Cardiology

Question 1

What ABPI would you expect in arterial disease?

Answer 1

<0.8

Question 2

Define first degree heart block

Answer 2

PR interval >0.2s

Question 3

What is the difference between Mobitz type 1 and type 2 heart block?

Answer 3

T1 - progressive prolongation of PR interval

T2 - Intermittent failure of conduction of atrial impulse without progressive prolongation of PR interval

Question 4

What is a Baker’s cyst?

Answer 4

Popliteal cyst is the result of accumulation of joint synovial fluid outside the knee joint - in the interval between the semimembranosus and the medial gastrocnemius.

Question 5

What is a normal PR?

Answer 5

0.12-0.2s or 3-5 small squares

Question 6

How do we determine right axis deviation?

Answer 6

The QRS complex is negative in lead I

Question 7

How do we determine L axis deviation?

Answer 7

The QRS complex is negative in II and aVF

Question 8

When do we give oxygen in MI?

Answer 8

If sats <94% or if pulmonary oedema

Question 9

When can you return to sexual intercourse after an MI?

Answer 9

1/12

Question 10

When can you return to work after an MI?

Answer 10

2/12

Question 11

What are the non-shockable rhythms?

Answer 11

PEA and asystole

Question 12

How does aortic dissection in the aortic arch and the descending aorta differ in presentation?

Answer 12

Aortic arch = pain in the neck or jaw

Descending aorta = pain in the intrascapular area

Question 13

What is the first-line anti-anginal medication?

Answer 13

BB or CCB to reduce the sx of stable angina

Question 14

What is stage 1 htn?

Answer 14

Clinic BP reading of 140/90 to 159/99
ABPM 135/85 to 149/94

Question 15

What is stage 2 htn?

Answer 15

Clinic BP reading of >=160/100 to 180/120
ABPM average over 150/95

Question 16

What is stage 3 htn?

Answer 16

Clinic BP of >= 180/120

Question 17

What is a provoked DVT?

Answer 17

Associated with a transient risk factor such as significant immobility, surgery, trauma, pregnancy or puerperium. Unprovoked have no identifiable risk factor or one which cannot easily be removed e.g. active ca or thrombophilia

Question 18

What is pulsus paradoxus?

Answer 18

An exaggeration of the normal inspiratory decrease of systemic BP (>12mmHg or 9%)

Question 19

Where do you see pulsus paradoxus?

Answer 19

Constrictive pericarditis
Severe obstructive pulmonary disease
Restrictive cardiomyopathy
PE
Rapid and laboured breathing
Right ventricular infarction with shock

Question 20

How does pericarditis present?

Answer 20

To do

Question 21

What is Beck’s triad?

Answer 21

Increased JVP, hypotension and muffled heart sounds = cardiac tamponade

Question 22

How do we treat ? cardiac tamponade

Answer 22

Pericardiocentesis when clinically unstable

Question 23

When do we use dipyramidole?

Answer 23

Indicated for secondary prevention of stroke (not associated with AF) and TIAs (either alone or with aspirin). Can also be used as an adjunct to oral anticoagulation for prophylaxis of VTE associated w/ prosthetic heart valves

Question 24

What is the most common cause of rhabdomyolysis?

Answer 24

Fall w/ long lie

Question 25

What are the ECG changes in hyperkalaemia?

Answer 25

Prolonged PR Broad, bizarre QRS complexes Peaked T waves

Question 26

What is pulsus paradoxus?

Answer 26

An exaggeration (>12mmHg or 9%) of the normal inspiratory decrease in systolic blood pressure. Seen in cardiac tamponade

Question 27

What is Kussmaul sign?

Answer 27

Paradoxical increase in venous distension and pressure during inspiration. Seen in cardiac tamponade

Question 28

What is Ewart sign or Pins sign

Answer 28

Seen in pts with large pleural effusions & is described as an area of dullness, with bronchial breath sounds and bronchophony below the angle of the left scapula. Seen in tamponade

Question 29

How do we treat cardiac tamponade?

