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Finals 2024 > Cardiology Finals > Flashcards

Cardiology Finals Flashcards

Questions you get wrong

1
Q

What Coronary Vessel has a complete heart block most likely affected? (Complete dissociation between atria and ventricles)

A

Right Coronary Artery

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2
Q

What are the Heart Blocks

A

1) If R is FAR from P - First Degree (PR>0.2)

2) LONGER LONGER LONGER - DROP ATTACK - WencKeBACK - MOB 1

3) If some P’s don’t get through - you have MOB 2

4) If P’s and Q’s don’t agree - third defree (no assx between P and QRS)

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3
Q

Features of Complete Heart Block

A

Bradycardia (<50)
Wide Pulse Pressure
JVP - cannon waves in neck
Heart failure
syncope
Variable Intensity of S1

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4
Q

What 3 things is an S3 heart sound associated with?

A

1) Due to Diastolic filling of ventricle

2) Considered normal in <30

3) Can be a sign of LVF, Constrictive Pericarditis, Mitral Regurgitation

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5
Q

What 3 things is an S4 heard sound associated with? (Atrial contraction against a stiff ventricle)

A

1) HOCM

2) Aortic Stenosis

3) Hypertension

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6
Q

When should Nitrates be used with cautious in ACS management?

A

When the patient is hypotensive

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7
Q

When should Oxygen be used in ACS management?

A

When SATS drop below 94%

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8
Q

When should moprhine be used in ACS management?

A

When patient is in extreme pain

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9
Q

First thing to give in ACS

A

300 mg Aspirin

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10
Q

Mx of HeartBlock (1st to 3rd degree)

A

1st degree - nothing unless symptomatic and other causes of symptoms excluded
2nd degree (Mobitz type I) -nothing unless symptomatic and other causes of symptoms excluded
2nd degree (Mobitz type II) pacemaker- transcut/transv
3rd degree pacemaker - transcut/transv

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11
Q

What do you give with PCI for STEMI

A

Prasugrel

(Give Clopidogrel if already on anticoagulants)

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12
Q

What do you give with Thrombolysis

A

Fondaparinux - antithrombin

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13
Q

Difference between Unstable Angina and NSTEMI

A

Present similarly on ECG - NSTEMI will have a RAISE of troponin

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14
Q

How to Treat Unstable Angina

A

Same as NSTEMI

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15
Q

Give examples of unmodifiable risk factors for ACS

A

Male SEX
Older Age
Family history

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16
Q

What to give with PCI for NSTEMI

A

Make sure in <72 hours (based on Grace score)

Give Prasugrel or Ticagrelor

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17
Q

What does GRACE score decide

A

> 3% Give coronary angiography (with follow up PCI <72HOURS)

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18
Q

What NSTEMI/UNSTABLE angina patients should have coronary angiography? (2)

A
  • Those who are unstable (hypotensive)
  • Those who score >3% on GRACE score
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19
Q

When do you give Clopidogrel over Ticagrelor in NSTEMI

A

When Patient is at a HIGH risk of bleeding

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20
Q

What is Prinzemetal (Variant) angina

HINT - You had it a lot as a kid

A

Clinical condition characterized by chest discomfort or pain at rest with transient electrocardiographic changes in the ST segment, and with a prompt response to nitrates

normally occurs in the younger population and in smokers.

Earlier in morning or at sleep - almost always at rest.

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21
Q

When should CHADVASc be started

A

> 1 in men
2 in women

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22
Q

What to do if CHADVASc suggests no need for DOAC in AF?

A

Transthoracic echocardiogram has been done to exclude valvular heart disease (if present - indication for DOAC)

23
Q

What counts as 2 points on CHADVASc

A

> 75 and Prev Stroke/TIA/ThromboEmbolism

24
Q

Criteria of ORBIT?

A

O - Older Age >75
R - Renal Failure ( eGFR <60)
B - Bleeding hx
I - Iron - LOW
T- Taking antiplatelet medication

25
Q

Features of Left Ventricular FREE wall Rupture

A

1 - 2 weeks after MI

Beck’s triad

26
Q

Features of Left Ventricular Aneurysm

A

Due to ischaemic damage

Persistent ST elevation NO chest pain

27
Q

Management of a LV Free wall rupture

A

Pericardiocentesis and Thoracetomy

28
Q

Most common cause of death following an MI?

