Pass Med Q's

Question 1

where do Thiazide Diuretics act

Answer 1

block NaCl symporter on proximal part of distal convoluted tubule

Question 2

where do Loop Diuretics act

Answer 2

ascending loop of Henley

Question 3

side effects of thiazide diuretics

Answer 3

postural hypotension 
hyponatraemia , hypokalaemia 
hypercalcaemia 
hyperglycaemia
gout

Question 4

side effects of loop diuretics

Answer 4

postural hypotension
hyponatramia, hypokalaemia, hypocalcaemia
ototoxicity

Question 5

if a patient develops an AKI after being started on an ACEi, what condition do they most likely have?

Answer 5

bilateral renal artery stenosis

Question 6

what is Buergers disease

Answer 6

also known as thromboangitis obliterates – small + median vessel vasculitis strongly associated with smoking

Question 7

symptoms of Buergers disease

Answer 7

intermittent claudication
ischaemic ulcers
superficial thrombophlebitis
reynauds

Question 8

What is Boerhaaves syndrome

Answer 8

rupture of the oesophagus following repeated episodes of vomiting (typically in alcoholics)
triad: vomiting, thoracic pain, subcutaneous emphysema

Question 9

presentation of mitral valve prolapse

Answer 9

chest pain / palpitations
mid systolic click / late systolic murmur
- associated with Polycystic kidney disease, marinas, turners, WPW

Question 10

What is De Mussets sign

Answer 10

head bobs in time with pulse

- seen in aortic regurgitation

Question 11

mechanism of dipyridimole

Answer 11

phosphodiesterase inhibitor

Question 12

how long should warfarin be stopped prior to planned surgery

Answer 12

5 days

- when INR < 1.5 surgery can go ahead

Question 13

how should a patient on warfarin requiring emergency surgery be managed

Answer 13

if surgery can wait 6-8 hours give 5mg Vit K IV

if surgery cannot wait give 25-50 units/Kg prothrombin complex

Question 14

what drugs are inducers of p450 system ?

how does this affect INR ?

Answer 14

inducers will decrease INR (increased risk of clot)

• phenytoin / carbamazepine
• rifampicin
• st johns wart
• phenobarbitone

Question 15

what drugs are inhibitors of p450 system ?

how does this affect INR ?

Answer 15

inhibitors will increase INR (increased risk of bleeding)

• ciprofloxacin
• clarithromycin
• amiodarone
• fluoxetine / sertraline
• fluconazole

Question 16

management of a major bleed on warfarin

Answer 16

stop warfarin
give IV Vit K 5mg + prothrombin complex
- if prothrombin complex not available give FFP

Question 17

management of high INR (>8) + minor bleed on warfarin

Answer 17

stop warfarin
give IV vit K 1-3 mg
repeat dose of Vit K if INR still high after 24 hours
restart warfarin when INR < 5

Question 18

what heart murmur is associated with pulmonary HTN

Answer 18

tricuspid regurgitation
- pan systolic murmur
+ loud S2

Question 19

BP target for Type 1 diabetic

• no albuminuria
• albuminuria present

Answer 19

no albuminuria = 135 / 85

albuminuria = 130 / 80

Question 20

BP target for Type 2 diabetic

Answer 20

140 / 90

Question 21

what drugs can be given in orthostatic hypotension

Answer 21

fludrocortisone or midodrine

Question 22

electrical alternans on ECG

Answer 22

cardiac tamponade

Question 23

symptoms of subclavian steal syndrome

Answer 23

dizziness

vertigo during use of an arm

Question 24

when is atorvastatin given to Type 1 diabetics

Answer 24

20mg atorvastatin given if

• > 40
• diabetes > 10 years
• nephropathy

Question 25

side effects of ivabradine

Answer 25

visual effects - luminous phenomena
headache
bradycardia

Question 26

why should statins be withheld while patient completes course of macrolide antibiotics (e.g. clarithromycin)

Answer 26

increased risk rhabdomyolysis - increased CK

Question 27

mechanism of action aspirin

Answer 27

inhibits thromboxane A2 production

Question 28

mechanism of action clopidogrel

Answer 28

inhibits ADP

Question 29

mechanism of action enoxaparin

Answer 29

activates antithrombin III

Question 30

what cardiac drugs are contraindicated in pregnancy

Answer 30

ACEi

statins

Question 31

what is Holter monitoring used for

Answer 31

to capture episodic arrhythmias

Question 32

how do thrombolytic agents work e.g. alteplase

Answer 32

activating plasminogen to form plasmin

Question 33

what is an absolute contraindication to thrombolysis

Answer 33

intracranial neoplasm

Question 34

presentation of skin necrosis due to warfarin

Answer 34

occurs when drug is first started
INR will still be in therapeutic range
large red patch that progresses to petechiae – purpura – ecchymoses

Question 35

what can cause widespread T wave inversion on an ECG

Answer 35

head injury / brain herniation

- hypertensive, bradycardic, tachypnoeic patient

Question 36

inferior MI + new aortic regurgitation murmur suggests what

Answer 36

proximal aortic dissection

Question 37

side effects of beta blockers

Answer 37

cold peripheries
impaired hypoglycaemic awareness
erectile dysfunction 
bradycardia / heart block
hypotension