Cardiology

Question 1

Myoglobin

Answer 1

First to rise 1-2 hrs
Peak 6-8hrs
Normal at 1-2days

Question 2

Ck-MB

Answer 2

2-6hrs
Peak 16-20
Normalised 2-3days

Question 3

CK

Answer 3

4-8hrs
Peak 16-24hrs
Normaised 3-4days

Question 4

Trop T

Answer 4

4-6hrs
Peak 12-24
Normalised 7-10days

Question 5

AST

Answer 5

12-24hra
Peak 36-48
Normalised 3-4data

Question 6

LDH

Answer 6

24-48hrs
Peak 72hrs
Normalised 8-10 days

Question 7

Thin filaments

Answer 7

Troponin
Tropomyosin
Actin

Question 8

Thick filaments

Answer 8

Myosin

Question 9

Atrial conduction

Answer 9

1m/s

Question 10

AV node conduction

Answer 10

0.05m/s

Question 11

Ventricular conduction

Answer 11

Large diameter Purkinje fibres 2-4m/s

Question 12

Quincke’s sign

Answer 12

AR

Nail bed fluctuations

Question 13

Corrigan’s pulse

Answer 13

AR
Water hammer pulse
Collapsing radial pulse

Question 14

Corrigan’s sign

Answer 14

Visible carotid pulsation

AR

Question 15

De Musset’s sign

Answer 15

AR

Head nodding with each systole

Question 16

Duroziez’s sign

Answer 16

AR moderate severity

Audible femoral bruits with diastolic flow

Question 17

Traube’s sign

Answer 17

AR

Pistol shot femorals

Question 18

Austin Flint murmur

Answer 18

AR

Functional mitral diastolic flow murmur

Question 19

Argyll Robertson pupils

Answer 19

Syphilis

Assoc with AR and syphylitic aortitis

Question 20

Muller’s sign

Answer 20

AR

Pulsatation of the uvula

Question 21

Mitral stenosis

Answer 21

Rheumatic fever
Two thirds female
Mid diastolic
Opening snap
LLP
Radiates to Scilla

Question 22

Mitral regurgitation

Answer 22

MV prolapse, LV dilatation, post Mi, rheumatic fever, connective tissue disorder
Blowing PSM
LLP
Axilla

Question 23

Aortic stenosis

Answer 23

Triad: angina, dysponea and syncope

Severe: gradients >60mmHg and valve area <0.5cm2

Bicuspid valve, degenerative calcification, rheumatic fever

Question 24

Mitral valve prolapse

Answer 24

5% 
More common females
Chest pains/palpitations/fatigue/asx 
Acid mucopolysaccharide deposit
Myxomatosis degeneration 

Click Increased by squatting, murmur by standing

Risks; emboli, rupture, dysrhytmias with prolonged QT,cardiac neurosis, sudden death

Question 25

Machinery murmur

Answer 25

PDA | Pulmonary trunk -> descending aorta

Question 26

Graham Steels murmur

Answer 26

Pulmonary regurg Causes: severe MS, Eisenmenger syndrome

Question 27

Tetralogy of Fallot

Answer 27

``` Pulmonary stenosis RV hypertrophy VSD Overriding of the aorta 25% rusher sided aortic knuckle ```

Question 28

Pansystolic murmur

Answer 28

MR | VSD

Question 29

CHADSVAS

Answer 29

``` Score for anticoagulant in AF Congestive HF HTN Age >75 2, 65-74 1 Diabetes Vascular disease Female ``` Oral anticoag if 2+

Question 30

HASBLED

Answer 30

Anticoagulant in AF ``` HTN Abnormal liver function Abnormal renal function Stroke Bleeding Labour LFTS Elderly Drugs Alcohol ```

Question 31

Adenosine

Answer 31

Used in SVT - transient heart block at AV node Agonist A1 receptor which inhibits adenyl Cyclades reducing cAMP causing hyperparization by outwards potassium flux Enhanced by dipyridamole Reduced by aminophylline DEAR Avoid in asthmatics

Question 32

Catecholamine polymorphic VT

Answer 32

AD inherited Commonly defect in Ryan I’d INR receptor RYR2 in sarcoplasmic reticulum Exercise or emotion induced -> syncope Symptoms <20yrs Tx: b blockers, ICD

Question 33

Methyldola

Answer 33

Centrally acting | Anti hypertensive used in pregnancy

Question 34

Moxonidine

Answer 34

Centrally acting | Used if conventional tx failed

Question 35

Clonidine

Answer 35

Centrally acting anti-HTN | Stimulates alpha2 adrenoreceptors in vasomotor centre

Question 36

MUGA scan

Answer 36

Multi gated acquisition scan Nuclear imaging Measure LV function Use in cardio toxics

Question 37

GRACE score

Answer 37

NSTEMI 6 month mortality <1.5% aspirin 1.5-3 aspirin and clopidogrel, OP imaging 3-6 and 6-9 and >9% glycoprotein inhib and angiography <96hrs

Question 38

Aspirin

Answer 38

Anti platelet | Inhibits production of thromboxane A2

Question 39

Clopidogrel

Answer 39

Anti platelet | Inhibits ADP binding to platelet receptor

Question 40

Enoxaparin

Answer 40

Activates antithrombin 3 | Potentiates inhibition of coag factor Xa

Question 41

Bivirudin

Answer 41

Reversible direct thrombin inhibitor

Question 42

Rheumatic fever

Answer 42

Group A strep Duckett Jones criteria, 2 maj or 1maj/1minor Major: carditis, polyarthritis, erythema marginatum, subcutaneous nodules, chorea Minor: fever, arthralgia, prv RHD, high ESR and CRP, prolonged PR interval