Cardiovascular System - Finals Paper One Flashcards
(276 cards)
1
Q
What screening is used in abdominal aortic aneurysm?
A
Single abdominal ultrasound scan for 65 year old males
2
Q
What is the next step in those with an abdominal aorta width <3cm?
A
No further action
3
Q
What is the next step in those with an abdominal aorta width 3cm - 4.4cm?
A
Rescan every 12 months
4
Q
What is the next step in those with an abdominal aorta width 4.5cm - 5.4cm?
A
Rescan every 3 months
5
Q
What is the next step in those with an abdominal aorta width >5.5cm?
A
2 week referral to vascular surgery
6
Q
What are the three criteria for 2 week referral for abdominal aorta surgery?
A
Symptomatic
Aortic diameter > 5.5cm
Rapidly enalrging > 1cm/yeat
7
Q
What is the first line management option of unruputered abdominal aortic aneurysms?
A
Elective endovascular repair
8
Q
What is the next step in those with ruptured abdominal aortic aneurysms?
A
Immediate vascular review
9
Q
What is the first line management option in those who are haemodynamically stable with a ruptured abdominal aortic aneurysm?
A
CT Scan
10
Q
What is the first line management option in those who are haemodynamically unstable with a ruptured abdominal aortic aneurysm?
A
Emergency Surgery
11
Q
In which three patient groups does acute coronary syndrome present atypically?
A
Elderly
Diabetic
Female
12
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the left anterior descending artery/anteroseptal region?
A
V1 - V4
13
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the right coronary artery/inferior region?
A
II
III
aVF
14
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the left anterior descending artery/anterolateral region?
A
V1 - V6
aVL
15
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the left circumflex artery/lateral region?
A
I
aVL
V5 - V6
16
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the posterior region?
A
V1 - V3
17
Q
Which ECG leads demonstrate changes when acute coronary syndrome develops in the posterior region?
A
V1 - V3
18
Q
What are the four ECG criteria for a diagnosis of STEMI?
A
Acute coronary syndrome features > 20 mins with persistent ECG features in > 2 contiguous leads of…
- 2.5mm ST elevation in leads V2-V3 in men < 40 years old
- > 2mm ST elevation in leads V2-V3 in men > 40 years old
- 1.5mm ST elevation in V2-V3 in women
AND
1mm ST elevation in other leads
AND
New left bundle branch block
19
Q
What are the five ECG features of posterior myocardial infarctions?
A
ST Depression
Tall, Broad R Waves
R Waves in V2
Upright T Waves
Q Waves In V7 - V9
20
Q
What is the initial management of acute coronary syndrome?
A
Morphine
Oxygen < 92%
Nitrates
Aspirin 300mg
21
Q
When should we be cautious about administering nitrates in acute coronary syndrome?
A
Hypotension
22
Q
When is percutanous coronary intervention used to manage STEMIs?
A
When individuals present within12 hours of clinical feature of onset AND within 120 minutes of the time when fibronlysis could have been given
When individuals present after 12 hours of clinical features with evidence of ongoing ischaemia
23
Q
Which antiplatelet should be administered, in addition to aspirin, prior to STEMI percutaneous coronary intervention - in those not taking an oral anticoagulant?
A
Prasugrel
24
Q
Which antiplatelet should be administered, in addition to aspirin, prior to STEMI percutaneous coronary intervention - in those taking an oral anticoagulant?
A
Clopidogrel
25
Which access artery is preferred in percutaneous coronary intervention?
Radial
26
Which drug therapy should be administered during STEMI percutaneous coronary intervention - with radial access?
Unfractioned heparin with bailout glycoprotein IIb/IIIa inhibitor
27
Which drug therapy should be administered during STEMI percutaneous coronary intervention - with femoral access?
Bivalirudin with bailout glycoprotein IIb/IIIa inhibitor
28
Which stent types are used in percutaneous coronary intervention?
Drug eluting stents
29
What should be conducted when individuals are haemodynamically unstable or experience pain post percutaneous coronary intervention?
Urgent CABG Surgery
30
When is fibronlysis used to manage STEMIs?
