Pregunta 1
Pregunta
ACE inhibitors work by:
Respuesta
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Blocking the sympathetic effect of noradrenaline on blood vessels.
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Preventing the conversion of angiotensin I to angiotensin II.
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Blocking angiotensin II receptors
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Rapid degradation of angiotensin II.
Pregunta 2
Pregunta
A 53-year-old man complains of erection difficulty. He recently had some transient angina and was given some medications.
His symptoms started soon after the consultation. Which drug is likely to be causing his symptoms?
Respuesta
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Nifedipine
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Ramipril
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Labetalol
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Spironolactone
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Bendroflumethiazide
Pregunta 3
Pregunta
An older man arrives at ED with swollen lips. Not anaphylactic shock. His regular prescriptions are nifedipine, simvastatin, warfarin, lansoprazole and Ramipril. Which is causing this angioedema?
Pregunta 4
Pregunta
A 65-year-old man presents with central crushing angina for the first time. He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted.
What are the most likely changes to have occurred on ECG during admission?
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ST elevation in leads V1–4
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ST elevation in leads V1–6
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ST elevation in leads I, aVL, V5, V6
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ST elevation in leads II, III and aVF
Pregunta 5
Pregunta
The ECG shows an antero-lateral STEMI. Which coronary artery is most likely to have been occluded?
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Left Circumflex artery
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Left anterior descending artery
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Right main coronary artery.
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Right posterior descending artery
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Left main coronary artery
Pregunta 6
Pregunta
Which of the following will be observed in a patient that has mitral regurgitation
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Diastolic murmur, 5th intercostal space, left midclavicular line
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Diastolic murmur, 4th intercostal space, left midclavicular line
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Diastolic murmur, apex of the heart
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Systolic murmur, apex of the heart.
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Systolic murmur, 2nd intercostal space, right sternal border.
Pregunta 7
Pregunta
A murmur is heard just to the left of the sternum in the 2nd intercostal space during systole, what kind of murmur do you suspect?
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Aortic Stenosis
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Aortic regurgitation
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Pulmonary stenosis
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Pulmonary regurgitation
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mitral stenosis
Pregunta 8
Pregunta
A 25-year-old woman with known mitral valve prolapse develops a low-grade fever, malaise and night sweats after a couple of weeks of a major dental procedure. Examination reveals tender vasculitic lesions on the finger pulps and microscopic haematuria. Which is the most appropriate initial step in management?
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Give antibiotics
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Chest X-ray.
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Give NSAIDs
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Sputum sample
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Get blood cultures
Pregunta 9
Pregunta
A middle aged female has central retrosternal angina. The pain is worse lying flat and when she takes a deep breath. It is relieved by sitting up, and leaning forward. An ECG is performed as below. What is the most likely diagnosis?
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The ECG
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Acute STEMI
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Endocarditis
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NSTEMI
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Pulmonary embolism
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Pericarditis
Pregunta 10
Pregunta
A 54 years old man presents to the emergency department with chest pain which does not go away with GTN spray. He sits down and the pain persists and he begins to feel an ache in his arm, and feels extremely sweaty. An ECG is performed.
Pregunta 11
Pregunta
At ED, an elderly woman with Type 2 diabetes mellitus, Hypertension and BMI of 33.6 was admitted to your department via ambulance after experiencing an episode of central crushing chest pain that radiated to her left arm. It came on while she was watching TV and has not been relieved despite rest and GTN spray.
Vital signs: RR: 35; BP:105/62; SpO2:90%; Temperature: 37.0oC
Based on the ECG, what is the most appropriate initial management for this?
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The ECG
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IV morphine, GTN, aspirin
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Percutaneous coronary intervention (PCI)
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Arrange a CTPA
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Coronary artery bypass graft (CABG)
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IV morphine, 15L high flow O2, GTN, aspirin
Pregunta 12
Pregunta
A [blank_start]heart[blank_end] [blank_start]murmur[blank_end] is an extra or unusual sound heard during a heartbeat.
Pregunta 13
Pregunta
Murmurs can either be [blank_start]systolic[blank_end] (S1) or [blank_start]diastolic[blank_end] (S2).
Valvular murmurs: 2 main reasons
[blank_start]Stenosis[blank_end]: Valve is too narrow for the blood to pass through.
[blank_start]Regurgitation[blank_end] (Incompetence): Valve does fully shut so there is backflow
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Stenosis
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Regurgitation
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systolic
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diastolic
Pregunta 14
Pregunta
Fill in the Table.
