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MRCP Part 1 (All) Flashcards

1
Q

What is the most common type of mechanical prosthetic heart valve in use today?

A

Bi-leaflet tilting disc design

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2
Q

What is the target INR for patients with MECHANICAL aortic valves?

A

2.5 - 3.5

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3
Q

How are bioprosthetic heart valves obtained?

A

Usually from bovine or porcine tissue

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4
Q

Which type of prosthetic heart valves have a lower failure rate? Mechanical or bioprosthetic?

A

Mechanical heart valves tend to last longer and have lower failure rate.

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5
Q

What is the key advantage of using bioprosthetic valves over mechanical valves?

A

Mechanical valves require long-term anticoagulation with warfarin. Bioprosthetic valves do not.

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6
Q

What is the MoA of ticagrelor?

A

P2Y12 receptor inhibitor (prevents adenosine-mediated platelet aggregation)

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7
Q

What is the KEY side effect to be aware of with ticagrelor?

A

Dyspnoea.
Causes adenosine to accumulate, binds to receptors in the lungs stimulating sensory nerve fibres producing dyspnoea.

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8
Q

What is the mechanism of action of aspirin?

A

Non-selective COX-1/2 inhibitor. Prevents prostaglandin synthesis.

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9
Q

What is the mechanism of action of Fondaparinux?

A

Factor Xa inhibitor

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10
Q

Which commonly used medications are known to reduce the efficacy of P2Y12 inhibitors?

A

PPIs (specifically omeprazole and esomeprazole)

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11
Q

In which patient group is prasugrel contra-indicated?

A

History of stroke / TIA

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12
Q

In which patient group is ticagrelor contra-indicated?

A

High bleeding risk (previous intracranial haemorrhage, severe liver disease)

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13
Q

What ECG change is ‘classically’ associated with subarachnoid haemorrhage?

A

ST elevation (very rare)

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14
Q

What key cardiac imaging finding is associated with HOCM?

A

Asymmetric septal hypertrophy with systolic anterior motion (SAM) of anterior mitral valve leaflet

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15
Q

What cardiac imaging finding would you expect to see in a patient with left ventricular aneurysm?

A

Discrete dyskinetic area

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16
Q

Persistent ST elevation following a recent MI, with NO chest pain would indicate what underlying pathology?

A

Left ventricular aneurysm

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17
Q

What are the 3 key clinical features of Dressler’s syndrome?

A

Fever
Pleuritic chest pain
Pericardial effusion

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18
Q

What is the textbook presentation of post-MI papillary muscle rupture?

A

Acute hypotension
Pulmonary oedema
New murmur (acute MR)

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19
Q

What are the presenting features of post-MI ventricular free wall rupture?

A

Chest pain
Syncope
Distension of jugular neck veins
Acute heart failure (secondary to cardiac tamponade)

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20
Q

What ECG findings are associated with ventricular free wall rupture?

A

Sinus tachycardia
Persistent ST elevation
Q waves

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21
Q

Atrioventricular block is most likely to occur after MI affecting which territori?

A

Inferior (RCA)

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22
Q

What are the clinical features of cardiac tamponade?

A

Beck’s Triad:
Pulsus paradoxus (systolic drops on inhalation)
Muffled heart sounds
Raised JVP

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23
Q

What are the clinical features associated with ventricular septal defect (post-MI)?

A

Acute heart failure associated with pan-systolic murmur

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24
Q

What ECG changes are associated with Brugada syndrome?

A

Convex ST segment elevation in V1-V3 followed by negative T wave
RBBB
(Can elicit ECG changes with injection of flecainide)

