Cardiology

Question 0

Causes of Peripheral Cyanosis

Answer 0

1. Peripheral vascular disease
2. Raynaud’s syndrome
3. Heart failure
4. Shock
5. Central cyanosis (when severe)

Question 1

Causes of Central Cyanosis

Answer 1

1. Hypoxic Lung Disease
2. Right to Left shunt
   - cyanotic congenital heart disease
   - eisenmenger’s syndrome
3. Methaemoglobinaemia (drug or toxin-induced)

Question 2

Causes of irregular irregular pulse

Answer 2

1. AF
2. Ventricular ectopic beats (VEB)
   Differentiate between 1 and 2 by exercising patient (VEB will be abolished)

Question 3

Causes of AF

Answer 3

1. Ischaemic heart disease
2. Rheumatic heart disease
3. Thyrotoxicosis
4. Pneumonia / PE / Alcohol

Question 4

Causes of an absent radial pulse

Answer 4

1. Congenital (usually bilateral)
2. Previous arterial line
3. Previous cardiac catheterisation
4. Atheromatous disease (usually subclavian)
5. Arterial embolism (e.g. AF)
6. Surgical ligation

Question 5

Increased JVP

Answer 5

1. RHF
2. Volume overload
3. PE
4. SVC obstruction (raised and fixed)

Question 6

Large a-wave

Answer 6

1. Pulmonary HTN

2. Pulmonary stenosis

Question 7

Giant v-wave

Answer 7

1. Tricuspid regurgitation

Question 8

Causes of non-palpable apex beat

Answer 8

1. Adipose tissue (obese patient)
2. Air (pneumothorax, COPD)
3. Fluid (pleural effusion, haemothorax, pericardial effusion)
4. Apex displaced (usually LVH)
5. Dextrocardia

Question 9

Causes of LVH

Answer 9

1. Aortic stenosis
2. Hypertension
3. HOCM
4. Coarctation of the aorta

Question 10

Causes of third heart sound

Answer 10

(Volume overload)
Normal if <30 years old
1. CHF/MI/cardiomyopathy
2. HTN
3. MR

Question 11

Causes of fourth heart sound

Answer 11

(Stiffening of ventricle walls) - always abnormal, cannot be Dx in the context of AF

1. CHF/MI/cardiomyopathy
2. HTN

Question 12

Causes of cardiac failure

Answer 12

1. Pump failure
2. Excessive preload
3. Excessive after load
4. Isolated RHF

Question 13

Cardiac failure - pump failure Ddx

Answer 13

1. IHD
2. Cardiomyopathy
3. Constrictive pericarditis
4. Arrhythmias
5. Negative ino/chronotropes

Question 14

Cardiac failure - excessive preload Ddx

Answer 14

1. AR/MR

2. Fluid excess (renal failure, Iv fluids)

Question 15

Cardiac failure - excessive after load Ddx

Answer 15

1. AS

2. HTN

Question 16

Cardiac Failure - isolated RHF

Answer 16

1. Cor pulmonale

2. Pulmonary HTN

Question 17

CXR features of LVF

Answer 17

ABCDE

1. Alveolar oedema
2. Kerley B lines
3. Cardiomegaly
4. Upper lobe venous diversion
5. Pleural effusion

Question 18

Causes of pericarditis

Answer 18

1. Viral (coxsackie)
2. Bacterial / fungal infection
3. Immediately post-MI
4. Dressler’s syndrome
5. SLE / RA / Scleroderma
6. Uraemia
7. Malignancy

Question 19

Indication for pacemakers

Answer 19

1. Sick sinus syndrome (symptomatic bradycardia with frequent sinus pauses)
2. Second degree AV Block
3. Third degree AV Block
4. Tachyarrhythmia - PSVT

Question 20

Pacemaker complications

Answer 20

Infection - erythema, swelling, purulent discharge

Risk factors - DM, defibrillator placement

Question 21

Tachyarrhythmia Ddx

Answer 21

1. Sinus tachycardia
2. SVT (paroxysmal, with aberrancy)
3. AF/Flutter
4. Torsades de pointes

Question 22

Most common marfans murmur

Answer 22

Aortic regurgitation

Question 23

Rheumatic fever Dx

Answer 23

JONES

1. Joints - migrating polyarthritis (tends to be large joints)
2. Heart - carditis (endocarditis causing rheumatic heart disease, mostly mitral stenosis), may also have pericarditis
3. Nodules - subcutaneous nodules on extensor surfaces
4. Erythema marginatum - non-itchy red rings on trunk
5. Sydenham’s chorea - late finding

Question 24

Rheumatic fever Ddx (migratory polyarthritis with rash)

Answer 24

1. Myocarditis 2. Lyme's disease 3. SLE 4. Bacterial endocarditis 5. Juvenile idiopathic arthritis

Question 25

Rheumatic fever investigations

Answer 25

1. FBC 2. ESR and CRP (raised due to inflammation) 3. Antistreptolysin O titre + throat culture (test for group A strep) 4. ECG - AV Block 5. CXR - signs of CHF 6. ECHO - check valves, MR,MS,AR

Question 26

Rheumatic fever management

Answer 26

1. NSAIDS - polyarthritis 2. Corticosteroids - carditis 3. Management of CHF 4. prophylactic penicillin

Question 27

Strepococcal pharyngitis Tx

Answer 27

10 days penicillin | Or 5 days erythromycin