Cardiology Flashcards
(126 cards)
1
Q
6 causes of orthostatic hypotension
A
Pregnancy Postprandial or exercise induced venous pooling Extended rest (deconditioning) Nifedipine Diabetic neuropathy Parkinson's
2
Q
Adult dose of adrenaline for analphylaxis
A
0.5ml of 1 in 1000 (500 micrograms) IM
3
Q
2 changes on echo for HOCM
A
Asymmetric septal hypertrophy
Systolic anterior movement (SAM) of anterior leaflets of mitral valve
4
Q
When to treat stage 1 hypertension in <80s (5 reasons)
A
Diabetic Renal disease QRISK2 >20% Established coronary vascular disease End organ damage
5
Q
Lifestyle advice for hypertension
A
Salt Caffeine Smoking Exercise Alcohol Weight loss Fruit and vegetables
6
Q
PE scans and contraindications
A
CTPA unless renal impairment or allergy to contrast - then VQ scan
7
Q
What drug can mask hypoglycaemic symptoms?
A
B blockers
8
Q
Drugs that can cause long qt
A
Amiodarone, sotalol, class 1a antiarrhythmics TCAs, SSRI (citalopram), haloperidol Methadone Erythromycin
9
Q
Non drug causes of long qt
A
Anterior MI Myocarditis Hypothermia SAH Electrolytes - low calcium, potassium, magnesium
10
Q
First ECG change for MI
A
Hyperacute T waves
11
Q
Anaphylaxis salbutamol and adrenaline repeats?
A
Back to back salbutamol nebs
Adrenaline every 5 mins
12
Q
BP targets for diabetics
A
130/80 if end organ damage (renal disease, retinopathy)
Otherwise 140/80
13
Q
ABG changes with PE
A
pH high
pO2 and pCO2 low
14
Q
Murmur with infective endocarditis
A
Pansystolic, left lower sternal border
15
Q
Management of patients on warfarin needing emergency surgery
A
If in 6-8h, give 5mg IV vit k
If surgery immediately, 25-50u/kg 4 factor prothrombin complex
16
Q
4 features of rheumatic fever
A
Erythema marginatum
Sore throat
Chorea
Polyarthralgia
17
Q
Aortic stenosis top cause
A
<65 = bicuspid valve >65 = calcification
18
Q
Mechanism of adenosine
A
Agonist of A1, inhibiting adenylyl cyclase so reduces cAMP and causes hyperpolarisation by potassium efflux
19
Q
3 ADRs of adenosine
A
Bronchospasm
Chest pain
Enhance conduction down accessory pathways, increasing ventricular rate
20
Q
Adrenaline dose for 6-12 year olds
A
300 micrograms 1 in 1000
21
Q
Heart sounds for AS (2)
A
Split second heart sound
Ejection systolic murmur
22
Q
heart sound for left heart failure
A
Third heart sound
23
Q
Management of INR 5-8 on warfarin with no bleeding
A
Withold 1 or 2 doses and reduce maintenance dose
24
Q
Features of constrictive pericarditis
A
Dyspnoea
Right heart failure - raised JVP, ascites, oedema, hepatomegaly
Loud S3 - pericardial knock
Kussmaul’s sign
25
Differentiate between constructive pericarditis and cardiac tamponsde
Kussmaul's sign and calcification on CXR = pericarditis
| Pulses paradoxus = tamponade
26
Rate control in asthmatic with AF
Calcium channel blocker (diltiazem) instead of usual b blocker
27
How does aspirin work
Antiplatelet - inhibits production of thromboxane a2