When individuals present within 12 hours of clinical feature onset, however percutaenous coronary intervention cannot be delivered within 120 minutes
31
What investigation is conducted following fibrinolysis? When? Why?
ECG Scan
60 - 90 minutes
In order to determine whether percutaneous coronary intervention is required
32
Which antithrombin is used to manage NSTEMIs? What is the contraindication?
Fondapurinax
High Bleeding Risk
33
What risk assessment system is used to determine management of NSTEMIs?
GRACE score
34
What is the management option of NSTEMIs in those who are clinically unstable?
Immediate coronary angiography
35
What is the management option of NSTEMIs in those who with a GRACE score > 3%?
Percutaneous coronary intervention within 72 hours
36
Which antiplatelet should be administered, in addition to aspirin, prior to NSTEMI percutaneous coronary intervention - in those not taking an oral anticoagulant?
Prasugrel
OR
Tricagrelor
37
Which drug therapy should be administered during NSTEMI percutaneous coronary intervention?
Unfractioned Heparin
38
Which antiplatelet should be administered, in addition to aspirin, prior to NSTEMI percutaneous coronary intervention - in those taking an oral anticoagulant?
Clopidogrel
39
Which antiplatelet should be administered, in addition to aspirin, when NSTEMIs are managed conservatively - in those with a low bleeding risk?
Ticagrelor
40
Which antiplatelet should be administered, in addition to aspirin, when NSTEMIs are managed conservatively - in those with a high bleeding risk?
Clopidogrel
41
What is the red blood transfusion threshold in those with acute coronary syndrome?
< 80g/L
42
What is a poor prognostic factor in acute coronary syndrome?
Cardiogenic Shock
43
What are the four secondary prevention pharmacological management options of acute coronary syndrome?
Dual Antiplatelet Therapy
ACE Inhibitor
Beta-Blocker
Statin
44
What atorvastatin dose is recommended in secondary prevention?
80mg once daily
45
What advice is given in regards to driving following myocardial infarction?
They cannot drive for a period of four weeks
46
What is the most common cause of death folllowing myocardial infarctions?
Ventricular Fibrillation
47
What arythmia can occur in inferior myocardial infarctions?
Arterioventricular Block (Bradyarrythmias)
48
When does Dressler's syndrome tend to occur > myocardial infarction?
2 - 6 weeks > myocardial infarctions
49
What are the three clincical features of Dressler's syndrome?
Fever
Pleuritic Chest Pain
Pericardial Effusion
50
What blood test result indicates Dressler's syndrome?
Increased ESR Levels
51
What is the management option of Dressler's syndrome?
NSAIDs
52
When does left ventricular aneurysm tend to occur > myocardial infarction?
4 weeks > myocardial infarction
53
When does left ventricular aneurysm tend to occur > myocardial infarction?
4 weeks > myocardial infarction
54
What are the three clinical features of left ventricular aneurysm?
Bibasal Crackles
3rd Heart Sound
4th Heart Sound
55
What are the two ECG features of left ventricular aneurysm?
ST Elevation
Q Waves
56
When does left ventricular free wall rupture tend to occur?
1 - 2 weeks > myocardial infarction
57
What is the clinical feature of left ventricular free wall rupture > myocardial infarction?
Acute heart failure secondary to cardiac tamponade
58
What are the three clinical features of cardiac tamponade?
Increased JVP
Pulsus Paradoxus
Diminshed Heart Sounds
59
When does ventricular septal defect tend to occur > myocardial infarction?
1 week > myocardial infarction
60
What is the clinical feature of ventricular septal defect > myocardial infarction?
Acute heart failure with pansystolic murmur
61
What is the invesigation used to diagnose ventricular septal defect?
ECHO Scan
62
How is acute mitral regurgitation associated with myocardial infarctions?
This is due to ischaemia or rupture of the papillary muscle
63
What are the three clinical features of acute mitral regurgitation?
Pulmonary Oedema
Hypotension
Pansystolic Murmur Radiates To Axilla
64
What investigation is used to in new-onset acute heart failure?
ECHO Scans
65
What is the gold standard management option of acute heart failure?
IV Loop Diuretics
66
Name two loop diuretics used to manage acute heart failure
Furosemide
Bumetanide
67
What is the management option of acute heart failure, with respiratory failure?
