Cardio

Question 1

NSTEMI vs STEMI

Answer 1

NSTEMI indicates ischaemia and STEMI indicates infarction.

STEMI requires urgent PCR, whereas NSTEMI is PCR within 48 hrs

Question 2

Anterior Heart

Answer 2

V1-2

LAD

Question 3

Septal Heart

Answer 3

V3-4

LAD

Question 4

Lateral Heart

Answer 4

V5-6

Left circumflex artery

Question 5

Anterolateral heart

Answer 5

V1-6

Left main stem disease

Question 6

Inferior heart

Answer 6

II, III, aVF

Posterior descending branch of RCA

Question 7

First sign of pulmonary oedema

Answer 7

Bibasal crepitation, as more fluid accumulates pleural effusion is seen on chest x-ray

Question 8

Key signs of Right Heart Failure

Answer 8

Raised JVP

Bilateral pedal oedema

Question 9

Murmur heard loudest on inspiration

Answer 9

Right-sided valve lesion

Question 10

Anatomical landmark for aortic valve

Answer 10

Right 2nd intercostal space midclavicular line

Question 11

Best way to hear mitral valve pathology

Answer 11

Patient to be in left lateral position

Question 12

Corrigans signs indications

Answer 12

Hyperdynamic circulation associated with AR

Question 13

Narrow Pulse pressure indications

Answer 13

Aortic stenosis

Question 14

Indiciations for CHAD2 score

Answer 14

Predicting risk of subsequent stroke as a result of AF

Question 15

Signs of ischaemia on ECG

Answer 15

Inverted T waves and ST depression

Question 16

Signs of infarction on ECG

Answer 16

ST elevation, Q waves and raised troponin

Question 17

Pulmonary embolism primary Sxs

Answer 17

SoB
Pleuretic chest pain
Hemoptysis

Question 18

Clinical signs of PE

Answer 18

Pleural rub
Coarse Crackles
AF

Question 19

Geneva scoring system

Answer 19

Used for predicting AF risk

Question 20

Hyper-resonance with lung auscultation

Answer 20

Pneumothorax

Question 21

Mitral Valve Prolapse

Answer 21

Barlow syndrome, click murmur syndrome.

Mid systolic click, followed by late systolic murmur is heard at apex as thickened mitral valve leaflet is displaced into LA during systole

Question 22

Austin Flint Murmur

Answer 22

low pitched, mid-diastolic rumble at the apex

mitral valve displacement as well as aortic turbulence due to regurgitation qualifies as an Austin Flint murmur

Question 23

Patent ductus arteriosus sound

Answer 23

Constant machinery murmur

Question 24

Graham Steel murmur

Answer 24

Hear best at left sternal edge, 2nd intercostal space during inspiration

High pitched early diastolic murmur associated with pulmonary HTN

Question 25

Carey Coombs murmur

Answer 25

Short, mid distolic rumble heard best at apex, due to turbulent blood flow over thickened mitral valve, often due to rheumatic fever

Question 26

Aortic dissection pain

Answer 26

severe, tearing pain that radiates toward the back though this can be to the jaw depending on the location of the dissection.

Question 27

MI pain description

Answer 27

severe, crushing chest pain with an acute onset

Question 28

Sustained VT

Answer 28

Cannon a waves on JVP and broad QRS complexes

Question 29

JVP wave forms

Answer 29

a wave – representing atrial systole; c wave – representing closure of the tricuspid valve (this wave is not usually visible); x descent – representing a fall in atrial pressure during ventricular systole; v wave – representing atrial filling against a closed tricuspid valve; y descent – representing the opening of the tricuspid valve

Question 30

Raised JVP seen means...

Answer 30

Fluid overload and RHF

Question 31

Features seen in CXR with congestive cardiac failure

Answer 31

Cardiomegaly Bilateral pleural effusions Alveolar oedema Kerley B lines (represent interstitial oedema)

Question 32

First degree heart block on ECG

Answer 32

PR > 0.2s

Question 33

Shortened PR interval

Answer 33

Fast AV conduction ie Wolff-Parikinson-White Syndrome

Question 34

Mid-diastolic murmur (±opening snap, representing a mobile valve)

Answer 34

Mitral stenosis

Question 35

Pan-systolic murmur

Answer 35

Mitral Regurgitation, tricuspid regurgitaiton and ventricular septal defects

Question 36

Cough seen in HTN patients

Answer 36

ACEi cause dry cough | If this happens, start pts on ARB

Question 37

Increasing SoB in previous 6 months Bried periods of central chest pain O/E BP 115/85 Few rales at both bases ECG - borderline criteria for left ventricular hypertrophy.

