Which of the following is NOT a drug used for metabolic modulation in heart failure?
Correct answer: 4. Sacubitril-valsartan
Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Trimetazidine is a 3-ketoacyl coenzyme A thiolase inhibitor, while ranolazine inhibits the late sodium current. Perhexiline inhibits carnitine palmitoyl transferase. Latter three are metabolic modulators while sacubitril-valsartan is a hemodynamic modulator in heart failure [Ashrafian H, Neubauer S. Metabolic modulation in heart failure: high time for a definitive clinical trial. Heart. 2011 Feb;97(4):267-8].
Fleischner’s sign is:
Prominent central pulmonary artery in acute massive pulmonary embolism
Partial anomalous pulmonary venous drainage to inferior vena cava
Supracardiac shadow in total anomalous pulmonary venous drainage
None of the above
Correct answer: 1. Prominent central pulmonary artery in acute massive pulmonary embolism
[Cooksley T, Husein B, Iqbal J, Bright J. Fleischner’s sign in a massive pulmonary embolism. J Emerg Med. 2012 Jun;42(6):698-9]. Partial anomalous pulmonary venous drainage to inferior vena cava seen on chest X-ray is scimitar sign. Supracardiac shadow in total anomalous pulmonary venous drainage is known as figure of 8 sign, cottage loaf sign and snow man appearance.
Biomarker useful in the evaluation of aortic dissection:
Caused by chronic inflammation in neointimal proliferation within a coronary stent
Disruption of neoatheroma can cause thrombotic occlusion
Lower prevalence in drug eluting stents
Occurs earlier in drug eluting stents
Correct answer: 3. Lower prevalence in drug eluting stents
Neoatherosclerosis was noted in 31% of drug eluting stent lesions and 16% of bare metal stent lesions in the CVPath stent registry of 406 neoatherosclerotic lesions from 299 autopsies [Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011 Mar 15;57(11):1314-22]. Mean implant duration was 1.5 years in drug eluting stents and 6.1 years in bare metal stents in that study.
Adverse health effects of partially hydrogenated vegetable oils are thought to be due to:
Ductus venosus has a higher oxygen saturation than left atrium
Eustachian valve directs inferior vena caval blood to the right ventricle
Only 12% of the blood ejected from the right ventricle reaches the lungs
45% of the combined ventricular output is delivered to the placenta
Correct answer: 2. Eustachian valve directs inferior vena caval blood to the right ventricle
Eustachian valve directs inferior vena caval blood across the patent foramen ovale into the left atrium. Saturation of blood in ductus venosus is 80-90% while that in the left atrium is only 65% saturated in the fetus. This is because the lungs are not functional in the fetus. Blood in the ductus venosus is that from the umbilical vein returning after oxygenation from the placenta [John PJ. The fetal circulation. Contin Educ Anaesth Crit Care Pain. 2005;5(4):107:112].
In cyanotic congenital heart disease, sum of the diameters of pulmonary arteries divided by the diameter of the aorta is known as:
Important J wave syndromes are Early Repolarization Syndrome and Brugada syndrome. J wave is mediated by:
Transient outward potassium current Ito
Slow component of delayed rectifier potassium current IKs
Fast component of delayed rectifier potassium current IKr
Inwardly rectifying potassium current IK1
Correct answer: 1. Transient outward potassium current Ito
J wave is mediated by the transient outward potassium current Ito. It has been suggested that arrhythmias associated early repolarization, Brugada syndrome, hypothermia and those occurring in the acute phase of ST elevation myocardial infarction are linked to abnormalities in Ito mediated J wave [Antzelevitch C, Yan GX. J wave syndromes. Heart Rhythm. 2010 Apr;7(4):549-58].