Continous positive airway pressure (CPAP)
68
When should beta-blockers stopped during acute heart failure?
They should only be stopped when the patient has a heart rate < 50bpm, second/third degree atrioventriculae block or shock
69
What heart failure classification is associated with hypertrophic obstructive cardiomyopathy?
Diastolic Heart Failure (HF-pEF)
70
What are the three clinical feature of right sided heart failure (cor pulmonale)?
Increased JVP
Ankle Oedema
Hepatomegaly
71
What is the first line investigation used to diagnose chronic heart failure?
N-Terminal Pro-B-Type Natriuretic Peptide (NT‑proBNP) Blood Test
72
What BNP level is deemed as high?
> 400
73
What NTproBNP level is deemed as high?
> 2000
74
What is the next step when BNP/NTproBNP levels are high?
2 week ECHO scan referral
75
What BNP level is deemed as raised?
100 - 400
76
What NTproBNP level is deemed as raised?
400 - 2000
77
What is the next step when BNP/NTproBNP levels are raised?
6 week ECHO scan referral
78
What is the NYHA class I of chronic heart failure?
No clinical features
No limitation of physical activity
79
What is the NYHA class II of chronic heart failure?
Mild clinical features
Slight limitation of physical activity, comfortable at rest however activity results in faitgue, palpitations or dyspnoea
80
What is the NYHA class III of chronic heart failure?
Moderate clinical features
Marked limitation of physical activity, comfortable at rest however less then ordinary activity
81
What is the NYHA class IV of chronic heart failure?
Severe clinical features
Severe physical limitation, clinical features at rest
82
What is the first line pharmacological management option of chronic heart failure?
ACE Inhibitor
AND
Beta Blocker
83
What two beta-blockers improve long term prognosis of chronic heart failure?
Bisoprolol
Carvediol
84
What two beta-blockers improve long term prognosis of chronic heart failure?
Bisoprolol
Carvediol
85
What are the two second line pharmacological management option of chronic heart failure?
Aldosterone/Mineralocorticoid Antagonists
Angiotension Receptor Blockers
86
What montioring should be conducted when individuals are administered ACE inhibitors and aldosterone antagonists? Why?
Potassium Levels
Hyperkalaemia Risk
87
What are the four third line pharmacological management options of chronic heart failure?
Ivabridine
Sacubitril-Valsartan
Digoxin
Hydralazine & Nitrates
88
When is ivabradine used to manage acute heart failure?
Heart Rate > 75bpm
AND
Left Ventricular Fraction < 35%
89
When is sacubitril-valsartan used to manage acute heart failure?
Left Ventricular Fraction < 35%
90
What should be conducted before starting heart failure patients on sacubitril-valsartan?
ACEI/ARB Washout Period
This involves stopping these medications 36 hours before administration
91
When is digoxin used to manage acute heart failure?
Coexistent atrial fibrillation
92
When is hydralazine, with nitrates, used to manage acute heart failure?
Afro-Caribbean Patients
93
Which drug class does not improve mortality in heart failure?
Diuretics
94
What is the first line management option of acute angina attacks?
Sublingual Glyceryl Trinitrate
95
What are the two first line prophylactic management options of stable angina?
Beta-Blocker
OR
Calcium Channel Blockers
96
What is the first line prophylactic management option of angina - in those with heart failure?
Beta-Blockers
97
What is the first line prophylactic management option of angina - in those with asthma?
Calcium Channel Blockers
98
Which two calcium channel blockers should be administered as monotherapy when prophylactically managing angina?
Verapamil
Dilitiazem
99
Which two calcium channel blockers should be administered when administered in compinated with a beta-blocker, when prophylactically managing angina?
Amlodpine
Nifedipine
*These are known as longer-acting dihydropyridine calcium channel blockers*
100
Which calcium channel blocker should not be prescribed with beta-blockers? Why?
Verapamil
Complete heart block risk
101
What are the two acute management options of angina?
Aspirin
102
What are the four second line prophylactic management options of angina - when individuals cannot toelrate dual therapy with a calcium channel blocker and beta blocker?
