Cardiovascular Medicine

Question 1

Myocardial Infarctions are described as a … , … chest pain. The pain sometimes radiates to the … … and … . Generalised symptoms that are associated with MIs are … , … and … .

Answer 1

Myocardial Infarctions are described as a CRUSHING, CENTRAL chest pain. The pain sometimes radiates to the LEFT ARM and JAW. Generalised symptoms that are associated with MIs are NAUSEA , SOB and SWEATING.

Question 2

Angina is exacerbated upon … and relieved by …

Answer 2

Angina is exacerbated upon EXERTION and relieved by REST

Question 3

The pain from aortic dissection is often described as … with a very … onset. It radiates to the … and is accompanied by … … … … . The BP in … is unequal in aortic dissection

Answer 3

The pain from aortic dissection is often described as TEARING with a very SUDDEN onset. It radiates to the BACK and is accompanied by PAIN AT OTHER SITES The BP in ARMS is unequal in aortic dissection.

Question 4

… is the site of pain in pericarditis. It is … . Relief from pericarditis pain comes from … … . The pain may radiate to the … … / … / …

Answer 4

RETROSTERNAL/PRECORDIUM is the site of pain in pericarditis. It is PLEURITIC. Relief from pericarditis pain comes from SITTING FORWARD. The pain may radiate to the TRAPEZIUS RIDGE / NECK / SHOULDER.

Question 5

Respiratory chest pain is … . Pain from pneumothorax is usually of a … onset. It is associated with the risk factors of … syndrome, … and asthma. It is perhaps also accompanied by SOB.

Answer 5

Respiratory chest pain is PLEURITIC . Pain from pneumothorax is usually of a SUDDEN onset. It is associated with the risk factors of MARFAN’S syndrome, COPD and asthma. It is perhaps also accompanied by SOB.

Question 6

Pain from a pulmonary embolism is accompanied by … and … . Risk factors for a PE include … , … and … .

Answer 6

Pain from a pulmonary embolism is accompanied by HAEMOPTYSIS and SOB . Risk factors for a PE include LONG FLIGHTS, IMMOBILITY and RECENT SURGERY .

Question 7

GORD pain is a retrosternal burning pain. It is related to … , … , … . On clinical examination someone with GORD may have … due to the excess acid.

Answer 7

GORD pain is a retrosternal burning pain. It is related to meals , lying down and straining. On clinical examination someone with GORD may have HYPERSALIVATION due to the excess acid.

Question 8

Musculoskeletal chest pain is described as. It is exacerbated by movement, … and … . The patient is able to point to a site where to pain is … .

Answer 8

Musculoskeletal chest pain is described as SHARP. It is exacerbated by movement, INSPIRATION and PRESSURE. The patient is able to point to a site where to pain is ‘WORSE’.

Question 9

The condition where cartilage in the thorax is inflamed is called…

Answer 9

COSTOCHONDRITIS/TIETZE’S SYNDROME

Question 10

Chest pain from anxiety usually has a trigger. It is a tight feels accompanied with …

Answer 10

SOB, SWEATING, DIZZINESS, PALPITATIONS

Question 11

What is pain from pleurisy like?

Answer 11

Sharp unilateral pleuritic

Question 12

Other differentials of chest pain are…

Answer 12

Gastritis and myocarditis

Question 13

In the humble CXR, an enlarged heart suggests … , a cardiac cause of chest pain.

Answer 13

In the humble CXR, an enlarged heart suggests CHF , a cardiac cause of chest pain.

Question 14

In the humble CXR, a globular heart indicates …?

Answer 14

In the humble CXR, a globular heart indicates PERICARDIAL EFFUSION

Question 15

Pulmonary oedema in the CXR suggests decompensated?.. . Rib notching indicates ?..

Answer 15

Pulmonary oedema in the CXR suggests decompensated HF . Rib notching indicates COARCTATION OF AORTA.

Question 16

Angiography is a … scan used in the diagnosis of ?

Answer 16

CT, STENOSIS IN CORONARY ARTERY DISEASE

Question 17

Cardiac MR scans are the first choice for … disease. An advantage us they are …

Answer 17

MYOCARDIUM, RADIATION FREE

Question 18

Nuclear imaging of the heart assesses … at rest and under stress. It is testing for … … distal to a blockage to see if the procedures of … or … are of value.

Answer 18

Nuclear imaging of the heart assesses PERFUSION at rest and under stress. It is testing for MYOCARDIUM VIABILITY distal to a blockage to see if the procedures of STENTING or CABG are of value.

Question 19

In nuclear imaging testing, if hypoperfusion is fixed and not reversible the area of the myocardium is … … and is therefore viable or not?

Answer 19

SCAR TISSUE, NOT VIABLE

Question 20

Which method of echocardiography can be used for continuous heart monitoring during surgery?

Answer 20

Transoesophageal

Question 21

Which drug is used as a pharmacological stressor if a patient cannot exercise?

Answer 21

Dobutamine

Question 22

A stunned myocardium is…..

Answer 22

when a section of myocardium shows a form of contractile abnormality

Question 23

What induces a stunned myocardium?

Answer 23

Acute ischaemia

Question 24

A hibernating myocardium is

Answer 24

when there is chronicity of the ischaemia and it is irreversible

Question 25

For secondary prevention of after a CV event, a low dose of which anti-platelet drug is given?

