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1MRCP Part 1 > Cardiology and Respiratory > Flashcards

Cardiology and Respiratory Flashcards

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1
Q

Features of EGPA

A

Asthma
Eosinophilia
Mononeuritis Multiplex

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2
Q

Ostium Primum

A

The septum primum splits the atria in the neonate/newborn: should seal off after birth
Failure = failure of fusion of the superior and inferior cardiac cushions
Associated with Down’s syndrome

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3
Q

Ostium Secundum

A

The septum secundum grows to cover the foramen ovale
Failure
1. Large foramen ovale
2. Inadequate growth of the secundum

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4
Q

Ostium Primum VS Secundum

A

Primum
= less common, presents earlier
Associated with RBBB and LAD, prolonged PR interval

Secundum
= presents later, more common
Associated with RBBB and RAD

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5
Q

QT interval
- Measure on ECG
- Represents?

A

= start of QRS to the end of the T wave
Ventricular depolarisation adn repolarisation

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6
Q

What is an Epsilon wave?

A

= small deflection in QRS
Excitation in the R ventricle
= arrhythmogenic right ventricular cardiomyopathy
- Due to replacement of myocytes with fat, delay in excitation of myocytes in R ventricle, seen as separate deflection

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7
Q

Cardiac Action Potenial

A

Na+ IN
Balance of Ca2+ IN and K+ OUT
K+ OUT

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8
Q

Patent Ductus Arteriosus
Closure =
Maintain patency =

A

Closure = indomethacin
Open = prostaglandins
Why cannot give NSAIDs in pregnancy/end of pregnancy - close PDA, foetus dependent on that to allow bypass of lungs

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9
Q

Interventions with proven benefit in COPD (3)

A

Smoking Cessation
LTOT
Lung Volume Reduction Surgery

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10
Q

LBBB
- effect on systole
- heart sounds finding

A

= delayed closure of the aortic valve as action potential must go right to left
- Reversed split S2
- Quiet S1

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11
Q

Marfan’s Syndrome
- Pathophysiology of aortic dissection

A

= dilated aortic root
- Aorta usually has x3 small pouches that sit above the aortic valve, which are the sinuses of valsalva
- Weakness of elastic lamina at junction of aortic media and annulus fibrosus (fibrous ring at aortic orfice to front and right of AV root)

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12
Q

PaO2/FiO2 ratio
- cut off value
- how to calculate

A

> 300 = suggests acute respiratory failure, helpful for determining oxygen pressures
- ABG PaO2 - if 7 = 70 divided by FiO2 if 40% VM = 0.4

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13
Q

Type A Aortic Dissection

A

Proximal to brachiocephalic vessels

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14
Q

What is the most likely cause of aortic stenosis in <65 years?

A

Bicuspid aortic valve (more prone to calcifcation)

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15
Q

What are the greatest risk factors for restenosis following PCI?

A

Diabetes
Renal Failure

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16
Q

What is the greatest risk factor for stent thrombosis following PCI?

A

Premature anti-platelet withdrawal

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17
Q

What endocrine abnormality is associated with pulmonary TB?

A

Hyponatraemia due to SIADH

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18
Q

Most likely cause of endocarditis in recent valve surgery

A

Staph epidermidis

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19
Q

Indication for CRT (2)

A

LVEF of <35%
AND
LBBB with QRS >130

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20
Q

Deficiency in pulmonary hypertension
- diagnostic test

A

Relative deficiency of nitric oxide
= inhaled NO reverses

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21
Q

Complete Heart Block in MI
- anterior vs inferior infarction

A

Anterior = doesn’t usually resolve, may need pacing
Inferior = may resolve once RCA is revascularised

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22
Q

Variable intensity in S1
- why?

