Cardiology

Question 1

Signs of cardiac tamponade… NEED TO KNOW THIS

Answer 1

Elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation.

Question 2

Which artery supplies the AV node?

Answer 2

Right coronary artery.

Question 3

What artery is blocked in an inferior stemi?

Answer 3

Right coronary artery, so if you see an inferior stemi, look for evidence of heart block.

Question 4

Name two causes of bradycardia?

Answer 4

Hypothermia and cushing reflex (increased ICP)/ heart block
Hypothyroid
Drugs (beta blockers)

Question 5

What is cushings reflex?

Answer 5

Bradycardia and hypertension and dyspnoea. Indicating raised ICP

Question 6

Which artery is affected in a posterior MI?

Answer 6

RCA

Question 7

Management of angina

Answer 7

Calcium channels, beta blockers, nitrates. GTN, 12 hour trop, repeat ECG and arrange cardiac perfusion scan,

Question 8

What is the first sign of an MI?

Answer 8

Hyper acute t waves, then ST segment elevation then T wave inversion then pathological q wave formation.

Question 9

Which patients may have a silent MI?

Answer 9

Diabetics and those taking beta blockers

Question 10

Treatment of VT?

Answer 10

Amiodarone, lidocaine

Question 11

What is wellens syndrome?

Answer 11

It indicates reperfusion of a previously occluded LAD artery.

Question 12

T wave inversion in V1-V4

Answer 12

This is a hall marker of RV strain (ie PE).
Next look at lead 1 for s wave
Lead 3 for abnormal q wave and t wave inversion

Question 13

ECG findings associated with PE

Answer 13

New right axis deviation
New right bundle branch block
New dominant R wave in V1
Non-specific ST segment changes

Question 14

Pericarditis on an ECG?

Answer 14

Spodvicks sign, downward sloping of the TP segment.

Question 15

Side effects of furosemide?

Answer 15

Cause hypocalcaemia which would increase PTH causing osteoporosis.

Question 16

Left lingual consolidation does what?

Answer 16

Obscures the left heart border.

Question 17

In what condition is digoxin severely indicated?

Answer 17

AF when HF coexistent

Question 18

Signs of cardiac tamponade?

Answer 18

Pulsus paradoxus, kussmauls sign & low BP

becks triad = muffled heart sounds, increased JVP & hypotension

Question 19

What is kussmauls sign?

Answer 19

Kussmaul sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration, or a failure in the appropriate fall of the JVP with inspiration. (normally the JVP should fall on inspiration)

Question 20

What is pulsus paradoxus?

Answer 20

Normally the bp lowers on inspiration but in conditions like cardiac tamponade there can be an abnormal decrease which can make it hard to detect a radial pulse on examination during inspiration. (accompanied by an increased JVP-kaussmals sign)

Question 21

What is corrigans sign?

Answer 21

An abrupt distension and collapse of carotid arteries as a sign indicating aortic incompetence. (aortic regurg)

Question 22

A good marker of left ventricular hypertrophy on ECG?

Answer 22

look at R wave on V5 + S wave in V1

Question 23

Right atrial dilation on ECG?

Answer 23

Tall p waves

Question 24

Left atrial dilation on ECG?

Answer 24

Wide p waves

Question 25

Dressler’s syndrome triad?

Answer 25

Fever, pleuritic chest pain + pericardial effusion

Question 26

External pacing in bradycardia?

Answer 26

Only used if there is no improvement aftfer 6 doses of atropine.

Question 27

What is persistant ST elevevation and left ventricular failure after an MI a sign of?

Answer 27

Left ventricular thromboembolism

Question 28

Should compression stockings be offered as DVT management?

Answer 28

NO

Question 29

Inferior MI and MR?

Answer 29

This should raise the suspicion of a tearing aortic dissection

Question 30

Acute heart failure secondary to cardiac tamponade presents 10 days after an MI?

Answer 30

Ventricular free wall rupture

Question 31

Epipen injection site?

Answer 31

Anterolateral aspect of middle third of thigh