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AKT > Cardiology 3 > Flashcards

Cardiology 3 Flashcards

1
Q

When treating a diabetic patient with hypertension, which combinations of anti-hypertensives should be avoided if possible?

A

thiazides and BB as can cause insulin resistance

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2
Q

Thiazides can cause which electrolyte abnormalities (3)
Adverse effects (3)

A

low K and Na
High calcium

gout, impaired glucose intolerance, impotence

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3
Q

Heart failure with reduced ejection fraction is defined as an ejection fraction below?

A

40%

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4
Q

Which PPI interacts with clopi?
Clopi MOA

A

Omeprazole - makes it less effective
Anti-platelet

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5
Q

Bioprosthetic versus mechanical valves
Anticoagulation for prosthetic
How is each option chosen?
Anticoagulation for mechanical aortic and mitral

A

Prosthetic - warfarin for first three months, otherwise aspirin long term
Given in >65yo aortic or >70 for mitral
Mechanical - warfarin aortic 3, mitral 3.5

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6
Q

Heart block
1st degree
Mobitz type 1
Mobitz type 2
Third degree

A

1st degree - prolonged PR >0.2
Mobitz type 1 increasingly prolonged PR then a dropped QRS
Mobitz type 2 PR interval is constant but the P wave is often not followed by a QRS complex
Third degree no association between P and QRS

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7
Q

Major bleeding
Minor bleeding + INR >8
No bleeding INR >8
Minor bleeding INR 5-8
No bleeding INR 5-8

A

Stop warfarin, IV vit K 5mg
Prothrombin complex concentrate - if not available then FFP*

Stop warfarin
Give IV vit K 1-3mg
Repeat dose of IV vit K if INR still too high after 24 hrs
Restart warfarin when INR < 5.0

Stop warfarin
Give PO vit K 1-5mg by mouth
Repeat dose of vitamin K if INR still too high after 24hrs Restart when INR < 5.0

Stop warfarin
Give IV vit K 1-3mg
Restart when INR < 5.0

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

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8
Q

What are the below scoring systems used for?
ABCD2
DAS28
Child Pugh
SCOFF
Epworth
IPSS
Waterlow
FRAX
Ranson
MUST

A

TIA
RA severity
Liver cirrhosis
Eating disorders
Sleep apnoea
Prostate symptoms score
Pressure sores
10 year risk of developing osteoporotic fracture
Acute pancreatitis
Malnutrition

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9
Q

Brugada syndrome
AD/AR
Common in which demographic?
Mutation in which gene?
ECG changes (3)

Ix of choice

Mx

A

Autosomal dominant
Asians
SCN5A gene

Convex ST segment elevation
Negative T waves V1-V3
RBB

Administration of flecainide or ajmaline - more apparent ECG changes following this

Mx ICD

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10
Q

What is Buerger’s diease?
Strongly associated with?

Features (5)

A

Small to medium vessel vasculitis
Smoking

Extremity ischaemia
Intermittent claudication
Ischaemic ulcers
Superficial thrombophlebitis
Raynaud’s phenomenon

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11
Q

Beck’s triad (3)
Found in which condition?

A

hypotension
raised JVP
muffled heart sounds

cardiac tamponade

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12
Q

Cardiac tamponade
ECG findings

Mx

A

ECG: electrical alternans

Mx urgent pericardiocentesis

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13
Q

When can one use dabigatran?

A

Non valvular AF with at least one of:
prev stroke/ TIA/ systemic embolism
LVEF <40% or NYHA class 2 or above
75yo >=
65yo >= with DM, CAD, HTN

VTE prophylaxis post knee or hip replacement surgery

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14
Q

Normal variants ECG in an athlete (4)

A

sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)

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15
Q

multiple red/yellow vesicles on the extensor surfaces

A

Eruptive xanthoma

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16
Q

Ix for palpitations

1st line (4) (including three sets of bloods)
2nd line (1)
3rd line (2)

A

ECG
TFT
FBC
U+E

2nd line 24 hour Holter

3rd line external loop recorder
implantable loop recorder

17
Q

MI secondary prevention meds (4)

A

dual antiplatelet therapy (aspirin plus ticagrelor OR prasugrel)
ACE inhibitor
beta-blocker
statin

18
Q

Pts who have sx of acute heart failure following an MI should be treated with?
How many days post MI should this treatment be started?