A

Complete heart block
- variable PR interval
- S1 intensity decreases with PR prolongation (<diastolic ventricle pressures increase, mitral leaflets drift together)

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23
Q

Cardiac conduction abnormality in myotonic dystrophy

A

Prolonged PR interval - disease of His-Purkinje system

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24
Q

Molecular cause of HOCM

A

Mutation in B-heavy chain protein

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25
TGA vs TOF
TGA = first days of life TOF = first months of life Both cyanotic heart disease
26
Long QT molecular problem - result
Defect in alpha subunit of slow delayed rectifier K+ channel = loss of function K+ channels
27
MI secondary to cocaine use - Mechanism - Management
= increased O2 demand due to sympathomimetic drive, coronary artery vasoconstriction and vasospasm - IV benzodiazepines: control BP and heart rate, reduce the above mechanisms
28
Most common organism in bronchiectasis
Haemophilus influenzae
29
Raised eosinophils, brittle asthma, parenchymal infiltrates - diagnosis - management
allergic bronchopulmonary aspergillosis - managed using PO steroids
30
Marker of disease progression in COPD
FEV1
31
Calcium and QT interval
Hypocalcaemia - QT prolongation Hypercalcaemia - QT shortening
32
What parameters should be measured when delivering MgSO4? Why?
Reflexes Respiratory Rate = magnesium toxicity presents as muscle weakness, respiratory depression and arrest
33
34
Condition associated with coarctation of the aorta
Neurofibromatosis
35
What medication should be avoided in HOCM?
ACE inhibitor = these decrease afterload and preload Want to INCREASE afterload/preload to stretch the myocardium
36
Management of Torsades de Pointes
Magnesium Sulphate 2g IV STAT
37
Anticoagulation following bioprosthetic valve
Aspirin only
38
Gene loci associated with bronchiectasis
HLA-DR1
39
Where is BNP secreted from?
Ventricular myocardium
40
What is a side effect of verapamil?
Constipation = relaxes smooth muscle, reduces gut motility
41
S2 - Fixed split S2 - Wide S2 - Reversed S2
= closure of aortic and pulmonary valve Fixed = ASD Wide = delay in closure of pulmonary valve Reversed = delay in closure of aortic valve
41
Causes of wide split S2
= delay in closure of pulmonary valve RBBB, pulmonary stenosis
41
Cause of reversed split S2
= delayed closure of aortic valve LBBB, PDA, aortic stenosis
41
S3 Timing Cause (2)
Occurs after S2 - diastole Seen in passive filling of the left ventricle with increased compliance Cause = DCM, normal variant <30 years
42
S4 Timing Cause (2)
Occurs before S1- diastole Active filling of the left ventricle Cause = HOCM, diastolic failure
42
Cause of ejection systolic murmur (4)
Aortic stenosis HOCM ToF ASD
42
Cause of late systolic murmur Cause of pansystolic murmur (2)
MV prolapse Harsh = VSD Blowing = MR
43
Continuous machine like murmur
Patent ductus arteriosus
44
Pulse alternans
= LVSD
45
ECG changes seen in hypokalaemia (4)
U waves Flattened T waves Prolonged PR Prolonged QTC
46
ECG changes seen in digoxin (4)
Bradycardia Prolonged PR ST depression Short QTC
47
Management of left ventricular wall rupture post MI
NOAC to prevent thrombosis
47
Causes of prolonged PR interval (5)
Digoxin Hypothermia Hypokalaemia Aortic Root Abscess Myotonic Dystrophy
47
What medication should be avoided in heart failure?
Rate limiting CCB e.g. verapamil, diltiazem
48
Glycoprotein 2B/3A inhibitors (3)
Abciximab Tirofiban Eptifibatide
49
Indication for drugs in HF - Entresto - Ivabradine - Digoxin
Entresto = EF <35% Ivabradine = EF <35% and HR >75 Digoxin = concomitant AF
50
Maximum dose of atropine
3mg (i.e. 6x500 microgram rounds)
50
Mobitz I vs Mobitz II
I = progressive PR prolongation until missed QRS II = PR interval is constant in conducted beats
51
Ventricular escape rhythm
= broad QRS + rate 20-40
51
What is the most common type of WpW syndrome?
Type B = right sided accessory pathway
51
ECG sign in mitral stenosis
