Cardio

Question 1

Pericarditis s/s? (5)

Answer 1

Fever, pleuritic chest pain relived by sitting up and leaning forward, cough, tachyopnoea, PERICARDIAL RUB

Question 2

Ax pericarditis? (4)

Answer 2

Viral (coxsackie), TB, trauma, dresslers (post-MI)

Question 3

ECG pericarditis?

Answer 3

Saddle-shaped ST elevation, PR depression

Question 4

Ax endocarditis?

Answer 4

Strep viridans, HACEK, staph aureus

Question 5

s/s endocarditis?

Answer 5

FROM JANE

Fever, roth spots, Osler’s nodes, murmur, janeway lesions, anaemia, nails (splinter haemorrhages), emboli

Question 6

Dx endocarditis?

Answer 6

Blood culture, anaemia, CXR, ECHO, urinalysis for microscopic haematuria

Question 7

Tx endocarditis?

Answer 7

• Native valves: amoxicillin + gentamicin
• Prosthetic valves: vancomycin, gentamicin + rifampacin
• IV drug: fluclox
• Staph aureus: fluclox
• MRSA: vancmycin, gentamicin + rifampacin
• Viridans strep: benzylpenicillin + gentamicin
• enterococcus: vancomycin + gentamicin
• staph epidermidis: vancomycin, gentamicin + rifampacin

Question 8

S/s myocarditis? (4)

Answer 8

Fever, chest pains, SOB, palpitations

Question 9

Ax myocarditis? (7)

Answer 9

Lymes, cocksakie, chaga’s disease, HIV, rheumatic fever, eosinophillic, SLE

Question 10

Ax arhythmias? (5)

Answer 10

LVH, accessory pathway, drugs, inflammation, genetic

Question 11

Dx arrhythmias?

Answer 11

ECG, electrophysiological study

Question 12

Tx bradycardia?

Answer 12

• If asymptomatic and >40 bpm, no Tx required

* If <40 bpm or asymptomatic, IV atropine (if no response to atropine - temporary pacing wire)

Question 13

SVT ECG?

Answer 13

Narrow complex tachy (QRS <0.12)

Question 14

Tx SVT?

Answer 14

Vagotonic manouvres, IV adenosine/verapamil, DC shock

• Maintenance: BB/verapamil (NEVER together!!), radiofrequency ablation

Question 15

ECG AF?

Answer 15

Irregularly irregular pulse, absent P waves, F waves

Question 16

Ax AF?

Answer 16

Ectopic foci in pulmonary VEINS

Question 17

Tx AF?

Answer 17

• Acute: emergency cardioversion, if unavailible = amiodarone + verapamil/bisoprolol
• Chronic: BB/CCB, if fails add amiodarone

ANTICOAGULATION if high risk of thomboembolism CHA2DS2-VAS

Question 18

Maintenance of AF?

Answer 18

Catheter ablation of pulmonary vein focus

Question 19

s/s AF? (6)

Answer 19

Palpitations, syncope, chest pain, breathlessness, fatigue, sweating

Question 20

ECG VT?

Answer 20

Broad complex tachy

Question 21

Tx VT?

Answer 21

Amiodarone/lidocaine, ICD, catheter ablation

Question 22

Wolf Parkinson White syndrome?

Answer 22

Congenital accessory conduction pathway between atria and ventricles
ECG = delta waves

Question 23

Tx WPW?

Answer 23

Ablation of accessory pathways

Question 24

1st degree heart block? Tx?

Answer 24

PR interval longer than normal (>0.2)

Tx = none

Question 25

2nd degree heart block? Tx?

Answer 25

* Mobitz 1 - progressive lengthening of PR interval eventually resulting in dropped beat * Mobitz 2 - usually 2:1 or 3:1 * Tx = pacemaker

Question 26

3rd degree heart block? Tx?

Answer 26

Heart stops (asystole) or enters escape rhythm

Question 27

Tx ventricular fib?

Answer 27

Defib + CPR

Question 28

Tx Long QT syndrome?

Answer 28

B-blockers (NOT SOTALOL)

Question 29

Tx brugada syndrome?

Answer 29

ICD

Question 30

ECG brugada syndrome?

Answer 30

ST elevation and RBBB

Question 31

Drugs to avoid with brugada syndrome?