A

aldosterone antagonist - eplerenone should be initiated within 3-14 days of the MI

19
Q

Coarctation associations (4)

A

Turner’s syndrome
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis

20
Q

Coarctation signs
Infancy:
Adults: (2)
Pulse
Murmur
Sound

A

infancy: heart failure
adult: hypertension, notching of the inferior border of the ribs
radio-femoral delay
mid systolic murmur, maximal over back
apical click from the aortic valve

21
Q

HOCM
Features - can give hint

A

MR SAM ASH
mitral regurg, systolic anterior motion, asymmetric hypertrophy

22
Q

HOCM
ECG findings (3)

A

left ventricular hypertrophy
deep q waves
+/- AF

23
Q

HOCM
Murmur type
Increases with?
Decreases with?

A

Ejection systolic murmur
Increases with Valsalva manoeuvre
Decreases on squatting

24
Q

jerky pulse, large ‘a’ waves, double apex beat = ?

A

HOCM

25
Q

SVT management (3)

CI for 2nd line tx, alternative choice

Prevention (2)

A
  1. vagal manoeuvres e.g valsalva and carotid sinus massage
  2. adenosine 6mg, then 12mg, then 18mg
  3. electrical cardioversion

asthmatics - verapamil

BB or ablation

26
Q

WPW
ECG (3)

right sided accessory pathway gives
left sided accessory pathways gives

A

short PR interval
wide QRS complexes
slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*

27
Q

Type A WPW
Type B WPW

Most common type?

A

Left sided pathway i.e RAD - dominant R wave
Right sided pathway i.e LAD - no dominant R wave

LAD (type B)

28
Q

WPW associations (3)

A

HOCM
mitral valve prolapse
thyrotoxicosis

29
Q

WPW mx (2)

A

ablation of accessory pathway
or medical mx with sotalol, amiodarone or flecainide

30
Q

Sharp pain relieved by sitting forwards, can be pleuritic?

A

Pericarditis

31
Q

What is Boerhaaves syndrome?
Diagnostic Ix
Mx

A

Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
CT contrast swallow
Thoracotomy and lavage if <12 hours

32
Q

Advice given to those who develop tolerance to ISMN?

A

Take the second dose after 8 hours instead of 12

33
Q

Warfarin INR target
VTE
recurrent VTE
AF
SE (4)

A

2.5
3.5
2.5
SE purple toes, skin necrosis, teratogenic, bleeding

34
Q

Examples of thrombolytic drugs (2)
CI (8)

A

alteplase, streptokinase

Active bleeding
Recent haemorrhage or surgery
Bleeding disorders
Intracranial neoplasm
Stroke <3 months prior
Aortic dissection
Recent head injury
Severe HTN

35
Q

What is Takayasu’s arteritis?

A

Large vessel vasculitis

36
Q

Name some features of Takayasu’s arteritis (6)

Hints:
Age, gender, ethnicity
x2 non specific
Impact on BP
Pulse
Murmur

Associated with which condition?
Mx

A

Young female Asians
- malaise, headache
- unequal BP in upper limbs
- carotid bruit and tenderness
- weak peripheral pulses
- upper and lower limb claudication on exertion
- AR

RAS
Steroids

37
Q

When would you consider treating a patient with stage 1 hypertension?

A

aged under 60

38
Q

ORBIT score (5)
Use
Risk group

A

Use instead of HASBLED

Hb <130 M <120 F 2
Age >74 1
eGFR <60 1
Prev hx of bleeding 2
On antiplatelets 1

2 or less low risk
3 medium risk
4 or more high risk

AKT (52 decks)

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