FRACPRACTICE Flashcards
Coronary artery anatomy
suspected culprit artery in STEMI ST elevation in V1-6, I, aVL and reciprocal depression in II, II, aVF
Left main disease
TIMI grade flow classification
TIMI 0 = no perfusion
TIMI 1 = penetration without perfusion
TIMI 2 = partial reperfusion
TIMI 3 = normal flow
Management of Left Main coronary artery disease with low-intermediate anatomic complexity
PCI 2 2nd gen DES in noninferior to CABG
Everolimus-eluting stents or bypass surgery for left main coronary artery disease NEJM Dec 2016
Differentials of acute kidney injury after cardiac embolisation
Contrast nephropathy vs renal atheroemboli
Contrast nephropathy usually resolves within 7 days where as cholesterol embolic is persistant
apixaban vs warfarin in non valvular AF
Greater reduction in rates of stroke or systemic embolism
Lower rate of major bleeding
recommended daily intake of salt to reduce cardiovascular events
3-6g/day
what murmur is present in severe MS
early diastolic murmur
mitral stenosis indications for surgery in an asymptomatic patientmod
mod to severe MS (<1.5cmsq)
and
pulmonary HTN (PASP >50mmHg at rest or 60mmHg with exercise)
what murmur does aortic sclerosis have
mid systolic ejection murmur
what is the most common mutation in hypertrophic cardiomyopathy
mutations in the cardiac myosin binding protein-C
signs of flecanide toxicity
PR prolongation
QRS widening
decreased myocardial contractility
Torsades
Indications for ICD in HOCM
- LV wall thickness >30mm
- FHx sudden cardiac death
- Previous cardiac arrest/VF/non sustained VT
- Unexplained syncope
signs and symptoms of acute digoxin overdose
Cardiac: atrial tachycardia, AV block, slow AF, bidirectional ventricular tachycardia, PVCs
Hyperkalaemia (due to inhibition of Na+-K+ ATPase in cardiac and skeletal muscle)
CNS: visual disturbance with abberation of colour vision with predominance of yellow green; other more non specific things like confusion, weakness, delirium
Treatment of digoxin toxicity
Severe digitalis poisoning: digitalis Fab fragment
Other adjunct tx:
- activated charcoal (1-2 hr of presentation)
- atropine is bradycardia where digitalis Fab is unavailable/delayed
- replete K+ if low
- hyperK+ in itself does not require direct lowering therapy as digitalis Fab treatment will rapidly lower the potassium
Digoxin MOA
- Increases myocardium contractility
- Inhinits adenosine triphosphatase (and sodium potassium exchange activity) -> augmented calcium ion influx
- Sensitises cardiopulmmonary baroreceptors
- Reduces sympathetic outflow
what is the most characteristic feature of HoCM on ECHO?
septal to posterior wall thickness greater than 1.3:1.0
Lown-Ganong-Levine Syndrome
Short PR, normal QRS
What murmur usuall accompanies HoCM?
Mitral regurg
what cardiac exam findings are from atrial myxoma?
Loud first and third HS, mid diastolic murmur
What murmur is associated with aortic regurg?
diastolic decrescendo murmur
best heard on the left sternal border in primary aortic disease but best heard along the right heart border for aortic dissection
other sx of AR: wide pulse pressure, hypotension, heart failure
what antihypertensive should be avoided in aortic dissection?
hydralazine as it can increase sheer stress
What are acceptable normal variants in an young athlete? (5)
- Bradycardia
- Wenkebach
- Junctional rhythm
- First degree heart block
- RBBB
What is the most sensitive/specific lead to diagnose right ventricular infarct?
Right sided V4 lead
Posterior infarct
In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI.
Maze procedure (cardiology)
making multiple atrial incisions to reduce the effective size of the atria and preventing formation and maintenance of atrial fibrillation wavelets.
99% efficacy
CHADVAS3 annual stroke rate
4%
On warfarin, INR 10, no bleeding and not high risk of bleeding next step
withhold warfarin
INR 4.5-10 withhold warfarin is safe
Management of sick sinus syndrome on beta blocker
ICD
What does an audible S4 heart sound indicate?
a S4 heart sound occurs during active LV filling when atrial contraction forces blood into a noncompliant LV.
