Cardio Flashcards
(220 cards)
1
Q
Revised Jones Major Criteria
A
Polyarthritis Pancarditis Subcut nodules Erythema marginatum Sydenham's Chorea
2
Q
Revised Jones Minor Criteria
A
Arthralgia
Prolonged PR interval
Pyrexia
CRP/ESR
3
Q
ACEi SFx
A
Cough (15%)
Hyperkalaemia
Angioedema
First dose hypo
4
Q
HTN regimen <55
A
- Ace inhibitor
- +Ca blocker
- +Thiazide
- If K+ <4.5 add Spiro, if not up Thiazides
5
Q
HTN regimen >55/Afro-Carribean
A
- Ca blocker
- +ACE inhibitor
- +Thiazide
- If K+ <4.5 add Spiro, if not up Thiazides
6
Q
Antiarrhythmics by class + action
A
- Procainamide/Flecainide - Na blockade
- Beta blockers
- Amiodarone - K+ blockade
- Verapamil/Diltiazem - Ca2+ blockade
7
Q
Amiodarone considerations
A
Long half life Dirty (CYP450 inh) Lots of side effects Proarrhythmic effect Thrombophlebitic (central vein)
8
Q
Amiodarone SFx (x7)
A
Thyroid dysfunction Thrombophlebitis Bradycardia (QT elongation) Corneal deposits Pulmonary fibrosis Liver fibrosis Peripheral neuropathy
9
Q
Post MI complications
A
Cardiogenic shock Cardiac arrest Heart failure Tachyarrhythmia Bradyarrhythmia Dressler's syndrome LV aneurysm LV wall rupture VSD Acute MR
10
Q
Contraindications to statin use
A
Pregnancy
Macrolide use
11
Q
HF Rx
A
1st line: ACEi AND B Blockade (start one at a time)
2nd line: ARB/Aldosterone antagonist
3rd line: Cardiac resynchronisation therapy +- digoxin
Furosemide/Spiro for fluid overload
Influenza and pneumococcal vaccines advised
12
Q
Drugs which improve mortality in stable HF
A
B Blockers
ACEi
Hydralazine with nitrites
Spironalactone
13
Q
Signs of tricuspid regurg
A
PSM
Pulsatile hepatomegaly
Prominent JVP V waves
Left parasternal heave
14
Q
Causes of tricuspid regurg
A
RV infarction
Pulmonary hypertension
Rheumatic heart disease
Infective endocarditis
15
Q
Giant V waves on JVP
A
Tricuspid regurg
16
Q
Absent A waves on JVP
A
AF
17
Q
Cannon A waves on JVP
A
Complete heart block/atrial flutter
18
Q
Posteroinferior MI on ECG
A
ST elevation in 2,3,aVF
Dominant R waves in V1 and V2
3rd degree HB (right coronary supplies AV node)
19
Q
Arrhythmia Ix?
A
12 lead ECG +- Holter
TFTs
U&Es
FBC
20
Q
Major GI bleed in pt on Warfarin Rx
A
STOP warfarin
Vit K 5mg IV
Prothrombin complex
Restart warfarin once bleeding stops and INR <5
21
Q
Acute pericarditis features
A
Chest pain (better when sitting forwards) Dry cough Fever Tachypnoea Tachycardia Pericardial rub Dyspnoea
22
Q
Acute pericarditis Rx
A
NSAIDs +- Colchicine for idiopathic/viral cases
23
Q
Mitral stenosis murmur
A
MDM at the apex.
24
Q
Mitral stenosis commonest cause
A
Rheumatic heart disease
25
Mitral stenosis Cx
AF
MI
IE
Stroke
26
Tricuspid regurg murmur
PSM at left sternal edge 4th space
27
Tricuspid regurg common in?
IVDU -> tricuspid endocarditis
28
Most sensitive serum marker of anaphylaxis?