Bifid p wave
51
What is the management of choice in mitral regurgitation?
Valve repair rather than valve replacement
52
Junctional escape rhythm
= narrow QRS + rate 40-60
53
Definition of pulmonary hypertension - number of groups - which group is: A. Idiopathic B. Respiratory disease
>25mmHg Groups 1-5 Idiopathic = group 1 Respiratory = group 3
53
What would be a contra-indication to introducing spironolactone to control hypertension?
K+ >4.5
54
+VE response to acute vasodilator testing in pulmonary hypertension
Calcium channel blocker
55
Associations with coarctation of the aorta (3)
Turner's syndrome Bicuspid aortic valve Neurofibromatosis
56
Investigating angina - 1st line - 2nd line
1st = CT coronary angiogram 2nd = non-invasive functional imaging e.g. stress echo, myocardial perfusion scan
57
Management of angina - all patients 1st line 2nd line
All patients = statin, aspirin, GTN 1st = BB or rate limiting CCB 2nd = BB + long acting CCB Should be on maximum dosing of each drug before next step
58
Cannon A wave =
= closed tricuspid valve e.g. VT, complete heart block
59
Kussmaul's wave =
= paradoxical JVP rise on inspiration e.g. constrictive pericarditis
60
Eisenmenger's - pathophysiology
1st left to right shunt, causing pulmonary hypertension THEN right to left shunt as pulmonary pressures exceed LV pressure = cyanosis
61
Tetralogy of Fallot =
Overriding aorta VSD Pulmonary stenosis Right ventricular hypertrophy
62
Poor prognostic factors in endocarditis (3)
Staph aureus Prosthetic valve Culture negative
63
Causes of pericarditis (4)
Uraemia Viral infections TB Post MI
64
Presentation of atrial myxoma (5)
Weight loss PUO Fatigue SOB Clubbing = left atrial pedunculated mass
65
Driving following ACS
4 weeks
66
Driving following ICD - symptomatic i.e. sustained VT - prophylaxis
Symptomatic = 6 months Prophylaxis = 1 month
67
If Q Risk >10 =
Start atorvastatin 20mg as primary prevention Lifestyle advice
68
DCCV successful - what is the plan for anti-coagulation?
4 weeks
69
Causes of low transfer factor (5)
= low rate of diffusion Fibrosis PE Pneumonia Pulmonary Oedema Emphysema
70
Causes of high transfer factor (3)
Asthma Haemorrhage Pregnancy
71
Causes of Upper Lobe Fibrosis
CHARTS C - coal miners lung H - hypersensitivity pneumonitis A - ankylosing spondylitis R - radiation T - TB S - silicosis/sarcoidosis
72
Cause of Lower Lobe Fibrosis
ACID A - asbestosis C - CTD I - idiopathic D - drugs
73
Investigation findings in Pulmonary Fibrosis
Restrictive spirometry Low TLCO/KO
74
Genetic finding in Kartegener Syndrome
Dynein arm defect = primary ciliary dyskinesia
75
First line investigation in adult asthma
Spirometry with bronchodilator reversibility and FENO testing
76
Severe VS Life threatening Asthma - PEF
Severe = PEF 33-50% Life threatening = PEF <33
76
What is a positive FeNO test?
> 40 parts per billion
77
Difference between asthma and COPD on spirometry
COPD = no significant reversibility on spirometry
78
Indications for LTOT (2)
paO2 = <7.3 kPa paO2 = 7.3-8.0 + RVH/pulmonary hypertension
78
Aspergilloma investigation finding =
= rounded crescent sign
79
When do you use PERC score?
In low risk Wells, if negative then can R/O PE
79
Management of Primary PTX - <2cm + not symptomatic
Discharge with F/U
79
Management of Primary PTX - >2cm or SOB
Aspirate Discharge with follow up - if unsuccessful then chest drain + admit
79
Features of allergic bronchopulmonary aspergillosis (4) Investigation of choice Management
Bronchiectasis Wheeze Cough Eosinophilia = RAST will be positive to aspergillus Initially steroids then itraconazole
80
Indications for VQ scan in suspected PE (2)
Pregnancy Renal impairment
80
Management of Secondary PTX - <1cm
Observe for 24 hours
80
Markers of good prognosis in sarcoidosis (2)
Rapid onset Erythema nodosum
81
Management of Secondary PTX - >2cm or SOB
Chest drain
81
Management of Secondary PTX - 1-2cm + not SOB
Aspirate then chest drain
81
What type of hypersensitivity reaction is hypersensitivity pneumonitis?