Long Acting Nitrate
Ivabradine
Nicorandil
Ranolazine
103
Name a long actine nitrate used to manage angina
Isosorbide Mononitrate
104
When is a complication of long acting nitrates? How do we prevent this complication?
Nitrate Tolerance
Asymmetric dosing interval, daily nitrate free time of 10 - 14 hours
105
What is the most important risk factor of aortic dissection?
Hypertension
106
What are the five clinical features of aortic dissection?
Sharp, Tearing Chest/Back Pain
Weak Peripheral Pulses
Asymmetrical Blood Pressure
Hypertension
Aortic Regurgitation
107
What is type A aortic dissection?
It involves the ascending aorta
108
What is type B aortic dissection?
It involves the descending aorta
109
What is type B aortic dissection?
It involves the descending aorta
110
What are the five clinical features of aortic dissection?
Sharp, Tearing Chest/Back Pain
Weak Peripheral Pulses
Asymmetrical Blood Pressure
Hypertension
Aortic Regurgitation
111
What pain occurs in type A aortic dissections?
Chest Pain
112
In which aortic dissection classification does aortic regurgitation occur?
Type A Aortic Dissection
113
In which aortic dissection classification does aortic regurgitation occur?
Type A Aortic Dissection
114
In which aortic dissection classification does aortic regurgitation occur?
Type A Aortic Dissection
115
What pain occurs in type B aortic dissections?
Upper Back Pain
116
What is the chest x-ray feature of aortic dissection?
Widened Mediastinum
117
What is the gold standard investigation option used to manage aortic dissection?
Chest Abdomen Pelvis CT Angiograph
118
What is a feature of aortic dissection on CT angiographs?
False Lumen
119
What is the investigation of choice when aortic dissection patients are unstable for CT angiographs?
Transoesophageal Echocardiography (TOE)
120
What are the two management options of type A aortic dissections?
Surgical Management
IV Labetalol
121
What is the surgical management option used to manage **proximal** type A aortic dissections?
Aortic Root Replacement
122
What are the two management options of type B aortic dissections?
Conservative Management
IV Labetalol
123
What is the management option of acute atrial fibrillation in those with haemodynamic instability (hypotension, heart failure)?
Electrical Cardioversion
124
What is the management option of acute atrial fibrillation in those with haemodynamic stability who present < 48 hours of clinical feature onset?
Rate/Rhythm Control
125
What is the management option of acute atrial fibrillation in those with haemodynamic stability who present > 48 hours of clinical feature onset?
Rate Control
126
How do we manage atrial fibrillation, rate control or rhythm control?
Rate Control
127
What are the two first line rate control management options of atrial fibrillation?
Beta-Blockers
Rate-Limiting Calcium Channel Blockers
128
What is the first line rate limiting calcium channel blocker used to manage atrial fibrillation?
Dilitiazem
129
What is the second line rate control management options of atrial fibrillation?
A combination therapy with **two** of the following should be administered...
* Beta-Blocker
* Dilitiazem
* Digoxin
130
In which atrial fibrillation patients, in which four circumstances do we use rhythm control management - rather than rate control management?
New Onset Atrial Fibrillation (< 48 Hours)
Obvious Reversible Cause
Coexistent Heart Failure
Coexistent Atrial Flutter
131
In which circumstance is electrical cardioversion is used to manage atrial fibrilaltion?
Haemodynamically Unstable
132
What should be administered to atrial fibrillation patients who require electrical rhythm control, and present < 48 hours of clinical feature onset?
Heparin
133
What electrical cardioversion is used in atrial fibrillation?
Synchronised DC Cardioversion
134
What is electrical cardioversion of atrial fibrillation synchronised to?
R Wave
135
What should be administered to atrial fibrillation patients who require electrical rhythm control, however present > 48 hours of clinical feature onset? How long should this be administered for?
Anticoagulation
4 Weeks
This should be continued lifelong, even when sinus rhythm is maintained
136
What are the two pharmacological cardioversion management options of atrial fibrillation?
Amiadarone
Flecainide
137
When is amiodarone recommended to pharmacologically cardiovert atrial fibrillation?
Structural Heart Disease
138
What investigation is conducted prior to flecainide administration in atrial fibrillation? Why?
