Cardiology

Question 1

What organism would cause infective endocarditis in a valve replacement that’s less than 2 months old?

Answer 1

Staphylococcus epidermidis

Question 2

What is the most common cause of infective endocarditis?

Answer 2

Staphylococcus aureus

Question 3

What increases the risk of asystole?

Answer 3

1) Complete heart block with broad QRS
2) Mobitz type II heart block
3) Ventricular pause >3 seconds
4) Recent asystole

Question 4

Which medications should be avoided in HOCM?

Answer 4

ACE inhibitors
Nitrates
Inotropes

Question 5

What is the management of HOCM?

Answer 5

Amiodarone
Beta blockers
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

Question 6

How is HOCM inherited?

Answer 6

Autosomal dominant

Question 7

A patient presents with SOBOE and an echo shows mitral regurgitation, systolic anterior motion of the anterior mitral valve leaflet and asymmetric hypertrophy. What is your diagnosis?

Answer 7

HOCM

Question 8

What other conditions are associated with HOCM?

Answer 8

Friedrich’s ataxia
Wolff-Parkinson-White

Question 9

What is the pathophysiology of HOCM?

Answer 9

1) Mutation in gene encoding beta-myosin heavy chain protein or myosin binding protein C
2) Diastolic dysfunction: LVH -> Decreased compliance -> Decreased cardiac output

Question 10

What would cause myofibrillar hypertrophy wtih chaotic and disorganised fashion myocytes and fibrosis on biopsy?

Answer 10

HOCM

Question 11

What causes S1 heart sound?

Answer 11

Closing of mitral and tricuspid valves

Question 12

What causes S2 heart sound?

Answer 12

Closing of aortic and pulmonary valves

Question 13

What would cause a loud S1?

Answer 13

Mitral stenosis

Question 14

What would cause a soft S1?

Answer 14

Mitral regurgitation or prolonged PR

Question 15

What would cause a soft S2?

Answer 15

Aortic stenosis

Question 16

What causes S3 heart sound?

Answer 16

Diastolic filling of the ventricles. LVF, constrictive pericarditis, MR

Question 17

What conditions cause S4 heart sound?

Answer 17

HOCM, AS, HTN

Question 18

What causes S4 heart sound?

Answer 18

Contraction of atria against a stiff ventricle

Question 19

Which part of the ECG coincides with S4 heart sound?

Answer 19

p wave

Question 20

A 35 year old man presents following an episode of syncope. The ECG shows ST elevation in V1-V3 with T wave inversion and a partial RBBB. What is the diagnosis?

Answer 20

Brugada syndrome

Question 21

What is the most common gene mutation in Brugada syndrome?

Answer 21

SCN5A

Question 22

What ECG change would you see in hypercalcaemia?

Answer 22

Shortened QT interval

Question 23

What ECG change would you see in severe hypercalcaemia?

Answer 23

Osborne (J) waves

Question 24

What ECG change would you see in hypokalaemia?

Answer 24

Prominent U waves

Question 25

An infarct in which myocardial territory would cause AV block?

Answer 25

Inferior

Question 26

An infarct in which myocardial territory increases risk of VF?

Answer 26

Anterior

Question 27

Which part of the heart has the fastest conduction velocities?

Answer 27

Purkinje fibres