Heart

Question 1

What is Eisenmenger syndrome?

Answer 1

When a left to right heart defect results in pulmonary HTN which then results in a right to left shunt. i.e. begins as an acyanotic cardiac defect but then becomes cyanotic.

Question 2

What medication can be used in a patent ductus arteriosis?

Answer 2

Indomethacin (an NSAID that inhibits prostaglandin E2)

Question 3

Investigations for suspected envenomation?

Answer 3

• INR more than 1.2 (due to venom induced consumption coagulopathy → VICC)
• prolonged APTT
• low or undetectable fibrinogen concentration (due to VICC)
• raised quantitative D-dimer (at least 10 times the assay cut-off, or more than 2.5 mg/L) → sensitive (due to VICC)
• serum creatine kinase concentration more than 1000 units/L (due to myotoxicity → muscle damage). Patients will have myalgia and/or muscle tenderness.
• raised serum creatinine concentration (due to kidney injury)
• evidence of thrombotic microangiopathy—thrombocytopenia, red cell fragments or spherocytes on blood film, raised serum lactate dehydrogenase concentration
• raised white cell count
• UEC -> kidney function