Serum tryptase
29
Most common ECG finding of PE
Sinus tachy
30
PE triad
Dyspnoea
Chest pain
Haemoptysis
31
PE commonest clinical signs
Tachypnoea
tachycardia
Pyrexia
Crackles
32
PE Ix/Rx
If Wells <4 then D-Dimer
If Wells >4 then CTPA
+- LMWH
VQ scan done if pt cannot tolerate CTPA (/is allergic to contrast medium)
33
Most important RF for aortic dissection?
Hypertension
34
Classification system for aortic dissection
Stanford classification
Type A - Ascending (2/3)
Type B - Descending (1/3)
35
NSTEMI ECG Fx
ST depression
36
NSTEMI Rx
300mg Aspirine
Nitrates/Morphine
Ticagrelor (preferred to clopi now)
Eptifibatide (GP2bR antagonist)
37
MI secondary prevention medications (for all patients)
B blocker
ACE inhibitor
Statin
DAPT
38
Diabetic BP targets
If end organ damage: <130/80
| Otherwise: <140/80
39
First line antihypertensive in diabetics
ACEi (regardless of age or ethnicity) due to renoprotective effects
40
Type of NIV used in acute heart failure
CPAP
41
Management options in acute heart failure
```
O2
Furosemide
Opiates
Vasodilators
Inotropes
CPAP
Mechanical circulatory assistance e.g. LVAD
```
42
ECG changes in Wolf Parkinson White?
PR prolongation
Broad QRS complex with slurred 'delta' upstroke
LAD
43
VT Rx
```
If symptomatic (shock, MI, HF, syncope): Synchronised DC cardioversion
If asymptomatic: Amiodarone, lidocaine or procainamide
```
44
Causes of QT prolongation?
Congenital causes
```
Drug causes:
Amiodarone
TCAs
Class 1a antiarrhythmics
SSRIs
```
```
Other causes
Hypokalaemia
Hypocalcaemia
Hypomagnesaemia
Hypothermia
Acute MI
Myocarditis
```
45
Coactation of the aorta Fx?
HF in infancy
Hypertension in adulthood
Radiofemoral delay
Mid systolic murmur loudest over back
46
Which cardiac enzyme is best when looking for re-infarction?
CK-MB as it takes 3-4 days to return to normal
47
How long does Troponin T take to return to normal levels?
10 days
48
ECG Fx of hypokalaemia
```
U waves (deflection after T wave)
PR prolongation
ST depression
QT elongation
Inverted/absent T waves
```
49
Which electrolyte abnormality would furosemide cause?
Hypokalaemia
50
Poor prognostic factors in infective endocarditis?
Staph infection
Seronegative endocarditis
Valve prosthesis
Low complement levels
51
Causes of a raised BNP?
```
Heart failure
CKD with eGFR<60
PE
COPD
Sepsis
Other cardio stuff
Diabetes
```
52
What is the mechanism of flash pulmonary oedema secondary to MI?
MI leads to acute MV regurg> backflow into LV and LA > pulmonary congestion > pulmonary oedema
53
AR murmur characteristics
```
Early diastolic
Loudest on expiration
Loudest over aorta
Radiates to 4th space
High pitched and blowing
Also presents with collapsing pulse and displaced apex beat
```
54
How does bifascicular block appear on ECG?
RBBB + LAD
55
When would you use the three-shock strategy?
In witnessed VF/pVT
56
Three features of autonomic neuropathy?
1. Postural hypotension
2. Loss of respiratory arrhythmia
3. Erectile dysfunction
57
Causes of postural hypotension?
Hypovolaemia
Autonomic failure - Diabetes, Parkinson's/MSA
Drugs: Diuretics, SSRIs, anti-hypertensives, LevoDOPA
Alcohol
58
STEMI Rx guidelines?
1. All patients receive Aspirin 300mg + Clopi/Ticagrelor (PY212i)
2. All should go for PCI with unfractionated heparin
3. Thrombolysis (tPA e.g. alteplase) if PCI not available
59
ECG findings in hypothermia?
```
J waves (weird bit after QRS)
QT prolongation
First degree HB
```
60
Which vein in the leg might you use for a venous cutdown, and what is its relation to the malleoli?
Long saphenous vein which passes anterior to the medial malleolus
61
NSTEMI Rx guidelines?
