Cardiology

Question 1

MoA of clopidogel/ticagrelor

Answer 1

Inhibits ADP from binding to platelet receptor (P2Y12)

Question 2

Dabigatran reversal

Answer 2

Idaracuzimab

Question 3

Apixaban and rivaroxaban reversal

Answer 3

Andexanet alfa. It binds and sequesters direct factor Xa inhibitors.

Question 4

Heparin reversal

Answer 4

Protamine is used to reverse heparin. It is a peptide that binds and sequesters heparin molecules.

Question 5

JVP waveform

Answer 5

A= Atrial contraction
C= Closure of triCuspid
x descent= relaXation of the Atrium (ventricular contraction)
V= passiVe filling of the atrium (ANS here as you can localise tricuspid regurg from stem)
Y descent= Tricuspid opening

Question 6

MUGA Scan

Answer 6

MUGA (multigated acquisition) scan, also known as radionuclide ventriculography or nuclear angiography, is a non-invasive nuclear medicine test that uses a small amount of radioactive tracer to evaluate the pumping function of the heart. It provides precise quantification of left ventricular ejection fraction (LVEF), which is an important parameter for assessing cardiac function. In patients receiving cardiotoxic chemotherapy agents like doxorubicin, monitoring LVEF with MUGA scans can help detect early signs of cardiotoxicity and guide timely interventions.

Question 7

Early diastolic murmur

Answer 7

Aortic regurgitation

e(AR)ly diastolic -> Aortic Regurgiation (AR)
(M)id Diastolic -> (M)itral stenosis

Question 8

Mid diastolic murmur

Answer 8

Mitral stenosis

e(AR)ly diastolic -> Aortic Regurgiation (AR)
(M)id Diastolic -> (M)itral stenosis

Question 9

Ivabradine SE

Answer 9

visual effects, particular luminous phenomena, are common
headache
bradycardia, heart block

Metabolised by CYP P450 therefore inhibitors of CYP 450 with increase SEs

Question 10

ECG changes with hypothermia

Answer 10

J waves (small bumps at the end of the QRS complex)

bradycardia
‘J’ wave (Osborne waves) - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

Question 11

ACEi first dose phenomenon?

Answer 11

First dose hypotension with ACEi

Question 12

Where is the site of action of bendroflumethiazide

Answer 12

Proximal part of the distal convoluted tubule

Thiazides/thiazide-like drugs (e.g. indapamide) - inhibits sodium reabsorption by blocking the Na+-Clˆ’ symporter at the beginning of the distal convoluted tubule

Question 13

Abx treatment for infective endocarditis with strep vs staph

Answer 13

Staph -> fluclox (+gent + rifampacin)
if penn allergic Vanc + gent

Strep -> Benpen (if penn allergic vanc)

Also addition of rifamacip depends on native or non native valve

Question 14

Tx for PAH without response to vasoactive substances on testing

Answer 14

If there is a negative response to acute vasodilator testing (the vast majority of patients)
prostacyclin analogues: treprostinil, iloprost
endothelin receptor antagonists
non-selective: bosentan
selective antagonist of endothelin receptor A: ambrisentan
phosphodiesterase inhibitors: sildenafil

Note: PDE inhibitors and proscyclin anallogues CI in patients with recent stroke (? risk of heamorrrhaagic transformation)

Question 15

Spndylarthropathies/ ank spond aassociated with what valve disease?

Answer 15

Aortic reguritaiton

Question 16

Best & worst pathogens in infective endocarditis for prognosis

Answer 16

best - strep worst - staph

The correct answer is Streptococcus viridans infection. This is because Streptococcus viridans is a common cause of subacute infective endocarditis, which typically has a more indolent course and better prognosis compared to other causes. It is often sensitive to penicillin, and the mortality rate associated with it is relatively low.

Staphylococcus aureus infection, on the other hand, often leads to acute infective endocarditis, which has a much higher mortality rate due to its rapidly progressive nature. Furthermore, methicillin-resistant Staphylococcus aureus (MRSA) may be resistant to many antibiotics, making treatment more difficult.

Question 17

Common SE of ticagrelorr

Answer 17

Dysponeoa

hypothesised that the sensation of dyspnoea in ticagrelor-treated patients is triggered by adenosine, because ticagrelor inhibits its clearance (by inhibiting the enzyme adenosine deaminase), thereby increasing its concentration in the circulation.

Question 18

Rare advrse effects of thiazides

Answer 18

Rare adverse effects
thrombocytopaenia
agranulocytosis
photosensitivity rash
pancreatitis

Question 19

bisferiens pulse

Answer 19

mixed aortic valve disease

Question 20

Name two endothelin receptor antagonists and when would they be used

Answer 20

PAH that is not rresponsive to vasaodialators)

Bosentan aand ambrisentan

Question 21

B-type natriuretic peptide is mainly secreted by?

Answer 21

the ventricular myocardium

Question 22

AV node supplied by which coronary artery?

Answer 22

The atrioventricular node is supplied by the posterior interventricular artery, which in the majority of patients is a branch of the right coronary artery.

Question 23

Keshan disease

Answer 23

Dialatd cardiomyopathy caused by selenium deficiency

Question 24

Wet beri beri disease caused by?

Answer 24

Thiamine deficiency

Question 25

Medications to avoid/use in Wolff parkinsons white

Answer 25

Avoid ABCD
Adenosine, Beta blockers, Calcium channel blockers, Digoxin

SAFe medications
Sotalol unless A.fib, Amiodarone, Flecainide