Cardio

Question 1

when is atorvastatin given as primary prevention regardless of q risk

Answer 1

T1DM
CKD

Question 2

QRISK for starting a statin

Answer 2

> 10%

Question 3

what is ideal response to statin therapy

Answer 3

check lipids 3 months after starting

aim for 40% reduction in non HDL cholesterol

Question 4

monitoring after starting a statin

Answer 4

check lipids and LFTs after 3 months

check LFTs after 12 months

Question 5

how do statins affect LFTs

Answer 5

cause transient rise in AST/ALT in first few weeks of use

Question 6

cholesterol lowering drugs besides statin

Answer 6

ezetimbe
PCSK9 inhibitors eg evolocumab

Question 7

pneumonic for secondary prevention of cardiovasc disease

Answer 7

ABCD

ACEi
Beta blocker
Cholesterol
Dual antiplatelet

Question 8

when is clopidogrel used for anticoagulation

Answer 8

PAD
after ischaemic stroke

Question 9

aspirin daily dose

Answer 9

75mg

Question 10

where are patients with angina referred to

Answer 10

rapid access chest pain clinic

Question 11

when to avoid use of diltiazem and verapamil

Answer 11

HF with reduced ejection fraction

Question 12

pharmacological mx of angina

Answer 12

1. short term relief= GTN spray
2. long term relief= beta blocker +- CCB (diltiazem or verapamil)
3. secondary prevention (ABCD)

Question 13

long acting nitrate example

Answer 13

isosorbide mononitrate

Question 14

3 forms of ACS

Answer 14

unstable angina
NSTEMI
STEMI

Question 15

RCA supplies

Answer 15

right atrium
right ventricle
inferior left ventricle
posterior septum

Question 16

LCx supplies

Answer 16

left atrium
posterior aspect of left ventricle

Question 17

LAD supplies

Answer 17

anterior left ventricle
anterior septum

Question 18

how to use GTN

Answer 18

take when sx start
second dose after 5 mins if sx remain
third dose after 5 mins if sx remain
call an ambulance after 5 mins if sx remain

Question 19

ECG changes in NSTEMI

Answer 19

ST depression
T wave inversion

Question 20

LCA STEMI has changes in leads

Answer 20

I, avL, v3-6

Question 21

LAD STEMI has changes in leads

Answer 21

V1-V4

Question 22

LCx STEMI has changes in leads

Answer 22

I, avL, V5-V6

Question 23

RCA STEMI has changes in leads

Answer 23

II, III, avF

Question 24

anterolateral stemi artery involved

Answer 24

LCA

Question 25

anterior stemi artery involved

Answer 25

LAD

Question 26

inferior stemi artery involved

Answer 26

RCA

Question 27

lateral stemi artery involved

Answer 27

LCx

Question 28

anticoagulation for STEMI

Answer 28

300mg aspirin PLUS 1. clopidogrel if high bleeding risk (on other anticoag) 2. prasugrel if normal bleeding risk PLUS fondaparinux (not needed if immediate PCI)

Question 29

in NSTEMI how is decision made for PCI

Answer 29

GRACE score >3% angiography w PCI within 72 hrs

Question 30

how do ACEi and aldosterone agonists affect potassium levels

Answer 30

cause hyperkalemia DONT USE THEM TOGETHER

Question 31

how long after MI does dresslers syndrome occur

Answer 31

2-3 weeks

Question 32

ECG changes in pericarditis

Answer 32

PR depression saddle shaped ST elevation

Question 33

pericarditis mx

Answer 33

NSAIDs Colchicine maybe steroids percardiocentesis

Question 34

cardiac output equation

Answer 34

stroke volume x heart rate

Question 35

what system is affected in LV failure

Answer 35

pulmonary

Question 36

what is the main outcome of LV failure

Answer 36

pulmonary oedema

Question 37

in whom is LV failure common

Answer 37

older patients who are given fluid resus quickly

Question 38

what type of resp failure does acute LV failure cause

Answer 38

type 1

Question 39

what ejection fraction is normal

Answer 39

> 50%

Question 40

what cardiothoracic ratio on CXR is cardiomegaly

Answer 40

>0.5

Question 41

COPD target o2 sats

Answer 41

88-92%

Question 42

LVF mx

Answer 42

sit up oxygen diuretics stop IV fluids monitor fluids assess underlying causes

Question 43

inotrope example

Answer 43

dobutamine

Question 44

HFpEF arises due to a dysfunction in

Answer 44

diastole

Question 45

when asking about SOB in HF what should you remember to ask about

Answer 45

paroxysmal nocturnal dyspnoea do you wake up at night out of breath

Question 46

what classification system is used to grade severity of HF

Answer 46

NYHA

Question 47

NYHA class 1

Answer 47

no limitation on activity

Question 48

NYHA class 2

Answer 48

comfortable at rest symptomatic with ordinary activity

Question 49

NYHA class 3

Answer 49

comfortable at rest symptomatic with any activity

Question 50

NYHA class 4

Answer 50

symptomatic at rest

Question 51

what BNP level warrants echo within 2 weeks besides this within what time frame should echo be done for HF

Answer 51

>2000- echo within 2 weeks otherwise within 6 weeks

Question 52

medical mx of HF

Answer 52

ABK ACEi Beta blocker Kidneys- aldosterone agonist and loop diuretic

Question 53

what is cardiac resynchronisation therapy

Answer 53

biventricular (triple chamber) pacemakers objective is to synchronise contractions to optimise heart function

Question 54

what structural heart change occurs in hypertension

Answer 54

left ventricular hypertrophy LV has to contract against an increased systemic resistance

Question 55

how is hypertension diagnosed

Answer 55

if BP in clinic is between 140/90-180/120 offer ABPM or home readings then diagnose

Question 56

stage 1 hypertension clinic and ABPM/home reading

Answer 56

clinic: >140/90 ABPM/home: >135/85

Question 57

stage 2 hypertension clinic and ABPM/home reading

Answer 57

clinic: >160/100 ABPM/home: >150/95

Question 58

stage 3 hypertension BP

Answer 58

>180/120

Question 59

how to screen for end organ damage in hypertension

Answer 59

kidney= albumin:creatinine ratio, renal function heart= echo for LVH, lipids eyes= opthalmoscopy

Question 60

is CCB is not tolerated in hypertension whats given

Answer 60

thiazide like diuretic

Question 61

what is a common side effect of CCB

Answer 61

ankle oedema

Question 62

4th step hypertension mx

Answer 62

if K+ >4.5= alpha blocker (doxazosin) or beta blocker if K+ <4.5= spironolactone

Question 63

how does spironolactone affect potassium levels

Answer 63

hyperkalemia

Question 64

hypertension BP targets

Answer 64

<80= <140/90 >80= <150/90

Question 65

alpha blocker example

Answer 65

doxazosin