3.0

Question 1

what are you likely to see on an ABG in someone with a PE?

why?

Answer 1

respiratory alkalosis

PE –> hyperventilation / high RR

Question 2

acute STEMI

drop in BP
high HR
increased RR / SOB
lung crackles

DDx?

Answer 2

congestive heart failure is taking place
progression of pulmonary oedema

mitral regurgitation

• common with infero-posterior infarction
• -> papillary muscle
• -> acute hypotension
• -> pulmonary oedema
• -> systolic murmur

left ventricular aneurysm
ischaemic damage –> resulting aneurysm formation

1. persistent STEM
2. left ventricular failure

Question 3

how does a VSD present?

Answer 3

early weeks of life heart failure

pan-systolic murmur –> larger hole = louder

Question 4

how does aortic regurg present?

Answer 4

AF
LVF (pulmonary oedema)
collapsing pulse
displaced apex
head bobbin (de musset's)

early diastolic
high pitched

Question 5

which heart failure drugs reduce long-term mortality + slow disease progression?

Answer 5

ace -i
beta blockers
spironolactone

Question 6

indapamide

Answer 6

thiazide-like diuretic

Question 7

treatment options for stemi

Answer 7

percutaneous coronary intervention

thrombolysis

Question 8

how often are troponins done?

Answer 8

every 4 hours

can peak at 24-48 hrs
staying high for up to 10 days

Question 9

ECG abnormalities after MI

Answer 9

inverted T waves
pathological Q waves

hyperacute T waves
ST elevation
new onset LBBB

Question 10

can you drive after MI?

Answer 10

can’t drive for 1 month after MI

no need to inform DVLA

Question 11

complications after MI

Answer 11

PE
DVT
Stroke
pericarditis (24-48 hrs)
dressler's  (2 weeks)
Left ventricular failure
LV aneurysm 
acute mitral regurg
AV node block
Cardiogenic shock
Chronic heart failure

Question 12

complications after MI

Answer 12

PE
DVT
Stroke
pericarditis (24-48 hrs)
dressler's  (2 weeks)
Left ventricular failure
LV aneurysm 
acute mitral regurg
AV node block
Cardiogenic shock
Chronic heart failure

Question 13

aside from trops - what other bloods would you do in someone with query MI?

Answer 13

FBC - anaemia
TFT - thyrotoxicosis
Lipid profile - hypercholestaemia
glucose - DM
U&E - renal disease / considering ACE-i

Question 14

how does aspirin reduce the risk of coronary events

Answer 14

1. COX inhibition
2. COX is then stopped from being made into prostaglandins + thromboxane
3. Low levels of thromboxane - a precursor for platelets
4. Hence inhibiting platelet aggregation for clots

Question 15

for treatment of heart failure, what drug can cause hypokalaemia

Answer 15

furosemide

acts on channel (Na/K out, chloride in)

Question 16

how would you increase his potassium levels?

Answer 16

oral (sando-k)

IV (KCL add to fluids)

Question 17

what drugs are used in heart failure and why?

Answer 17

furosemide - to offload fluid
morphine / nitrates - reduce pre-load

inotropic support / increase contractility - adrenaline / noradrenaline / dopamine

Question 18

what is a capture beat?

Answer 18

normal QRS complex between VT complexes

Question 19

drugs used in cardiac arrest

Answer 19

adrenaline 1mg IV 1L 1:10,000

amiodarone 300mg IV

Question 20

what are the reversible causes of cardiac arrest?

Answer 20

hypoxia
hypovolaemia
hyper/hypokaelamia - calcaemia - glycaemia
hypothermia

thrombosis
tension pnemothorax
tamponade
toxins

Question 21

what classification is used for heart failure

Answer 21

new york heart association (NYHA)

Question 22

how + where does furosemide act?

Answer 22

competitively inhibits Na-K-2Cl cotransport

at thick ascending loop of Henle

preventing reaborption by reducing osmotic gradient (Na, K out)

• hypovolaema
• hypokalaemia
• hypocalcaemia

Question 23

side effects of ACE-i

Answer 23

1st dose hypotension
dry cough
angiodema
hyperkalaemia

Question 24

complications of essential HTN

Answer 24

ischaemic heart disease
peripheral vascular disease
stroke
hypertensive retinopathyf
CKD

Question 25

bedside signs of hypercholestraemia

Answer 25

xanthelasmata tendon xanthoma corneal arcus

Question 26

common causes of AF

Answer 26

``` Pulmonary (PE/ COPD) Idiopathic Rheumatic disease (rheumatic fever, mitral REGurg) Anaemia / alcohol Thyrotoxicosis Electrolytes / endocarditis Sepsis ```

Question 27

methods of AF conversion

Answer 27

medical - amiodarone / flecanide electrical - DC cardioversion ablation

Question 28

where are microemboli likely to be found?

Answer 28

eyes - roth's spots urine dip - microhaemorrhages nail beds - splinter haemorrhages

Question 29

what criteria is used for endocarditis?

Answer 29

Duke's

Question 30

features of aortic regurg

Answer 30

``` early diastolic murmur high pitched collapsing pulse head bobbin (de musset's sign) wide pressure pulse ```

Question 31

features of infective endocarditis

Answer 31

splinter haemorrhages osler's nodes janeway lesions clubbing

Question 32

during cardiac arrest, when would you administer 3 successive shocks

Answer 32

if cardiac arrest was witnessed on monitor

Question 33

Inferior STEMI - where would you find reciporcal ST depression?

Answer 33

anterior lateral (PAILS)

Question 34

Mx for angina

Answer 34

beta blocker / CCB - 1st line all angina patients should all have recieved aspirin + statin

Question 35

``` Pt shows an inferior MI on ECG BP 85/60 HR 96 ECG ST depression ``` what drug is contraindication?

Answer 35

nitrates are CI in patients with hypotension systolic <90mmHg vasoilator effects - reducing revous return - worsening hypotension

Question 36

what abx can cause torsades de pointes

Answer 36

macrolides

Question 37

pericarditis ecg features (3)

Answer 37

- PR depression - saddle shape ST - wide spread ST elevation

Question 38

what is bifasicular block?

Answer 38

1. RBBB | 2. Left axis deviation

Question 39

what is trifascular block?

Answer 39

1. RBBB 2. Left axis deviation 3. 1st heart block