cardio amk Flashcards

1
Q

how to assess a patients stroke score risk

A

CHAD2DS2 - VASc score

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2
Q

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

A

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

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3
Q

what is atorvastatin

A

statin

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4
Q

what INR

A

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

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5
Q

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

A

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.

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6
Q

3 arterial blood supplies of the thymus

A
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)
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7
Q

at what level does the right phrenic nerve cross the diaphragm

A

T8

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8
Q

STEMI in leads II, III, avF

hat infarction and artery

A

inferior myocardial infarction

right coronary artery

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9
Q

st elevation seen in V1,2

A

anteroseptal defect

LAD

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10
Q

V3,4

A

anterior RCA/LAD

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11
Q

I , AVL V5,6

A

lateral

circumflex artery

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12
Q

bundle branch blocks through what structure

A

bundle of his
MARROW
WILLIAM - left

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13
Q

if hypertension with typ2 or

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

A

first line ACEi or ARB

then either or or add thiazide or CCB

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14
Q

if ages 55 or over or black without T2D

A

CCB first line

then ACEi or ARB or thiazide

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15
Q

enalapril is an ACEi how does it work and side effects

A

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

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16
Q

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

A

headaches and flushing feeling with swollen ankles

17
Q

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

A

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

hyperkalaemia

18
Q

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

A

subclavian and carotid arise from arch of the aorta singularly

19
Q

atrial blood pressure formula

A

DBP + 1/3 ( SBP - DBP)

20
Q

AGT2 is vasoconstrictor of the efferent arterioles what does Ace work

A

lungs

21
Q

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

A

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

22
Q

renin secreted by what cells

A

juxtaglomerular cells

23
Q

what factors stimulate renin secretion

A
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.)

24
Q

origin of IVC

A

L5

25
Q

level the aorta bifurcates into the left and right common iliac

A

L4

26
Q

Intercristal plane

A

L4 - level of highest point of iliac crest

27
Q

Intertubercular plane

A

level of L5 body

28
Q

subcostal margin

A

Lowest margin of 10th costal cartilage

29
Q

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

A

endothelin - 1 receptor antagonist

30
Q

ecg finding of hypokalaemia

A

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.

31
Q

ecg findings of hyperkalaemia

A

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

QRS complexes become wide and unusual.

32
Q

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?

A

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.

33
Q

branches of external carotid

A

‘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
34
Q

what nerve supplies the central diaphragm and pericardium

A

phrenic nerve

35
Q

what is aortic dissection and symptoms

A

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

36
Q

common symptom In heart failure

A

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

37
Q

MI symptoms

A

chest pain, clamminess, nausea and ECG changes.

38
Q

PE symptoms

A

pleuritic chest pain, shortness of breath and haemoptysis.

39
Q

right sided heart failure symptoms

A

raised JVP, ankle oedema and hepatomegaly.