A

Ventricular fibrillation

29
Q

Features of Ventricular septal defect post MI

A

Acute heart failure and Pan-systolic murmur

30
Q

Management of LV Aneurysm

A

Anticoagulation

31
Q

Contraindications of Statins (2)

A

Pregnancy

Macrolide Antibiotics - erythromycin etc

32
Q

Dosage of statin

A

20 mg Primary Prevention

80 mg Secondary Prevention (if non HDL has not fallen by >40% or known CVD)

33
Q

What should you do if patient experiences dry cough on ACE inhibitor?

A

SWITCH to ARB or lower down BP pathway

34
Q

ACEI side effects

A

DRY cough, Hyperkalaemia, Angioedema, Hypotension

35
Q

Amlodipine SE

A

Flushing, Headache, oedema

36
Q

What is Mackler Triad for Boerhave Syndrome

What is dx

what is tx

A

Vomiting, thoracic pain, subcutaneous emphysema (can be described as mild crepitus)

Dx is CT contrast swallow

tx is a thoractomy

37
Q

AF and strokes and DOACs

When should patients with AF + TIA stroke START DOAC

When should patients with AF + Acute ischaemic (complete) stroke start DOAC

A

TIA - start DOAC immediately (once Haemorrhage excluded)

For acute/complete stroke - 2 WEEKS AFTER (give antiplatelet therapy meanwhile - clopidogrel)

38
Q

Who may have a silent MI

A

Diabetic AND elderly

39
Q

How to treat a PE?

2) How to treat a MASSIVE PE (HYPOTENSIVE)

A

1) DOAC

2) Thrombolyse

40
Q

Torsade De Pointes causes

A

T - Thiazides
O - Olanzapine
O - Opioids
Q - Quinolones (Fluoroquinolones antibiotics)
R - Risperidone (Typical and atypical antipsychotics)
S - Sotalol (Class III antiarrhythmic)
A - Azithromycin
D - Donepezil
E - Erythromycin (Macrolide antibiotics)
S - SSRI antidepressants

41
Q

Treatment of Rheumatic Fever

A

IM benzypenicillin/Oral penicillin V

42
Q

Treatment of Broad Complex Tachycardia caused by VT

Treatement of Unstable broad complex tachy

A

Amiodarone IV

Or lidocaine second line

If unstable: synchronised DC

43
Q

What is a BROAD complex Tachycardia

What are main causes (2)

A

QRS - >0.2s/3 small squares

Cause 1 - is a Ventricular Tachycardia
Cause 2 - Torsade de pointed (tx is IV magnesium)

44
Q

What is contraindicated in VT?

A

Verapamil

45
Q

Why may acute mitral regurgitation occur post -MI

A

may be due to ischaemia or rupture of the papillary muscle

46
Q

what are the causes of long QT?
Normal is <430 ms in males and 450 ms in females.

Mechanism?

Long QT signs on ECG

A

HYPO - calcium, magnesium, potassium, hypothermia

Tramadol, Metoclopramide

Malnutrition

Mechanism is the blocking of the K+ CHANNELS

ECG: MORE than two large squares - LONG QT

47
Q

What is the management of Long QT

A

Avoid causes

BB - except solatolol

implantable defib

48
Q

Management for HFrEF

A

The four drugs used in HFrEF - ACE-inhibitors, beta-blockers, MRA (spironolactone) and SGLT2 inhibitors (e.g. Dapagliflozin).

49
Q

Treatment for Bradycardia

A

Intravenous atropine (first line)
Inotropes (e.g., isoprenaline or adrenaline)
Temporary cardiac pacing - transcutaneous, transvenous
Permanent implantable pacemaker, when available

50
Q

When should tests be done after starting a statin

A

3 months - lipid profile, LFTS

51
Q

When should you stop a statin?

A

If serum AST is >3x the upper limit

52
Q

When do you measure CK after starting a statin

A

When indicated - ex muscle pain

53
Q

Features of Acute Mitral Regurgitation (post MI)

A

Hypotension
Pan-systolic murmur
Flash Pulmonary oedema - frothy sputum,

Finals 2024 (8 decks)

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