Answer 25

Aspirin 75mg

Question 26

Clopidogrel, Prasugrel and Ticagrelor are all examples of which drug class?

Answer 26

ADP receptor antagonists

Question 27

Clopidogrel, Ticagrelor and Prasugrel are used for II prevention if a pt is intolerant of ... or they are used with it after ... ... or for ...

Answer 27

Clopidogrel, Ticagrelor and Prasugrel are used for II prevention if a pt is intolerant of aspirin or they are used with it after stent insertion or for ACS

Question 28

Warfarin is being replaced by ... and ... for treatment of AF and blood clots, but warfarin is still the drug of choice for ... ... .

Answer 28

Warfarin is being replaced by DOAC (APIXIBAN) and DIRECT THROMBIN INHIBITORS (DABIGATRAN) for treatment of AF and blood clots, but warfarin is still the drug of choice for MECHANICAL VALVES .

Question 29

The 3 anticoagulants used for ACS are ...

Answer 29

LMWH, Xa inhibitors (FONDPARIUX), BIVALIRUDIN

Question 30

Which beta receptor when blocked is negatively inotropic and chronotropic?

Answer 30

Beta 1

Question 31

Which beta receptor when blocked causes peripheral vasoconstriction and bronchioconstriction?

Answer 31

Beta 2

Question 32

Propranolol is non-selective whereas Bisoprolol is relatively selective for beta.?

Answer 32

1

Question 33

Beta blockers are contraindicated in which 3 conditions

Answer 33

Asthma, COPD, heart block

Question 34

5 common side effects of beta blockers

Answer 34

``` Lethargy Erectile dysfunction Decreased joie de vivre Nightmares Headache ```

Question 35

ACE inhibitors are commonly used in ... , ... and post .. . In hypertension with severe CCF, .... acting ACE inhibitors should be used. Their main side effects are .... and ... .....

Answer 35

ACE inhibitors are commonly used in HYPERTENSION, HF and post MI . In hypertension with severe CCF, LONG acting ACE inhibitors should be used. Their main side effects are DRY COUGH and URTICARIA

Question 36

The loop diuretic used for heart failure is

Answer 36

Furosemide

Question 37

The thiazide like diuretic used for heart failure is

Answer 37

metolazone

Question 38

The thiazide like diuretic used for hypertension is

Answer 38

Indapamide

Question 39

Potassium sparing diuretics

Answer 39

Spironolactone, eplerenone, amiloride

Question 40

Nitrates work to dilate veins and large arteries which decreases ...... pressure

Answer 40

PRELOAD

Question 41

Hydralazide dilates ... vessels and Prazosin dilates... and...

Answer 41

Resistance , arteries and veins

Question 42

Why are calcium antagonists such as amlodipine and nifedipine often used with a beta blocker?

Answer 42

Reflex bradycardia

Question 43

How do calcium antagonists work? What are they used for?

Answer 43

Promote coronary peripheral vasodilation, decreasing myocardial O2 consumption. They are used for hypertension and angina.

Question 44

Which calcium antagonists are not to be used with a beta blocker?

Answer 44

Non-dihydropines; verpamil and dilitiazam

Question 45

What is a contraindication in the use of calcium antagonists?

Answer 45

Heart block

Question 46

Digoxin is used in the treatment of AF. It works by...

Answer 46

Blocking the Na/K pump.

Question 47

Amiodarone works by ... which reduces the potential for tachyarrhytmias. If taking digoxin with amiodranone, the dose of digoxin must be ...

Answer 47

Prolonging cardiac action potential, halved

Question 48

Sodium channel blockers are ... ... ... ...

Answer 48

Class 1 anti arrhythmics.

Question 49

Ivabradine works by blocking the ... ... . This slows the pulse down with little drop in ... ... . It is contraindicated in ...

Answer 49

Ivabradine works by blocking the FUNNY CURRENT. This slows the pulse down with little drop in . It is contraindicated in ACUTE MI, BRADYCARDIA, LONG QT SYNDROME, SHOCK

Question 50

How do stating work?

Answer 50

HMG-CoA reductase inhibitors, decreasing LDL cholesterol

Question 51

What are the main features of angina?

Answer 51

constricting/discomfort in the chest that may radiate, exacerbated by exertion, relieved with rest or GTN

Question 52

Angina is associated with...

Answer 52

dyspnoae, nausea, sweatiness and faintness BUT NOT palpitations or dizziness or pleuritic pain

Question 53

The main cause of angina is

Answer 53

atheroma

Question 54

Angina that is caused by coronary artery spasm is known as ... angina. Angina that is precipitated by lying flat is ... angina. Stable angina is that which is induced by... and relieved ... ... . Unstable angina is that with an increased risk of ... with increasing ... and ...

Answer 54

Angina that is caused by coronary artery spasm is known as VARIANT angina. Angina that is precipitated by lying flat is DECUBITUS angina. Stable angina is that which is induced by EXERTION and relieved AT REST . Unstable angina is that with an increased risk of MI with increasing FREQUENCY AND SEVERITY.

Question 55

Angina is tested with ...

Answer 55

ECG, ANGIOGRAPHY AND FUNCTIONAL IMAGING

Question 56

Angina is managed with...

Answer 56

lifestyle changes and PRN GTN