ECHO Scan
Structural Heart Disease
139
How is the CHA2-DS2-VASC2 score used to determine atrial fibrillation management?
It is used to determine the most appropriate anticoagulation strategy based upon stroke risk
140
What is the CHA2-DS2-VASC2 score?
Congestive Heart Failure = 1 Point
Hypertension = 1 Point
Age > 75 Years Old = 2 Points
Age 65 - 74 Years Old = 1 Point
Diabetes = 1 Point
Stroke, TIA, Thromboembolism History = 2 Points
Vascular Disease = 1 Point
Female Sex = 1 Point
141
What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 0?
No Treatment
142
What investigation should be conducted when no anticoagulation is required in atrial fibrillation patients? Why?
Transthoracic Echocardiograms
This is to exlcude valvular heart disease
143
What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 1?
Males = Consider Treatment
Females = No Treatment
144
What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 2?
Offer Anticoagulation
145
Do we withold anticoagulation solely due to increased age or falls risk?
No
146
What scoring system is used to assess bleeding risk prior to anticoagulation?
ORBIT Scoring System
147
What is the first line anticoagulant management option of atrial fibrillation?
Direct Oral Anticoagulants
148
What is the second line anticoagulant management option of atrial fibrillation?
Warfarin
149
What is the stage one hypertension criteria?
Clinic Blood Pressure = > 140/90 mmHg
ABPM/HBPM = > 135/85 mmHg
150
What is the stage two hypertension criteria?
Clinic Blood Pressure = > 160/100 mmHg
ABPM/HBPM = > 150/95 mmHg
151
What is the severe hypertension criteria?
Clinic Blood Pressure = > 180/120 mmHg
152
What is the most appropriate management step in those with severe hypertension - when individuals present with end-organ damage features or life threatening features?
We admit for specialist assessment
153
What is the most appropriate management step in those with severe hypertension - when individuals don't present with end-organ damage features or life threatening features?
Urgent end-organ damage investigations
154
What is the step four management option of hypertension in those with a potassium < 4.5mmol?
Spironolactone
155
What is the step four management option of hypertension in those with a potassium > 4.5mmol?
Alpha-Blocker
Beta-Blocker
156
What is the blood pressure target in individuals < 80 years old?
Clinic BP = < 140/90mmHg
ABPM/HBPM = < 135/85 mmHg
157
What is the blood pressure target in individuals > 80 years old?
Clinic Blood Pressure = < 150/90 mmHg
ABPM/HBPM = < 145/85 mmHg
158
What is the first line management option of hypertension, in those with coexistent type two diabetes mellitus?
ACE Inhbitors
OR
ARBs
159
What are the hypertension targets in those with type two diabetes mellitus?
< 140/90mmHg
160
What is the inheritance of hypertrophic obstructive cardiomyopathy?
Autosomal Dominant
161
What dysfunction is associated with hypertrophic obstructive cardiomyopathy?
Diastolic Dysfunction
162
What are the seven clinical features of hypertrophic obctructive cardiomyopathy?
Syncope
Extertional Dyspnoea
Jerky Pulse
Large A Waves
Double Apex Beat
Ejection Systolic Murmur
Sudden Death
163
Describe the ejection systolic murmur associated with hypertrophic obstructive cardiomyopathy
It is increased with Vasalva manouevre
It is decreased with squatting
164
What are the two associations of hypetrophic obstructive cardiomyopathy?
Friedreich's Ataxia
Wolff-Parkinson White
165
What are the three ECHO features of hypetrophic obstructive cardiomyopathy?
MR SAM ASH
Mitral Regurgitation
Systolic Anterior Motion
Assymetric Hypertrophy
166
What is the cause of death in hypetrophic obstructive cardiomyopathy?
Ventricular Arrythmias
167
What are the five management options of hypetrophic obstructive cardiomyopathy?
ABCDE
Amiodarone
Beta-Blockers
Implantable Cardioverter Defibrilator
Dual Chamber Pacemaker
Endocarditis Prophylaxis
168
What is the most effective management option used to reduce the risk of sudden death in hypertrophic obstructive cardiomyopathy?
Implantable Cardioverter Defibrilator
169
Which valve is most commonly affected by infective endocarditis?
