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FRACP Shuyu > FRACPRACTICE > Flashcards

FRACPRACTICE Flashcards

1
Q

Coronary artery anatomy

A
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2
Q

suspected culprit artery in STEMI ST elevation in V1-6, I, aVL and reciprocal depression in II, II, aVF

A

Left main disease

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3
Q

TIMI grade flow classification

A

TIMI 0 = no perfusion

TIMI 1 = penetration without perfusion

TIMI 2 = partial reperfusion

TIMI 3 = normal flow

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4
Q

Management of Left Main coronary artery disease with low-intermediate anatomic complexity

A

PCI 2 2nd gen DES in noninferior to CABG

Everolimus-eluting stents or bypass surgery for left main coronary artery disease NEJM Dec 2016

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5
Q

Differentials of acute kidney injury after cardiac embolisation

A

Contrast nephropathy vs renal atheroemboli

Contrast nephropathy usually resolves within 7 days where as cholesterol embolic is persistant

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6
Q

apixaban vs warfarin in non valvular AF

A

Greater reduction in rates of stroke or systemic embolism

Lower rate of major bleeding

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7
Q

recommended daily intake of salt to reduce cardiovascular events

A

3-6g/day

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8
Q

what murmur is present in severe MS

A

early diastolic murmur

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9
Q

mitral stenosis indications for surgery in an asymptomatic patientmod

A

mod to severe MS (<1.5cmsq)

and

pulmonary HTN (PASP >50mmHg at rest or 60mmHg with exercise)

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10
Q

what murmur does aortic sclerosis have

A

mid systolic ejection murmur

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11
Q

what is the most common mutation in hypertrophic cardiomyopathy

A

mutations in the cardiac myosin binding protein-C

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12
Q

signs of flecanide toxicity

A

PR prolongation

QRS widening

decreased myocardial contractility

Torsades

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13
Q

Indications for ICD in HOCM

A
  1. LV wall thickness >30mm
  2. FHx sudden cardiac death
  3. Previous cardiac arrest/VF/non sustained VT
  4. Unexplained syncope
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14
Q

signs and symptoms of acute digoxin overdose

A

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

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15
Q

Treatment of digoxin toxicity

A

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
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16
Q

Digoxin MOA

A
  1. Increases myocardium contractility
  2. Inhinits adenosine triphosphatase (and sodium potassium exchange activity) -> augmented calcium ion influx
  3. Sensitises cardiopulmmonary baroreceptors
  4. Reduces sympathetic outflow
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17
Q

what is the most characteristic feature of HoCM on ECHO?

A

septal to posterior wall thickness greater than 1.3:1.0

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18
Q

Lown-Ganong-Levine Syndrome

A

Short PR, normal QRS

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19
Q

What murmur usuall accompanies HoCM?

A

Mitral regurg

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20
Q

what cardiac exam findings are from atrial myxoma?

A

Loud first and third HS, mid diastolic murmur

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21
Q

What murmur is associated with aortic regurg?

A

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

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22
Q

what antihypertensive should be avoided in aortic dissection?

A

hydralazine as it can increase sheer stress

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23
Q

What are acceptable normal variants in an young athlete? (5)

A
  1. Bradycardia
  2. Wenkebach
  3. Junctional rhythm
  4. First degree heart block
  5. RBBB
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24
Q

What is the most sensitive/specific lead to diagnose right ventricular infarct?

A

Right sided V4 lead

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25
Q
A

Posterior infarct

In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI.

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26
Q

Maze procedure (cardiology)

A

making multiple atrial incisions to reduce the effective size of the atria and preventing formation and maintenance of atrial fibrillation wavelets.

99% efficacy

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27
Q

CHADVAS3 annual stroke rate

A

4%

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28
Q

On warfarin, INR 10, no bleeding and not high risk of bleeding next step

A

withhold warfarin

INR 4.5-10 withhold warfarin is safe

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29
Q

Management of sick sinus syndrome on beta blocker

A

ICD

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30
Q

What does an audible S4 heart sound indicate?

A

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)

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31
Q

MOA aspirin

A

Irreversibly inhibition of COX1 and COX2 and thus suppressing the production of prostaglandins and thromboxanes

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32
Q

MOA bivalirudin

A

reversible direct thrombin inhibitor

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33
Q

MOA carvedilol

A

beta-1, beta-2 and alpha-1 antagonist

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34
Q

V1, V2 anatomical location correlation

A

septal

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35
Q

what anti-arrhythmics should be avoided in torsades de pointes

A

Class IA (quinidine, procainamide, disopyramide)

IC (flecainide)

III (sotalol, amiodarone)

(treatment is correct underlying cause, magesium, consider DC cardioversion if haemodynamically unstable)

36
Q

MOA of ezetimibei

A

inhibits gut reabsorption of cholesterol from food and also from bile

37
Q

effect of cholestyramine on lipid profile

A

decreases LDLs increases triglycerides

(MOA Bile acid sequestrants )

38
Q

pathogenesis of heterozygous familial hypercholesterolaemia

A

LDL receptor defect

(clinical hx: early CVD in family, tendon xanthomas)