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diastole
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diastole
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diastole
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systole
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systole
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systole
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systole
Pregunta 15
Pregunta
Non-valvular murmurs also exist.
Pregunta 16
Pregunta
Label the different valves.
Respuesta
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Aortic
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Pulmonary
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tricuspid
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mitral
Pregunta 17
Pregunta
[blank_start]Calcification[blank_end] of the aortic valves (due to naturally [blank_start]aging[blank_end]) mainly causes [blank_start]aortic[blank_end] [blank_start]stenosis[blank_end].
The most common cause of [blank_start]mitral[blank_end] [blank_start]stenosis[blank_end] is rheumatic heart disease due to the bacteria of group [blank_start]A[blank_end] Streptococcus.
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Calcification
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aortic
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stenosis
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aging
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stenosis
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mitral
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A
Pregunta 18
Pregunta
What is the correct ordering of the heart layers?
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fibrous pericardium, parietal serous pericardium, pericardial cavity, pericardial fluid, visceral serous pericardium, epicardial fat, myocardium, endocardium
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fibrous pericardium, epicardial fat, visceral serous pericardium, pericardial cavity, pericardial fluid, parietal serous pericardium, myocardium, endocardium
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fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid, epicardial fat, emyocardium, endocardium
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epicardial fat, fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid,endocardium, myocardium
Pregunta 19
Pregunta
What is true regarding endocarditits?
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Inflammation of the endocardium
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common cause: Staph Aureus
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common cause: Strep viridans
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New murmur
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Fever
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Splinter Hemorrhage
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Janeway lesions and Osler nodes
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Diagnosis: Echocardiograms and electrocardiograms
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Diagnosis: Blood culture and echocardiograms
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Manage: antibiotics and NSAIDS
Pregunta 20
Pregunta
What is true regarding pericarditits?
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inflammation of pericardium
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Common cause: Coxsackie B virus
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Chest pain which feels better when sitting forward
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Auscultation: pericardial friction rub audible
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Widespread saddle shaped ST-elevation on ECG = diagnosis
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1-2 weeks course of NSAIDs
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complication: cardiac tamponade
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Auscultation: crackles
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Chest pain better from lying down
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dispersed ST-elevation on ECG leads = diagnosis
Pregunta 21
Pregunta
What are these clinical symptoms?
Respuesta
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osler nodes
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splinter hemorrhages
Pregunta 22
Pregunta
[blank_start]Unstable[blank_end] angina is due to problems in blood supply. It comes about at [blank_start]rest[blank_end] or [blank_start]minimal[blank_end] [blank_start]exertion[blank_end], like walking.
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Unstable
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rest
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minimal
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exertion
Pregunta 23
Pregunta
Stable angina is due to [blank_start]myocardial[blank_end] [blank_start]ischemia[blank_end]. It is a [blank_start]central[blank_end] chest tightness or heaviness, which is relieved by [blank_start]rest[blank_end]. It may radiate to one or both [blank_start]arms[blank_end], the neck, jaw or [blank_start]teeth[blank_end].
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myocardial
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ischemia
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central
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rest
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arms
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teeth
Pregunta 24
Pregunta
GRAB to treat stable angina:
[blank_start]Glycerol[blank_end] [blank_start]Trinitrate[blank_end] spray for symptomatic relief
[blank_start]Risk[blank_end] Factor modification like stop smoking and reduced cholesterol
[blank_start]Aspirin[blank_end] reduces mortality by 34% (fact)
[blank_start]Beta[blank_end] [blank_start]blockers[blank_end] to reduce symptoms unless contraindicated
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Glycerol
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Trinitrate
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Risk
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Aspirin
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blockers
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Beta
Pregunta 25
Pregunta
Unstable angina, NSTEMI and STEMI are a group of conditions that occur due to decreased blood flow in the [blank_start]coronary[blank_end] arteries, leading to heart muscle [blank_start]ischemia[blank_end]. This is known as [blank_start]acute[blank_end] [blank_start]coronary[blank_end] [blank_start]syndrome[blank_end].
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coronary
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ischemia
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acute
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coronary
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syndrome
Pregunta 26
Pregunta
How does ACS (acute coronary syndrome) present?
Pregunta 27
Pregunta
Which is NSTEMI and which is STEMI?