1. Aspirin + Prasugel/Ticagrelor + Nitrates/Morphine for all.
2. PCI + unfractionated Hep if possible.
2a. If not, Antithrombin e.g. Fondaparinux
62
What is the mechanism and site of action of thiazide diuretics?
Sodium reabsorption inhibitor at the proximal end of the DCT
63
Thiazide diuretic side effects?
```
Dehydration
Hyponatraemia
Hypokalaemia
Hypercalcaemia
Postural hypotension
IGT
```
64
Which infective agents cause endocarditis, and in which groups?
S. aureus: COMMONEST cause, particularly seen in IVDUs.
Strep viridans is seen after dental procedures
Staph epidermis is seen after valve surgery
Coxiella is seen in farm workers (causes Q fever)
Streptococcus bovis is seen in colorectal cancer
65
How long should patients with provoked PEs be anticoagulated for?
3 months
66
What are the first two stages in management of a narrow complex SVT?
1. Valsalva manouvre
| 2. IV Adenosine
67
Management of symptomatic bradycardia?
IV Atropine (up to 3mg)
68
Causes of constrictive pericarditis?
1. TB (esp in developing world)
2. CTDs e.g. scleroderma,
3. Uraemia secondary to CKD
4. Radiation
69
Features of constrictive pericarditis?
```
Raised JVP
Peripheral oedema
Bibasal crackles
Dyspnoea
Hepatomegaly
Kussmaul's breathing
Pericardial knock (Loud S3)
```
70
Which murmur is associated with collagen disorders?
Mitral regurg
71
Causes of mitral regurg?
1. Acutely post MI
2. MV prolapse
3. Infective endocarditis
4. Rheumatic fever
5. Congenital
72
How long before surgery should Warfarin patients hold their medication?
5 days
73
Modified Duke major criteria
Positive serology:
2x consecutive positive cultures (Staph/strep)
Coxiella/Bartonella/chlamydia positive serology
Evidence of endocardial involvement:
Positive echocardiogram
New valvular regurgitation
74
Modified Duke minor criteria
Pre-existing heart condition or IVDU
Microbiological evidence which does not meet major criteria
Vascular signs (Major emboli, clubbing, splenomegaly Janeway lesions, splinter haemorrhages)
Immunological signs (Roth spots, Osler's nodes, glomerulonephritis)
Fever >38.
75
Diagnostic requirements for IE
2x major criteria OR
5x minor criteria OR
1x major AND 3x minor OR
Pathological criteria positive (positive histology at autopsy or cardiac surgery)
76
Ix for suspected PE in CKD?
V/Q scan
77
Rate control in AF?
1. B blocker
2. Ca blocker
3. Digoxin
78
Rhythm control in AF?
Sotalol
| Flecanide
79
Dipyridamole MOA
Platelet inhibitor which works by phosphodiesterase
80
Dipyridamole use?
With aspirin after acute ischaemic stroke
81
Does zopiclone cause orthostatic hypotension?
NO!
82
What is the ALS procedure for VF/VT cardiac arrest?
30:2 with defibrillator charging
Shock at >150 joules every 2 minutes, with 1mg IV adrenaline given after the third shock then every 3-5 minutes after that.
83
How would you manage pulseless electrical activity?
1mg adrenaline ASAP as this is not a shockable rhythm.
| Continue high quality CPR
84
What is Wellen's syndrome?
Precordial 'arrowhead"T wave inversion seen in acute ischaemia in underlying unstable angina
85
ECG features of posterior MI?
Tall R waves in V1 and V2
86
What is Eisenmenger's syndrome and what is its management?
The reversal of a left-to-right shunt due to pulmonary hypertension.
Can only be managed with a heart-lung transplant.
87
PND is a sign of left or right sided HF?
Left
88
What are the side effects of loop diuretics?
```
Hypokal/nat/cal/magnesaemia
Ototoxicity
Gout
Renal impairment
Hyperglycaemia
```
89
What class of medication should be given to MI patients with high cardiovascular risk who are due PCI within 96 hours of admission?
