Cardiology

Question 1

Risk factors to assess for cardiac disease?

Answer 1

Smoking, alcohol, obesity, diabetes, low exercise, kidney disease, atypical antipsychotics

Question 2

What scoring system do you use to assess stroke and myocardial infarction risk?

Answer 2

QRISK 3 score

Question 3

What medication should you consider for primary prevention of cardiovascular disease and in what instances?

Answer 3

If QRISK 3 >10% of stroke/MI in 10 years then start atorvastatin 20mg OD at night.
OR
in CKD or Type I diabetes

Question 4

What should you check if you are starting a statin and why?

Answer 4

You should check lipids, after 3 months you should see a 40% reduction in non HDL cholestrol.

Check LFTs at 0, 3 and 12 months. Transient increase in ALT and AST is nomral but not more than 3x normal

Question 5

What is the treatment regime for secondary prevention of cardiac events?

Answer 5

AABS

Asprin and clopidogrel
ACE inhibitor
Beta blocker
Statin

Question 6

What is the difference between stable and unstable angina

Answer 6

Stable angina only happens with exercise
Ustable angina happens even at rest

Question 7

What investigations should you do for Angina

Answer 7

Physical examination
ECG
Bloods - U&Es, LFTs, FBC, lipids, thyroid, Hba1c
CT coronary angiogram

Question 8

What is the correct GTN usage ?

Answer 8

Spray under tounge , again at 5 minutes, at 10 minutes if there is still pain call 999

Question 9

Secondary prevention of cardiac disease

Answer 9

Aspirin and clopidogrel
ACE inhibitor
Beta blocker
Statin

Question 10

What is an NSTEMI

Answer 10

Raise Troponin levels alongside ST depression, T wave inversion or pathological Q waves

Question 11

When should you take troponin levels?

Answer 11

At onsent, 6 hours and 12 hours

Question 12

What is the acute NSTEMI treatment (medical)

Answer 12

BATMAN
Betablockers
Aspirin - 300mg
Ticagrelor 180mg or clopidogrel
Moprhine
Anticoagulant - enoxaparin
Nitrates

Question 13

What is dresslers syndrome?

Answer 13

Pericarditis 3 weeks after an MI

Question 14

How does dresslers syndrome present

Answer 14

Pleuritic chest pain

Question 15

What are the signs of dresslets syndrome

Answer 15

Pericardial rub,
ECG global ST elevation and T wave inversion
Raised CRP and ESR

Question 16

What is the treatment for dresslers syndrome?

Answer 16

NSAIDs and Steroids

Question 17

What is the secondary prevention medication for MIs

Answer 17

6As,
Aspirin
Another antiplatelet
Atorvastatin
ACE inhibitors
Atenolol
Aldosterone anatagonist

Question 18

What are the best investigations for congestive heart failure?

Answer 18

B-type natriuretic peptide
Echocardiogram looking for ejection fraction

Question 19

What is the managment of acute left ventricular failure

Answer 19

POUR SOD
Pour away the fluids
Sit up
Oxygen
Diuretics

Question 20

What might you see on Xray in pulmonary oedema ?

Answer 20

Fluid in the fissures
Bi lateral pleaural effusions
Kerley lines

Question 21

What blood test can you check in chronic heart failure and what action should it prompt

Answer 21

N-terminal pro-B-type natriuretic peptide
If over 2000 ng/L then urgent referral to cardiology

Question 22

First line treatment for chronic heart failure?

Answer 22

ABAL

ACE inhibitor
Beta blocker
Aldosterone antagonist spironolactone or eplerenone
Loop diuretics

Question 23

What is Cor Pulmonale?

Answer 23

Right sided heart failure caused by lung disease

Question 24

What is the treatment algorithm for hypertension

Answer 24

step 1
Young = ACE inhibitor
Old Black = Calcium channel blocker

Step 2
Not black = ACE inhibitor and Calcium channel blocker
Black = Candesartan + Calcium channel blocker

Step 3
ACE inhibitor + Calcium channel blocker + Thiazide like diuretic (indapamide)

Question 25

What is candesartan and what is the usual dosage?

Answer 25

Angiotensin II recpetor blocker 8mg - 32mg OD

Question 26

What should you use if thiazide like diuretics are causing too much hypokalaemia ?

Answer 26

Use spironolactone

Question 27

What is indapamide and what is the usual dosage?

Answer 27

thiazide like diuretic 2.5mg OD

Question 28

What makes the S1 and what makes S2 heart sounds?

Answer 28

S1 Tricuspid and Mitral valves S2 Pulmonary and Aortic valves

Question 29

What murmur is an ejection systolic high pitched murmer

Answer 29

Aortic Stenosis

Question 30

What causes a pan systolic whisteling murmor?

Answer 30

Mitral regugitation

Question 31

What causes a rumbling diastolic murmur?

Answer 31

Mitral Stenosis

Question 32

What is the target INR for a bioprosthetic valve?

Answer 32

2-3 INR

Question 33

When is rythm control the preffered 1st option rather than rate control in AF?

Answer 33

Reversible cause of AF New onset less than 48 hours It is causing Heart failure Symptomatic after rate control

Question 34

What are the rate control options for AF

Answer 34

Beta Blocker Atenolol 50 mg Calcium Channel Blocker diltiazem Digoxin

Question 35

What is the calcium channel blocker of choice for Rate control in AF

Answer 35

Diltiazem

Question 36

You have indetified your AF patient should have cardioversion. What are the two types?

Answer 36

if new AF then immediate cardioversion if longstanding AF then delayed cardioversion ( Anticoagulation for 3 weeks prior to cardioversion

Question 37

What is the first line drug for pharmacological cardioversion of AF

Answer 37

Flecanide or Amiodarone

Question 38

What are your options for long term rythmn control in AF

Answer 38

Beta blockers Dronedarone Amidodarone

Question 39

What is the halflife of warfarin

Answer 39

1-3 days

Question 40

What is the halflife of DOACs

Answer 40

12 hours

Question 41

What is in HASBLED

Answer 41

hypertension abnormal renal fucntion stroke bleeding liabile INR Elderly Drugs