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25
What is the pathophysiology underlying Brugada syndrome?
Abnormal myocardial sodium ion channel protein (SCN5A gene)
26
What is the only way to manage Brugada syndrome?
ICD implantation
27
What is the pathophysiology underlying ARVC?
Abnormal connexin gap-junction proteins
28
What is the difference in the JVP waveform of cardiac tamponade compared to constrictive pericarditis?
Cardiac tamponade - absent Y descent Constrictive pericarditis - X + Y present
29
What CXR features is classically associated with constrictive pericarditis?
Pericardial calcification
30
The ECG feature 'electrical alternans' is associated if which underlying pathology?
Cardiac tamponade (Or severe pericardial effusion)
31
How is the Well's score used to guide further investigation of possible pulmonary emobilsm?
Well's score >4 : urgent CTPA Well's score =/<4 : D-dimer
32
What are the ECG features associated with PE?
Sinus tachycardia S1Q3T3 RBBB Right axis deviation
33
What is the most common cause of infective endocarditis in IVDU patients?
Staphylococcus aureus
34
What is the most common cause of infective endocarditis in the first 2 months post-valvular surgery?
Staphylococcus epidermidis
35
What is the most common cause of infective endocarditis overall?
Staphylococcus aureus
36
Which valve is most commonly affected in infective endocarditis?
Mitral valve (except in IVDU where it is tricuspid valve)
37
What is Libman-Sacks endocarditis?
A type of non-infective endocarditis associated with SLE, APLS and malignancy
38
Which statins are most strongly associated with myopathy?
Simvastatin and Atorvastatin This is because they are lipophilic and are extensively metabolised by CYP3A4
39
Which commonly used antibiotics are contra-indicated for concurrent use with statins?
Macrolides (eg erythromycin, clarithromycin)
40
Are statins safe to use during pregnancy?
No
41
When using adenosine to terminate SVT, what dose regimen is recommened?
6mg -> 12mg -> 18mg
42
In which patient group is IV adenosine contra-indicated? What should be used instead for SVT termination in this group?
Asthmatics Use verapamil instead
43
What clinical signs might you find in a patient with complete heart block?
Variable intensity of S1 JVP cannon waves Wide pulse pressure
44
Paradoxical JVP (aka Kussmaul's sign) is associated with which underlying pathologies?
Caused by defective RV filling Constrictive pericarditis Pericardial effusion Severe right heart failure
45
A FIXED split S2 is most associated with what underlying pathology?
Atrial septal defect As blood shunts L to R, there is delayed closure of pumonary valve
46
What is the difference between Mobitz I and II?
Mobitz I: progressive prolongation of PR interval until dropped QRS. Mobitz II: constant PR interval but occasional p wave with no subsequent QRS
47
What are the ECG features associated with ostium secundum (ASD)?
RBBB Right axis deviation
48
What are the ECG features associated wit ostium primum (ASD)?
RBBB Left axis deviation
49
What is the most common cause of aortic stenosis?
> 65 years: calcification < 65 years: bicuspid aortic valve
50
What clinical features indicate that aortic stenosis treatment should be considered?
Symptomatic Valve gradient >40mmHg
51
What is Eisenmenger's syndrome?
Reversal of a left to right shunt (due to pulmonary hypertension)
52
Eisenmenger's syndrome is associated with which underlying pathologies?
VSD ASD PDA
53
BNP levels can be artificially lowered by which commonly used cardiac medications?
ACE inhibitors ARBs Diuretics
54
What are the physiological effects of BNP?
Vasodilation Suppress RAAS (to reduce Na/H2O reabsoprtion and reduce blood volume)
55
What are the clinical features of SEVERE aortic stenosis?
Soft S2 S4 Narrow pulse pressure Delayed ESM Slow rising pulse
56
What receptor mutation underlies catecholaminergic polymorphic VT?
Ryanodine receptor abnormality
57
How is catecholaminergic polymorphic VT diagnosed?
Resting ECG normal. Exercise elicits polymorphic VT
58
What is the first-line treatment for catecholaminergic polymorphic VT?
Beta blockers
59
What three types of cardiac medications are contra-indicated in HOCM?
ACE inhibitors Nitrates Nifedipine-type calcium agonists
60
What murmur is associated with HOCM?
Crescendo-decrescendo, mid-systolic. Best heart at lower left sternal border
61
What is HOCM?
Hypertrophy of interventricular septum. Causes LV outflow tract obstruction and functional aortic stenosis.
62
What is the inheritance pattern of HOCM?
Autosomal dominant
63
How is HOCM managed?
ABCDE A - amiodarone B - beta blocker C - cardioverter defibrillator D - dual chamber pacemaker E - endocarditis prophylaxis