Pregunta 28
Pregunta
Acute management of ACS: MONA
IV [blank_start]Morphine[blank_end]
Oxygen (if Sats < 94%)
[blank_start]Nitrates[blank_end]
[blank_start]Aspirin[blank_end]
Respuesta
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Morphine
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Nitrates
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Aspirin
Pregunta 29
Pregunta
Secondary management of ACS is [blank_start]revascularization[blank_end]:
STEMI
[blank_start]reperfusion[blank_end] therapy--> [blank_start]primary[blank_end] PCI ([blank_start]percutaneous[blank_end] [blank_start]coronary[blank_end] intervention)
If this cannot be achieved within [blank_start]2[blank_end] hours of diagnosis or PCI is not available, [blank_start]thrombolytic[blank_end] therapy such as streptokinase is to be done.
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revascularization
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reperfusion
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percutaneous
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coronary
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primary
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2
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thrombolytic
Pregunta 30
Pregunta
Secondary prevention of myocardial infarction: AAABC
[blank_start]Aspirin[blank_end] (antiplatelet)
[blank_start]ACE[blank_end] inhibitor
[blank_start]Atorvastatin[blank_end]
Beta-blocker
[blank_start]Clopridogrel[blank_end] (antiplatelet)
Respuesta
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Clopridogrel
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Atorvastatin
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ACE
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Aspirin
Pregunta 31
Pregunta
What morphology is shown below? (2 words)
Pregunta 32
Pregunta
Which leads are lateral?
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AVF
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AVL
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AVR
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II
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I
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III
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V1 and V2
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V3 and V4
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V5
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V6
Pregunta 33
Pregunta
Which leads are anterior?
Respuesta
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AVF
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AVR
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AVL
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lead I
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lead II
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lead III
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V1 AND V2
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V3 AND V4
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V5
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V6
Pregunta 34
Pregunta
Which of these leads is not inferior?
Pregunta 35
Pregunta
Fill in what each abbreviation in the table stands for.
Pregunta 36
Pregunta
Which of these could result from severe or untreated hypertension?
Respuesta
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stroke
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MI
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blindness
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renal failure
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pulmonary disease
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aneurysms
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ovarian cancer
Pregunta 37
Pregunta
What are side effects of ACE inhibitors?
Respuesta
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Dry cough
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Angioedema
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Hypotension
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Hyperkalemia
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Hypercalcemia
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Hypoglycemia
Pregunta 38
Pregunta
Hydrochlorothiazide and Metolazone are examples of thiazide-like diuretics.
Pregunta 39
Pregunta
[blank_start]Angiotenisin[blank_end] [blank_start]Receptor[blank_end] [blank_start]Blockers[blank_end] end in “sartan” e.g. [blank_start]Losartan[blank_end]
They're given if side effects of ACE inhibitors are experienced.
Respuesta
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Angiotenisin
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Receptor
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Blockers
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Losartan
Pregunta 40
Pregunta
Beta blockers reduce the [blank_start]cardiac[blank_end] [blank_start]output[blank_end] by reducing heart rate and force of contraction (hence the [blank_start]stroke[blank_end] [blank_start]volume[blank_end]).
They end in -lol like [blank_start]metoprolol[blank_end].
Respuesta
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metoprolol
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cardiac
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output
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stroke
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volume
Pregunta 41
Pregunta
What is true regarding beta blocker side effects?
Pregunta 42
Pregunta
If the patien is younger than 8o years, treatment for stage [blank_start]1[blank_end] hypertension is given if:
[blank_start]End[blank_end] [blank_start]organ[blank_end] damage
[blank_start]Cardiovascular[blank_end] disease (or significant risk of developing it)
Renal disease
[blank_start]Diabetes[blank_end]
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1
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organ
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End
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Cardiovascular
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Diabetes
Pregunta 43
Pregunta
NSTE-ACS refers to Unstable Angina and NSTEMI.
Pregunta 44
Pregunta
Cardiac markers: [blank_start]Troponin[blank_end] I/T
They are the most specific/sensitive tests for [blank_start]MI[blank_end].
Respuesta
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Troponin
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myocardial infarction
Pregunta 45
Pregunta
Fill in the diagram. (ABREVIATIONS WHERE APPROPRIATE)
Respuesta
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STEMI
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NSTEACS
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NSTEMI
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unstable angina
Pregunta 46
Pregunta
WHICH are side-effects of calcium channel blockers?
Respuesta
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peripheral edema
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flushing
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headache
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severe hypotension
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angina
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hidrosis
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miosis
Pregunta 47
Pregunta
CCBs used to treat hypertension end in –dipine such as [blank_start]nifedipine[blank_end]