Cardiology

Question 1

Causes of lower limb oedema

Answer 1

• HF -> Increased venous pressure
• Renal/liver failure -> decreased osmotic pressure
• Cancer, DVT -> blocked lymphatics
• Infection, sepsis -> increased capillary permeability
• Drugs - dihydropyridines, steroids, NSAIDs

Question 2

Criteria for metabolic syndrome

Answer 2

Abdominal obesity plus ≥2 of:

• ↑ triglycerides
• ↓ HDL
• hypertension
• hyperglycaemia - impaired fasting glucose, or T2DM

Question 3

Precipitants for decompensated HF

Answer 3

• Vascular - new infarct/ ischaemia, PE
• Infection
• Drug changes
• Metabolic - thyrotoxicosis, renal/liver failure, anaemia
• Arrhythmia esp AF

Question 4

What kind of pulses in:

1. AF
2. Aortic stenosis
3. Aortic regurgitation
4. Coarctation of aorta
5. Constrictive pericarditis/tamponade
6. Sepsis

Answer 4

1. Irregularly irregular
2. Slow-rising pulse
3. Collapsing pulse
4. Radiofemoral delay
5. Pulsus paradoxus
6. Bounding pulse

Question 5

What kind of JVP in:

1. SVC obstruction
2. Cardiac tamponade
3. Tricuspid regurgitation
4. AF
5. Complete heart block

Answer 5

1. Raised, non-pulsating JVP
2. JVP rises on inspiration
3. Large v waves
4. Absent a waves
5. Cannon a waves

Question 6

Features of mitral stenosis

Answer 6

• Tapping apex
• Loud S1
• Rumbling mid-diastolic murmur

Question 7

Features of mitral regurgitation (apex, HS, murmur)

Answer 7

• Displaced, volume overloaded apex beat
• Soft S1
• Pansystolic murmur at apex radiating to axilla

Question 8

Features of aortic stenosis (pulse, HS, murmur)

Answer 8

• Narrow pulse pressure
• Soft S2
• Ejection systolic murmur heard in aortic area radiating to carotids

Question 9

Features of aortic regurg (pulse, apex, murmur)

Answer 9

• Wide pulse pressure
• Displaced, volume-overloaded apex beat
• Early diastolic murmur heard at lower sternal edge

Question 10

Features of tricuspid regurg (JVP, murmur)

Answer 10

• Large systolic v waves

- Pansystolic murmur at lower left sternal edge

Question 11

Features of VSD (murmur, heave)

Answer 11

• Harsh pansystolic murmur heard at lower left sternal edge

- Left parasternal heave

Question 12

Physical signs associated with infective endocarditis

Answer 12

• Roth spots - retinal haemorrhages
• Oslers nodes - painful swellings
• Janeway lesions - painless erythematous macules on palms

Question 13

ECG findings in hypocalcaemia

Answer 13

• Long QT

- Tetany

Question 14

Side effects of beta blockers

Answer 14

• Impotence
• SOB
• Cold peripheries

Question 15

Side effects of amiodarone

Answer 15

• Hyper/hypothyroid
• Corneal microdeposits
• Lung/liver fibrosis

Question 16

Side effects of dihydropyridines

Answer 16

• Flushing
• Headache
• Ankle oedema