Acute = type III reaction Chronic = becomes type IV reaction
81
What is the mechanism of hypercalcaemia in sarcoidosis?
Over production of 1,25(OD)2D3 by macrophages
82
Skin features of sarcoidosis (2)
Erythema nodosum Lupus pernio
83
Genetic fault in CF
Deletion at dF508 on chromosome 7 in CFTR gene
83
Spirometry finding in sarcoidosis
Restrictive spirometry
84
Causes of bronchiectasis (5) - most common infection cause
CF Kartagener's syndrome Hypogammaglobulinaemia IgA deficiency Measles = haemophilus influenzae
85
Indications for steroids in sarcoidosis (5)
Symptomatic + CXR findings Hypercalcaemia Eye involvement Neurological involvement Cardiac involvement
86
What asbestos fibres are the most dangerous?
Blue fibres
87
XR signs in bronchiectasis
- Tramlines - Signet sign
88
Drug used in CF
Orkambi (lumacaftor/ivacaftor)
89
Association with mycoplasma
Cold AIHA Bilateral consolidation
90
What is the most common cause of pneumonia?
Streptococcus
91
Management of low severity CURB score pneumonia
Amoxicillin or macrolide antibiotic
92
Management of severe PCP
- initial is co-trimoxazole (+ steroids if hypoxia) Can use IV pentamidine in severe disease
93
Transudate effusion = Causes (5)
= <30 grams of protein = causes of low protein Heart failure Liver failure Nephrotic Syndrome Hypothyroidism Meig's Syndrome
94
Exudate Effusion = Causes (5) Indications for chest drain (2)
= >30g/protein Infection Malignancy Autoimmune Pancreatitis Pulmonary emboli Indications = pH <7.2, turbid fluid
95
Squamous cell lung cancer paraneoplastic syndromes (3)
Hyperthyroidism Hypercalcaemia HPOA
96
Large cell lung cancer association
Can be bHCG positive
97
Contra-indications to surgical management of lung cancer (3)
FEV <1.5 Hilar malignancy - SVCO, vocal cord paralysis Malignant effusion
98
Derivation of lung carcinoid - finding on bronchoscopy
= APUD cells - Cherry red balloon appearance on bronchoscopy
99
Investigation in ARDS
Pulmonary capillary wedge pressures - help to rule out cardiac causes
100
Management of aspergilloma
Surgical resection
101
Most common site for atrial myxoma
Left atria
102
Valve abnormality associated with HOCM
MR with anterior systolic leaflet movement
103
Mechanism of clopidogrel and ticagrelor
P2Y12 inhibition Clopidogrel = IRREVERSIBLE Ticagrelor = REVERSIBLE
104
Marker positive in small cell lung cancer
Banbesin
105
Reduced LV gradient - good or bad?
= little pressure difference Minimal LV obstruction Good
106
What to avoid in HOCM (medication)?
ACE-I
107
Histology finding in rheumatic fever
Aschoff bodies = granulomatous nodules
108
Indication for LTOT in COPD
Polycythaemia
109
ECG findings in Brugada Syndrome
ST elevation in V1-V3 and RBBB
110
What can right axis deviation indicate?
Left posterior hemiblock
111
ST depression specific for ischaemia
Downsloping
112
Why aren't b-blockers used as frequently in hypertension?
Less likely to prevent stroke Impairment of glucose tolerance
113
What is alpha-1 antitrypsin?
A protease inhibitor
114
Genotype of familial hypercholesterolaemia
Heterozygous
115
Pulmonary HTN heart sound finding
Loud S2
116
What should you avoid in accessory pathways in AF?
Avoid AV blocking drugs = encourages atrial fibrillation to travel down the accessory pathway - can become v. fibrillation Use fleccanide instead
117
Poor prognosis in HOCM
Septal thickness >3cm
118
Management of multifocal atrial tachycardia
Verapamil - DCCV and digoxin not useful
119
Pulse feature in PDA
Collapsing pulse (left to right shunt, rapidly dropping/changing volumes in aorta)
120
What is found in EAA?
Circulating IgG preceptins
121
Give a cause of DCM
Selenium
122
What is the mechanism of bosentan?
Endothelin A and B antagonist
123
What is the most common cause of congenital long QT syndrome?
Defects in K+ channel
124
What is the mechanism of cardiomyopathy with trastuzumab?
erb-b2 blockade (HER2 receptor) = herceptin

1MRCP Part 1 (20 decks)

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