Answer 29

Pericardiocentesis

Question 30

How do we manage those on warfarin with AF?

Answer 30

Considering switching patients from warfarin to a DOAC at the next review

Question 31

What is seen on ECG in hypercalcaemia?

Answer 31

Reduced QT interval

Question 32

What is seen on ECG in hypocalcaemia

Answer 32

Prolonged QT interval

Question 33

What is the most common cause of pericarditis?

Answer 33

Viral infection

Question 34

What is lone AF?

Answer 34

AF in younger adults (<60y.o.) with no clinical history or echocardiographic evidence of cardiovascular disease/pulmonary conditions

Question 35

What is paroxysmal AF?

Answer 35

Episodes lasting longer than 30s but less than 7/7 that are self-terminating and recurrent

Question 36

How do we manage acute HF?

Answer 36

Sit pt upright and give 100% O2 unless CO2 retainer Furosemide IV Consider small amounts opioids if pain GTN IV BP permitting Consider CPAP if poor response

Question 37

What do we administer directly after thrombolysis of MI?

Answer 37

Heparin

Question 38

What are femoral pseudoaneurysms?

Answer 38

Haematomas that result from a leaking hole in an artery - complication of cardiac catheterisation Present with pulsatile mass, femoral bruit and compromised distal pulses

Question 39

How does AAA present?

Answer 39

Constant and gnawing epigastric pain Pain radiating to lower back and both groins Palpable pulsatile mass just left of the midline of the umbilicus

Question 40

What is Tietze's syndrome?

Answer 40

Like costochondritis but with swelling of the costal cartilages

Question 41

How does the pain in pericarditis change on movement?

Answer 41

Worsens on lying down, improves on sitting forward

Question 42

What do you see on ECG in PE?

Answer 42

Sinus tachy Right axis deviation RBBB Rarely S1QIIITIII

Question 43

How does digoxin toxicity impact eyesight?

Answer 43

Objects may appear green or yellow

Question 44

How does digoxin toxicity present on ECG?

Answer 44

Reverse tick sign - ST depression and inverted T waves in V5-6

Question 45

How may hypokalaemia present?

Answer 45

Muscle weakness and cramps

Question 46

What is the most common cause of IE?

Answer 46

S aureus

Question 47

What ECG change do you see in hypothermia?

Answer 47

J waves

Question 48

When do we offer ABPM?

Answer 48

If clinic BP between 140/90 and 180/120

Question 49

When does Dressler's syndrome usually present?

Answer 49

1-6wks post MI Pericarditis

Question 50

How do we manage htn in an under 40y.o. with no evidence of disease?

Answer 50

Refer to investigate secondary cause of htn

Question 51

What is Vincent's angina?

Answer 51

Vincent's angina is a bacterial infection that causes inflammation of the tonsils and pharynx, and is also known as trench mouth

Question 52

How does oesophageal spasm present?

Answer 52

Painful contractions in the esophagus that can feel like sudden chest pain. These contractions can also cause difficulty swallowing or regurgitation.

Question 53

When do we favour warfarin over apixaban?

Answer 53

If eGFR <30ml/min, significant liver dysfunction or weight greater than 120kg

Question 54

What is streptokinase?

Answer 54

Thrombolytic agent derived from streptococcal bacteria

Question 55

What is the ORBIT score used for?

Answer 55

Risk of major bleeding with anticoagulation in pts with AF

Question 56

What is first-line in stable angina?

Answer 56

BB or CCB

Question 57

How does hypokalaemia present?

Answer 57

Fatigue, muscle cramps, spasms and polyuria

Question 58

How does digoxin toxicity present?

Answer 58

Yellow-green distortion Reverse tick sign on ECG

Question 59

Which ECG change is characteristic of hypothermia?

Answer 59

J waves

Question 60

What does nicotinic acid do?

Answer 60

lowers both cholesterol and triglyceride concentrations by inhibiting synthesis & it also increases HDL-cholesterol.

Question 61

Give a common SE of nicotinic acid

Answer 61

Vasodilation - flushing