Cardiology

Question 1

Name 2 physiologic arrhythmias

Answer 1

Sinus arrythmia, 1st/2nd degree AV block

Question 2

Name 3 pathologic arrhythmias

Answer 2

3rd degree AV block
Ventricular Premature Complexes
Atrial Fibrillation

Question 3

What are 3 DDx/underlying causes of pathologic arrhythmias

Answer 3

Quinidine toxicity
Electrolyte imbalance (K)
Systemic Disease/Inflam

Question 4

What is the cause of physiologic arrhythmias

Answer 4

Vagally mediated - disappear with exercise

Question 5

What is S1 associated with?

Answer 5

closure of AV valves

Question 6

What is S2 associated with?

Answer 6

closure of semilunar valves

Question 7

What is S3 associated wtih?

Answer 7

Rapid ventricular filling (early diastole)

Question 8

What is S4 associated wtih?

Answer 8

Atrial depolarisation/kick

Question 9

List 5 signs of cardiac disease

Answer 9

Poor athletic performance
Jugular distension
Ventral oedema
Pale/cyanotic mm
Tachycardia/altered PP

Question 10

What does QUILTS stand for?

Answer 10

QUality
Intensity
Location
Timing 
Shape

Question 11

When are you indicated to tx VPCs?

Answer 11

when they are frequent +/- polymorphic

Question 12

How do you treat polymorphic VPCs

Answer 12

• tx any underlying cause
• magnesium sulphate bolus
• lidocaine bolus –> CRI
• procainamide 1mg/kg/min CRI (up to 20mg/kg)
• propanolol 0.03mg/kg IV
• propofenone 1mg/kg in 5% D5W over 5min IV

Question 13

What pathologic heart murmur is excluded if you hear S4

Answer 13

Atrial fibrillation

Question 14

2 characteristics of supraventricular premature complexes

Answer 14

• Reduced R-R interval

- abnormal, monophasic P waves (usu. bi-phasic)

Question 15

What are DDx for supraventricular atrial tachycardia

Answer 15

if P waves visible – sinus tachycardia

if P waves not visible - ventricular tachycardia

Question 16

3 characteristics of atrial fibrillation

Answer 16

• irregularly irregular
• no S4
• variable heart sounds/pulse intensity

Question 17

2 characteristics of ventricular premature contractions

Answer 17

• no P wave

- wide and bizarre QRS

Question 18

What do VPCs predispose to?

Answer 18

VPCs –> Vtach –> V.Fib

Question 19

Describe a Grade 1 heart murmur

Answer 19

a soft murmur audible only careful auscultation in a localised area of the thorax – often inconsistent. (Night time murmur)

Question 20

Describe a Grade 2 heart murmur

Answer 20

a soft murmur which is clearly audible after a few seconds of auscultation.

Question 21

Describe a Grade 3 heart murmur

Answer 21

a moderately loud murmur that is immediately audible even if off by 1-2 rib spaces. Similar intensity to S1 and S2.

Question 22

Describe a Grade 4 heart murmur

Answer 22

a loud murmur that is immed. Audible over a wide area of the thorax w/ no precordial thrill. Radiates.

Question 23

Describe a Grade 5 heart murmur

Answer 23

the loudest murmur that becomes inaudible when the stethoscope is removed from direct contact w/ thorax. Precordial thrill.

Question 24

Describe a Grade 6 heart murmur

Answer 24

the loudest murmur that can still be heard when the stethoscope is removed from direct contact w/ thorax + precordial thrill.

Question 25

What is the difference between pan and holosystolic?

Answer 25

Pan- can’t hear heart sounds

Holo - can hear heart sounds

Question 26

What are the murmur qualities of mitral valve regurgitation?

Answer 26

Harsh
Varied intensity
L.apex (radiates dorsally)
Holosystolic
Band

Question 27

What are the murmur qualities of tricuspid valve regurgitation?

Answer 27

Blowing-Harsh
Varied intensity
R. 4th ICS
Pansystolic
Band

Question 28

What are the murmur qualities of aortic valve regurgitation?

Answer 28

Musical
Varied
L.base radiates bilaterally
Band, Holo or early diastolic
Decrescendo

Question 29

What are the murmur qualities of VSD?

Answer 29

RIGHT SIDE = LOUD
Pansystolic
Band

LEFT SIDE (Base) = SOFT = relative pulmonic stenosis
Systolic
Crescendo-Decrescendo

Question 30

What are the qualities of physiologic/flow murmur?

Answer 30

Soft, blowing
<2 in grade
L.base
Early/short systolic

Question 31

What is the lead placement to collect an ECG in a horse?

Answer 31

RA = R.scap/R.jug. groove
LA = behind L.elbow
LH = left neck/scapula, jug. groove

Question 32

what is a wide P wave indicative of?

Answer 32

L.atrial enlargement

Question 33

what is a tall P wave indicative of?

Answer 33

R.atrial enlargement

Question 34

what is a narrow/spiked T wave indicative of?

Answer 34

hyperkaelamia

Question 35

what does a wide/bizzare QRS complex tell you? Vs. a normal one?

Answer 35

Origin; wide/bizarre - ventricular

vs. normal - supraventricular

Question 36

what does a P wave w/out a QRS complex tell you?

Answer 36

there is an AV block

Question 37

What does a QRS complex w/out a P wave tell you?

Answer 37

Ectopic foci

Question 38

No P wave?

Answer 38

SA block

Question 39

a 50mm/sec paper means 1 large box = how many seconds

Answer 39

0.1 seconds

Question 40

a 50mm/sec paper means 1 small box = how many seconds

Answer 40

0.02 seconds

Question 41

At a paper speed of 25mm/second, count the number of QRS complexes in 6 seconds (usually denoted by black ‘ticks’ on the paper) and multiple by ?

Answer 41

10

Question 42

At 50mm/second, the same length of strip will be 3 seconds, so multiple the number of QRS complexes by ?

Answer 42

20

Question 43

An irreg. rhythm w/ abnormal QRS morphology is more likely to be ? in origin.

Answer 43

ventricular

Question 44

• A changing P wave morphology, normal rate and QRS complex after each P wave, and irreg. rhythm signals a ???? (as the electrical impulse originates in several different areas of the R.atrium that may/may not include the sinus node). Usually vagally-mediated and physiologic. (stops w/ sympathetic drive)

Answer 44

wandering pacemaker