Cardiology

Question 1

Hyperkalaemia ECG changes

Answer 1

Tall T waves
Prolonged PR interval
Flattened/absent P waves

Question 2

Severe hyperkalaemia ECG changes

Answer 2

Wide QRS
Sine wave pattern
Ventricular tachycardia/ventricular fibrillation/asystole

Question 3

Loud S2

Answer 3

Pulmonary hypertension (loud P2)
Systemic hypertension

Question 4

Soft S2

Answer 4

Aortic stenosis

Question 5

Widely split S2

Answer 5

Deep inspiration
RBBB
Pulmonary stenosis

Question 6

Fixed in the middle S2

Answer 6

Atrial septal defect

Question 7

Reverse split S2

Answer 7

LBBB
Severe aortic stenosis

Question 8

ASD

Type of murmur
Loudest when

Answer 8

Ejection systolic murmur
Louder on inspiration

Question 9

Mitral regurgitation

Type of murmur
Loudest when

Answer 9

Pansystolic
Louder on expiration

Question 10

Loud S1 causes

Answer 10

Hyperdynamic states
Tachycardic states
Left-to-right shunts
Short PR interval

Question 11

Soft S1 causes

Answer 11

Hypo-dynamic states
Mitral regurgitation
Poor ventricular function
Long PR interval

Question 12

Split S1 causes

Answer 12

RBBB
LBBB
VT
Inspiration
Ebstein’s anomaly (congenital tricuspid regurgitation)

Question 13

Variable intensity S1 (causes)

Answer 13

Complete heart block
Atrial fibrillation

Question 14

Cannon a waves (causes)

Answer 14

Atrial contraction against closed tricuspid
Complete heart block

Question 15

Tricyclic overdose (ECG changes)

Answer 15

Sinus tachycardia
Widening of QRS
Prolongation of QT interval

Question 16

Syncope
Previous MI
HR 80
Displaced apex beat
No chest pain
ST elevation and Q waves on ECG

Answer 16

Ventricular tachycardia

Question 17

Left ventricular aneurysm (ECG changes)

Answer 17

Persistent ST elevation and Q waves

Question 18

Restoring sinus rhythm in a young patient with acute onset AF

Answer 18

Flecainide

Question 19

Causes of upper zone fibrosis

Answer 19

Coal workers pneumoconiosis
Histiocytosis
Ankylosing sponylitis
Radiation
TB
Sarcoidosis

Question 20

Causes of lower zone fibrosis

Answer 20

Most connective tissUe disorders (RA…)
Astbestosis
Idiopathic
Drugs (methotrexate)

Question 21

Constrictive pericarditis signs

Answer 21

Earliest: hepatomegaly
- pericardial knock
- ascites

Question 22

Giant a waves (and v waves)

Answer 22

Tricuspid regurgiation

Question 23

Collapsing pulse

Answer 23

Aortic regurgitation
Arterio-venous fistula
Patent ductus arteriosus

Question 24

Slow rising pulse

Answer 24

Aortic stenosis

Question 25

Bisferiens pulse

Answer 25

double shudder due to mixed aortic valve disease

Question 26

Jerky pulse

Answer 26

HOCM

Question 27

Alternans pulse

Answer 27

Severe LVF

Question 28

Pulsus paradoxus

Answer 28

Excessive reduction in pulse with inspiration (drop in BP) Tamponade Ventricular compression Constrictive pericarditis Severe asthma

Question 29

Septal MI ST elevation Blood vessel

Answer 29

V1-V2 Left anterior descending

Question 30

Anterior MI ST elevation Blood vessel

Answer 30

V3-V4 Left anterior descending

Question 31

Lateral MI ST elevation Blood vessel

Answer 31

V5-V6 Left anterior descending

Question 32

Left anterior descending localisation

Answer 32

Septal MI Anterior MI Lateral MI

Question 33

Inferior MI ST elevation ST depression Blood vessel

Answer 33

II, III, aVF aVL (reciprocal STD) Right coronary artery (RCA)

Question 34

Posterior MI ST elevation ST depression Blood vessel

Answer 34

V7-V9 V1-V3 left circumflex and RCA

Question 35

B-type natriuretic peptide Origin...

Answer 35

Cardiac ventricles

Question 36

Complete heart block secondary to an inferior myocardial infarction Management

Answer 36

Manage conservatively

Question 37

Vessel supplying AV node

Answer 37

Right coronary (90% of patients)

Question 38

Long QT causes Electrolytes: Drugs: Others:

Answer 38

Electrolytes: hypokalaemia, hypocalcaemia Drugs: tricyclic antidepressants, antihistamines, erythromycin, clarithromycin, amiodarone, haloperidol Congenital long QT MI Cerebrovascular incident (SAH) hypothermia

Question 39

HOCM treatment ABCDE

Answer 39

Amiodarone Beta blocker or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis

Question 40

Brugada Features ECG findings

Answer 40

Palpitations, syncope, sudden death ST elevation V1 to V3

Question 41

Valvular issue in pulmonary hypertension

Answer 41

Functional tricuspid regurg (pansystolic murmur)

Question 42

Post-MI signs of LVF Which treatment to add?

Answer 42

Aldosterone antagonist -> e.g. epleronone

Question 43

SVT + asthma = ?treatment

Answer 43

Verapamil

Question 44

Angiodysplasia of gut linked to which valvular disorder?

Answer 44

Aortic stenosis

Question 45

Management of cocaine-related MI

Answer 45

IV benzodiazepines

Question 46

AV block (heart block) affected by which MI territory?

Answer 46

Inferior MI

Question 47

Hypercalcaemia ECG changes

Answer 47

Shortening of QT interval J waves (in severe hypocalcaemia)

Question 48

Which area has fastest conduction velocity in heart?

Answer 48

Purkinje fibres

Question 49

Digoxin toxicity ECG changes

Answer 49

Prolonged PR interval Short QT interval ST depression Inverted T waves

Question 50

Anti-anginal treatment

Answer 50

1. Statin and aspirin 2. Beta-blocker or calcium channel blocker (verapamil or diltiazem) 3. Titrate monotherapy to max dose 4. Add the other from 2nd line 5. If thinking of adding ivabradine or nicorandil - assess for PCI first

Question 51

S3 (ventricular gallop rhythm)

Answer 51

LVF Normal in children/young adults

Question 52

Troponin I binds to...

Answer 52

actin

Question 53

Factors causing high pulse pressure (high SBP)

Answer 53

Reduced aortic compliance High stroke volume