Mitral Valve
170
Which valve is most commonly affected by infective endocarditis - in intravenous drug users?
Tricuspid Valve
171
What is the most common infective organism of infective endocarditis?
Staphylococcus Aureus
172
What is the most common infective organism of infective endocarditis - in intravenous drug users?
Staphylococcus Aureus
173
What is the most common infective organism of infective endocarditis - in those with poor dental hygiene?
Streptococcus Viridans
174
What is the most common infective organism of infective endocarditis - within 2 months of prosthetic valve surgery?
Staphylococcus Epidermis
175
What is the most common infective organism of infective endocarditis - in those with colorectal cancer?
Streptococcus Bovis
176
What criteria is used to diagnose infective endocarditis?
Duke Criteria
177
What is the gold standard investigation used to diagnose infective endocarditis?
3 x Blood Cultures
178
What is the initial antibiotic used to manage infective endocarditis affecting native valves?
Amoxicillin
179
What are the five indications for urgent surgical management of infective endocarditis?
Severe Valvular Incompetence
Aortic Abscess
Resistant Infections
Heart Failure
Emboli > Antibiotic Therapy
180
Are prophylactic antibiotics required before procedures in those with infective endocarditis?
No
181
What is a risk factor of acute pericarditis?
Systemic Lupus Erythematosus
182
Describe the chest pain associated with pericarditis
It is pleuritic, often relieved by sitting forward
183
What are the two ECG features of pericarditis?
Saddle Shaped ST Elevation
PR Depression
184
What is the most specific ECG feature of pericarditis?
PR Depression
185
What is a gold standard investigation used to investigate all cases of pericarditis?
Transthoracic ECHO Scan (TTE)
186
What is the first line management option of pericarditis?
NSAIDs & Colchicine
187
Name two NSAIDs used to manage pericarditis
Naproxen
Ibuprofen
188
What are the eight clinical features of constrictive pericarditis?
Dyspnoea
Peripheral Oedema
Kussmaul's Sign
Increased JVP
JVP X + Y Descent
Pericardial Knock
Hepatomegaly
Ascites
189
What is the chest x-ray feature of constrictive pericarditis?
Pericardial Calcification
190
What are the three differences between cardiac tamponade and constrictive pericarditis?
Cardiac Tamponade = Absent JVP Y Descent, Pulsus Paradoxus Present, Kussmaul's Sign Rare
Constrictive Pericarditis = Present JVP X+Y Descent, Pulsus Paradoxus Absent, Kussmaul's Sign Present
191
What is pulsus paradoxus?
It is when there is an abnormally large drop in blood pressure during inspiration
Therefore the peripheral pulses will disappear during inspiration
192
What are the five clinical features of rheumatic fever?
Erythema Marginatum
Sore Throat
Polyarthritis
Sydenham's Chorea
Ejection Systolic Murmur
193
Describe the rash associated with rheumatic fever
There are pink, ring shaped lesions, with a pale-pink centre, surrounded by a slightly raised red outline
194
What is Sydenham's chorea?
It is defined as involuntary jerking
195
What is the first line pharmacological management option of rheumatic fever?
IM Benzylpenicillin/Oral Penicillin V
196
What is the first line management option of supraventricular tachycardia?
Vagal Manouevres
197
What are the two vagal manouvres used to manage supraventricular tachycardia?
Valsalva Manouevre
Carotid Sinus Massage
198
What is the first line pharmcaological management option of supraventricular tachycardia? Describe the dosing
IV Adenosine
6mg, then 12mg, then 18mg
199
How do we administer IV adenosine?
Insert 16G cannula in right antecubital vein
200
What are the three side effects of adenosine?
Chest Pain
Bronchospasm
Transient Flushing
201
What are the three side effects of adenosine?
Chest Pain
Bronchospasm
Transient Flushing
202
What is the second line pharmcaological management option of supraventricular tachycardia?
Verapamil
203
What are the two features of Torsades de Pointes on ECG scans?
Prolonged QT Interval
Rapid Polymorphic QRS Complexes
204
What is the feature of Torsades de Pointes on ECG scans?