Gp11b/111a inhibitors e.g. Abciximab and Tirofiban
90
What is the precise site and MOA of furosemide
Na-K-Cl co transporter inhibitor in the thick ascending loop of Henle
91
What should you do if high suspicion of PE but delay in CTPA?
Give treatment dose of LMWH while waiting for scan
92
Commonest cause of S3 in under and over 30s?
Under: Physiological
Over: LHF
93
What heart sound does HOCM cause?
S4
94
How should glycaemic control be managed in post MI patients?
Stop all diabetic medications and place on sliding scale insulin infusion with regular BMs aiming for <11mmol
95
What is the medical management for Torsades de Pointes?
IV MgSO4.
96
What is the progression of ECG changes in MI?
Mins - hyperacute T waves
Mins-Hours - ST elevation
Hours- Days - Q waves
Days- months - T inversion
97
In which leads is it normal to see T wave inversion?
aVL, III, V1
98
What are the features of aortic coarctation in infants and in adults?
Infancy - HF with HTN, ESM and weak femorals
| Adult - Hypertension, RF delay, mid systolic murmur
99
What does persistent ST elevation after an MI indicate, and what is the main concerning complication of this?
Left ventricular aneurysm which may result in thromboembolic stroke
100
When would you see a J wave?
In a hypothermic patient after the QRS complex
101
Outline the cardiac causes of syncope
Arrhythmia - brady/tachy
Structural - valvular, MI, HOCM
Other - PE
102
How does carotid sinus hypersensitivity cause syncope, and how is it diagnosed?
Carotid sinus massage involves massaging the carotid for 5 seconds which stimulates baroreceptors and the PNS. This increases vagal tone and SA/AV nodes resulting in a BP and HR drop. If the baroreceptor is hypersensitive - as it is in CSH - this can cause a ventricular pause, diagnostic when >3 seconds in duration
103
What are some causes of long QT syndrome?
Congenital - Romano Ward
Drugs - Amiodarone, sotalol, SSRIs, TCAs
Electrolyte abnormalities
104
What is the management of long QT syndrome?
B-blockers NOT sotalol (causes long QT)
105
What is the acute management of an SVT?
Valsalva manouvre/carotid sinus massage
IV adenosine if above fails (CI inasthmatics)
DC cardiovert
106
What investigation should patients with acute pericarditis have?
TTE
107
What is the ATLS management of PEA or asystole?
CPR with rhythm checks every two minutes
| 1mg adrenaline ASAP then every 3-5 minutes
108
What is the most common accompanying feature of an aortic dissection?
Hemiplegia
109
How do you manage a choking patient/
If patient able to talk - encourage coughing first then proceed to...
If patient unable to talk - 5 back blows then 5 abdo thrusts and repeat
110
What pulse is seen in LVF?
Pulsus alternans, where the upstroke varies between strong and weak
111
What is the target INR for patients with 1 or many occasions of VTE?
1 - INR 2.5
| more than 1 - INR 3.5
112
What is the management ladder for angina?
Aspirin and statin as standard
GTN for acute attacks
BB or CCB next
Beta blockers should not be prescribed with verapamil (CHB)
113
How do you manage a broad complex tachyarrhythmia?
No adverse features - IV amiodarone
| Adverse features - DC cardiovert
114
Name 4 CYP450 inducers
Carbamazepine
Phenytoin
Barbituates
St Johns Wart
115
Name 6 CYP450 inhibitors
```
Cipro
Erythro/clarithromycin
Isoniazid
Cimetidine
Omeprazole
Amiodarone
```
116
What are the features of cardiac tamponade?
Falling BP
Rising JVP
Muffled heart sounds
(Becks triad)
117
Which artery is blocked in a lateral MI?
Left circumflex
118
What other investigation must be done before a CTPA?
CXR
119
What may occur in patients with an ostium secundum septal defect?
Emboli may pass from the right sided circulation the left causing a stroke
120
Which cardiac drug predisposes to hyperuricaemia?
Thiazides
121
What murmur is seen in VSD patients?