64
How does HOCM affect JVP?
Prominent 'a' wave
65
What is the most important test in the diagnosis of pulmonary hypertension?
Cardiac catheterisation (to measure right heart pressures)
66
How is pulmonary hypertension diagnosed?
Resting pulmonary arterial pressure >20 mmHg
67
What clinical signs are associated with pulmonary hypertension?
Loud S2 Prominent 'a' wave of JVP RV heave
68
How is pulmonary hypertension which is vasodilator responsive treated?
CCB
69
How is pulmonary hypertension which is not vasodilator responsive treated?
Prostacyclin infusion Endothelin receptor antagonist Phosphodiesterase inhibitor (Sildenafil)
70
What are the pathological cause of S3?
Dilated cardiomyopathy Constrictive pericarditis (aka pericardial knock) Mitral regurgitation
71
What is Carvallo's sign?
Holosystolic murmur that increases with inspiration (seen in tricuspid regurgitation)
72
What valve pathology is associated with wide pulse pressure?
Aortic regurgitation
73
What is the JVP feature associated with tricuspid regurgiation?
Prominent 'v' waves
74
Which congenital heart defect is associated with tricuspid regurgitation?
Ebstein's anomaly
75
Following a recent MI, what are the indications that a patient required temporary pacing?
Any patient who develops Type 2 or complete heart block following ANTERIOR MI. After an INFERIOR MI, only patients who become haemodynamically unstable from complete heart block
76
What four conditions are associated with aortic coarctation?
Bicuspid aortic valve Turner's syndrome Neurofibromatosis Berry aneurysm "Buy Two New Berries"
77
What is the underlying mechanism of QT prolongation?
Blockage of potassium channels
78
What is normal QT interval length?
< 430ms in males < 450ms in females
79
Which commonly used antibiotic is known to prolong the QT interval?
Erythromycin
80
List the drugs / drug types known to prolong the QT interval
Amiodarone Sotalol Tricyclic antidepressants (eg amitriptyline) SSRIs (eg citalopram) Methadone Chloroquine (anti-parasitic) Terfenadine (anti-histamine) Erythromycin Haloperidol Ondansetron "A Silly Titter Suggests Mike Cant Take Ever Having Orgasms"
81
What are the two congenital causes of long QT syndrome and how can you differentiate between them?
Jervell-Lange-Nielsen syndrome (deafness) Romano-Ward syndrome (no deafness)
82
What electrolyte abnormalities can cause long QT syndrome?
Hypokalaemia Hypomagnesaemia Hypocalcaemia
83
In patients aged below 80, what is the target BP in known hypertensives?
Clinic BP <140/90 HBPM <135/85
84
In patients aged above 80, what is the target BP in known hypertensives?
Clinic BP <150/90 HBPM <145/85
85
What vaccinations are advised for patients with chronic heart failure?
Annual influenza vaccine One-off pneumococcal vaccine
86
What is first-line treatment for chronic heart failure?
ACE inhibitor + Beta-blocker
87
What is the second-line treatment for chronic heart failure?
Aldosterone antagonist
88
What is the RILE rule?
Regarding heart murmurs: Right - louder on inspiration Left - louder on expiration
89
What are the causes of an ejection systolic murmur, loudest on expiration?
Aortic stenosis HOCM
90
What are the causes of an ejection systolic murmur, loudest on inspiration?
Pulmonary stenosis ASD
91
What are the causes of a pansystolic (aka holosystolic) murmur?
Tricuspid regurgitation (louder on inspiration) Mitral regurgitation VSD
92
What are the causes of late systolic murmur?
Mitral valve prolapse Aortic coarctation
93
What are the causes of early diastolic murmur?
Aortic regurgitation Graham-Steel murmur (pulmonary regurgitation)
94
What are the causes of mid-late diastolic murmur?
Mitral stenosis Austin-Flint murmur (severe aortic regurgitation)
95
What murmur is associated with patent ductus arteriosus?
Continuous machine-like murmur
96
J-waves on an ECG are associated with what underlying pathology?
Hypothermia
97
What is the first-line investigation for pregnant women with signs of both PE and DVT?
Doppler - If doppler confirms DVT - commence VTE treatment
98
What are the causes of REGULAR cannon waves?
AVNRT VT
99
What are the causes of IRREGULAR cannon waves?
Complete heart block
100
What are the cardinal features of Takayasu's arteritis?
Occlusion of aorta (absent limb pulse)
101
What are the causes of fixed-split S2?
ASD
102
What are the causes of reversed split S2?
LBBB
103
What are the causes of wide split S2?
RBBB
104
What are the causes of loud S2?
Hypertension
105
What is the threshold for prescribing anti-hypertensive treatment in gestational hypertension?
Over 20 weeks pregnant with new-onset BP >140/90
106
What is the first-line treatment for pregnancy-induced hypertension?
