Cardiology

Question 1

Heart sounds

S1

Answer 1

• closure of mitral and tricuspid valves
• soft if long PR or mitral regurg
• loud in mitral stenosis

Question 2

Heart sounds

S2

Answer 2

• closure of aortic and pulmonary valves
• soft in aortic stenosis
• splitting during inspiration is normal

Question 3

Heart sounds

S3

Answer 3

• caused by diastolic filling ventricle
• normal if <30
• heard in LVHF e.g. dilated cardiomyopathy, constrictive pericarditis (pericardial knock), mitral regurgitation

Question 4

Heart sounds

S4

Answer 4

• aortic stenosis, HOCM, hypertension

- caused by atrial contraction against a stiff ventricle (coincides with the P wave on ECG)

Question 5

Reversible causes of cardiac arrest
- pneumothorax
What kind of arrest rhythm

Answer 5

• pulseless electrical activity

Question 6

ECG P wave changes

Answer 6

• increased P wave amplitude in cor pulmonale
• broad, notched bifid P wave: pronounced in lead II due to mitral stenosis (enlargement of left atria)
• absent P waves in AF

Question 7

Mitral regurg associations

Mitral valve prolapse

Answer 7

• Marfan’s syndrome and Ehlers- Danilo’s syndrome, PCKD

- pansystolic murmur due to AR

Question 8

Causes of postural hypotension

Answer 8

• hypovolaemia
• autonomic dysfunction: diabetes, Parkinson’s
  Drugs: diuretics, antihypertensives, L-dopa
• alcohol

Question 9

Features of autonomic dysfunction

Answer 9

• postural hypotension
• loss of respiratory arrhythmia
• erectile dysfunction

Question 10

Warfarin

Answer 10

• prolonged prothrombin time

- normal aptt

Question 11

What is a trifasicular block

Answer 11

• RBBB + left anterior or posterior hemiblock + 1sr degree heart block

Question 12

Murmurs

Ejection systolic

Answer 12

- tetralogy of fallot
Louder on expiration 
- AS, HOCM 
Louder on inspiration 
- PS, ASD

Question 13

Murmurs (pansystolic)

Answer 13

• mitral/ tricuspid regurg

- VSD

Question 14

Late systolic

Answer 14

• mitral valve prolapse

- coarctation of aorta

Question 15

Early diastolic

Answer 15

• AR

Question 16

Mid-late diastolic

Answer 16

• MS

- Austin flint murmur (serve aortic regurg)

Question 17

Continuous machinery like murmur

Answer 17

PDA

Question 18

Bifasciular branch block

Answer 18

• RBBB + left axis deviation

Question 19

Mechanism of thrombolytic drugs

Answer 19

• activates plasminogen to form plasmin

Question 20

Pharmacological Rx for orthostatic hypotension

Answer 20

• fludrocortisone and midodrine

Question 21

Ace - i

Cautions

Answer 21

• pregnancy and breastfeeding
• renovascular disease
• AS

Question 22

Loud S2 causes

Answer 22

• hypertension A2 or P2

- hyper dynamic states

Question 23

Soft S2 causes

Answer 23

• AS