MaM Paper 11

Question 1

MOA of Fondaparinux

Answer 1

Actor Xa inhibitor

Question 2

MOA of aspirin

Answer 2

Irreversible COX inhibitor

Question 3

MOA of Clopidogrel and Ticagrelor

Answer 3

P2Y12 receptor (APD receptor) antagonists

Question 4

MOA of alteplase

Answer 4

Tissue plasminogen activator that converts plasminogen to plasmin

Question 5

5 medications and dosages post-discharge for ACS

Answer 5

Aspirin 75 mg OD, Ticagrelor 90 mg BD, Bisoprolol 1.25 mg OD, Ramipril 1.25 mg OD, Atorvastatin 80 mg OD

They should receive dual antiplatelet therapy (either aspirin 75 mg OD and clopidogrel 75 mg OD oraspirin 75 mg OD and ticagrelor 90 mg BD).

Dual antiplatelet therapy should continue for 1 year, after which patients can continue on aspirin alone for life.

Patients should also be started on:
- a beta-blocker (e.g. bisoprolol),
- an ACE inhibitor (e.g. ramipril)
- a statin (e.g. atorvastatin).

The beta-blocker and ACE inhibitor are usually started at the lowest dose and should be escalated to the maximum dose that the patient can tolerate. The statin should be started at a high dose (e.g. atorvastatin 80 mgOD).

Question 6

Ejection fraction

Answer 6

Stroke Volume/End Diastolic Volume

Question 7

When do you use BiPap vs CPAP

Answer 7

CPAP: pulmonary oedema and Type 1 respiratory failure
It is usually started at a relatively low pressure of 5-10 cm H2O.

BiPap: Type 2 respiratory failure
The IPAP is always higher than the EPAP.

Question 8

What tendons are contained in the carpal tunnel?

Answer 8

The carpal tunnel is formed by two layers -a deep carpal arch and a superficial flexor retinaculum.

The carpal tunnel contains 9 tendons surrounded by their synovial sheaths, and the mediannerve. The tendons it contains include:
- the flexor pollicis longus,
- flexor digitorum profundus (4 tendons),
- flexor digitorum superficialis (4 tendons).

Question 9

Spinal stenosis investigations

Answer 9

MRI spine

Question 10

Back and leg pain that is worse when standing or walking downhill

Answer 10

Spinal Stenosis

Question 11

Treatment for mild and severe Alzheimer’s

Answer 11

Donepezil is an acetylcholinesterase inhibitor that is used in the treatment of Alzheimer’s dementia.

Memantine is an NMDA receptor antagonist that is used to treat severe Alzheimer’s disease.

Question 12

Bronchiectasis Investigation

Answer 12

High resolution CT