Labetalol Nifedipine (if asthmatic)
107
How is major bleeding managed in patients on warfarin?
Stop warfarin Give IV Vit K + prothrombin complex concentrate
108
What is the mechanism of action of dipyridamole?
Phosphodiesterase inhibitor and inhibits cellular adenosine uptake
109
What is the recommended INR target in first episode of DVT?
2.5
110
What is the recommended INR target in recurrent episode of DVT whilst anticoagulated?
Increase from 2.5 to 3.5
111
How should acute AF with onset <48 hours ago be managed? Patient is haemodynamically stable.
Rate or rhythm control
112
How should acute AF with onset >48 hours ago be managed? Patient is haemodynamically stable
Rate control 3 weeks anticoagulation before any cardioversion
113
In HOCM, what is the underlying muscle tissue abnormality?
Defect affecting beta myosin heavy chains
114
What is used to treat PDA in newborns?
Indomethacin (prostaglandin E2 inhibitor)
115
How is aortic dissection managed?
Type A - labetalol + surgery Type B - labetalol
116
What is the characteristic CXR finding of transposition of the great arteries?
Egg on a string appearance
117
What is the most common cardiac abnormality associated with Down's syndrome?
AVSD
118
What is the most common cardiac abnormality associated with Turner's syndrome?
Coarctation of aorta
119
What are the abnormalities in tetralogy of fallot?
VSD Overriding aorta Pulmonary stenosis RV hypertrophy
120
Which drug should be avoided in VT as it may cause transformation into VF?
Verapamil
121
When should you anticoagulate patients with AF?
Man: if CHADVASC >1 Woman: if CHADVASC >2
122
What is the recommended antibiotic therapy for patients with staph aureus infective endocarditis in a patient with a prosthetic valve?
Flucloxacillin + rifampicin + low-dose gentamicin
123
What antibiotic is used for endocarditis caused by strep
Benzylpenicillin
124
What is the definitive treatment of choice for atrial flutter?
RFA of tricuspid valve isthmus
125
Which echocardiographic finding is the poorest prognostic indicator in HOCM?
Septal thickness > 3cm
126
What is the anticoagulation treatment strategy for stroke in patient with AF?
2 weeks aspirin followed by life-long anticoagulation with DOAC
127
What are the contraindications for the use of iloprost in the treatment of PH?
Stroke within the last 3 months
128
What are the indications to terminate ETT?
Severe chest pain >3 mm ST depression >2 mm ST elevation SBP > 230 mmHg SBP drop by > 20 mmHg
129
Which IE - causing pathogen is associated with colon cancer and immunocompromise?
Streptococcus gallolyticus
130
What is the blood pressure target for patients with aortic dissection?
Systolic 100-120
131
What is the typical duration of anticoagulation for provoked and unprovoked PE?
Provoked - 3 months Unprovoked - 6 months
132
What treatment option can be considered in patients who have recurrent PE despite adequate anticoagulation?
IVC filter
133
What is the initial blind therapy for infective endocarditis affecting prosthetic valve?
Vancomycin + gentamicin + rifampamicin
134
What is the initial blind therapy for infective endocarditis affecting native valve?
Amoxicillin (+/- gent)
135
What is the initial blind therapy for infective endocarditis affecting native valve in patient with penicillin allergy?
Vancomycin + gent
136
What is the main ECG abnormality associated with hypercalcaemia?
Shortening of QT interval
137
What is the most common cause of cyanotic congenital heart disease which becomes evident very shortly after birth?
TGA
138
What is the most common cause of acyanotic congenital heart disease?
VSD
139
What are the first two stages of HTN management for a patient who is over 55 years old?
1. C 2. C+A / C+D (thiazide-like diuretic eg indapamide)
140
In the context of infective endocarditis, lengthening of the PR interval is suggestive of what associated abnormality
Aortic root abscess
141
List CYP450 inhibitors
SICKFACES.COM Group Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (binge drinking) Chloramphenicol Erythromycin Sulphonamides Ciprofloxacin / Cranberry juice Omeprazole Metronidazole Grapefruit juice
142
List CYP450 inducers
CRAP GPS Carbamazepine Rifampicin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbital Sulphonylureas
143
What drugs are used for pharmacological cardioversion of AF?
Amiodarone Flecainide (no structural heart disease)
144
What is the long-term anti-thrombotic therapy for bioprosthetic valves?
Aspirin alone
145
Which two cardiac medications are contra-indicated in WPW syndrome?
Verapamil and Digoxin
146
Which radiotracer is used for cardiac PET imaging?
Fluorodeoxyglucose (FDG)
147