Prolonged QT Interval
205
What are the four causes of Torsades de Pointes?
Hypothermia
Subarachnoid Haemorrhage
Erythromycin
Citalopram
206
What is the management option of Torsades de Pointes?
IV magnesium sulphate
207
What is the management option of Torsades de Pointes?
IV magnesium sulphate
208
What is the most common cause of mitral stenosis?
Rheumatic Fever
209
What are the four clinical features of mitral stenosis?
Dyspnoea
Haemoptysis
Malar Flush
Atrial Fibrillation
210
What are the four clinical features of mitral stenosis?
Dyspnoea
Haemoptysis
Malar Flush
Atrial Fibrillation
211
What are the five murmur features of mitral stenosis?
Mid-Late Diastolic Murmur
Increased Murmur On Expiration
Loud S1 Sound
Opening Snap
Low Volume Pulse
212
What are the five murmur features of mitral stenosis?
Mid-Late Diastolic Murmur
Increased Murmur On Expiration
Loud S1 Sound
Opening Snap
Low Volume Pulse
213
What is the management option of asymptomatic mitral stenosis?
ECHO Scan Monitoring
214
What are the two management options of symptomatic mitral stenosis?
Percutanoeus Mitral Balloon Valvotomy
Mitral Valve Surgery
215
What are the two risk factors of mitral regurgitation?
Marfans Syndrome
Ehlers Danlos Syndrome
216
What are the five murmur features of aortic regurgitation?
Pansystolic Murmur
Murmur Radiation To Axilla
Murmur Loudest At Apex
Quiet S1 Sound
Widely Split S2 Sound
217
What is the most common valvular heart disease?
Aortic Stenosis
218
What is the most common cause of aortic stenosis in individuals > 65 years old?
Degenerative Calcification
219
What is the most common cause of aortic stenosis in individuals < 65 years old?
Bicuspid Aortic Valve
220
What is the most common cause of supravalvular aortic stenosis?
William's Syndrome
221
What are the seven murmur features of aortic stenosis?
Ejection Systolic Murmur
Murmur Radiation To Carotids
Murmur Decreased > Valsalva Manouevre
Soft/Absent S2 Sound
S4 Sound
Narrow Pulse Pressure
Slow Rising Pulse
222
What feature makes aortic stenosis murmurs quieter?
Left ventricular systolic dysfunction
223
What is the management option of asymptomatic aortic stenosis?
Observation
224
What is the management option of asymptomatic aortic stenosis, with a valvular gradient > 40mmHg?
Aortic Valve Replacement
225
What is the management option of symptomatic aortic stenosis?
Aortic Valve Replacement
226
What aortic valve replacement method is selected in those with low/medium operative risk?
Surgical Aortic Valve Replacement
227
What aortic valve replacement method is selected in those with high operative risk?
Transcatheter Aortic Valve Replacement
228
What is the most common cause of aortic regurgitation?
Marfan's Syndrome
229
What are the five murmur features of aortic regurgitation?
Early Diastolic Murmur
Quincke's Sign
De Musset's Sign
Collapsing Pulse
Wide Pulse Pressure
230
What is Quinke's sign?
It is defined as nailbed pulsation
231
What is De Musset's sign?
It is defined as head bobbing
232
When is aortic valve surgery recommended in aortic regurgitation?
Symptomatic & Severe
Asymptomatic & Severe With LV Systolic Dysfunction
233
What investigation is used to diagnose valvular heart disease?
ECHO Scans
234
What anticoagulation class is recommended in those with mechanical heart valves?
Warfarin
235
What are the four features of Wolff Parkinson White syndrome on ECG scans?
Short PR Interval
Wide QRS Complexes
Delta Waves
Axis Deviation
236
What is the best management option of radiofrequency ablation?
Radiofrequency Ablation
237
What is the ECG feature of first degree heart block?
Increased PR Interval > 0.2s
238
What is the management option of first degree heart block?
No treatment
239
What is the ECG feature of second degree heart block type one?
Progressive prolongation of the PR interval until a dropped QRS complex occurs
240
What is the ECG feature of second degree heart block type two?
Constant PR interval however the P wave is not often followed by a QRS complex
241
What is the ECG feautre of third degree heart block?
