Revise MBBS

Paper I — 2022 February (2019 Scheme) — Q1

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Paper I
2022 February (2019 Scheme) · 100 marks · 180 min

Question

Mr. X, a 65-year-old retired teacher had severe retrosternal chest pain radiating to shoulder and left arm. He was profusely sweating and his ECG revealed ST elevation and a diagnosis of Acute Myocardial infarction was made. (

  • (a) Write the management of Acute Myocardial infarction with rationale for use of each drug. ( 8 mark(s)
  • (b) Enumerate the drugs to be prescribed at the time of discharge. ( 4 mark(s)
  • (c) Mention the lifestyle modifications to be advised to this patient. 3 mark(s)
Q115 marksEssays

Answer

a) Management with rationale

  • Morphine — analgesia, reduces sympathetic drive and preload
  • Oxygen (if SpO2 < 90%) — corrects hypoxia
  • Sublingual/IV Nitrates — venodilation, reduces preload, relieves ischemic pain (avoid if hypotensive)
  • Aspirin (chewed, 325 mg) — immediate irreversible COX-1 antiplatelet effect
  • P2Y12 inhibitor (Clopidogrel/Ticagrelor) — dual antiplatelet therapy
  • Heparin (UFH/LMWH) — prevents thrombus propagation
  • Beta-blocker — reduces myocardial O2 demand and arrhythmia risk (if not contraindicated)
  • High-intensity statin — plaque stabilization
  • ACE inhibitor — limits remodeling, especially with LV dysfunction
  • Reperfusion: Primary PCI (preferred) or thrombolysis if PCI unavailable within 90–120 min

b) Discharge drugs

  • Aspirin + Clopidogrel (dual antiplatelet therapy)
  • Beta-blocker
  • Statin
  • ACE inhibitor

c) Lifestyle modifications

  • Smoking cessation
  • Low-salt, low-fat diet
  • Regular physical activity / cardiac rehabilitation
  • Weight management
  • Glycemic and blood-pressure control
  1. 1Antianginal Drugs

Other Years Asked

  1. 1(2022 July (Supplementary) (2019 Scheme)Essay · 9 marks
  2. 2(2024 June (Supplementary) (2019 Scheme)Short Essay · 8 marks
  3. 3Classify drugs used in the treatment of angina pectoris. What is the effect of nitrates on coronary blood flow. Describe the mechanism of action and any two adverse effects of nitrates. (2+1+2+1 =6)2017 February (2010 Scheme)Essay · 6 marks
  4. 4A 60-year-old man gives history of chest pain, sweating and breathlessness on brisk walking, which is relieved on taking rest.  Classify drugs that are useful in this condition.  Explain the mechanism and pharmacological actions, uses and adverse effects of nitrates (2+4)2022 May (Supplementary) (2010 Scheme)Essay · 6 marks
  5. 5Nicorandil2013 April (2010 Scheme)Short Note · 3 marks
  6. 6Calcium channel blockers2019 July (Supplementary) (2010 Scheme)Short Note · 3 marks
  7. 7Amlodipine2023 March (Supplementary) (2010 Scheme)Short Note · 3 marks
  8. 8Two uses and two adverse effects of calcium channel blockers.2014 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  9. 9Use of morphine in left ventricular failure2017 February (2010 Scheme)Short Answer · 1 mark
  10. 10Amlodipine and metoprolol in angina2023 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  11. 11Calcium channel blockers2018 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  12. 12Rationale of combining beta blockers with long acting nitrates2013 April (2010 Scheme)Short Answer · 1 mark
  13. 13Morphine in Acute myocardial infarction2024 March (Supplementary) (2010 Scheme)Short Answer · 1 mark
  14. 14Glyceryl trinitrate.2025 March (Supplementary) (2010 Scheme)Short Answer · 1 mark
  15. 15Rationale for use of calcium channel blockers in angina2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  16. 16Angina pectoris2013 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  17. 17Rationale for the use of nitrates in angina pectoris.2014 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  18. 18Nitrates in acute attack of angina.2016 February (2010 Scheme)Short Answer · 1 mark
  19. 19Isosorbidedinitrate2021 February (Supplementary) (2010 Scheme)Short Answer · 1 mark
  20. 20Mechanism of action of nitrates.2017 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  21. 21Morphine in Acute left ventricular failure.2025 March (Supplementary) (2010 Scheme)Short Answer · 1 mark
  22. 22Drugs for the prophylaxis of angina pectoris2014 March (2010 Scheme)Short Answer · 1 mark
  23. 23Morphine in Acute left ventricular failure2023 March (Supplementary) (2010 Scheme)Short Answer · 1 mark
  24. 24Two uses and two adverse effect of nifedipine.2016 February (2010 Scheme)Short Answer · 1 mark
  25. 25Sodium nitrite in the treatment of Cyanide poisoning2024 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  26. 26Beta blockers in angina2020 February (Supplementary) (2010 Scheme)Short Answer · 1 mark
  27. 27Anti anginal agents2024 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  28. 28Drugs used for PSVT2020 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks

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