What is the cut-off age in AS for patients being offered bioprosthetic valve vs mechanical?
Bioprosthetic valve if over 65
148
Rheumatic fever typically causes what valvular pathology?
Mitral stenosis
149
What is the intervention of choice for severe mitral stenosis?
Percutaneous mitral comissurotomy
150
What does the 'a' wave of the JVP waveform represent?
Atrial contraction
151
What does the 'c' wave of the JVP waveform represent?
Tricuspid valve closure
152
What does the 'v' wave of the JVP waveform represent?
Passive atrial filling against closed tricuspid valve
153
What does the 'x' descent of the JVP waveform represent?
Fall in atrial pressure during ventricular systole
154
What does the 'y' descent of the JVP waveform represent?
Opening of tricuspid valve
155
How does the JVP waveform change in patients with cardiac tamponade?
No 'y' descent "Tamponade = TampaX"
156
What is the mechanism of action of dabigatran?
Direct thrombin inhibitor
157
What is the mechanism of action of heparin?
Activates anti-thrombin III
158
What is the mechanism of action of rivaroxaban?
Direct factor X inhibitor
159
Adenosine is classically enhanced and inhibited by which two drugs?
Enhanced by dipyridamole Inhibited by aminophyllines
160
Key side effect of nicorandil?
GI ulceration
161
What is the mechanism of action of thiazide diuretics?
Inhibit Na absorption from DCT
162
How is torsades de pointes managed?
IV Mg
163
How is GRACE score used to manage NSTEMI?
GRACE 3% - PCI (within 72h)
164
What are the main side effects of thiazides?
Hypokalemia Hyponatremia Hypercalcemia Gout Impotence Pancreatitis (rare)
165
How do you manage a warfarinised patient with INR > 8.0 but no bleeding?
Stop warfarin PO Vit K Repeat INR in 24h, restart when INR < 5.0
166
What are the conditions known to increase risk of aortic dissection?
MEN TSH BP Marfans syndrome Ehlers-Danloss syndrome Noonans syndrome Turners syndrome Syphilis Hypertension Bicuspid aortic valve Pregnancy
167
What is the most common site of atrial myxoma?
Left atrium
168
What is the difference in MoA between ticagrelor, clopidogrel and prasugrel?
Ticagrelor - reversible PDY12 inhibition Clopidogrel & prasugrel - irreversible PDY12 inhibition
169
What are the INR targets for mitral and aortic valves respectively?
Mitral: 2.5 - 3.5 Aortic: 2.0 - 3.0
170
How does obesity affect BNP?
Obesity may artificially reduce BNP levels
171
In the context of MI, when should nitrates be avoided?
Right ventricular MI
172
What is the reversal agent for Dabigatran?
Idarucizumab
173
What is the reversal agent for heparin?
Protamine
174
Which anti-anginal drug is associated with visual disturbance?
Ivabradine
175
What ECG change is associated with ARVC?
TWI V1-V3 with notching
176
What is the first-line treatment for symptomatic bradycardia?
IV atropine
177
What type of shock is used in CPR for pulseless VT / VF?
Unsynchronised 200J
178
Inherited long QT syndrome is caused by what underlying channel pathology?
Loss of function of potassium channels
179
Pulsus alternans is highly specific for what underlying cardiac abnormality?
LVSD
180
What are the causes of S4?
LVH AS HOCM
181
What is the mechanism of action of Hydralazine?
Increased cGMP causing smooth muscle relaxation
182
Maternal lithium use during pregnancy is linked to what congenital heart disease?
Ebstein's anomaly
183
Which of the cardiac enzymes is first to rise in MI?
Myoglobin (1-2 hours)
184
Which of the cardiac enzymes if most useful for identifying re-infarction?
CK-MB
185
What are the most common viral causes of myocarditis?
Coxsackie B, HIV
186
What are the most common bacterial causes of myocarditis?
Diptheria, clostridia
187
What are the most common protozoan causes of myocarditis?
Chagas' disease Toxoplasmosis
188
What is the ejection fraction cut-off for Entresto?
EF < 35% - can start entresto
189
How can you differentiate between VT and SVT with aberrancy?
Features suggesting VT: AV dissociation Fusion or Capture beats Positive QRS concordance in chest leads LAD History of IHD
190
What cardiac abnormality is associated with ankylosing spondylitis?
Aortic regurgitation
191
How does pregnancy affect blood pressure?
BP falls in first half then returns to baseline
192
What underlying condition is associated with bisferiens pulse?
Mixed aortic valve disease
193
What clinical feature of mitral stenosis indicates the valve leaflets still have good mobility?
Opening snap
194
Which clotting factors are affected by warfarin?
"1972" 10 9 7 2
195
What pathogen is most associated with infective endocarditis, shortly after dentistry?
Streptococcus mitis
196
How long must you stop driving after having an ICD fitted?
If fitted for ventricular arrhythmia - 6 months If fitted prophylactically - 1 month
