Cardiology

Question 1

LQT1

Answer 1

KVLQT1

Phase 3 K channels (Kr)

Question 2

LQT2

Answer 2

HERG gene

Under active K channel (Ks)

Question 3

LQT3

Answer 3

SCN5A

Overactive Na channel on depolarisation (NaL)

Question 4

Drug with best mortality benefit HFrEF

Answer 4

Beta Blockers
Carvedilol (CAPERNICUS for severe HF)
Metoprolol
Bisoprolol

MRA > ACEi > ARB

Question 5

Benefit of ACE for HF

Answer 5

Mortality 3.8%
Decreased readmission for heart failure
no difference compared to ARB

Question 6

Digoxin in HF

Answer 6

Reduce HF hospitalisation for those intolerant to B Blockers or persistent symptoms on B Blockers

Question 7

Emperor Preserve Trial

Answer 7

Empagliflozin vs placebo

21% RR for CV death and HHF

Question 8

E/e’ consistent with HFpEF

Answer 8

> 13

Question 9

Impaired longitudinal strain cut off

Answer 9

Abnormal if >-16

Question 10

Indication for CMRI

Answer 10

LV Hypertrophy

Question 11

LA volume index consistent with HFpEF

Answer 11

> 34

Question 12

Clinically significant MS

Answer 12

Valve area <1cm
Mean gradient >10mmhg
PASP >30mmHg

If symptomatic, recommended for perc MV repair or surgery

Question 13

PCSK9 Inhibitors

Answer 13

Alirocumab

Evolocumab

Question 14

COURAGE trial

Answer 14

In stable angina (2000)
Optimal medical therapy vs PCI
Nil reduction in death or MI

Question 15

ISCHAEMIA trial

Answer 15

No reduced risk of Mortality or MI in invasive vs conservative strategy

Question 16

SYNTAX study

Answer 16

Cardiac surgery superior to PC in triple vessel or left main disease
> MACE at 1 year

Question 17

STITCHES trial

Answer 17

At 10 years, mortality benefit of CABG for ischaemic CM

Should be considered in young patients without angina

Question 18

Non dihydropyridine CCB

Answer 18

Diltiazem

Verapamil

Question 19

The immediate success rate of cardio version

Answer 19

90%
Falls with duration of AF
risk of early recurrence

Question 20

Drugs that increase likelihood of successful cardio version

Answer 20

Sotalol
Ibutilide
Dofetilide

Question 21

Irreversible P2Y12 platelet receptor

Answer 21

Clopidogrel

Question 22

Reversibly binds to P2Y-12 receptor

Answer 22

Ticagrelor

Question 23

Poor METS

Good METS

Answer 23

<4

>10

Question 24

MACE

Answer 24

total death
MI
stroke
hospitalization because of HF
revascularization (PCI, ACBG)

Question 25

Main benefit of DES over BMS

Answer 25

Less restenosis

Question 26

Triple therapy post stent

Answer 26

1/52 for triple therapy 12/12 clop + DOAC At 1 year aspirin + DOAC

Question 27

regular broad complex tachy

Answer 27

pre-excited atrial tachycardia svt with abberency VT electrolytes

Question 28

VT features

Answer 28

A-V dissociation fusion/capture beats Concordance within the precordial leads

Question 29

Trigger for brugada

Answer 29

Fever

Question 30

Antiarrhythmic for brugada

Answer 30

Quinidine

Question 31

Genetic abnormality leading to Arrythmogenic RV cardiomyopathy

Answer 31

Defect in genes encoding desmosomal proteins

Question 32

Giant TWI precordial leads

Answer 32

apical HOCM

Question 33

prolonged PR in Aortic IE

Answer 33

Aortic root abscess | Need surgery

Question 34

Cause of haemorrhagic pericardial effusion

Answer 34

TB Neoplasm Uraemic effusion

Question 35

Cardiac syndrome X

Answer 35

Microvascular disease that leads to typical angina Normal coronaries Positive stress test (ischaemic changes)