PSM with loud P2
122
What QRISK2 score warrants statin prescription?
>10%
123
What investigation should be done in a patient with GFR 30 and a Wells score of 9?
V/Q scan (CTPA contraindicated due to contrast)
124
How does nicorandil work and what is it used for?
K channel activator with vasodilatory effects used in angina patients
125
What is the management of a patient with symptomatic Mobitz type two type two heart block?
Pacemaker insertion
126
What is the definitive of WPW?
Accessory pathway ablation
127
Kussmal sign vs pulsus paradoxus?
Kussmal sign is a rise in JVP on inspiration, while pulsus paradoxus is a drop in BP on inspiration
128
What are some of the side effects of beta blockers?
Bronchospasm
Insomnia/fatigue
Cold peripheries
Impotence
129
What should be done in the event of chest pain or haemodynamic instability following PCI for MI?
CABG - as this likely indicates that the procedure has failed and that myocardial ischaemia is continuing
130
Outline the NYHA HF classification
1 - no sx
2 - mild sx
3 - mod sx
4 - severe, sx at erst
131
You are asked to urgently review a 61-year-old female on the cardiology ward due to difficulty in breathing. On examination she has a raised JVP with bilateral fine crackles to the mid zones. Blood pressure is 100/60 mmHg and the pulse is 140-150 and irregular. ECG confirms atrial fibrillation. What is the most appropriate management?
This is a narrow complex tachycardia with HF as an 'adverse sign' so DC cardioversion is indicated
132
What should be done or patients on warfarin requiring emergency surgery?
If can wait 6-8 hours - 5mg vit K IV
| If cannot wait - Four factor prothrombin complex
133
What is trifascicular block?
RBBB
Left axis deviation
1st degree HB
134
Which antihypertensives cause hyperkalaemia, and which cause hypokalaemia/
Hyper - ACEi, ARB
| Hypo - Thiazides, Loop diuretics
135
What drug class is Indapamide?
Thiazide diuretic
136
What drug class is Bumetanide?
Loop diuretic
137
What are the common adverse effects of thiazide diuretics?
```
Dehydration
Gout
Postural hypos
HypoNa
HypoK
HypErCa with hypocalcuria
IGT
Impotence
```
138
S3 indicates?
DCM in older patients
| Normal if under 30
139
Which drugs improve mortality in HF?
ACEi
BBlockers
Spiro
140
Next HTN drug if already on A, C and D?
Alpha or Beta blocker
141
Which valve is commonly affected with IE in IVDU?
Tricuspid
142
What should be given to patients with major risk factors before a long haul flight?
Anti-embolic stockings
143
Which artery is commonly blocked in complete heart block?
the posterior interventricular artery which is a branch of the Right Coronary Artery
144
What is the full MOA of aspirin/
Inhibits Cox1 to reduce production of thromboxane A2
145
What are some poor prognostic factors in ACS?
```
Dev/Hx of heart failure
Age>65
Peripheral vascular disease
Hypotension
Elevated cardiac markers
```
146
What drug type are candesartan, irbesartan etc?
ARBs
147
What should be done if BP is >135/85 but <150/90 at first presentation/
Ambulatory blood pressure monitoring
148
What should be done for a warfarin patient with major bleeding?
Stop warfarin
5mg IV Vit K
Prothrombin Complex Concentrate
149
What should be done for a warfarin patient with INR>8 and minor bleeding?
Stop warfarin
Give 1-3mg IV vit K and repeat after 24hrs if necessary
Restart warfarin when INR<5
150
What should be done for a warfarin patient with INR>8 and no bleeding?
Stop warfarin
Give 1-5mg oral vit K and repeat after 24 hrs if necessary
Restart warfarin when INR<5
151
What should be done for a warfarin patient with INR 5-8 and minor bleeding/
Stop warfarin
Give IV vit K 1-3mg
Restart when INR<5
152
WHat should be done for a warfarin patient with INR 5-8 and no bleeding?
Withhold 1-2 doses
| Reduce subsequent maintenance dose
153
What dose of IV amiodarone is given initially in ATLS?