197
What is the most common cause of restrictive cardiomyopathy?
Amyloidosis
198
What are the different causes of abnormal S2?
Loud: HTN Soft: AS Fixed split: ASD Reversed split: LBBB
199
What is the first-line treatment for multifocal atrial tachycardia (MAT)?
Rate-limiting CCB (eg Verapamil)
200
What are the clinical features of cholesterol embolisation?
Occurs after a procedure Livedo reticularis Eosinophilia Pupura Renal failure
201
Which part of the ECG waveform does the S4 heart sound coincide with?
P wave
202
What are the normal ECG variants?
Sinus bradycardia Wenkebach (Mobitz 1) Junctional rhythm 1st degree heart block
203
What are the ECG features of hypokalaemia?
U waves Prolonged PR interval Flattened T waves ST depression Long QT interval
204
Target INR in recurrent DVT?
3.5
205
How does tricuspid stenosis affect JVP?
Large 'a' waves
206
What conditions are associated with WPW syndrome?
"SHaME" ostium Secundum HOCM Hyperthyroidism MVP Ebstein's anomaly
207
What is the MoA of nicorandil?
Activates potassium channels
208
In AF, how long should anticoagulation be continued after cardioversion?
4 weeks
209
What is the difference in DAPT duration for DES vs bare metal stent?
DES - 12 months DAPT Bare metal - 1 month DAPT
210
In pre-eclampsia, why is it important to restrict fluids?
Reduce the risk of pulmonary oedema (these patients are at increased risk due to abnormal capillary permeability)
211
If a patient with AF has a TIA or a stroke, when is it safe to start DOAC?
TIA: can start DOAC immediately Ischaemic stroke: wait 14 days before starting DOAC (risk of haemorrhagic transformation)
212
What is the mechanism of Sacubitril (component of Entresto)
Neprilysin inhibitor (prevents breakdown of BNP)
213
Which part of the ECG waveform is DC cardioversion synchronised to?
R wave
214
What is Syndrome X?
Anginal chest pain Abnormal ETT Normal coronary angiography
215
Best option for rate control in HF + AF + asthma?
Digoxin
216
What is used for SVT prophylaxis in pregnancy?
Metoprolol
217
How can you differentiate between restenosis and stent thrombosis?
Stent thrombosis - within 30 days, nitrate resistant Restenosis - months later, nitrate responsive
218
What is the name of the granulomatous nodules found in rheumatic fever?
Aschoff bodies
219
What skin rash is associated with rheumatic fever?
Erythema marginatum
220
What are the rules around HGV license with HF?
Cannot drive HGV if EF < 40%
221
What is the management for uraemic pericarditis?
Haemodialysis
222
How soon after pacemaker insertion can you resume driving?
1 week
223
What are the guidelines for patients who require both anti-platelet for CVD and anticoagulant (AF, VTE, valvular heart disease)?
Stable CVD + VTE/AF - anticoagulant monotherapy Post ACS/PCI - 6 months triple therapy - 6 month dual therapy VTE on antiplatelet - calculate ORBIT / HASBLED, if low dual, if high anticoagulant monotherapy
224
What dose adrenaline is given in CPR?
1ml 1:10,000
225
What murmur is associated with atrial myxoma?
Mid-diastolic
226
ECG features associated with Hypothermia?
J waves Long QT 1st degree HB
227
What is the renoprotective mechanism of ACE inhibitors?
Efferent arteriole dilation (reduce glomerular pressure)
228
What must be monitored when giving IV Mg?
Resp rate Reflexes
229
First line treatment for pericarditis?
NSAID + Colchicine
230
Options for rate control in AF?
1st line: BB If asthmatic: rate-limiting CCB (eg diltiazem, verapamil) If HF: digoxin
231
What are the features of severe pre-eclampsia?
HTN + proteinuria Hyperreflexia Headache Visual disturbance / papilloedema RUQ / epigastric pain Low platelets
232
When is ivabradine considered for angina?
Established on CCB + BB with no benefit Can consider adding ivabradine if HR >70 and EF <35%
233
How should long-acting nitrates be given for angina?
Asymmetric dosing regimen to reduce nitrate-resistance
234
Centrally acting anti-hypertensives?
CMM Clonidine Moxonidine Methyldopa
235
What are the ECG features associated with digoxin?
Down-sloping ST depression Flattened T waves Short QT interval AV block, bradycardia
236
What is the first-line treatment for magnesium sulfate induced respiratory depression?
Calcium gluconate
237
The murmurs of which heart pathologies are made louder on valsalva?
HOCM MVP
238
Rule of thumb for artificially raised vs artificially reduced BNP?
Drugs (ACE, BB, Loop diur.) and obesity - artificially lower. Pretty much everything else, artificially raise BNP.
239
How long should anticoagulation be continued after electric cardioversion for AF? (Onset >48h ago)
At least 4 weeks
240
ECG features in ETT in syndrome X?
ST depression
241