Question 36

Most common aetiology of viral myocarditis

Answer 36

Coxsackie virus

Question 37

Most common heart defet in Down's syndrome

Answer 37

Atrio-ventricular cushion defect 1. Common AV valve 2. Ostium primum ASD 3. Posterior septal ventricular defect

Question 38

Ratio that indicates ASD closure is required

Answer 38

Pulmonary:systemic flow ratio >2:1

Question 39

Duration of antibiotic prophylaxis for RHD

Answer 39

ARF nil cardiac involvement - 5 years or 21 Mild RHD - 10 years or 21 Mod RHD - 10 years or 35 Severe RHD - 10 years or 40

Question 40

Signs of severe AS

Answer 40

1. Loud (grade 4) murmur 2. Mid or late peaking murmur 3. Diminished or absent S2 4. Split s2 (AV closes after PV) 5. Disappearance of ejection click 6. Parvus et tardus carotid pulse 7. S3/S4

Question 41

S4

Answer 41

Diastolic sound before S1 Atrial gallop Blood ejecting into a stiff ventricule (diastolic HF)

Question 42

S3

Answer 42

Ventricular gallop After S2 Blood entering a floppy ventricle Systolic HF

Question 43

Signs of AR

Answer 43

``` Early diastolic /holodiastolic if severe Displaced apex with apical thrust Corrigans= water hammer pulse De mussets = head bobbing Landolfis sign = pulsing pupils Becker’s = retinal artery pulsing Austin Flint Taubes = pistol shot over femoral Quinces Hills = LL systolic > UL by 20mmhg ```

Question 44

Type 3 MI

Answer 44

Typical MI with death before troponins

Question 45

Type 4a MI

Answer 45

Associated with PCI

Question 46

Type 5 MI

Answer 46

Associated with CABGS

Question 47

Type 4b MI

Answer 47

In stent thrombosis

Question 48

ASD ECG

Answer 48

First degree heart block Rbbb Notching of r wave in inferior leads

Question 49

Congenital cause of cyanosis heart diseas

Answer 49

``` Truancy’s arteriosis Tricuspid atresia TOF TAPVR Transposition of great vessels ``` Non cyanotic - asd vsd PDA (until eisenmonger syndrome with shunt reversal)

Question 50

Neprilysin hydrolysis action

Answer 50

glucagon, enkephalins, substance P, neurotensin, oxytocin, and bradykinin.

Question 51

Diagnosis of HFpEF on exercise RHC

Answer 51

pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg during exercise is diagnostic for HFpEF.

Question 52

Echo findings of HFpEF

Answer 52

Doppler echocardiographic E/e' >15 Pulmonary artery systolic pressure >35 mmHg Left atrial volume index (LAVI) >34 mL/m2

Question 53

Treatment of ventricular septal rupture

Answer 53

Surgery

Question 54

Window for thrombolysis

Answer 54

12 hours

Question 55

High risk cardiac abnormalities requiring antibiotic prophylacis

Answer 55

– Prosthetic cardiac valves or prosthetic material – Previous infective endocarditis – Unrepaired cyanotic congenital defects – Rheumatic Heart Disease patients – Heart Transplant patients

Question 56

Alzheimer's medication with bradycardic effect

Answer 56

Donezapil (anticholinesterase with muscarinic effects)

Question 57

Prostate medication leading to drop in BP

Answer 57

Tamusolin A1- antagonist Preferential selectivity of a1A in the prostate over a1B in blood vessels

Question 58

Lipoprotein Lipase Deficiency cholesterol pattern

Answer 58

No LDL | High VLDL therefore high total cholesterol

Question 59

Adenosine deaminase (>50 U/L) in the pericardial fluid

Answer 59

TB pericaditis

Question 60

Ostium secumdum vs ostium primum ASD

Answer 60

2nd- Nil MR No LAD