor antagonist

Question 30

ecg finding of hypokalaemia

Answer 30

Small or inverted T waves, ST segment depression and prominent U waves are all ECG signs of hypokalaemia. Other signs include a prolonged PR interval (can also be present in hyperkalaemia) and a long QT interval.

Question 31

ecg findings of hyperkalaemia

Answer 31

small or absent P waves is an ECG sign of hyperkalaemia.

QRS complexes become wide and unusual.

Question 32

A patient develops shortness of breath, wheezing and hypotension following head and neck surgery. It is suspected that this could be due to a large air embolism.

Which of the following could have allowed this to happen?

Answer 32

Negative atrial pressures may allow air embolization to occur when neck veins are exposed to air
Important for meLess important
Head and neck surgeries are the most common causes of air embolisms. Depending on the position of the patient negative pressures can develop in the venous circulation and the atria due to thoracic wall movement. If a vein is cut during the surgery then these negative pressures cause air to move into the veins causing an air embolism.

Question 33

branches of external carotid

Answer 33

‘Some Angry Lady Figured Out PMS’

Superior thyroid (superior laryngeal artery branch)
Ascending pharyngeal 
Lingual 
Facial (tonsillar and labial artery)
Occipital 
Posterior auricular 
Maxillary (inferior alveolar artery, middle meningeal artery)
Superficial temporal

Question 34

what nerve supplies the central diaphragm and pericardium

Answer 34

phrenic nerve

Question 35

what is aortic dissection and symptoms

Answer 35

Aortic dissection is aorta splits

present with symptoms of sudden onset chest pain with radiation to the back, shortness of breath and the patient would be systemically unwell e.g. hypotension

Question 36

common symptom In heart failure

Answer 36

Paroxysmal nocturnal dyspnoea (suddenly waking up at night short of breath) is a key feature in heart failure; more commonly occurring in left-sided heart failure

Question 37

MI symptoms

Answer 37

chest pain, clamminess, nausea and ECG changes.

Question 38

PE symptoms

Answer 38

pleuritic chest pain, shortness of breath and haemoptysis.

Question 39

right sided heart failure symptoms

Answer 39

raised JVP, ankle oedema and hepatomegaly.