What are the risk factors for statin-related myothapy?
thin old diabetic lady
242
Risk factors for asystole in bradycardic patient?
Mobitz 2 Recent asystole CHB with wide QRS Ventricular pauses > 3s All indications for transvenous pacing
243
First line treatment for vasospastic angina?
CCB (eg amlodipine)
244
Regarding LFTs, when should statin be stopped?
If ALT rises beyond 3x UL of normal
245
What is the mechanism of action of Amiloride?
Potassium-sparing diuretic Works by inhibiting Na channels in DCT
246
What are the clinical features of organophosphate poisoning?
'SLUD' Salivation Lacrimation Urination Defacation
247
ECG feature most likely to be seen following poisoning with insecticide (organophosphate)?
Sinus bradycardia
248
Which antibiotics are contra-indicated in G6PD?
QSN Quinolones Sulfonamides Nitrofurantoin
249
What are the adverse effects of quinolone antibiotics?
Lower seizure threshold Tendon rupture Long QT
250
Which antibiotics inhibit cell-wall peptidoglycan cross linking?
Penicillins Cephalosporins Carbapenems
251
Which antibiotics inhibit peptidoglycan synthesis?
Glycopeptides
252
Which antibiotics inhibit 50S ribosome sub-unit?
Macrolides Chloramphenicol Clindamycin
253
Which antibiotics inhibit 30S ribosome sub-unit?
Aminoglycosides Tetracyclines
254
Which antibiotics inhibit DNA synthesis?
Quinolones
255
Which antibiotics work by damaging DNA?
Metronidazole
256
Which antibiotics inhibit folic acid formation?
Sulphonamides Trimethoprim
257
Which antibiotics inhibit RNA synthesis?
Rifampicin
258
With regard to electrolytes, what are the precipitating factors for digoxin toxicity?
Hypokalemia Hypomagnesemia Hypernatremia Hypercalcemia
259
What drugs are known to precipitate digoxin toxicity?
Amiodarone Quinidine Verapamil Diltiazem Spironolactone Ciclosporin
260
What drugs are known to cause lithium toxicity?
DAMN Diuretics (esp. thiazides) ACE / ARB Metronidazole NSAIDs
261
What are the two phases of drug metabolism?
Phase 1: oxidation, reduction, hydrolysis (By CYP450, active products) Phase 2: conjugation (inert products for excretion)
262
Which drugs exhibit zero order kinetics?
HEAP Heparin Ethanol Aspirin Phenytoin
263
Which drugs are know to increase risk of optic neuritis?
Ethambutol Amiodarone Metronidazole
264
Which drugs are known to increase risk of retinopathy?
Chloroquine Quinine
265
Drugs known to cause urticaria?
Penicillins NSAIDs / Opioids
266
How is lithium toxicity managed?
<4 - IVF >4 or >2.5 with life-threatening features (seizure, coma) - Haemodialysis
267
What is acute porphyria?
Attacks of abdominal pain and neurological symptoms. Result of deficiency of enzymes used for haem group production
268
Which drugs are known to precipitate an attack of acute porphyria?
Alcohol COCP Benzodiazepines Sulphonamides
269
What is the most important prognostic factor in paracetamol overdose?
Arterial pH
270
What is the mechanism of action of buprenorphine?
Partial mu agonist Kappa antagonist
271
What is the mechanism of action of methadone?
Full mu agonist
272
What is the clinical utility of anion gap?
Helps determine cause of metabolic acidosis. Raised anion gap: - Suggests presence of unmeasured anions - Lactic acidosis, DKA, renal impairment - Toxicity: methanol, ethylene glycol, salicylates Normal anion gap: - Suggests loss of bicarbonate - Diarrhoea, certain kidney diseases
273
What are the causes of raised anion gap?
MUDPILES Methanol Uremia DKA Paracetamol, propylene glycol Infection, iron, isoniazid Lactic acidosis Ethylene glycol Salicylates
274
How is ethylene glycol (antifreeze) poisoning treated?
IV ethanol or Fomepizole
275
What is the treatment for oculogyric crisis?
Benztropine or Procyclidine
276
Doxazosin exerts its effects through binding to which receptors?
Alpha-1
277
Tamsulosin exerts its effects through binding to which receptors?
Alpha-1a
278
What is the mechanism of action of cyanide?
Inhibits cytochrome C oxidase
279
Classic features of cyanide poisoning
Red skin Bitter almond smell
280
Treatment for cyanide poisoning?
Hydroxycobalamin (B12)
281
How does NAC help in paracetamol overdose?
NAC is precursor to glutathione, so it replenishes store
282
What conditions are dopamine receptor agonists used to treat?
Parkinsons Cyclical breast disease Prolactinoma Acromegaly
283
Patients taking allopurinol who are at risk of skin reactions are tested for what gene?
HLA-B 5801
284
What is the mechanism of action of digoxin?
Inhibits Na/K ATPase pump Leads to increased cellular Ca Leads to stronger contraction, slower HR
285
Patients with non-hodgkin lymphoma, being treated with CHOP should also be given what medications?
Allopurinol - reduce risk of gout (rapid tumor lysis causes hyperuricaemia)