Any condition that creates a noncompiant LV will produce a S4
(overly compliant LV will produce a S3)
MOA aspirin
Irreversibly inhibition of COX1 and COX2 and thus suppressing the production of prostaglandins and thromboxanes
MOA bivalirudin
reversible direct thrombin inhibitor
MOA carvedilol
beta-1, beta-2 and alpha-1 antagonist
V1, V2 anatomical location correlation
septal
what anti-arrhythmics should be avoided in torsades de pointes
Class IA (quinidine, procainamide, disopyramide)
IC (flecainide)
III (sotalol, amiodarone)
(treatment is correct underlying cause, magesium, consider DC cardioversion if haemodynamically unstable)
MOA of ezetimibei
inhibits gut reabsorption of cholesterol from food and also from bile
effect of cholestyramine on lipid profile
decreases LDLs increases triglycerides
(MOA Bile acid sequestrants )
pathogenesis of heterozygous familial hypercholesterolaemia
LDL receptor defect
(clinical hx: early CVD in family, tendon xanthomas)
Oral to parentral morphine conversion
3:1
oral to parentral IV hydromorphone conversion
3:1
oral morphine to oral hydromorphone conversion
5:1
oral codeine to oral morphine conversion
10:1
oral tramadol to oral morphine conversion
10:1
what opioids are avoided in renal failure
1) Morphine 2) Codeine 3) Dihydrocodeine 4) Dextropropoxyphene
how much pain relief should be prescribed for breakthrough pain
1/6th of the regular 24 hour dose
treatment of metastatic bone pain
- paracetanol/NSAIDs
- Add opioid
- glucocorticoids, osteoclast inhibitors, radiation therapy
what opioid analgesic can cause seizures
pethidine - through the production of a metabolite called norpethidine which is a stimulant
what opioid has risk of QT prolongation
methadone
what is the most common side effect with opioids
constipation (90% but less with fentanyl)
nausea + vomiting (30-50% and short term side effect)
selexipag MOA
novel oral selective prostacyclin-receptor agonist used for pulmonary arteria lhypertension
(headache is one of the major SE)
how to test for respiratory muscle strengths?
mean inspiratory pressure (MIP), maximal sniff nasal pressure (SNIP), mean expiratory pressure (MEP)
Kartegener syndrome mutation
DNAI1 and DNAH5
Effect of withdrawal of inhaled steroids dueing optimized bronchodilator management
No different between exacerbations but increased FEV1 reduction
long term effects of inhaled ICS withdrawal has not been studied
how to calculate an age adjusted D-dimer cut off
age x10
what lung cancer has the best prognosis
carcinoid
Lofgren’s syndrome
hilar adenopathy, acute arthritis, and erythema nodosum
95% for sarcoidosis
good prognosis with high remission rates
how does sarcoidosis cause hypercalcaemia
granulomatous disease produces calcitriol which increase intestinal absorption of calcium
more people have calciuria than frank hypercalcaemia
what interstitial lung disease improves with smoking cessation
Respiratory bronchiolitis-associated interstitial lung disease
management of patients with infectious pleural effusions who failed antibiotics and chest drain
tPA and DNAse (used together)
adjunct chemo for resectable NSCLC
pair with cisplatin a third-generation cytotoxic agent such as pemetrexed for those with nonsquamous histology, or vinorelbine, gemcitabine, or docetaxel
what infectious cause of pneumonia can cause erythema multiforme
mycoplasma pneumoniae
what lung cancer is the most associated with cavitating lesions
squamous cell lung cancer
Ddx of low DLC and high KCO
lobectomy, khyphoscoliosis, diaphragmatic paralysis
very low DLCO with normal CXR diagnosis
PE
what lung cancer have serum neuron specific enolase
small cell lung cancer (75% have)
most common fungal infection in transplant patient
candida
what is the most common bacteria isolated in an acute exacerbation of COPD
H Influenzae
What is the threshold for long term O2 therapy in COPD
PO2 < 55mmHg or
PO2 <60mmHg w pulmonary HTN or HF
do males or females have a worse prognosis in CF
females have a worse prognosis
what CF mutation will response to tezacaftor and ivacaftor
Phel508del mutation
what antihypertensive is contraindicated in sarcoidosis
thiazides
what is the MOA of dupilumab
used for asthma
interleukin 4 and 13 blocker
what condition has a predominantly lymphocytic cellular appearance on the bronchoalveolar lavage?
sarcoidosis
sitagliptin MOA
DPP-4 inhibitor
effect of GLP-1 on pulse rate
increase in pulse rate
estimate of average glucose (mmol/L) from HbA1C
1.59 x HbA1C - 2.59
the biochemical tests needed for the workup of Cushing’s syndrome
urinary free cortisol
plasma cortitropin (ACTH)
plasma cortisol measurements
dexamethasone suppression has a low positive predictive value
what is the utility of monitoring thyroglobulin/anti-TGBa
papillary and follicular cancer
relationship between adiponectin and fat levels
increased fatty tissue = low adiponectin
Vit D synthesis pathway
best investigation for persistent thyroid cancer
US thyroid (high sensitivity)
+ thyroglobuln
what birth defects does carbimazole/methimazole cause
scalp defect - aplasia cutis
dopamine effects on TSH
decreases TSH
what does estrogen do to the thyroid binding globulin
increases thyroid binding globulin
does T3 or T4 cross the placenta?
T4 but not T3
T4 has an important role in fetal development
MOA of fibrates
Activates PPARs which modulate carbohydrate and fat metabolism
61M w recent NSTEMI lipid management
statin + ezetimibe (IMPROVE it)