28
How does clopidogrel work
Antiplatelet - inhibits ADP binding to platelet receptor
29
How does enoxaparin work
Activates antithrombin 3 which potentiates inhibition of coagulation factors Xa
30
How does fondaparinux work
Activates antithromin 3 which potentiates inhibition of coagulation factors Xa
31
How does bivalirudin work
Reversible direct thrombin inhibitor
32
How do abciximab, eptifibatide and tirofiban work
Glycoprotein 2b/3a receptor antagonists
33
4th drug for hypertension with low potassium or high potassium
Spironolactone if low (<4.5)
| High dose thiazides like (>4.5)
34
Anticoagulation if post-stroke with AF
5mg apixiban BD
35
Features of prinzmetal angina
Smokers
Young
Morning or at sleep
ST elevation
36
Difference between PR segment and interval
Segment is from end of p wave to beginning of q
| Interval is beginning of p wave to beginning of q
37
Heart failure first line treatments
Ace inhibitor and b blockers
38
Heart failure 3rd drug
Aldosterone antagonist
ARB
Hydralazine and nitrate if afrocaribbean
39
HF symptoms persisting (2 treatments) not diuretic
Implantable cardioverter defibrillator
| Digoxin
40
ACS immediate management
```
Morphine
Oxygen
Nitrates (GTN)
Aspirin
Clopidogrel or ticagrelor
Anticoagulation - enoxiparin or fondaparinux
```
41
What is Buerger's disease, what features and risk factors
```
Thromboangiitis obliterans (small and medium vessel vasculitus)
Causes extremity ischaemia (intermittent claudication, ischaemic ulcers) superficial thrombophlebitis and raynaud's
Risk factors: 20-40, male, smoker,
```
42
Features of WPW on ECG
Left axis deviation (right sided pathway)
Short PR
Wide qrs with delta wave
43
Management of WPW
Radio frequency ablation of pathway
Sotalol unless AF
Amiodarone
Flecainide
44
3 mechanisms contributing to bronchiectasis
Infection
Airway obstruction
Peribronchial fibrosis
45
Bronchiectasis on CXR
Tram track
Tubular opacities (mucous filled bronchi)
Ring opacities (dilated end on bronchi)
Compensatory overinflation of less affected lung
Lobar atelectasis from mucous plugging
46
What is kartagener syndrome
Dextracardia and bronchiectasis
47
Long term medication after STEMI
Dual antiplatelet
B blocker
ACEi
Statin
48
Bilateral hilar lymphadenopathy, Fever, cough and erythema nodosum
Sarcoidosis
49
When to start COPD patient on non invasive ventilation?
PCO2>6
| Ph<7.35
50
Indications for NIV
Type 2 resp failure secondary to obstructive sleep apnoea, chest wall deformity, neuromuscular disease
Copd with resp acidosis
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation
51
Dyspnoea, non productive cough, malaise, weight loss, hypercalcaemia
Sarcoidosis
52
Obstructive sleep apnoea management
Weight loss
CPAP if moderate or severe
Intramural devices if CPAP not tolerated or mild (no day time sleepiness)
53
What causes pulmonary oedema in cardiogenic shock?
