Cardiology

Question 1

Which nerve is responsible for pain radiating to the shoulder when have pericarditis?

Answer 1

phrenic nerve- this nerve supplies the pericardium

Question 2

What is classically associated with a sawtooth appearance on an ECG?

Answer 2

Atrial Flutter

Question 3

First, second line treatment to reduce stroke risk in AF?

Answer 3

First line: DOACs- apixaban, dabigatran, edoxaban, rivaroxaban
Second line: Warfarin

Question 4

Side effects of nicotinic acid? (Niacin)

Answer 4

Flushing: mediated by prostaglandins
Impaired glucose tolerance
Myositis

Question 5

What causes acute mitral regurgitation?

Answer 5

Ischaemia or rupture of papillary muscles

Question 6

Timeline of MI histology findings

Answer 6

0-24hrs: early coagulative necrosis, neutrophils, wavy fibres, hyper contraction of myofibrils. High risk of ventricular arrhythmia, HF and cardiogenic shock
1-3 days: Extensive coagulative necrosis, neutrophils (associated with fibrinous pericarditis)
3-14 days: macrophages + granulation tissue at margins. high risk of free wall rupture, papillary muscle rupture and LV pseudo aneurysm
2weeks- several months: dressler syndrome, contracted scar complete, HF, arrhythmia, mural thrombus

Question 7

How do the vertebral arteries enter the cranial cavity?

Answer 7

Through the foramen magnum

P.s. if someone tilts there head back, like washing hair in a salon, the vertebral artery can be dissected

Question 8

What is heparin mechanism of action?

Answer 8

Activates antithrombin III

Question 9

Thiazide diuretic side effects

Answer 9

Dehydration
Postural hypotension
Hyponatraemia, hypokalaemia, hypercalcaemia
Gout 
Impaired glucose tolerance
Impotence

Question 10

Which nerve regulates the baroreceptors reflect correcting an acute decrease in arterial blood pressure- in the aortic arch!!?

Answer 10

Vagus nerve

Question 11

Which nerve regulates the baroreceptors reflect correcting an acute decrease in arterial blood pressure- in the carotid sinus?

Answer 11

Glossopharyngeal nerve

Question 12

What is the mechanism of action of adenosine?

Answer 12

A1 receptor agonist

Question 13

Mechanism of action of warfarin

Answer 13

Inhibits epoxide reductase preventing vitamin K from being converted to it’s activated form

Question 14

What do all the different troponin do in skeletal and cardiac muscle contraction:

Answer 14

troponin C- binds to calcium ions
troponin T- binds to tropomyosin, forming a troponin-tropomyosin complex
Troponin I- binds to actin to hold the troponin-tropomyosin complex in place

Question 15

If you get painless loss of vision with a stroke, where is the lesion?

Answer 15

Either ophthalmic artery or central retinal artery (branch of ophthalmic artery)
And ophthalmic artery is a branch of the internal carotid artery

Question 16

Complications from CABG

Answer 16

Atrial fibrillation (30-40%)
Stroke (2%)

Question 17

What is administered as first line treatment for significant hypercalcaemia?

Answer 17

Calcium chloride

Question 18

What is varicocele and what does it suggest

Answer 18

When veins in your scrotum swell and get larger- “bag of worms”. Most often on the left
Can indicate left renal tumour

Question 19

When do you do pre-operative U&Es?

Answer 19

If patient over 60 years old
Cardiovascular and renal disease
Diabetics and patients on steroids
Diuretics
ACE inhibitors

Question 20

How do ACEI affect eGFR?

Answer 20

Some reduction in GFR is expected because of haemodynamic changes within the kidney.

Question 21

What does this all mean:
A) Normal urine + normal stools
b) dark urinalysis + normal stools
C) dark urine + pale stools

Answer 21

A= pre-hepatic cause
b= hepatic cause
C= post-hepatic cause (obstructive)

Question 22

What is sclera icterus?

Answer 22

Also known as conjunctival icterus

Yellowish pigmentation of the sclera- normally white part of the eye

Question 23

What is Gilbert’s syndrome?

Answer 23

Isolated elevation of bilirubin, and specific elevation of unconjugated bilirubin
Lack of risk factors for hepatitis

Question 24

What is the MELD score used to measure?

Answer 24

Severity of Cirrhosis based on:
Serum bilirubin 
INR
Sodium
Creatinine
Need for dialysis