Answer 37

Aortic stenosis

Question 38

Aortic stenosis murmur

Answer 38

Crescendo systolic murmur heard best at R sternal edge

Question 39

Mitral stenosis murmur

Answer 39

Mid-diastolic murmur best heard at the apex with opening snap and loud P2

Question 40

Aortic regurg murmur

Answer 40

Decrescendo Diastolic murmur best heard at the left sternal edge

Question 41

Mitral regurg murmur

Answer 41

Pan-systolic murmur best heard at the apex

Question 42

Tricuspid regurg murmur

Answer 42

Pan-systolic murmur best heard at the left sternal edge

Question 43

Dressler's syndrome

Answer 43

Autoimmune pericarditis

Question 44

Rapid BP lowering needed, what drug to give

Answer 44

Sodium nitroprusside

Question 45

Large vs Small ventricular septal defects

Answer 45

Large ventricular septal defects (VSDs) may indeed be associated with pulmonary hypertension , heart failure and shunt reversal, but a small defect is unlikely to lead to these problems. VSDs not associated with dysrhythmias ENDOCARDITIS is persistent hazards

Question 46

A 61-year-old man presents with a 2-hour history of moderately severe retrosternal chest pain, which does not radiate and is not affected by respiration or posture. He complains of general malaise and nausea, but has not vomited. His ECG shows ST segment depression and T wave inversion in the inferior leads.

Answer 46

Acute Coronary Syndrome - unstable angina as no evident of tissue damage

Question 47

A 46-year-old man develops sudden severe central chest pain after lifting heavy cases while moving house. The pain radiates to the back and both shoulders but not to either arm. His BP is 155/90 mmHg, pulse rate is 92 beats per minute and the ECG is normal. He is distressed and sweaty, but not nauseated.

Answer 47

Aortic dissection

Question 48

Aortic dissection management plan

Answer 48

If confirmed, BP reduction and dampening of the aortic systolic wave by beta-blockade is indicated and urgent surgical intervention should be considered.

Question 49

Aortic regurg signs

Answer 49

Wide Pulse pressure Decrescendo diastolic murmur Collapsing pulse

Question 50

Treatment of SVT

Answer 50

DC cardioversion and IV adenosine

Question 51

What is SVT associated with

Answer 51

SVT is common in young people and may be associated with excessive nicotine, caffeine and alcohol

Question 52

Variant angina

Answer 52

Variant angina, sometimes called Prinzmetal’s angina (E), of which this is a typical presentation. Its mechanism is controversial and even its existence has been questioned. The general view is that it is due to vasospasm in small coronary arteries and this is likely to respond to the effects of nitrates and calcium channel blockers such as verapamil. Beta-blockers are not effective and in theory could make it worse by aggravating vasoconstriction, but whether this actually happens is also controversial.

Question 53

A previously fit 19-year-old man presents with unusual shortness of breath on exertion. At times, this is also associated with central chest pain. On examination there is a loud mid-systolic murmur at the left sternal edge. Heart rate and blood pressure are normal and there is no oedema. The ECG shows left axis deviation and the voltage criteria for left ventricular hypertrophy and the echocardiogram reveals a significant thickened interventricular septum, with delayed ventricular filling during diastole. There is a family history of sudden death below the age of 50.

Answer 53

Hypertrophic obstructive cardiomyopathy

Question 54

Treatment for hypertrophic obstructive cardiomyopathy

Answer 54

Beta blockers first Then rate limiting Ca2+ blockers These 2 slow heart and improve disastolic relaxation

Question 55

What are 3rd heart sounds and 4th heart sounds associated with?

Answer 55

Heart failure

Question 56

Sign with constrictive pericarditis

Answer 56

Kussmaul's sign - increased JVP upon inspiration

Question 57

Digoxin toxicity

Answer 57

Yellow-tinged vision (xanthopsia) | Slow pulse, with probably ectopics

Question 58

Most common cause of AF in young person

Answer 58

Thyrotoxicosis