Cardiovascular

Question 1

Definition of AAA

Answer 1

Permanent dilatation of >3 cm (i.e. 1.5x)

Question 2

Most sensitive and specific imaging for AAA

Answer 2

U/S

Question 3

Indications for open AAA repair

Answer 3

Large (≥5.5 cm) Expanding at ≥1 cm/year Symptomatic

Question 4

Types of aortic dissection

Answer 4

DeBakey: 1 - ascending + arch + descending 2 - ascending 3 - descending Stanford: A - ascending B - descending

Question 5

Radiation of pain in ascending vs. descending aortic dissection

Answer 5

Ascending - anterior Descending - interscapular

Question 6

Management of aortic dissection

Answer 6

Fluids, oxygen, beta blockers, morphine, surgical repair, post-op antihypertensives

Question 7

Indications for surgical repair of aortic dissection

Answer 7

Type A Type B with persistent pain or branch occlusion

Question 8

ECG findings in cardiac tamponade

Answer 8

Low voltage QRS, electrical alternans, PR depression

Question 9

Indications for carotid endarterectomy

Answer 9

Symptomatic ≥70% stenosis Symptomatic 50-70% stenosis (less benefit) Asymptomatic ≥70% stenosis (debated)

Question 10

Bifascicular block

Answer 10

LAD + RBBB

Question 11

Trifascicular block

Answer 11

LAD + RBBB + 1st degree heart block

Question 12

Rate control for AF

Answer 12

Beta blocker (atenolol, metoprolol) Non-dihydropyridine CCB (verapamil, diltiazem) Digoxin - in heart failure

Question 13

Rhythm control for AF (cardioversion and maintenance)

Answer 13

Cardioversion: DC cardioversion Flecainide + beta blocker Amiodarone Maintenance: Flecainide Sotalol Amiodarone

Question 14

Management of SVT (AVNRT/AVRT)

Answer 14

Vagal manoeuvres Adenosine Verapamil Catheter ablation

Question 15

Management of VT/VF

Answer 15

DC defibrillation Amiodarone Lignocaine

Question 16

Management of heart block

Answer 16

1 - none 2 (Mobitz I) - none if asymptomatic, atropine if symptomatic 2 (Mobitz II) - pacemaker 3 - pacemaker

Question 17

ECG findings in SVT

Answer 17

Delta wave, small P wave, short PR interval

Question 18

Management of asystole/PEA

Answer 18

Adrenaline

Question 19

ECG findings in HOCM

Answer 19

ST depression, tall QRS, T wave inversion

Question 20

Management of HOCM

Answer 20

Symptomatic relief - BBs, CCBs Surgical myectomy

Question 21

Morphological changes in MI

Answer 21

12-24 hours - dark mottling

1-3 days - mottling + yellow-tan centre

3-7 days - yellow-tan centre + hyperaemic borders

7-10 days - maximally yellow-tan + depressed red-grey borders

10-14 days - depressed red-grey borders

2-8 weeks - grey-white scar

>2 months - complete scarring

Question 22

ECG changes in MI

Answer 22

Question 23

ABI values in PVD

Answer 23

Normal >1.0

Intermittent claudication 0.5-1.0

Critical limb ischaemia <0.5

Question 24

Signs of aortic stenosis

Answer 24

Ejection systolic click

Soft S2

S4 heart sound

Carotid parvus et tardus

Narrow pulse pressure

Question 25

Signs of mitral regurgitation

Answer 25

Pansystolic murmur S3 heart sound Displaced apex beat Soft S1

Question 26

Signs of aortic regurgitation

Answer 26

Early diastolic murmur Increased pulse pressure Displaced apex beat Various eponymous signs (Watson's/Corrigan's, de Musset's, Quincke's, Traube's)

Question 27

Signs of mitral stenosis

Answer 27

Opening snap + mid-diastolic murmur Loud S1 Tapping apex beat

Question 28

What is this rhythm?

Answer 28

SA block

Question 29

What is this rhythm?

Answer 29

Premature ventricular contractions (bigeminy)

Question 30

Management of congenital long QT syndrome

Answer 30

Intracardiac defibrillator

Question 31

Management of torsades de pointes

Answer 31

Magnesium sulfate

Question 32

Management of bradycardias

Answer 32

Atropine

Question 33

Reversible causes of cardiac arrest

Answer 33

6Hs: * Hypoxia * Hypovolaemia * Hypothermia * Hydrogen ions (acidosis) * Hyper/hypokalaemia * Hypo/hyperglycaemia 6Ts: * Tablets/toxins * Cardiac tamponade * Tension pneumothorax * Thrombosis (MI) * Thromboembolism (PE) * Trauma

Question 34

Management of pericarditis

Answer 34

NSAID (+PPI) Colchicine Corticosteroids

Question 35

When does rheumatic fever occur?

Answer 35

2-6 weeks after group A streptococcal pharyngeal infection

Question 36

Jones Criteria for rheumatic fever

Answer 36

Polyarthritis Carditis Sydenham's chorea Erythema nodosum Subcutaneous nodules

Question 37

Management of rheumatic fever

Answer 37

Analgesia Antibiotics (benzathine penicillin, phenoxymethlypenicillin) NSAIDs - for arthritis Diuretics - for heart failure Anticonvulsants - for chorea

Question 38

Management of PEA in haemorrhage

Answer 38

Colloid (reversable cause)