High pulmonary pressures - treat with venodilators
54
Joint pain and raised ACE
Sarcoidosis
55
Contraindications to lung cancer surgery
SVC obstruction
FEV<1.5
Malignant pleural effusion
Vocal cord paralysis
56
Prognostic score for risk stratifying potential TIA
ABCD2
57
Prognosis of prostate cancer score
Gleason
58
Risk of patient developing pressure sore score
Waterlow
59
Acute pancreatitis score
Ranson
60
Indication for long term oxygen therapy in COPD
2 ABGs with pO2 <7.3
61
Cause of eruptive xanthoma
High triglyceride levels
62
Paraneoplastic features of lung cancers
Adenocarcinoma - gynaecomastia
SCC - hypercalcaemia (PTHrP), hyperthyroid (TSH), clubbing and hypertrophic pulmonary osteoarthropathy
Bronchial adenoma - carcinoid
Large cell - bHCG
63
COPD management after salbutamol
FEV1 <50 = LABA+ICS or LAMA
| >50 LABA or LAMA
64
Resp complication of pancreatitis
ARDS
65
Target sats if COPD with Normal pCO2
94-98%
66
Features of klebsiella pneumonia
Cavitating in upper lobes on CXR
Abscess and empyema, 30-50% mortality
Red currant jelly sputuml'
Diabetes and alcoholics
67
Who is at risk and what is on CXR of pseudomonas aeruginosa
Bronchiectasis and CF, ventilated
| Ground glass
68
Features of mycoplasma pneumoniae
Flu like - headache, arthralgia, myalgia, dry cough
| Patchy consolidatoin of 1 lobe
69
Features of legionella pneumophilia
Flu like - fever, myalgia
Extra pulmonary ie hepatitis, diarrhoea, vomiting
Bi basal consolidatoin on cxr
70
Mild, moderate, severe and very severe FEV1 readings in COPD
<0.7
50-70%
30-50
<30
71
CXR COPD
Hyperinflation
Flat diaphragm
Bullae
72
Causes of upper lobe pulmonary fibrosis
```
CHARTS
Coal workers oneumonitis
Hypersensitivity pneumonitis or Histeocytosis
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis or Sarcoidosis
```
73
Indications for chest drain in pleural infection
Frankly purulent or turbid/cloudy on sample
Cultured organisms
PH<7.2
74
What kind of NIV in COPD?
BiPAP
75
Most common bacteria in COPD exacerbations
H influenzae
Strep pneumoniae
Moraxella catarrhalis
Rhinovirus
76
COPD exacerbation management
Increase bronchodilator frequency, maybe nebulise
Prednisolone 30mg for 7-14d
Abx if purulent or clinical signs of pneumonia
77
Order of 6 drugs for acute asthma management
```
Oxygen
Salbutamol nebs
Ipratropium nebs
Hydrocortisone IV or oral prednisone
Magnesium sulfate IV
Aminophylline or IV salbutamol
```
78
Bronchiectasis management
```
Physio
Postural drainage
Abx for exacerbations or long term
Bronchodilators
ImmunisAtions
Surgery if localised
```
79
2 imaging for suspected lung cancer
CXR then CT contrast
80
Electrolyte abnormality in sarcoidosis and why
Hypercalcaemia because macrophages in granulomas convert vit D to active form more
81
Cannonball mets on cxr
Renal cell cancer
82
Difference in emphysema in COPD or a1at def
Upper in COPD
| Lower lobes in a1at
83
R3current chest infections and subfertility
Ciliary dyskinesia - kartagener
84
Complication of long qt
Ventricular tachycardia and sudden collapse or death
85
Management of long qt
Avoid drugs and precipitates ie strenuous exercise
B blockers
Implantable cardioverter defibrillator
86
ComplicToin of embolisation of left ventricular thromboembolism
Emboli
87
3 features of constructive pericarditis and one cause
Cardiac surgery
Dyspnoea
Peripheral oedema
Kussmaul's sign
88
Rate or rhythm control if AF with obvious reversible cause eg pneumonia?