39
Q

Oral to parentral morphine conversion

A

3:1

40
Q

oral to parentral IV hydromorphone conversion

A

3:1

41
Q

oral morphine to oral hydromorphone conversion

A

5:1

42
Q

oral codeine to oral morphine conversion

A

10:1

43
Q

oral tramadol to oral morphine conversion

A

10:1

44
Q

what opioids are avoided in renal failure

A

1) Morphine 2) Codeine 3) Dihydrocodeine 4) Dextropropoxyphene

45
Q

how much pain relief should be prescribed for breakthrough pain

A

1/6th of the regular 24 hour dose

46
Q

treatment of metastatic bone pain

A
  1. paracetanol/NSAIDs
  2. Add opioid
  3. glucocorticoids, osteoclast inhibitors, radiation therapy
47
Q

what opioid analgesic can cause seizures

A

pethidine - through the production of a metabolite called norpethidine which is a stimulant

48
Q

what opioid has risk of QT prolongation

A

methadone

49
Q

what is the most common side effect with opioids

A

constipation (90% but less with fentanyl)

nausea + vomiting (30-50% and short term side effect)

50
Q

selexipag MOA

A

novel oral selective prostacyclin-receptor agonist used for pulmonary arteria lhypertension

(headache is one of the major SE)

51
Q

how to test for respiratory muscle strengths?

A

mean inspiratory pressure (MIP), maximal sniff nasal pressure (SNIP), mean expiratory pressure (MEP)

52
Q

Kartegener syndrome mutation

A

DNAI1 and DNAH5

53
Q

Effect of withdrawal of inhaled steroids dueing optimized bronchodilator management

A

No different between exacerbations but increased FEV1 reduction

long term effects of inhaled ICS withdrawal has not been studied

54
Q

how to calculate an age adjusted D-dimer cut off

A

age x10

55
Q

what lung cancer has the best prognosis

A

carcinoid

56
Q

Lofgren’s syndrome

A

hilar adenopathy, acute arthritis, and erythema nodosum

95% for sarcoidosis

good prognosis with high remission rates

57
Q

how does sarcoidosis cause hypercalcaemia

A

granulomatous disease produces calcitriol which increase intestinal absorption of calcium

more people have calciuria than frank hypercalcaemia

58
Q

what interstitial lung disease improves with smoking cessation

A

Respiratory bronchiolitis-associated interstitial lung disease

59
Q

management of patients with infectious pleural effusions who failed antibiotics and chest drain

A

tPA and DNAse (used together)

60
Q

adjunct chemo for resectable NSCLC

A

pair with cisplatin a third-generation cytotoxic agent such as pemetrexed for those with nonsquamous histology, or vinorelbine, gemcitabine, or docetaxel

61
Q

what infectious cause of pneumonia can cause erythema multiforme

A

mycoplasma pneumoniae

62
Q

what lung cancer is the most associated with cavitating lesions

A

squamous cell lung cancer

63
Q

Ddx of low DLC and high KCO

A

lobectomy, khyphoscoliosis, diaphragmatic paralysis

64
Q

very low DLCO with normal CXR diagnosis

A

PE

65
Q

what lung cancer have serum neuron specific enolase

A

small cell lung cancer (75% have)

66
Q

most common fungal infection in transplant patient

A

candida

67
Q

what is the most common bacteria isolated in an acute exacerbation of COPD

A

H Influenzae

68
Q

What is the threshold for long term O2 therapy in COPD

A

PO2 < 55mmHg or

PO2 <60mmHg w pulmonary HTN or HF

69
Q

do males or females have a worse prognosis in CF

A

females have a worse prognosis

70
Q

what CF mutation will response to tezacaftor and ivacaftor

A

Phel508del mutation

71
Q

what antihypertensive is contraindicated in sarcoidosis

A

thiazides

72
Q

what is the MOA of dupilumab

A

used for asthma

interleukin 4 and 13 blocker

73
Q

what condition has a predominantly lymphocytic cellular appearance on the bronchoalveolar lavage?

A

sarcoidosis

74
Q

sitagliptin MOA

A

DPP-4 inhibitor

75
Q

effect of GLP-1 on pulse rate

A

increase in pulse rate

76
Q

estimate of average glucose (mmol/L) from HbA1C

A

1.59 x HbA1C - 2.59

77
Q

the biochemical tests needed for the workup of Cushing’s syndrome

A

urinary free cortisol

plasma cortitropin (ACTH)

plasma cortisol measurements

dexamethasone suppression has a low positive predictive value

78
Q

what is the utility of monitoring thyroglobulin/anti-TGBa

A

papillary and follicular cancer

79
Q

relationship between adiponectin and fat levels

A

increased fatty tissue = low adiponectin

80
Q

Vit D synthesis pathway

A
81
Q

best investigation for persistent thyroid cancer

A

US thyroid (high sensitivity)

+ thyroglobuln

82
Q

what birth defects does carbimazole/methimazole cause

A

scalp defect - aplasia cutis

83
Q

dopamine effects on TSH

A

decreases TSH

84
Q

what does estrogen do to the thyroid binding globulin

A

increases thyroid binding globulin

85
Q

does T3 or T4 cross the placenta?

A

T4 but not T3

T4 has an important role in fetal development

86
Q

MOA of fibrates

A

Activates PPARs which modulate carbohydrate and fat metabolism

87
Q

61M w recent NSTEMI lipid management

A

statin + ezetimibe (IMPROVE it)

FRACP Shuyu (65 decks)

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