Cardiology

Question 1

Pulsus paradoxus (>10mmHg fall in SBP during inspiration) -

Answer 1

severe asthma, cardiac tamponade

Question 2

SLow rising/ plateau pulse

Answer 2

Aortic stenosis

Question 3

Collapsing pulse (3)

Answer 3

Aortic regurgitation, patent ductus arteriosus, hyperkinesis (anaemia, thrytotoxic, fever, exercise, pregnancy)

Question 4

Pulsus alternans

Answer 4

severe LVF

Question 5

Bisferiens pulse (double pulse)

Answer 5

Mixed aortic valve disease

Question 6

jerky pulse

Answer 6

HOCM

Question 7

BNP actions (3)

Answer 7

vasodilator
diuretic and natriuretic
supress sympathetic tone and RAAS

Question 8

Cause of loud S2 (2)

Answer 8

hypertension (systemic A2, pulmonary P2)

ASD

Question 9

Cause of soft S2

Answer 9

aortic stenosis

Question 10

Cause of split S2 (5)

Answer 10

ASD (fixed split S2)
deep inspiration
RBBB
pul stenosis
Mitral regurg

Question 11

warfarin MOA

Answer 11

inhibit epoxide reductase therefore preventing reduction of vit K. Acts as cofactor for clotting factor II, VII, IX, X and protein C

Question 12

Causes of Endocarditis (5)

Answer 12

Staph aureus (most common) - IVDU
Strep viridans (eg mitis/ sanguinis) - associated poor dentition
Staph Epidermidis (coag neg) - perioperative, valve surgery, indwelling lines
Staph bovis - colorectal Ca
non infective - SLE, malignancy

Question 13

Target INR
VTE
Mechanical Aortic
Mechanical Mitral

Answer 13

VTE - 2.5, if recurrent 3.5
Aortic 3.0
Mitral 3.5

Question 14

Wold parkinson white ECG features (3)

Answer 14

short PR
wide QRD + slurred upstroke (delta)
left axis deviation (if right side accessory pathway)

Question 15

Wolf parkinson white Mx (2)

Answer 15

definitive: radiofrequency ablation
Medical: sotalol (avoid in AF), amiodarone, flecainide

Question 16

Angina Mx

Answer 16

1st aspirin + statin (all patients)
2nd B blocker/ CCB (verapamil or diltiazem) - maximise monotherapy before adding another
3rd add B block or CCB (nifedipine if dual therapy)

Question 17

JVP:
Prominent V
Cannon A
Absent A
Prominent X
Absent X

Answer 17

Prominent V - Tricuspid regurg
Cannon A - complete heart block
Absent A - AF
Prominent X - cardiac tamponade/ constrictive pericarditis
Absent X - AF

Question 18

Clopidogrel MOA

Answer 18

P2Y12 ADP receptor antagonist, inhibiting platelet activation

Question 19

HOCM Mx (5)

Answer 19

Amiodarone
B blocker/ CCB
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

Question 20

S3 heart sound

a) caused by
b) found in

Answer 20

diastolic filling of ventricle
normal if <30 years old
found in LVF (dilated CM), constrictive pericarditis, Mitral regurg

Question 21

S4 heart sound

Answer 21

atrial contraction against stiff ventricle (coincide with P wave on ECG)
found in aortic stenosis, HOCM, HTN

Question 22

Torsade de pointes Mx

Answer 22

IV Magnesium sulfate

Question 23

Warfarin and emergency surgery

a) surgery in 6-8 hours - give?
b) surgery immediately - give?

Answer 23

a) IV Vit K 5mg

b) four factor prothombin complex

Question 24

Multifocal atiral tachycardia Mx

Answer 24

CCB - verapamil

Question 25

Major bleeding + warfarin Mx

Answer 25

Cease warfarin Vit K 5mg IV Prothrombin complex

Question 26

Post Inferior MI complication (1)

Answer 26

Atrioventricular block (bradycardia)

Question 27

HOCM gene mutation

Answer 27

HOCM due to a mutation in the gene encoding β-myosin heavy chain protein or myosin binding protein C

Question 28

Chronic Heart Failure Mx (3)

Answer 28

1st: ACEi + B Blocker 2nd: Spriniolactone 3rd: Ivabradine/ Digoxin/ Sacubitril-Valsartan/ Hydralazine/ Cardiac resynchronisation

Question 29

Digoxin ECG changes (4)

Answer 29

down-sloping ST depression ('reverse tick', 'scooped out') flattened/inverted T waves short QT interval arrhythmias e.g. AV block, bradycardia

Question 30

pansystolic murmur cause inspiration expiration

Answer 30

inspiration - tricuspid regurg | expiration - mitral regurg

Question 31

Ejection systolic murmur causes expiration (2) inspiration (2)

Answer 31

expiration: aortic stenosis, HOCM inspiration: ASD, pulmonary stenosis

Question 32

SUpraventricular arrhythmia Mx

Answer 32

1st - vagal manoeuvers 2nd - IV Adenosine 6mg, 12mg, 18mg (contraindicated in asthmatics, give verapamil) 3rs - DC cardioversion

Question 33

Infective endocarditis antibiotics a) Generic b) prosthetic valve

Answer 33

a) Amoxicillin + Gent | b) Vancomycin + Rifampicin + Gent

Question 34

Cannon a wave regular irregular

Answer 34

a) regular - AVNRT, VT | b) irregular - complete heart block

Question 35

wolf parkinson white Mx

Answer 35

accessory pathway ablation

Question 36

``` Moa Heparin Clopidogrel Abciximab Dabigatran Rivaroxaban ```

Answer 36

``` Drug name MOA Heparin activates anti-thrombin III Clopidogrel P2Y12 inhibitor Abciximab glycoprotein IIb/IIIa inhibitor Dabigatran direct thrombin inhibitor Rivaroxaban direct factor X inhibitor ```

Question 37

Complete heart block heart sound

Answer 37

Variable s1

Question 38

Eisenmenger's syndrome describes...

Answer 38

the reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.

Question 39

Reversal agents: a) Dabigatran b) Heparin

Answer 39

a) idarucizumab | b) Protamine sulphate

Question 40

Congenital heart disease Most common cyanotic: (2) acyanotic: (1)

Answer 40

cyanotic: TGA most common at birth, Fallot's most common overall acyanotic: VSD most common cause

Question 41

Amiodarone - MOA:

Answer 41

blocks potassium channels

Question 42

Mitral stenosis definitive Mx (2)

Answer 42

1st: Percutaneous mitral commissurotomy | 2nd (if surgery contraindicated): Transcatheter mitral valve repair

Question 43

Brugada ECG changes

Answer 43

convex ST elevation in V1-V3 with a partial right bundle branch block