MCQs Revision Flashcards by Joe Hamer

What is the target INR in a patient with a mechanical heart valve?

3.5

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What should we do to a patient with minor bleeding and an INR of 6.0?

Stop the warfarin and restart when the INR is less than 5.

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What should we do to a patient with their first DVT and an INR of 2.5?

Nothing, continue warfarin with no change.

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What should we do to a patient with AF, no bleeding and an INR of 8.0?

Stop the warfarin and restart when the INR is less than 5.

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What should we do to a patient who has had a recurrent DVT while being treated with warfarin with an INR of 2.0?

Increase the warfarin dose, the target INR is 3.0 for them.

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The efficacy of unfractionated heparin 20units/kg/hour intravenous infusion is routinely measured via what

APTT

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Have beta blockers been shown to improve mortality, but not reduce hospitalisations in people with CHF?

NOOO

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What antidepressants should be first line in patients with known suicidality?

SSRIS

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TCAs can cause what side effects?

Heart block
Urinary retention
Constipation

TCAs have anticholinergic side effects

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SSRIs are most commonly associated with what electrolyte disturbances?

Hyonatraemia

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Why can SSRIs and TCAs increase the fall risk in the elderly?

Postural hypotension.

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What treatment is essential in all patients with established cardiovascular disease?

Antiplatelet

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Patients diagnosed with acute coronary syndrome should be offered higher intensity statins with what target level of non-LDL reduction?

No target.

Offer even if they have TC below 4, which is the NICE target.

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When should BBs be started in a patient who is clinically stable post STEMI?

As soon as POSSIBLE.
They reduce myocardial oxygen demand, we can even give it to them via IV as it has been shown that the earlier they are started, the better outcomes.

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What carries a higher risk of mortality at 6 months post event, STEMI or NSTEMI?

NSTEMI,

STEMI higher in short term but NSTEMI higher in longer term.

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Which is the better option to limit the extension of coronary thrombosis in ACS?
LMWH or UFH?

LMWH are better.

Use Fondaparinux.

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Why are UFH usually administered via a continuous IV infusion?

URH are rapid acting with a half-life of approximately 60 minutes.

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Why is warfarin used in patients with AF (no other conditions)?

For thrombus (clot) prevention.

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Patients diagnosed with TIA should be prescribed __________ 75mg om for primary prevention of ischemic stroke.

Clopidogrel

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Atelpase is recommended for the treatment of what?

Stroke if within 4.5 hours.

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Would we recommend anticoagulants as an alternative to antiplatelet drugs in acute ischaemic stroke patients who are in sinus rhythm?

NOOOOOO
NOOOO
NO

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What common classes of drugs can cause falls in the elderly? [5]

Antidepressants such as amitriptyline.

Antipsychotics such as prochloperazine - frequently inappropriately prescribed for dizziness due to postural instability and the most frequently implicated drug causing drug induced parkinsons disease.

Anticoagulants e.g. warfarin No - but risk of bleeding if patient did fall.

Dopaminergic drugs: co-beneldopa. Yes, sudden excessive daytime sleepiness can occur with levodopa and other dopamine receptor agonists. Careful dose titration is particularly important in iniatiation of treatment because of additional risk of inducing confusion: reduce dose as aging occurs.

Antihypertensives: yes.

Thyroxine (T4) is activated into _____________ (__) predominantly in the ______.

Thyroxine (T4) is activated to tri-iodothyronine (T3) predominantly in the liver

Which is more potent, T3 or T4?

T3 is about four times more potent.

How is the Thyroid gland regulated?

Thyroid is regulated by the anterior pituitary which is in turn regulated by the hypothalamus. Hypothal: TRH TRH causes anterio pituitary to relase TSH which cause thyroid hormone release from thryroid.

