Cardiovascular 1/2

Question 1

Answer 1

Answer: Staphylococcus epidermidis

Question 2

Answer 2

Answer: colorectal carcinoma.

Question 3

Answer 3

Answer: TSH

Question 4

Answer 4

Answer: Stroke volume

Question 5

Answer 5

Answer: Hyperplastic arteriosclerosis

Question 6

Answer 6

Answer: AV node

Question 7

Answer 7

Answer: Blocking calcium channels

Question 8

Answer 8

Answer: Inhibits lipolysis in adipose tissue

Question 9

Answer 9

Answer: Wolff-Parkinson-White Syndrome

Question 10

Answer 10

Answer: Third-degree AV block

Question 11

Answer 11

Answer: They block fast sodium channels

Question 12

Answer 12

Answer: Supraventricular tachycardia

Question 13

Answer 13

Answer: Coxsackievirus

Question 14

Answer 14

Answer: Second-degree AV block (Type II)

Question 15

Answer 15

Answer: Option D

Question 16

Answer 16

Answer: Hypokalaemia

Note the presence of a U wave, with the associated flattened T wave. The merging of the T wave and the U wave is often misinterpreted as a prolonged or wide QRS; don’t fall for this common student trap! Also note the depressed ST segment, especially marked in Lead II. Causes of hypokalaemia include anorexia, chronic alcohol use, gepphagia, alkalosis, and thiazide/loop diuretics (among others).

Question 17

Answer 17

Answer: Atrial Flutter

Question 18

Answer 18

Answer: II, III, and aVF

Question 19

Answer 19

Answer: Irregularly irregular

Question 20

Answer 20

Answer: Left heart failure

Question 21

Answer 21

Answer: Prolongation of the QT interval

Torsade de pointes is an uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line (see the image below). Torsade de pointes, often referred to as torsade, is associated with a prolonged QT interval, which may be congenital or acquired. Torsade usually terminates spontaneously but frequently recurs and may degenerate into ventricular fibrillation.

Question 22

Answer 22

Answer: small but sustained inward current of calcium ions

Question 23

Answer 23

Answer: Bundle branch block

Question 24

Answer 24

Answer: First-degree AV block

Question 25

Answer 25

**Answer: Sinus bradycardia**

Question 26

Answer 26

**Answer: Blocks voltage-gated sodium channels**

Question 27

Answer 27

**Answer: Persistent elevation \>1mm in 2 limb leads and elevation \> 2mm in 2 contiguous chest leads.**

Question 28

Answer 28

**Answer: 1st degree AV block**

Question 29

Answer 29

**Answer: Amiodarone** ## Footnote For a patient with atrial fibrillation who has a normal left ventricular function and no coronary disease, flecainide is preferred. For a patient with atrial fibrillation who has left ventricular dysfunction (left ventricular ejection fraction less than 40%), or coronary disease, amiodarone is preferred as there is no negative inotropic effect.

Question 30

Answer 30

**Answer: Ventricular depolarisation, ventricular repolarisation, and atrial repolarisation**

Question 31

Answer 31

**Answer: Sinus tachycardia**

Question 32

Answer 32

**Answer: Patent ductus arteriosus**

Question 33

Answer 33

Question 34

Answer 34

**Answer: Atrial fibrillation**

Question 35

Answer 35

**Answer: Digoxin**

Question 36

Answer 36

**Answer: Atrial septal defect**

Question 37

Answer 37

**Answer: Mitral valve regurgitation**

Question 38

Answer 38

**Answer: Option A**

Question 39

Answer 39

**Answer: Ventricular tachycardia and ventricular fibrillation**

Question 40

Answer 40

**Answer: K⁺ efflux**

Question 41

Answer 41

**Answer: Bifascicular block**

Question 42

Answer 42

**Answer: Left bundle branch block (LBBB)**

Question 43

Answer 43

**Answer: Atrial flutter with variable block** ## Footnote The degree of AV block varies from 2:1 to 4:1 The diagnosis of flutter with variable block could be inferred here from the R-R intervals alone (e.g. if flutter waves were indistinct) — note how the R-R intervals during periods of 4:1 block are approximately double the R-R intervals during 2:1 block.

Question 44

Answer 44

**Answer: 2nd degree AV block, Mobitz type I (Wenckebach)**

Question 45

Answer 45

**Answer: S. viridans**

Question 46

Answer 46

**Answer: S. aureus**

Question 47

Answer 47

**Answer: Subendocardial infarct**

Question 48

Answer 48

**Answer: Atrial flutter with 4:1 block only** Atrial flutter with 4:1 block, * There is 4:1 block, resulting in a ventricular rate of 75 bpm.

Question 49

Answer 49

**Answer: Lignocaine** ## Footnote Lidocaine is a class IB anti-arrythmic drug that inhibits sodium channels, shortens repolarisation and decreases the QT interval.

Question 50

Answer 50

**Answer: Normal sinus rhythm**

Question 51

Answer 51

**Answer: Mitral stenosis**

Question 52

Answer 52

**Answer: Atrial fibrillation**

Question 53

Answer 53

**Answer: Supraventricular tachycardia** ## Footnote This arrhythmia has such a fast rate that the P waves may not be seen. Clinical Tip: SVT may be related to caffeine intake, nicotine, stress, or anxiety in healthy adults.

