cardiology

Question 1

investigation for infective endocarditis

Answer 1

3 blood cultures taken from different parts of the body atleast 1 hour apart and a transoesophageal echocardiogram

Question 2

diagnosis for infective endocarditis

Answer 2

dukes critera: either 2 major criteria, 1 major and three minor or 5 minor

Question 3

What is in duke major criteria

Answer 3

positive blood culture tests, strong suggestive abnormality on echo

Question 4

what is in duke minor criteria

Answer 4

fever more than 38, positive blood culture, but not for correct organism, cardiac/valvular abnormality, vasculitic phenomenon, embolic phenomenon, suggestive echo

Question 5

When does aortic stenosis in someone with a biscupid valve present

Answer 5

by 30 years

Question 6

what is the difference between stenosis and regurgitation

Answer 6

stenosis: valve cannot open properly and impedes forward flow and regurgitation: cannot close properly causing reverse flow

Question 7

In which group is mitral valve prolapse most common

Answer 7

mainly women

Question 8

most common cause of mitral valve regurg

Question 9

what happens to the valves during mitral valve prolapse

Answer 9

dense collagen and elastin matrix is replaced by myxoedematous glucoaminoglycans

Question 10

What is acute heart failure always a complication of

Answer 10

MI, either ischaemia, papillary muscle rupture or developing an arrythmia

Question 11

what is the most important risk factor for developing AAA

Answer 11

atherosclerosis

Question 12

characterising malignant/accelerated hypertension

Answer 12

marked raised diastolic pressure over 130mm-140Hg in younger adults where their arteries are not protected by atherosclerosis, fibrinoid necrosis nests are formed within arteries and there are complications of acute renal failure, blindness and microangiopathic haemolytic anaemia and DIC are complications

Question 13

investigation for all patients with suspected pericarditis

Answer 13

transthoracic echo

Question 14

what is the first and second line for supraventricular tachycardia

Answer 14

valslava manouevre and then adenosine

Question 15

side effect of adenosine

Answer 15

flushing

Question 16

Where does furosemide act

Answer 16

ascending loop of henle

Question 17

when should people with a NSTEMI need a coronary angiography

Answer 17

grace score more than 3% do a coronary angiography within 72 hours

Question 18

common cause of infective endocarditis in iv drug users

Answer 18

staph auerus- highly pathogenic

Question 19

what to do for severe pneumonia (CAP)

Answer 19

coamoxiclav

Question 20

What pneumonia causative agents does the urine antigen test for

Answer 20

legionella and strep pneumoniae

Question 21

how are TSH and T4 and T3 affected by severe pneumoniae

Answer 21

normal TSH and low T4/T3

Question 22

give examples of inspiratory and expiratory wheeze

Answer 22

inspiratory: croup, epiglottitis, anaphylaxis and expiratory: COPD and asthma

Question 23

where would you see curshmann’s spirals

Answer 23

asthma

Question 24

ejection systolic murmurs

Answer 24

aortic stenosis, pulmonary stenosis

Question 25

pansystolic murmur

Answer 25

mitral regurgitation, tricuspid regurgitation and ventricular septal defect

Question 26

mid systolic murmur

Answer 26

mitral valve prolapse

Question 27

early diastolic

Answer 27

aortic regurgitation

Question 28

mid diastolic

Answer 28

tricuspid stenosis and bicuspid stenosis

Question 29

which hypertensive medication should we avoid in someone with gout

Answer 29

thiazide like diuretic: bendroflumethiazide

Question 30

hypotension, tachycardia and muffled heart sounds and raised JVP

Answer 30

cardiac tamponade

Question 31

example of a shockable rhythm

Answer 31

monomorphic ventricular tachycardia without a pulse

Question 32

short and long term treatment for complete heart block

Answer 32

transcutaneous pacing is temporary to wait for a pacemaker

Question 33

what is long QT syndrome and bazots formula

Answer 33

long QT syndrome: is 470ms in men and 440ms in women when there is coprescription of a macrolide and antiepileptic medication

Question 34

what can cause hypoxic ischaemic strokes

Answer 34

. Precipitous drops in blood pressure can cause “watershed” area ischaemic strokes.

Question 35

difference between mobitz i and ii

Answer 35

i is progressively increase PR until P wave drops and ii is constant PR with occasional non conducted p waves and first degoree is when they get progressively longer but no effect on P waves

Question 36

dizziness and yellowing of vision describes the toxicity of which drug

Answer 36

digoxin and can be caused by hypokalaemia

Question 37

feature of pericarditis on an ecg

Answer 37

saddle shaped st elevation

Question 38

which medication is contraindicated in aortic stenosis

Answer 38

nitrates like GTN

Question 39

when do you offer cardiac resynchronisation therapy

Answer 39

in an ejection fraction less than 35%

Question 40

reduced ejection fraction with continual heart failure symptoms: treatments

Answer 40

ARB/ACEi, mineralocorticoid receptor and beta blocker

Question 41

st elevation in someone with no obstructtive coronary heart disease and looks like an octopus pot

Answer 41

takotsubo cardiomyopathy

Question 42

angina with beta blocker is insufficieent what can be used in combination

Answer 42

long acting dihydrapyridine calcium channel blocker

Question 43

angina but asthmatic first line medication

Answer 43

rate limitng ccb: dilitazem

Question 44

which of the following is not associated with aortic stenosis: soft S2, ejection click murmur, narrow pulse pressure and S4 heart sound and quinickes sign

Answer 44

quinickes sign and s4 heart sound

Question 45

u waves

Answer 45

hypokalaemia

Question 46

turners syndrome aortic valve

Answer 46

bicuspid aortic valve

Question 47

ECG changes in v1 to v4- part of the heart and artery affected

Answer 47

anteroseptal and left anterior descending

Question 48

ECG changes in I II avF- part of the heart and artery affected

Answer 48

inferior and right coronary artery

Question 49

ECG changes in I, avL, V5-6 part of the heart and artery affected

Answer 49

lateral, left circumflex

Question 50

ECG changes in I avL, v1-v6 part of the heart and artery affected

Answer 50

anterolateral, proximal left anterior descending

Question 51

ECG changes in v1-3 part of the heart and artery affected

Answer 51

posterior, left circumflex and right coronary

Question 52

beck's triad for cardiac tamponade

Answer 52

hypotension, muffled heart sounds and sitended neck veins

Question 53

what can an aortic abscess lead to

Answer 53

complete heart block as it is close to the AVN node

Question 54

does aortic regurgitation lead to HFNEF, HFrEF

Answer 54

HFrEF

Question 55

pansystolic murmur radiating to the axilla

Answer 55

mitral regurgitation

Question 56

quinickes sign

Answer 56

nail bed pulsation due to aortic regurg: early diastolic

Question 57

which medication can lead to redcued hypoglycaemic awareness

Answer 57

beta blockers

Question 58

first line treatment for otitis externa

Answer 58

topical antibiotics