Answer 31

Analgesics, anti-arrhythmic drugs, psychotropics, anathetics

Question 32

Collapsing pulse?

Answer 32

Aortic regurgitation

Question 33

Radiofemoral delay?

Answer 33

Coarctation of aorta

Question 34

s/s mitral stenosis?

Answer 34

Tapping apex, loud S1, rumbling mid-diastolic, malar flush

Question 35

Aortic stenosis s/s?

Answer 35

Soft S2, ejection systolic (radiates), slow-rising pulse, heave

Question 36

s/s aortic regurg?

Answer 36

Displaced apex, early diastolic, collapsing pulse

Question 37

s/s mitral regurg?

Answer 37

Displaced apex, soft S1, pansystolic murmur (radiates to axilla)

Question 38

Tricuspid regurg s/s?

Answer 38

JVP 'v' waves

Question 39

Parasternal heave?

Answer 39

Cor pulmonale/pulmonary hypertension

Question 40

JVP rising on inspiration?

Answer 40

Cardiac tamponade, constrictive pericarditis

Question 41

Blurred yellowing vision + headache?

Answer 41

Digoxin toxicity

Question 42

Tall tented T waves, prominent U waves?

Answer 42

Hyperkalaemia

Question 43

Flattened T waves, prominent U waves?

Answer 43

Hypokalaemia

Question 44

ST depression?

Answer 44

Myocardial ischaemia

Question 45

ST elevation?

Answer 45

Acute MI

Question 46

Saddle shaped ST elevation?

Answer 46

Constrictive pericarditis

Question 47

S I, Q III, T III pattern?

Answer 47

PE

Question 48

Dx AF?

Answer 48

ECG - absent P waves, irregular R-R intervals

Question 49

Tx AF?

Answer 49

* Restore rate:BB, Ca+ antagonist, digoxin, amiodarone * Restore rhythm: BB, cardioversion, amiodarone * Anticoagulant: warfarin, apixiban, dabigatran, rivaroxiban

Question 50

Tx MI?

Answer 50

Acute = MONAAB Morphine, oxygen, nitrates, anti-platelet, antiemetic, BB, aspirin Tx = PCI within 90 mins

Question 51

s/s heart failure?

Answer 51

RHF - ankle oedema | LHF - pleural effusion, paroxysmal nocturnal dyspnea

Question 52

Tx heart failure?

Answer 52

ACE/ARB, BBs, digoxin, furosemide, spironolactone

Question 53

Ix heart failure?

Answer 53

Bloods, CXR (oedema), ECHO, ECG

Question 54

Aneurysm?

Answer 54

Dilation of vessel by more than 50% its normal diameter

Question 55

True aneurysm vs false aneurysm?

Answer 55

True: vessel wall is intact False: breach in vessel wall

Question 56

Ax AAA?

Answer 56

smoking, hypertension, diabetes

Question 57

s/s AAA?

Answer 57

Pain can mimic renal colic

Question 58

AAA rupture? (3)

Answer 58

* sudden onset epigastric pain * Can radiate to back * Collapse

Question 59

Ix AAA?

Answer 59

* Duplex US | * CT angiogram - ONLY imaging that can identify ruptured AAA

Question 60

Tx rupture AAA?

Answer 60

Open repair/EVAR

Question 61

s/s acute limb ischaemia?

Answer 61

6 P's | Pain, pallor, pulseless, perishingly cold, paraesthesia, paralysis

Question 62

Tx diabetic foot sepsis?

Answer 62

SURGERY, wide spectrum antibiotics (wound left open to encourage drainage) * If patient very ill, GUILLOTINE PROCEDURE

Question 63

Abdominal retroperitoneal structures?

Answer 63

SADPUCKER * Suprarenal glands, aorta/IVC, duodenum (except 1st part), pancreas (not tail), ureters, colon (ascending + descending), kidneys, esophagus, rectum

Question 64

Shockable rhythms? | Tx?

Answer 64

VF, pulseless VT * 1 shock then continue CPR for 2 mins, shock again if necessary * After 3rd shock, IV adrenaline and IV amiodarone 300 mg

Question 65

Non-shockable rhythms? | Tx?

Answer 65

Pulseless electrical activity, asystole | * adrenaline 1mg IV immediately then every 2 CPR cycles