cardiovascular

Question 1

What is the most common type of arrhythmia?

Answer 1

Atrial fibrillation (AF) is the most common type of arrhythmia.

Question 2

How does atrial fibrillation increase stroke risk?

Answer 2

AF causes incomplete blood ejection, increasing the risk of clot formation and stroke.

Question 3

What is the management of life-threatening AF with haemodynamic instability?

Answer 3

Immediate electrical cardioversion without delay for anticoagulation.

Question 4

What is the management of AF with onset <48 hours and no haemodynamic instability?

Answer 4

Consider rhythm or rate control.

Question 5

What is the management of AF with onset >48 hours and no haemodynamic instability?

Answer 5

Rate control is preferred.

Question 6

What drugs are used for pharmacological cardioversion in AF?

Answer 6

Flecainide or amiodarone.

Question 7

What is used in maintenance therapy for rate control in AF?

Answer 7

Beta blocker (not sotalol), diltiazem, verapamil, or digoxin for sedentary patients.

Question 8

When should digoxin be used for AF?

Answer 8

For sedentary patients with non-paroxysmal AF.

Question 9

What is the requirement for cardioversion if AF has lasted more than 48 hours?

Answer 9

Patient must be anticoagulated for at least 3 weeks before and 4 weeks after cardioversion.

Question 10

Which drugs are used to maintain sinus rhythm post-cardioversion in AF?

Answer 10

Sotalol, propafenone, amiodarone, or flecainide.

Question 11

How should paroxysmal AF be treated?

Answer 11

Beta blockers; if symptomatic, consider ‘pill-in-pocket’ with flecainide or propafenone PRN.

Question 12

What is a typical treatment for atrial flutter?

Answer 12

Rate or rhythm control, often using beta blockers or CCBs.

Question 13

What is a definitive treatment for recurrent atrial flutter?

Answer 13

Catheter ablation.

Question 14

How is paroxysmal supraventricular tachycardia managed?

Answer 14

Vagal maneuvers, IV adenosine, or IV verapamil; use catheter ablation for recurrent cases.

Question 15

How is unstable ventricular tachycardia managed?

Answer 15

Direct current cardioversion followed by IV amiodarone.

Question 16

What drugs can cause Torsade de Pointes due to QT prolongation?

Answer 16

Amiodarone, sotalol, macrolides, SSRIs, TCAs, antifungals.

French for “twisting of the points” fast heart rhythm in lower chambers

Question 17

What is the treatment for Torsade de Pointes?

Answer 17

IV magnesium sulfate, beta-blocker (not sotalol), AV pacing.

Question 18

What is the amiodarone loading regimen?

Answer 18

200mg TDS for 1 week, 200mg BD for 1 week, then 200mg OD for maintenance.

Question 19

What are key adverse effects of amiodarone?

Answer 19

Thyroid disorders, pulmonary toxicity, hepatotoxicity, corneal microdeposits, photosensitivity.

Please Check Patients Tired Livers

Question 20

What monitoring is required for amiodarone?

Answer 20

Thyroid function, LFTs every 6 months, serum potassium before treatment, CXR baseline, annual eye exam.

Question 21

What are digoxin toxicity symptoms?

Answer 21

Bradycardia, nausea, vomiting, yellow vision, confusion, AV block.

SICK and SLOW

Question 22

What is the therapeutic range of digoxin?

Answer 22

0.7–2.0 ng/mL; toxicity increases above 1.5–3.0 ng/mL.

Question 23

Which drugs interact with digoxin?

Answer 23

Beta blockers, TCAs, drugs causing hypokalaemia, CYP450 inducers/inhibitors.

Question 24

What is first-line treatment for heart failure?

Answer 24

ACE inhibitor and beta blocker.

Question 25

What is second-line for persistent heart failure symptoms?

Answer 25

Add aldosterone antagonist like spironolactone or eplerenone.

Question 26

Which diuretics relieve breathlessness in HF?

Answer 26

Loop diuretics such as furosemide.

Question 27

Which drugs reduce hospitalisation in worsening HF?

Answer 27

Ivabradine, sacubitril/valsartan, dapagliflozin, digoxin.

Question 28

What combination of drugs is used in ACS?

Answer 28

Dual antiplatelet therapy (aspirin + clopidogrel/prasugrel/ticagrelor), ACE inhibitor, beta blocker, statin.

Question 29

What is the strongest statin for secondary prevention?

Answer 29

Atorvastatin 80mg OD.

Question 30

What statin monitoring is required?

Answer 30

Baseline lipids, LFTs at baseline, 3 and 12 months, CK if muscle pain.

Question 31

Which food/drugs interact with statins?

Answer 31

Macrolides, grapefruit juice, fusidic acid, CYP450 modulators.

Question 32

What are ACE inhibitor side effects?

Answer 32

Cough, hyperkalaemia, angioedema, renal impairment, dizziness.

Question 33

Which drugs increase hyperkalaemia with ACE inhibitors?

Answer 33

ARBs, NSAIDs, potassium-sparing diuretics, heparins.

Question 34

What side effect makes ARBs preferred over ACE inhibitors?

Answer 34

No cough or angioedema with ARBs.

Question 35

Which side effects are associated with beta blockers?

Answer 35

Bradycardia, blunted hypoglycaemia response, bronchospasm, fatigue.