300mg
154
Which antihypertensives reduce awareness of hypoglycaemia?
Beta blockers
155
Which medications should MI PCI patients be discharged on?
DAPT
ACEi
Beta blocker
Statin
156
What agents are used for rate control of patients in fast AF?
1. Atenolol
2. Digoxin
3. CCBs
157
What agents are used to maintain sinus rhythm in patients with a Hx of AF?
Sotalol
Amiodarone
Flecainide
158
What iatrogenic causes of Torsades de Pointes/
```
Amiodarone
Sotalol
TCAs
Antipsyhotics
Chloroquine
Erythromycin
```
159
What is the management of TdP?
IV Magsulf
160
What are the features of constrictive pericarditis?
Dyspnoea
Peripheral oedema
Positive Kussmaul's sign
Pericardial knock
161
What drug class are Ivabradine, Nicorandil and Ranolazine and when are they used?
Long acting nitrates used for angina when CCBs are not tolerated
162
Eismenger presents following VSD/ASD/PDA, with cyanosis, RV failure, haemoptysis and clubbing, but what are the ECG findings?
RV hypertrophy
163
OUtline the management of orthostatic hypotension
Education and lifestyle advise
Discontinuing vasoactives (nitrates, antihypertensives, neuroleptics, dopamines)
Consider Fludricortisone
164
What should be tried next for angina if not controlled with Beta blockade/
CCB
165
Which medication must be temporarily stopped while on a macrolide and why?
Statins due to increased risk of rhabdomyolysis
166
A 59-year-old woman presents to the emergency department complaining of a three-day history of new-onset palpitations. She has no structural or ischaemic heart disease. Her heart rate is 120bpm, and she shows no signs haemodynamic compromise. Her ECG shows an irregularly irregular rhythm with the absence of p waves. The consultant recommends elective cardioversion for this patient. Which one of these management plans is the most appropriate for this patient?
Bisoprolol and oral anticoagulant therapy for 3 weeks and then electrical cardioversion
167
Where and on what do loop diuretics act?
NaKCl cotransporter in the thick ascending limb of the loop of Henle
168
What ECG change is seen in patients with mitral stenosis?
P mitrale (L atrial hypertrophy)
169
Young male smoker with limb ischaemia think...
Buerger's
170
Which antianginal might patients develop a tolerance to?
Isosorbide mononitrate
171
A 52-year-old male presents with tearing central chest pain. On examination he has an aortic regurgitation murmur. An ECG shows ST elevation in leads II, III and aVF.
Proximal aortic dissection
172
What should you do if you see new onset LBBB in the context of chest pain?
PCI/thrombolysis
173
Which drugs are used for chemical cardioversion in AF?
Amiodarone + Flecainide
174
What should be given in a stable SVT when adenosine 6mg fails?
Adenosine 12mg
175
What is the management of symptomatic bradycardia if 6 doses of atropine fails?
External pacing
176
What is the time limit for primary PCI?
2 hours
177
What are the common side effects of amiodarone?
```
Bradycardia
Thyroid dysfunction
Pulm fibrosis
Hepatitis/fibrosis
Jaundice
Slate grey skin
N&V
Constipation
```
178
Atropine
Amiodarone
Adenosine
When do you use them?
Atropine is for symptomatic bradys
Amiodarone is for VT/VF
Adenosine is for SVTs
179
What is the MOA of LMWH?
Activates antithrombin 3
180
What is the BP target for T2DM?
<140/80
181
What is the commonest cause of mitral stenosis?
Hx of RhFever
182
What is the acute management of a PE?
LMWH
| Unless massive PE or hypotensive in which case unfractionated heparin and thrombolysis is indicated
183
What is the secondary prevention of a PE?
Warfarin for 3 months (extend if unprovoked PE)
| If active cancer then use LMWH for 6 months
184
What may cause a falsely low BNP?
ACEi
185
What is the protocol for a witnessed cardiac arrest while on a monitor?
Up to 3 successive shocks before CPR
186
What investigation is first line for stable angina?
Contrast enhanced coronary CT angiography
187
What access is required for administration of adenosine?