No association between the P waves and QRS complexes
242
When third degree heart block occurs following a myocardial infarction, which artery tends to be affected?
Right Coronary Artery
243
When third degree heart block occurs following a myocardial infarction, which artery tends to be affected?
Right Coronary Artery
244
What is the most common risk factor of acute limb ischaemia?
Atrial Fibrillation
245
What are the six clinical features of acute limb ischaemia?
6 P's
Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishing With Cold
246
What vessel is affected by peripheral arterial disease when individuals present with buttock pain rather than calf pain?
Iliac Vessels
246
What vessel is affected by peripheral arterial disease when individuals present with buttock pain rather than calf pain?
Iliac Vessels
247
How do we differentiate between acute limb ischaemia and critical limb ishaemia?
Acute Limb Ischaemia = The clinical features develop within days
Critical Limb Ischaemia = The clinical features develop over weeks
248
How do we differentiate between acute limb ischaemia and critical limb ishaemia?
Acute Limb Ischaemia = The clinical features develop within days
Critical Limb Ischaemia = The clinical features develop over weeks
249
How do we differentiate between acute limb ischaemia and critical limb ishaemia?
Acute Limb Ischaemia = The clinical features develop within days, pain not present at rest
Critical Limb Ischaemia = The clinical features develop over weeks, pain worse on exertion and persistent at rest
250
How do we differentiate between acute limb ischaemia and critical limb ishaemia?
Acute Limb Ischaemia = The clinical features develop within days
Critical Limb Ischaemia = The clinical features develop over weeks
251
What is the intial investigation option of acute limb ischaemia?
Handheld arterial doppler scan
252
What is the next appropriate investigation option of acute limb-threatening ischaemia - when doppler scans are positive?
Ankle-Brachial Pressure Index
253
What are the four initial management options of acute limb ischaemia?
ABC Approach
Paracetamol, Codeine, IV Opioids
IV Unfractioned Heparin
Vascular Review
254
What is the conservative management option of peripheral arterial disease?
Exercise Training
255
What are the two pharmacological management options of peripheral arterial disease for secondary prevention of cardiovascualr disease?
Atorvastatin 80mg once daily
Clopidogrel 75mg once daily
256
What are the two pharmacological management options of peripheral arterial disease?
Statin
Clopidogrel
257
What is the surgical management option of peripheral arterial disease - in high-risk patients with short segment stenosis (<10cm) or aortic iliac disease?
Endovascular Angioplasty Revascularisation
258
What is the surgical management option of peripheral arterial disease - in high-risk patients with long segment stenosis (>10cm), multifocal lesions, lesions of the femoral artery or purely infrapopliteal disease?
Open Surgical Angioplasty Revascularisation
259
What is a risk factor of venous leg ulcers?
Chronic venous insufficiency
260
Where are venous leg ulcers located?
It is located above the medial malleolus
261
Are venous leg ulcers painful or painless?
Painless
262
What is the investigation used to diagnose venous ulceration?
Ankle-Brachial Pressure Index (ABPI)
263
What is the feature of venous ulcers on ankle brachial pressure index measurements?
Normal (0.9-1.2)
264
What is the most important management option of venous ulcers?
Compression Bandaging
265
What is the most cpommon risk factor of arterial leg ulcers?
Chronic Obliterative Arterial Disease
266
Where are arterial ulcers located?
Toes & Heels
267
Describe the appearance of arterial leg ulcers
Deep, punched out appearance
268
Are arterial leg ulcers painful or painless?
Painful
269
What is the feature of arterial ulcers on ankle brachial pressure index measurements?
Reduced < 0.9
270
What is the most common risk factor of neuropathic ulcers?
Diabetes mellitus
270
What is the most common risk factor of neuropathic ulcers?
Diabetes mellitus
271
Where are neuropathic ulcers located?
Plantar surface of metatarsal head
Plantar surface of hallux
272
What is the management option of neuropathic ulcers?
Cushioned Shoes
273
What is Marjolin's ulcer?
It is a form of squamous cell carcinoma
274
What are the two risk factors of pyoderma gangrenosum?
Inflammatory Bowel Disease
Rheumatoid Arthritis