Question 36

Which drugs interact with beta blockers?

Answer 36

Digoxin, other antihypertensives.

Question 37

What are side effects of rate-limiting CCBs? (Verapamil and diltiazem)

Answer 37

Flushing, headache, ankle oedema, AV block, gingival hyperplasia.

Question 38

How is hypertension managed in pregnancy?

Answer 38

Labetalol first-line, then nifedipine or methyldopa.

Question 39

How is stable angina managed acutely?

Answer 39

GTN sublingual up to 2 doses, 5 minutes apart, then call emergency services.

Question 40

Which drugs prevent stable angina?

Answer 40

Beta blockers or CCBs first-line, followed by long-acting nitrates, nicorandil, ivabradine, or ranolazine.

Question 41

How should GTN tablets be stored?

Answer 41

Discard 8 weeks after opening.

Question 42

What are GTN side effects?

Answer 42

Headache, flushing, dizziness, hypotension, especially in elderly.

Question 43

What is the initial management for suspected STEMI?

Answer 43

300mg aspirin, GTN, morphine, and PCI within 2 hours.

Question 44

What is used for secondary prevention after MI?

Answer 44

Aspirin + prasugrel/clopidogrel/ticagrelor, ACEi, BB, statin.

Question 45

what medication should not be used to manage htn following a stroke?

Answer 45

Beta-blockers such as bisoprolol should not be used to manage hypertension following a stroke, unless it is already being used for an existing condition.

Question 46

which beta blockers are prefered in patients experiencing nightmares

Answer 46

Beta-blockers may cause nightmares due to crossing the blood-brain barrier. Water soluble beta-blockers are less likely to cross the blood brain barrier and cause nightmares. Water soluble beta-blockers include Celiprolol Atenolol Nadolol Sotalol (Water CANS)

Question 47

what is dose of tranexamic acid for menorrhagia

Answer 47

Tranexamic acid should be taken at a dose of 1g three times a day for up to four days. The maximum daily dose can be increased to 4 grams daily, but still only for up to 4 days

Question 48

how soon should alteplase be given after onsent of stroke?

Answer 48

Alteplase should be administered as soon as possible, but within 4.5 hours. Intracranial haemorrhage should be ruled out with imaging before administering it.

Question 49

what colour urine can be caused by triamterene

Answer 49

Triamterene may cause urine to turn a fluorescent blue colour under certain lights but this is harmless.

Question 50

two types of hypertension in pregnancy?

Answer 50

before pregnancy or in first 20 weeks = chronic hypertension new onset after 20 weeks = gestational hypertension or it can occur after 20 weeks gestation with features of multi organ involvement = pre-ecamplsia

Question 51

when is referal needed in pregant ladies with hypertension

Answer 51

all pregnant hypertension. If first episode of HTN (>140/90) refer to secondary care to be seen within 24 hours. if >160/110 urgent same day referal

Question 52

symptoms of pre-eclampsia

Answer 52

Advise all pregnant women to seek immediate medical review if they experience symptoms of pre-eclampsia (including during the first 4 weeks postpartum), such as: Severe headache. Problems with vision, such as blurring or flashing before the eyes. Severe pain just below the ribs. Vomiting. Sudden swelling of the face, hands, or feet. | BP higher than 140/90

Question 53

what should be done at each antenatal visit for pregnant ladies | relating to BP

Answer 53

For all pregnant women, dipstick the urine for protein and measure blood pressure at each antenatal visit. If dipstick screening is positive [1+ or more], use albumin:creatinine ratio or protein:creatinine ratio to quantify proteinuria in pregnant women.

Question 54

risk factors of pre-examplsia

Answer 54

CKD, DM, autoimmune disease, chronic HTN, or HTN during prev pregnancy

Question 55

if severe pre-eclampsia and birth is planned within 24 hours what should you give?

Answer 55

IV magnesium Sulphate

Question 56

what are the recommendations for females at risk of pre eclampsia

Answer 56

unlicenced = take aspirin from week 12 until baby is born (75-150mg)

Question 57

moderate risk factors for developing pre-eclampsia

Answer 57

high risk of pre-eclampsia if they have: One of the following high-risk factors: A history of hypertensive disease during a previous pregnancy. Chronic kidney disease. Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome. Type 1 or type 2 diabetes. Chronic hypertension. **Two or more of the following moderate risk** factors: First pregnancy. Aged 40 years or older. Pregnancy interval of more than 10 years. Body mass index (BMI) of 35 kg/m2 or greater at the first visit. Family history of pre-eclampsia. Multiple pregnancy.

Question 58

if a female has HTN and gets pregnant what drugs should you stop?

Answer 58

ACE, ARB, Thiazide like diuretics due to increased risk of congenital abnormalities - 1st line is labetolol, if unsuitable offer nifedipine (unlicenced) and if unsuitable offer methyldopa (unlicenced)

Question 59

what should you give in severe pre-eclampsia if early birth is considered likely in 7 days

Answer 59

antenatal corticosteroids for fetal lung maturation

Question 60

what is 1st line in women who have HTN and want to breastfeed

Answer 60

enalapril maleate for post-natal period - monitor renal function and serum potassium

Question 61

what is the antidote for LMWH and heparin

Answer 61

Protamine would be the antidote for unfractionated and low molecular weight heparin