Large bore cannula in large calibre vein or (ideally) centrally
188
What is the MOA of alteplase?
Converts plasminogen to plasmin
189
When should young type 1 diabetics be offered primary CV prevention?
Older than 40 OR
Diavetic more than 10 years OR
Established nephropathy OR
Other CV riskf actors
190
WHat should be added to hypertensive pts already on A + C + D with a K+ <4.5?
Spiro
191
WHen do you use flecainide and when do you use amiodarone for chemical cardioversion of AF?
Use amiodarone if there is evidence of underlying structural disease
192
What class of drug is contraindicated in aortic stenosis?
NItrates
193
When should statin treatment be discontinued (LFTs)
If transaminases are persistently above 3 times the upper limit
194
Inheritence pattern of HOCM?
AD
195
What is the main cause of sudden death in HOCM patients?
Ventricular arrhythmia
196
What are the features of hypercalcaemia?
Bones stones groans moans
| Shortened QT interval
197
What is the optimal management of an ascending aortic aneursym?
Aortic root replacement
198
Which valvular disease is associated with PKD?
Mitral valve prolapse
199
What rogue Xray thing is seen in CoA?
Notching of the inferior border of the ribs
200
A 65-year-old man calls an ambulance as he has central crushing chest pain that radiates to his left arm and jaw. As he arrives at the emergency department his heart rate is found to be 50/min. An ECG is performed which shows ST elevation and bradycardia with a 1st-degree heart block.
Given the history, which of the following are the leads will most likely show the ST elevation?
Inferior
201
What time of day should statins be taken at?
Night
202
What is the BP target for diabetics with signs of end organ damage?
<130/80
203
What regarding blood products is indicated in patients with suspected ruptured AAA?
X match 6 units
204
How might a DVT cause a stroke and not a PE?
ASD
205
Give some important side effects of furosemide
```
Hypotension
HypoNaKMgCa -> osteoporosis
Ototoxicitiy
Renal impairment
Gout
```
206
Give two contrainidications to statin therapy
Pregnancy
| Macrolides
207
What condition can cause a bisferiens pulse?
HOCM
208
True or false ; warfarin is safe for use in breastfeeding women
True
209
What investigations should be done before starting a patient on amiodarone?
FBC
TFT
UNE
CXR
210
A 65-year-old lady with long-term type II diabetes mellitus had been suffering from recurrent falls due to orthostatic hypotension. During the table tilt test, it was noted that her systolic blood pressure reduced by 30mmHg. Her heart rate remained unchanged despite the drop in the blood pressure. She drinks a glass of wine on rare occasions.
Which of the following contributes to the lack of heart-rate response to standing in this patient?
Diabetes
Dehydration/anaemia cause an exaggerated increase in HR
211
What is the most common cause of death in patients following MI?
VF
212
What is the management of IE causing CCF?
Emergency valve replacement surgery
213
True or false; furosemide increases life expectancy in HF
False
214
What is Subclavian steal syndrome?
Posterior circulation symptoms (dizziness and vertigo) during exertion of an arm
215
What are the side effects of GTN sprays?
Hypotension
tachycardia
headaches
216
One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.
Papillary muscle rupture leading to acute mitral regurg
217
What are the diagnostic criteria for Osler Weber Rendu syndrome (HHT)?
Epistaxes
Telangiectasiae at multiple sites
Visceral lesions
FHx
218
What is the definitive management of an uncomplicated descending aortic dissection?
Beta blockade and analgesia alone
219
Standard post ischaemic stroke management/secondary prevention?
Asp 300 for 2 weeks then clopi 75 lifelong
220
A 58-year-old female on the respiratory ward was admitted with a pulmonary embolism one week ago and was started on warfarin at the time of diagnosis. She was covered with low molecular weight heparin until the INR was > 2 for 24 hours. For the past week she has been taking 4mg of warfarin and her INR four days ago was 2.2. Her INR has been checked today and is 1.3.
What is the most appropriate action to take?
Increase warfarin to 6mg and start LMWH till INR>2
