Cardiology

Question 1

1st Line Rx SVT:

Answer 1

Carotid sinus massage

Question 2

Class of drugs causing hearing loss

Answer 2

Loop diuretics

Question 3

2 levels wells score

Answer 3

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) 3
An alternative diagnosis is less likely than PE 3
Heart rate > 100 beats per minute 1.5
Immobilisation for more than 3 days or surgery in the previous 4 weeks 1.5
Previous DVT/PE 1.5
Haemoptysis 1
Malignancy (on treatment, treated in the last 6 months, or palliative) 1

If score >4 points then straight to CTPA

Question 4

Persistent ST elevation following MI + Pulm Oedema

Answer 4

Left ventricular aneurysm

The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.

Question 5

Acute mitral regard following MI? New LVSD

Answer 5

Papillary muscle rupture.

More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle. Acute hypotension and pulmonary oedema may occur. An early-to-mid systolic murmur is typically heard. Patients are treated with vasodilator therapy but often require emergency surgical repair.

Question 6

Major bleeding and on Warfarin

Answer 6

Stop warfarin, give IV vitamin K and IV prothrombin complex

Question 7

patients on CCB who have angina that isn’t controlled

Answer 7

Usually would give B Blocker however if unable (due to asthma) then give ISMN or Ivabradine/Nicorandil

Question 8

Diabetes and primary cardiovascular prevention

Answer 8

Individuals with type 1 diabetes who do not have established cardiovascular disease (CVD) risk factors should be offered atorvastatin 20 mg for primary prevention of CVD if they are:
Older than 40 years of age
Have had diabetes for more than 10 years
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)

Question 9

Inferior MI, What artery?

Answer 9

RCA

Question 10

Anteroseptal , what artsy / leads?

Answer 10

LAD

V1-V4

Question 11

Lateral MI, artery lead?

Answer 11

1, AVL +/- V5/V6

Left circumflex

Question 12

posterior MI, artery?

Answer 12

Circumflex / RCA

Question 13

What do with anticoagulation following DC cardioversion (even in remains sinus)

Answer 13

Following elective DC cardioversion for AF, anticoagulation should be continued even if sinus rhythm is maintained

Question 14

Bus / Lorry drivers and hypertension?

Answer 14

The same rules apply to those who drive buses and lorries. However, if their resting blood pressure is consistently above 180mmHg systolic or above 100mmHg diastolic they should stop driving and inform the DVLA

Question 15

Diastolic murmur + AF?

Answer 15

Think mitral stenosis

Question 16

Angina first line?

Answer 16

CCB or BB

Question 17

Has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor

Answer 17

Spironolactone

Question 18

Bradycardia with MI

Answer 18

Think RCA / Inferior MI (supplies AV node)

Question 19

HOCM inheritance?

Answer 19

Autosomal dominant

Question 20

Statin mechanism of action?

Answer 20

Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis

Question 21

chadvasc calculator

Answer 21

C Congestive heart failure 1
H Hypertension (or treated hypertension) 1
A2 Age >= 75 years 2
Age 65-74 years 1
D Diabetes 1
S2 Prior Stroke, TIA or thromboembolism 2
V Vascular disease (including ischaemic heart disease and peripheral arterial disease) 1
S Sex (female) 1

Question 22

chadvasc and anticoagulation

Answer 22

0 No treatment
1 Males: Consider anticoagulation
Females: No treatment (this is because their score of 1 is only reached due to their gender)
2 or more Offer anticoagulation

Question 23

What are the ranson criteria used for

Answer 23

pancreatitis

Question 24

Waterlow scoring

Answer 24

pressure sores

Question 25

NYHA scoring

Answer 25

heart failure

Question 26

head bobs in time with pulse =

Answer 26

aortic regurgitate early diastolic murmur

Question 27

Cardiac resynchronisation therapy for patients with heart failure and wide QRS biventricular pacing improved symptoms and reduced hospitalisation in NYHA class III patients

Answer 27

Verapamil should be avoided in patients with known heart failure.

Question 28

refractory HTN in young people .

Answer 28

Think coarcation or renal artery stenosis The most common type of coarctation of the aorta seen in adults is the postductal variety, i.e. the aortic narrowing is distal to the ductus arteriosus. This means that the upper limb blood pressure is greater than that in the lower limbs as the narrowing occurs after the left subclavian artery branches from the aorta. Another approach to answering this question is to look at the history. A young person with refractory hypertension raises the possibility of secondary, rather than essential (primary) hypertension. The only two diagnoses listed above which cause hypertension are coarctation and renal artery stenosis. This narrows the diagnositic possibilities and makes the question easier to answer.

