Cardiology

Question 1

Most common cardiac defect seen in patients with Downs Syndrome?

Answer 1

Endocardial cushion defect - AKA atrioventricular septal canal defects (c. 40%)
Ventricular Septal Defect (c. 30%)
Secundum Atrial Septal Defect (c. 10%)
Tetralogy of Fallot (c. 5%)
Isolated Patent Ductus Arteriosus (c. 5%)

Question 2

Ivadrabine: MOA and indication

Answer 2

Action at the If (funny) channel blocking influx of sodium leading to a reduction in the action potential slope

Reduces HR (by c. 10bpm) which in turn lowers cardiac workload and myocardial oxygen demand

Indication: stable angina, NSR and HR >70bpm
Stable CCF, NSR and HR >77bpm

Question 3

Hypertrophic Cardiomyopathy

Answer 3

Characterised by LV hypertrophy

• LV outflow obstruction (anterior displacement of the mitral valve during systole)
• Diastolic dysfunction
• Myocardial ischaemia
• Mitral regurgitation

Question 4

Clopidogrel

Answer 4

P2Y12 inhibitor
4 hours onset
Irreversible

Question 5

Ticagrelor

Answer 5

P2Y12 inhibitor
30 minute onset
Reversible

TicagreloR = Reversible

Question 6

Prasugel

Answer 6

P2Y12
30 minute onset
Irreversible

Question 7

Dabigatran precautions

Answer 7

GI haemorrhage more common
Contraindicated with prosthetic heart valve; CrCl <30; liver enzymes > 2 times ULN
Dose reduce if: CrCl 30-50; patient >75 yrs
NOT to be taken with Verapamil

Question 8

ECG changes in pericardial effusion

Answer 8

Low QRS voltage

Tachycardia

Question 9

ECG in Wolff Parkinsons White

Answer 9

Short PR
Wide QRS
Slurred upstroke of QRS (delta waves)

Question 10

ECG in Wellens

Answer 10

Deeply inverted or biphasic T waves in V2 and V3

Question 11

ECG in aortic stenosis

Answer 11

Left axis deviation
R Wave V5, V6 > 25mm
S Wave V1, V2 > 25mm

Question 12

ECG in dextrocardia

Answer 12

R axis deviation
Positive QRS in AVR
Lead I: inversion of all complexes
Dominant S waves throughout

Question 13

ECG in Atrial Septal Defect

Answer 13

RBBB

Question 14

ECG changes with posterior infarct

Answer 14

Changes in V1 - V3
Horizontal ST depression
Tall R waves
Upright T waves

Question 15

Atropine:MOA and indications

Answer 15

Competitively inhibits binding of acetylcholine to muscarinic receptors in the parasympathetic and central nervou systems
Causes increased HR, inhibits smooth muscle contraction in GI and GU systems
Indication: bradycardia

Question 16

Substance P

Answer 16

Receptor - neurokinin type 1
Potent vasodilator
Trigger for nausea and emesis
Important element in pain perception

Question 17

CHA2DS2VAS

Answer 17

CCF
HTN
Age >/= 75
Diabetes
Sex (F=2)
Vascular disease (prior MI, PVD, aortic plaque)
Age 65-74
Stroke / TIA / VTE