Rhythm control
89
Threshold for treating >80yo with hypertension
150/
90
Murmur scale and basic explanation
```
Levine scale
1 very faint
2 slight
3 moderate
4 loud and thrill
5 very loud and very palpable thrill
6 extremely loud without stethoscope
```
91
When is coarctation of the aorta diagnosed and how
At day 2 when PDA closes = heart failure and absent femoral pulses
92
Second line treatment for AF rate control
Digoxin or diltiazem
93
Diagnosis of pulmonary fibrosis
Spirometry
Reduced TLCO
High resolution CT
94
Complications of asbestos
```
Benign pleural plaques
Pleural thickening
Asbestosis - lower lobe
Lung cancer
Mesothelioma
```
95
Artery affected in complete heart block after MI
Right coronary artery (AVN)
96
What is malignant hypertension
Severe hypertension with potentially life threatening sx suggesting acute organ impairment - kidneys, eyes, heart
97
How does miliary TB travel through lung parenchyma
Pulmonary venous system
98
What is granulomatosis with polyangitis
Necrotising granulomatous vasculiitis - upper and lower resp sx, glomerulonephritis, saddle shaped nose
99
Marker for granulomatosis with polyangitis
ANCA
100
Management of secondary pneumothorax
<1cm - admit for high flow o2 for 24h
1-2cm - aspirate
>2cm - chest drain
101
ECG indications for thrombolysis or PCI
ST elevation of >2mm in 2+ consecutive anterior leads V1-6
Or >1mm in 2 consecutive leads 2,3,avF,avL
New lbbb
102
Hypertension therapy after A + C + D
Add thiazide (spironolactone if low K, high dose thiazide if high)
Or a blocker
Or b blocker
103
What diuretic should be used first in hypertension
Indapamide or chlorthiazone
104
When should a statin be given (what qrisk2)
>=10%
105
8 reversible causes of cardiac arrest
```
4H 4T
Hypothermia
Hypoxia
Hypovolaemia
Hypo/erK, hypoglycaemia
Tensoin pneumothorax
Tamponade
Toxins
Thrombosis
```
106
What can and cannot be used for smoking cessation in pregnancy
Yes NRT
Varenicline harmful
Bupropion insufficient info
107
Features on CXR of HF
```
Alveolar oedema
kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
```
108
Calcified nodule on CXR from previous tb
Ghon complex - latent Tb. Granuloma
109
4 features of centor criteria and what do they suggest
```
3+ = 40-60% chance group a b haemolytic strep
No cough
Exudate on tonsils
Tender anterior cervical lymphadenopathy
Fever
```
110
Management of torsades de pointes
Magnesium sulfate iv
111
Lung and liver features of a1ar
Lung - panacinar emphysema (lower lobes)
| Liver - cirrhosis, hepatocellular carcinoma, cholestasis in children
112
Manage a1at
Physio, bronchodilators
IV a1at protein concentrates
Surgery - volume reduction, transplant
113
Manage HOCM
Implantable cardioverter-defibrillator
114
What presents at 1w old with reduced femoral pulses and what murmur is there
Coarctation of the aorta
| Systolic in left sternal edge
115
Features of idiopathic pulmonary fibrosis
50-70yo, 2x in men
Dry cough, Dyspnoea
Weight loss Bibasal inspiratory crackles
Finger clubbing
116
COPD exacerbation and no CXR change?
| Treatment
Haemophilus influenzae
| Amoxicillin and prednisolone
117
Specific chemicals affected by drugs in kidney disease (afferent and efferent arterioles) and why use in ckd
Afferent - prostaglandin E2 - NSAIDS
Efferent - angiotensin 2 - ACEi, ARB
ACEi and ARB for antihypertensiin and anti inflammatory, reduce glomerular perfusion pressure to prevent damage
118
Features of pulmonary oedema on cxr
```
Pleural effusion
Interstitial oedema
Bat wings
Upper lobe diversion
Kerley b lines
```
119
Cause of raised TLCO
```
Asthma
Pulmonary haemorrhage
Left to right shunt
Polycythaemia
Hyperkinetic
Male, exercise
```
120
Cause of low TLCO
```
Fibrosis
Pneumonia
Emboli
Oedema
Emphysema
Anaemia
Low cardiac output
```
121
Heart failure pulse
Pulsus alternans - upstroke alternate strong and weak, - systolic dysfunctiom
122
Inferior MI and aortic regurgitation murmur?
Proximal aortic dissection
123
Features of boerhaave syndrome
Middle aged male alcoholics
| Mackler triad: vomiting, thoracic pain, subcut emphysema
124
Borders of triangle for chest drain insertion
Lat dorsi
Pec major
Line superior to nipple
Apex of axilla
125
FEV cut offs for severity of COPD
Mild >80
Moderat 50-79
Severe 30-49
Very severe <30
126
FEV/FVC for airflow obstruction
Less than 0.7
