Week 206 - Myocardial Infarction

Question 1

Which leads look at the Inferior Part of the Heart?

Answer 1

II, III and aVf

Question 2

Which leads look at the Anterior Part of the Heart?

Answer 2

V2, V3, V4

Question 3

Which leads look at the Lateral Part of the Heart?

Answer 3

I, aVL, V5, V6

Question 4

Which leads look at the Posterior Part of the Heart?

Answer 4

V1, aVR

Question 5

What artery is involved if an ANTERIOR infarct is seen?

Answer 5

LAD (Left anterior descending artery)

Question 6

What artery is involved if an INFERIOR infarct is seen?

Answer 6

RCA (Right Coronary Artery)

Question 7

What artery is involved if an LATERAL infarct is seen?

Answer 7

Circumflex

Question 8

What artery is involved if an POSTERIOR infarct is seen?

Answer 8

Circumflex

Question 9

What ECG changes would indicate hypokalaemia?

Answer 9

U waves (V2, V3) T wave depression

Question 10

What is a J wave indicative of?

Answer 10

Hypothermia

Question 11

What do you get in Digoxin toxicity?

Answer 11

Bradycardia Prolonged PR interval Frequent premature beats Nausea, Vomiting, Abdo pain, headache, delirium

Question 12

What do chylomicrons do?

Answer 12

Carry fats from intestine and release in liver

Question 13

What LDL is present in HEALTHY individuals?

Answer 13

Few LARGE LDL

Question 14

What LDL is present in Atheromatous disease?

Answer 14

Lots SMALL dense LDL

Question 15

What is the ideal cholesterol level in the blood?

Answer 15

<5 mmol/L

Question 16

What is the action of Aspirin?

Answer 16

Anti-platelet action via irreversible acetylation of COX-1

Question 17

What enzyme converts arachadonic acid into eicosanoids? (e.g. prostaglandins, TXA2)

Answer 17

COX-1 and -2

Question 18

What is the function of Thromboxane A2?

Answer 18

Released by platelets Vasoconstrictor + Platelet agonist

Question 19

What clinical features would you expect to find in a patient with FH?

Answer 19

Tendon Xanthomata (virtually diagnostic of FH) - mobile nodules on tendons Corneal arcus

Question 20

What can raised troponin indicate?

Answer 20

?MI ?PE ?Septicaemia ?Renal Failure ?Myocarditis ?Trauma

Question 21

What ECG changes would suggest MI?

Answer 21

ST elevation New LBBB Pathological Q waves

Question 22

What does Fondaparinux do?

Answer 22

Anti-coagulant Inhibits Factor Xa

Question 23

What do Clopidogrel, prasugrel and ticagrelor do?

Answer 23

Anti-platelet Act on ADP receptor –> prevents activation of platelets Clopidogrel activated by P450 (loss of function allele possible)

Question 24

What is the most common mode of death <12 hrs after MI?

Answer 24

Arrhythmic Death

Question 25

What can be used to assess the risk of MI?

Answer 25

GRACE TIMI

Question 26

What action do steroids have?

Answer 26

Inhibit PL-A2 -\> inhibit inflammatory mediators

Question 27

What function do Abciximab, Eptifibatide, Tirofiban have?

Answer 27

Glycoprotein IIB-IIIA Antagonists

Question 28

In large pericardial effusions, what structures can become compressed?

Answer 28

Oesophagus-\> Dysphagia Recurrent Laryngeal-\> Hoarseness Diaphragmatic stimulation (hiccups)

Question 29

What are the signs of Cardiac Tamponade?

Answer 29

Tachycardia Hypotension Rales/Oedema/Ascites Muffled heart sounds Pulsus Paradoxus

Question 30

What does the **a wave** signify?

Answer 30

Atrial Contration if **AF no** a waves

Question 31

What does the **c wave** signify?

Answer 31

Tricuspid closure

Question 32

What happens during the **x descent**?

Answer 32

Atria relax

Question 33

What happens during the **v wave**?

Answer 33

RA filling

Question 34

What happens during the **y descent**?

Answer 34

Tricuspid valve opens

Question 35

What dermatomes innervate the pericardium (sensory)?

Answer 35

C3-C5