Question 54

Answer 54

**Answer: Class III, Phase 3**

Question 55

Answer 55

**Answer: I, aVL, V5-6**

Question 56

Answer 56

Question 57

Answer 57

**Answer: His-Purkinje system**

Question 58

Answer 58

**Answer: Atrial fibrillation**

Question 59

Answer 59

**Answer: Atrial fibrillation**

Question 60

Answer 60

**Answer: Inhibits HMG-CoA reductase** ## Footnote Statins inhibit the hepatic synthesis of cholesterol. They do this by inhibiting HMG CoA reductase, the enzyme responsible for the rate-limiting step in cholesterol synthesis.

Question 61

Answer 61

Question 62

Answer 62

**Answer: Atrial flutter** There is a 2:1 AV block resulting in a ventricular rate of 150 bpm

Question 63

Answer 63

Question 64

Answer 64

**Answer: atria and ventricles**

Question 65

Answer 65

**Answer: Activates PPARs and thus lipoprotein lipase**

Question 66

Answer 66

**Answer: First-degree AV block** ## Footnote PR Interval: Prolonged (\>0.20 sec)

Question 67

Answer 67

**Answer: Coagulative necrosis**

Question 68

Answer 68

**Answer: Phase 2**

Question 69

Answer 69

Question 70

Answer 70

**Answer: class IV; phase 2**

Question 71

Answer 71

**Answer: Second-degree AV block (Type I)**

Question 72

Answer 72

**Answer: CK-MB**

Question 73

Answer 73

**Answer: Fibrosis**

Question 74

Answer 74

**Answer: Systolic dysfunction**

Question 75

Answer 75

**Answer: Diastolic dysfunction**

Question 76

Answer 76

**Answer: Verapamil** ## Footnote Blocks L-type, voltage-gated, Ca²⁺ channels which are important in the action potential plateau and in particular affects action potential propagation in the SA and AV nodes. Shows use-dependence so is more active in tachyarrythmias. Decreases automaticity and slows AV conduction.

Question 77

Answer 77

**Answer: Subendocardial ischaemia** ## Footnote Widespread subendocardial ischaemia due to LMCA occlusion

Question 78

Answer 78

**Answer: Left bundle branch block (LBBB)**

Question 79

Answer 79

**Answer: Right coronary artery**

Question 80

Answer 80

Question 81

Answer 81

**Answer: Old inferior MI**

Question 82

Answer 82

**Answer: Second-degree AV block (Type I)**

Question 83

Answer 83

**Answer: Coagulative necrosis with interstitial infiltration of neutrophils**

Question 84

Answer 84

**Answer: Old inferior MI with first-degree heart block**

Question 85

Answer 85

**Answer: Phase 3**

Question 86

Answer 86

**Answer: class III; phase 3**

Question 87

Answer 87

**Answer: First-degree AV block** ## Footnote PR Interval: Prolonged (\>0.20 sec)

Question 88

Answer 88

**Answer: class II; phase 4**

Question 89

Answer 89

**Answer: Spironolactone**

Question 90

Answer 90

**Answer: 3rd heart sound**

Question 91

Answer 91

**Answer: Atrial systole**

Question 92

Answer 92

**Answer: Macrophage influx**

Question 93

Answer 93

Question 94

Answer 94

Question 95

Answer 95

**Answer: None of the above**

Question 96

Answer 96

Question 97

Answer 97

Question 98

Answer 98

**Answer: ECG changes in leads I, aVL, V5, and V6**

Question 99

Answer 99

**Answer: Mitral regurgitation**

Question 100

Answer 100

**Answer: Sinus tachycardia**

Question 101

Answer 101

**Answer: Rapid filling**

Question 102

Answer 102

**Answer: ST segment elevation with Q wave formation in the precordial leads (V1-6) ± the high lateral leads (I and aVL).**

Question 103

Answer 103

**Answer: 1. Funny Na⁺ channels are open, 2. Transient Ca²⁺ (T-type) channels open, 3. Long-lasting Ca²⁺ (L-type) channels open, 4. Opening of K⁺ channels and closing of Ca²⁺ (L-type) channels.** ## Footnote Note that the funny channels are called thus as they let sodium into the cell, but also let potassium out of the cell. This mixed permeability allows for a slow, but automatic, depolarisation of the cardiac pacemaker cell.

Question 104

Answer 104

**Answer: Rhythm 1 and 4** ## Footnote Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT)) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). The main difference in the treatment of these two groups is the need for attempted defibrillation in patients with VF/pVT.

Question 105

Answer 105

Question 106

Answer 106

**Answer: Excess afterload**

Question 107

Answer 107

**Answer: LAD**

Question 108

Answer 108

**Answer: Aortic regurgitation**

Question 109

Answer 109

**Answer: Mitral regurgitation**

Question 110

Answer 110

**Answer: Severe aortic regurgitation is shorter in duration compared with mild aortic regurgitation.**

Question 111

Answer 111

**Answer: Ischaemia**

Question 112

Answer 112

**Answer: Splinter haemorrhages, Osler's nodes, Janeway lesions**

Question 113

Answer 113

**Answer: Tricuspid regurgitation**

Question 114

Answer 114

**Answer: Aortic stenosis**

Question 115

Answer 115

**Answer: Diastasis**

Question 116

Answer 116

**Answer: Third-degree AV block**

Question 117

Answer 117

**Answer: Clopidogrel**

Question 118

Answer 118

**Answer: chronic obstructive airway disease**

Question 119

Answer 119

**Answer: Coagulative necrosis**

Question 120

Answer 120

**Answer: Posterior infarct**

Question 121

Answer 121

Question 122

Answer 122

**Answer: Option B**

Question 123

Answer 123

**Answer: Pericarditis** ## Footnote Patients presenting with acute pericarditis demonstrate diffuse ST segment elevation in all leads except aVR and V1 (see above).

Question 124

Answer 124

**Answer: Tunica adventitia**