Cardio

Question 1

ECG findings PE (3)

Answer 1

Large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III - ‘S1Q3T3’
Right axis deviation/RBBB
Sinus tachycardia

Question 2

Sacubitril (neprilysin inhibitor) MoA in heart failure

Answer 2

Inhibits degradation of BNP and ANP - thus promotes natriuresis and vasodilation

Question 3

Stage 1 HTN

Answer 3

Clinic BP >140/90 and subsequent ABPM/HBPM >135/85

Question 4

Stage 2 HTN

Answer 4

Clinic BP >160/100 and subsequent ABPM/HBPM >150/95

Question 5

Stage 3 HTN

Answer 5

Clinic systolic >180 or diastolic >110

Question 6

Indications for treating Stage 1 HTN

Answer 6

Target organ damage 
Established CVD
Renal disease 
DM
10-year cardiac risk 10% or greater

Question 7

Resistant HTN defintion

Answer 7

clinic BP >= 140/90 mmHg after step 3 treatment with optimal or best tolerated doses as resistant hypertension

Question 8

Infective Endocarditis poor prognostic features (4)

Answer 8

Staph aureus
Low complements
Prosthetic valve (esp if soon after placement)
Culture negative

Question 9

Mortality per IE organism - staph, bowel, strep

Answer 9

30%, 15%, 5%

Question 10

Initial blind Rx for IE - native valve

Answer 10

Amoxicillin +/- gent low dose

Question 11

Initial blind Rx for IE - native valve - pen allergic/MRSA/Severe sepsis

Answer 11

Vancomycin + low dose gent

Question 12

Initial blind Rx for IE - prosthetic valve

Answer 12

Vanc + rifampicin + low dose gent

Question 13

Native valve endocarditis caused by staphylococci

Answer 13

Flucloxacillin

Vanc + rifamp if pen allergic

Question 14

Prosthetic valve endocarditis caused by staphylococci

Answer 14

Flucloxacillin + rifampicin + low-dose gentamicin

Pen allergic - vancomycin + rifampicin + low-dose gentamicin

Question 15

Endocarditis caused by fully-sensitive streptococci (e.g. viridans)

Answer 15

Benzylpenicillin

Pen allergic - vanc + low dose gent

Question 16

Endocarditis caused by less sensitive streptococci

Answer 16

Benpen + low dose gent

Pen allergic - Vanc + low dose gent

Question 17

IE indications for Sx (5)

Answer 17

Severe valvular incompetence
Aortic abscess (often indicated by a lengthening PR interval)
Infections resistant to antibiotics/fungal infections
Cardiac failure refractory to standard medical treatment
Recurrent emboli after antibiotic therapy

Question 18

Indications for a temporary pacemaker (3)

Answer 18

Symptomatic/haemodynamically unstable bradycardia, not responding to atropine
Post-ANTERIOR MI - type 2 or complete heart block
Trifascicular block prior to surgery

Question 19

Poor prognostic factors in HOCM (5)

Answer 19

Syncope
Family Hx of sudden death
Young age at Px
Non-sustained ventricular tachycardia on 24 or 48h Holter monitoring
Abnormal BP changes on exercise

Question 20

Features suggesting VT rather than SVT with aberrant conduction (7)

Answer 20

AV dissociation
Fusion or capture beats 
Positive QRS concordance in chest leads
Marked left axis deviation
Hx of IHD
Lack of response to adenosine or carotid sinus massage
QRS > 160ms

Question 21

Cholesterol Embolisation characterisitics (4)

Answer 21

Eosinophilia
Purpura
Renal failure (common site of emboli)
Livedo reticularis

Question 22

Aspirin antiplatelet effect MoA

Answer 22

Inhibits thromboxane A2 production

Question 23

CLopidogrel MoA

Answer 23

Inhibits ADP binding to its plt receptor

Question 24

Enoxaparin MoA

Answer 24

Activates anti-thrombin III, in turn potentiates the inhibition of coagulation factors Xa

Question 25

Fondparinux MoA

Answer 25

Activates antithrombin III, in turn potentiates the inhibition of coagulation factors Xa§

Question 26

Bivalirudin MoA

Answer 26

Reversible direct thrombin inhibitor

Question 27

Abciximab, eptifibatide, tirofiban MoA

Answer 27

Glycoprotein IIb/IIIa receptor antagonists

Question 28

Pulsus paradoxus - description, conditions

Answer 28

>10mmHg fall in systolic BP during inspiration -> faint or absent pulse in inspiration Severe asthma or cardiac tamponade

Question 29

Slow rising/plateau condition

Answer 29

Aortic stenosis

Question 30

Collapsing pulse

Answer 30

AR Patent ductus arteriosus Hyperkinetic - anaemia, thyrotoxicosis, fever, exercise/pregnancy

Question 31

Pulsus alternans conditions

Answer 31

Regular allternation of the force of the arterial pulse | Severe LVF

Question 32

Bisferiens pulse description, conditions

Answer 32

Double pulse - two systolic peaks | Mixed aortic valve disease

Question 33

CHA2DS2-VaSc

Answer 33

``` Congestive heart failure HTN Age >75 (2), 65-74 (1) Diabetes Prior stroke/TIA (2) Vascular disease - inc IHD/PVD Sex (female) ```

Question 34

HASBLED

Answer 34

HTN - uncontrolled (systolic >160) Abnormal renal function (dialysis, Cr >200) Abnormal Liver function - Cirrhosis, bili>x2 normal, AST/ALT/ALP x3 normal Stroke Bleeding Hx Labile INRs - <60% of time in therapeutic range Elderly >65 Drugs predisposing to bleeding (NSAIDs, antiplatelets) or alcohol use >8 drinks per week

Question 35

ST elevation V1-4

Answer 35

Anteroseptal MI | LAD (proximal V1-2, distal V3-34)

Question 36

ST elevation leads II, III, AvF

Answer 36

Inferior MI | Right coronary

Question 37

ST elevation leads V4-6, I, aVL

Answer 37

Anterolateral | LAD or left circumflex

Question 38

ST elevation I, aVL +/- V5-6

Answer 38

Lateral | Left circumflex

Question 39

Tall R waves V1-2

Answer 39

Posterior MI | Usually left circumflex, also R coronary

Question 40

LVEF calculation

Answer 40

Stroke volume/ end diastolic volume

Question 41

Stroke volume calculation

Answer 41

end diastolic volume - end systolic volume