286
What are the antibodies formed against in HIT?
PF4 and heparin
287
What are the side effects of isoniazid?
Peripheral neuropathy
288
What are the side effects of Rifampicin?
Orange body fluids
289
What are the clinical features of Quinine toxicity (aka Cinchonism)?
Ototoxicity (tinnitus) Cardiotoxicity (wide QRS) Hypoglycaemia
290
What is the mechanism of action of ketamine?
NMDA receptor antagonist
291
What is the mechanism of action of propofol?
GABA receptor agonist
292
What drugs exhibit zero-order kinetics?
'WATT Power' Warfarin Aspirin / Alcohol Theophylline Tolbutamide Phenytoin
293
How does aspirin exert it's antiplatelet effect?
Irreversible Cox-1/Cox-2 inhibition, prevention formation of Thromboxane A2
294
Which drugs when co-prescribed with statin, are known to further increase risk of myalgia?
Fibrates (mainly) Nicotinic acid
295
How is cocaine-induced hypertension managed?
Benzodiazepine + sodium nitroprusside
296
Which commonly used medications are known to cause pulmonary fibrosis?
Amiodarone Bromocriptine Bleomycin MTX Nitrofurantoin
297
MoA infliximab
Anti-TNF
298
MoA rituximab
Anti-CD20
299
MoA Cetuximab
Anti-EGFR
300
What features would put someone in the high-risk category of skin reaction in response to allopurionl, and therefore warrant HLA-B5801 testing?
Chinese/Korean/Thai
301
Textbook side effect of verapamil?
Constipation
302
How is beta-blocker overdose managed?
Atropine + glucagon
303
How do you differentiate between the two types of amiodarone-induced thyrotoxicosis and how is each type treated?
AIT 1 - Goitre - Tx: Carbimazole AIT 2 - No goitre - Tx: Corticosteroids
304
What drugs can be cleared with haemodialysis?
BLAST Barbiturate Lithium Alcohol (inc methanol, ethylene glycol) Salicylates Theophyllines
305
What are the functions of Alpha-1 adrenoreceptors?
Vasoconstriction GI smooth muscle relaxation
306
What are the functions of Alpha-2 adrenoreceptors?
Inhibit insulin Platelet aggregation
307
What are the functions of Beta-1 adrenoreceptors?
Increase heart rate and force of contraction
308
What are the functions of beta-2 adrenoreceptors?
Bronchodilation Vasodilation
309
Drug causes of oculogyric crisis
Antipsychotics Metoclopramide
310
What are the functions of beta-3 adrenoreceptors?
Lipolysis
311
Key side effect of PO Mg replacement?
Diarrhoea
312
What is the pathophysiology behind heparin-induced thrombocytopenia?
Antibodies against platelet factor 4 (PF4) and heparin
313
MoA Ciclosporin
Reduce IL-2 release, inhibiting calcineurin
314
How can you differentiate ethylene glycol (antifreeze) poisoning from other types of poisoning?
Ethylene glycol poisoning has both a raised anion gap AND raised osmolar gap. Significantly raised lactate is also characteristic.
315
Which drugs are affected by acetylator status?
Isoniazid Procainamide Hydralazine Dapsone Sulfasalazine
316
What is the first-line management for tricyclic antidepressant overdose causing hypotension or arrhythmia?
IV bicarbonate
317
What is the treatment for adrenaline-induce ischaemia?
Local phentolamine
318
What are the side effects of ciclosporin?
'Everything increases' Fluid BP Potassium Gums Hair Glucose
319
What is the mechanism of action of sildenafil?
PDE type V inhibitor
320
Example of tyrosine kinase receptor
Insulin
321
Example of nuclear receptor
Levothyroxine
322
How do digoxin and sildenafil affect vision respectively?
Digoxin: yellow-green vision Sildenafil: blue vision
323
What is the mechanism of action of flecainide?
Na channel blocker
324
COCP increases risk of which cancers?
Breast Cervical
325
Which anti-epileptic drugs are known to cause agranulocytosis?
Carbamazepine Sodium valproate
326
What are the acetylator affected drugs?
'its all in D HIPS' Dapsone Hydralazine Isoniazid Procainamide Sulfasalazine
327
Which TB drug should have dose reduced if renal function impaired?
Ethambutol
328
Treatment for local anaesthetic toxicity?
Lipid emulsion
329
How does CO poisoning affect oxygen dissociation curve?
Shift down + left
330
Mechanism of action of ondansetron?
5-HT3 antagonist
331
ECG features of tricyclic antidepressant overdose
Wide QRS Long QT
332
Which diabetes drug is known to cause fluid retention?
Glitazones
333
How does mercury poisoning manifest?
Visual problems Hearing problems NAGMA (RTA)
334
How do aminoglycosides exert renal toxicity?
Tubular necrosis (muddy brown casts)
335
How is serotonin syndrome managed?
IVF Benzo In severe cases, serotonin antagonists (cyproheptadine or chlorpromazine)
336
Adverse findings in paracetamol OD
PT > 100s Cr > 300 G3 encephalopathy pH < 7.3
337

MRCP Part 1 (1 decks)

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