Question 29

Infective endocarditis, spots on hands

Answer 29

Janeway lesions

Question 30

ACS and DVLA guidance

Answer 30

The DVLA guidance on driving after an acute coronary syndrome is as follows: If successfully treated by coronary angioplasty, driving may recommence after 1 week provided: No other urgent revascularisation is planned. (Urgent refers to within 4 weeks from acute event) Left ventricular ejection fraction is at least 40% prior to hospital discharge. There is no other disqualifying condition.

Question 31

NSTEMI conservative Rx

Answer 31

NSTEMI (managed conservatively) antiplatelet choice aspirin, plus either: ticagrelor, if not high bleeding risk clopidogrel, if high bleeding risk

Question 32

Raynauds with extremity ischaemia

Answer 32

Raynaud's phenomenon with extremity ischaemia think Buerger's disease (thromboangiitis obliterans)

Question 33

Murmur associated with polycystic kidney disease?

Answer 33

Mitral valve prolapse

Question 34

Aortic regurgitate murmur

Answer 34

Early diastolic

Question 35

Which valve in IE form IVDU

Answer 35

Tricuspid Mitral most common for normal people

Question 36

Muffled heart sounds + JVP raised + hypotension indicate Beck's Triad

Answer 36

Think Wall rupture

Question 37

INR >8.0 and minor bleeding

Answer 37

Stop warfarin and give IV vit K Restart when INR < 5

Question 38

Cause of VT following MI, electrolyte?

Answer 38

Hypokalaemia

Question 39

Factors that decrease BNP?

Answer 39

Obesity Diuretics ACE inhibitors Beta-blockers Angiotensin 2 receptor blockers Aldosterone antagonists

Question 40

Factors that increase BNP?

Answer 40

Left ventricular hypertrophy Ischaemia Tachycardia Right ventricular overload Hypoxaemia (including pulmonary embolism) GFR < 60 ml/min Sepsis COPD Diabetes Age > 70 Liver cirrhosis

Question 41

Signs of aortic stenosis ?

Answer 41

narrow pulse pressure slow rising pulse a thrill palpable over the cardiac apex a fourth heart sound (S4) indicative of left ventricular hypertrophy a soft/absent S2

Question 42

What medication should be avoided in HOCM?

Answer 42

ACE I

Question 43

Hypokalaemia

Answer 43

U waves, long PR and long QT

Question 44

Cut off for stage 1 HTN

Answer 44

135/85 Can offer lifestyle modifications if 10 year risk <10% and no other co-morbid

Question 45

What heart drug can cause anal ulceration?

Answer 45

Nicorandil

Question 46

blood monitoring of statin

Answer 46

LFTs at baseline, 3 months and 12

Question 47

Ix Pre Amiodarone

Answer 47

TFT / LFT / U&E / CXR

Question 48

How long after MI for viagra?

Answer 48

6months

Question 49

What to do if requiring 3rd line anti-anginas

Answer 49

start the med and refer cardio for ? angioplasty / CABG

Question 50

Persistent ST elevation following recent MI, no chest pain -

Answer 50

left ventricular aneurysm

Question 51

ACE I for htn and altered renal function

Answer 51

angiotensin-converting enzyme inhibitors should only be stopped if the creatinine increases by 30% or eGFR falls by 25% or greater

Question 52

NYHa

Answer 52

NYHA Class 0 is incorrect because it represents no limitations in ordinary physical activities and no symptoms from cardiac causes. Patients in this category have no signs or symptoms of heart failure. NYHA Class I is also incorrect as it describes patients with mild limitations in physical activity due to cardiac reasons. They may experience some symptoms, such as fatigue or shortness of breath, but only during strenuous activities that would not cause similar issues in healthy individuals. NYHA Class II does not fit the patient's description either. Patients classified as NYHA Class II have a slight limitation in their ability to perform regular physical activities. They are comfortable at rest but may experience fatigue, palpitations, or dyspnea during ordinary activities. NYHA Class III, although closer to the correct answer than Classes 0-II, still does not fully describe the severity of the patient's condition. Patients in NYHA Class III have marked limitations in their ability to carry out normal physical activities. They are comfortable at rest but experience significant symptoms with less-than-ordinary exertion. In summary, NYHA Class IV best describes the severity of this patient's heart failure due to their inability to carry out any physical activity without discomfort and experiencing symptoms even at rest.

Question 53

cause of torsades - hypo

Answer 53

hypothermia hypoca hypoka hypomag

Question 54

hypercalcaemia ecg finding

Answer 54

shortened qtc

Question 55

Athletes often have a high vagal tone which results in additional normal variants: ECG

Answer 55

Sinus bradycardia 1st degree atrioventricular block Wenckebach phenomenon (2nd degree atrioventricular block Mobitz type 1) Junctional escape rhythm

Question 56

drug given to patient pre thromvolyis for mi

Answer 56

give fondaparinux