What are the clinical features of hyperthyroidism? [6]

``` Agitation Tachycardia Warm skin Sweating Heat intolerance Weight loss ``` ``` HYPO: Lethargy Bradycardia Dry, pale skin Hypothermia Weight gain ```

How should patients with a diagnosis of COPD be managed regarding ICSs?

Not monotherapy, but in combinated with a LABA.

What is the first line preventer therapy for asthma and COPD? Why might they differ?

1st line preventer asthma: ICS 1st line preventer CODP: bronchodilators. ICS in COPD: increased pneumonia risk.

Inflammation in asthma is mainly caused by

Eosinophils

Inlfammation in COPD is mainly due to

Neutrophil involvment

Is airway smooth muscle usually contricted in COPD causing obstruction?

No, normally due to mucous hyper-secretion and mucosal infiltration by inflammatory cells.

What is Omalizumab?

Monoclonal antibody that binds to IgE. Recommended by NICE for patients who have uncontrolled severe persistent allergic asthma with proven IgE-mediated sensitivity to allergens.

What are 5 risk factors for ischaemic stroke? Not including previous vascular events.

1. Age 2. AF 3. Diabetes 4. Hypertension 5. Smoking

What is type 2 respiratory failure?

Low PO2 | High PCO2

When should anti-embolic stockings be used for prophylaxis in surgical patients?

In the absence of CIs, NEVER in stroke patients. Can use intermittent pneumatic compression devices or simply early mobilisation may be the safest options available.

What should people diagnosed with a suspected PE be initially treated with?

Therapeutic doses of heparin or fondaprinux or LMWH

After the firs episode of limb DVT or PE, treatment with a vitamin K antagonist should be initiated and the INR maintained at what for how long?

INR of 2.5 for at least 3-6 months.

What is the CHA2DS2VASc score for someone diagnosed with AF with the following history: Age: 65 BP: 140/80 Weight: 70kg Past history of TIA, CHF, Asthma and Diabetes which is now well controlled.

``` CHF = 1 Hypertension: >140/90 = 1 Age: >75 = 2, 65-74 = 1. Diabetes: 1 Stroke/TIA/Thromboembolism: 2 Vascular disease: 1 Sex female: 1 ``` Patient has 1 from CHF, 1 from being 65, 1 from diabetes, 2 from a past history of TIA making 5.

What are 5 signs or symptoms of dementia?

1. Short term memory loss 2. Agitation 3. Neglecting self-care and hygiene 4. Hallucinations 5. Difficulty finding names and other words.

What is asthma?

A long-term condition that typically presents with cough, breathlessness and wheezing.

What is theophylline?

A bronchial smooth muscle relaxant used in the treatment of asthma.

If the IV aminophylline dose is 35mg/hour, then a suitable preparation to use would be 250mg aminophylline in 250ml of what?

0.9% NaCl or 5% glucose.

What impact would a viral infection have on plasma theophylline concentration?

Increase it. | Theophylline is metabolised in the liver

What are two factors affecting theophylline clearance?

Whether the patient smokes or has congestive heart failure.

The neuroendocrine response to surgery results in

Sodium and water retention, with a reduction in maintenance requirements.

Inadequate fluid replacement leads to reduced what?

Cardiac output and oxygen delivery to injured tissues.

Negative fluid balance after surgery is associed with reduced mortality, why?

Negative balance referes to good hydration, good hydration is associated with better outcomes.

We can estimate the fluid defecit based on heart rate, blood pressure and central venous pressure.

No these are not exclusive measurements.

Fluid restriction and diuresis may decrease oedema in patients with poor ventricular function but may increase the incidence of

AKIs

Why should hypothyroidism be ruled out or confirmed before iniatiating a statin?

Hypothyoidism can cause high levels of cholesterol - so make sure this is treated

Renal function of below what value contraindicates the use of metformin? Why?

eGFR of less than 30, due to risk of lactic acidosis. VERY rare, but 50%!! mortality if it does occur.

We reduce the apixaban dose when the weight is less than what?

60kg

What is HAS-BLED?

Bleeding risk in AF. ``` H = hypertension >160 Abronal renal function = 1, abnormal liver function = 1 S = stroke in past B = active bleeding L = labile INR (<60% in TTRO=) E = elderly >65 D = drugs or alcohol (1 point each) ```