CCC - Cardiology

Question 1

What investigations do you do for a MI?

Answer 1

1. ECG
2. Troponin
3. Echocardiography

Question 2

What do you do if the troponin is positive?

Answer 2

coronary angiography

Question 3

What do you do if the troponin is negative?

Answer 3

ETT

Question 4

What are the cardiac differential diagnosis of chest pain?

Answer 4

1. IHD
2. Aortic dissection: sudden onset
3. Pericarditis: worse on breathing in and leaning forward

Question 5

What are the respiratory differential diagnosis of chest pain?

Answer 5

1. PE
2. Pneumonia: temp recently?
3. Pneumothorax: sudden onset, SOB, sharp pain, pain worse breathing in

Question 6

What are GI differential diagnosis of chest pain?

Answer 6

1. oesophageal spasm

2. oesophagitis, gastritis

Question 7

What are the musculoskeletal differential diagnosis of chest pain?

Answer 7

costochrondritis: pain on movement

Question 8

What is first line investigation for chest pain?

Answer 8

ECG - if ST elevation or not

Question 9

If it is an anterior MI which coronary artery is affected and in which leads will there be ECG changes?

Answer 9

1. LAD

2. V1-V4

Question 10

If it is a lateral MI which coronary artery is affected and in which leads will there be ECG changes?

Answer 10

1. circumflex

2. V5, V6, I, aVL

Question 11

If it is an inferior MI which coronary artery is affected and in which leads will there be ECG changes?

Answer 11

1. RCA

2. II, III, aVF

Question 12

What does the different in BP need to be for postural hypotension?

Answer 12

20mmHg

Question 13

If there is a FHx of sudden cardiac collapse should vasovagal be high sus?

Answer 13

no

Question 14

What are the 3 categories for differential diagnosis of collapse?

Answer 14

1. hypoglycaemia
2. cardio
3. brain

Question 15

What are the different cardio reasons for collapse?

Answer 15

1. Vasovagal
2. Arrhythmia
3. Outflow obstruction
4. Postural hypotension

Question 16

Which arrhythmia can cause collapse and how would you manage?

Answer 16

1. tachycardia, bradycardia

2. ECG (long QT predisposes you to VT), cardiac monitor, 24hr tape

Question 17

What could a left outflow obstruction lead to collapse be due to?

Answer 17

1. HOCM

2. Aortic stenosis

Question 18

What could a right outflow obstruction lead to collapse be due to?

Answer 18

PE - low volume/slow rising pulse, ESM (ejection systolic murmur), echocardiogram

Question 19

How do you determine if postural hypotension causes collapse?

Answer 19

lying/standing BP

Question 20

What are the brain causes of sudden collapse?

Answer 20

seizure

Question 21

What does a long QT mean?

Answer 21

abnormal ventricular reporlarization

Question 22

What are the congenital causes of long QT syndrome?

Answer 22

• mutations in K+ channels

- FH of sudden death

Question 23

What are the acquired causes of long QT syndrome?

Answer 23

low K+/Mg2+, drugs

Question 24

How do you know if it is a long QT?

Answer 24

red line in between QRS and T waves should have finished by red line

Question 25

Which valves are affected in infective endocarditis?

Answer 25

right sided valves get affected (as inject into veins) and right sided murmurs are louder on inspiration

Question 26

When would mitral regurgitations have a high JVP?

Answer 26

only with heart failure

Question 27

What is tricuspid regurgitation associated with?

Answer 27

raised JVP and hepatomegaly

Question 28

Which type of murmurs are louder on inspiration?

Answer 28

right

Question 29

What are the differential diagnosis of a raised JVP?

Answer 29

1. Right sided heart failure 2. Tricuspid regurgitation 3. Constrictive pericarditis

Question 30

What is right sided heart failure caused by?

Answer 30

1. Secondary to L heart failure (CCF) 2. Caused by pulmonary HTN (secondary to PE, COPD etc) leads to - Left parasternal heave is a sign of right ventricular hypertrophy

Question 31

What is tricuspid regurgitation caused by?

Answer 31

1. Valve leaflets | 2. Right ventricle dilation

Question 32

What is constrictive pericarditis caused by?

Answer 32

1. Infection e.g. TB 2. Inflammation: Connective tissue disease 3. Malignancy

Question 33

What are the DDx for a systolic murmur?

Answer 33

1. aortic stenosis 2. mitral regurg 3. tricuspid regu 4. VSD

Question 34

How can you tell if the systolic murmur is aortic stenosis?

Answer 34

loudest is aortic area and radiates to neck - associated with slow rising pulse

Question 35

How can you tell if the systolic murmur is mitral regurgitation?

Answer 35

loudest in apex and radiates to axilla - associated with displaced apex beat

Question 36

How can you tell if the systolic murmur is tricuspid regurgitation?

Answer 36

loudest in tricuspid area and loudest on inspiration and associated with high JVP

Question 37

How can you tell if systolic murmur is due to VSD?

Answer 37

systolic murmur not associated with anything - hole between two ventricles

Question 38

What does SVT stand for?

Answer 38

supraventircular tachycardia

Question 39

What are the DDx for sinus tachycardia on an ECG?

Answer 39

1. sepsis 2. hypovolemia 3. endocrine (thyrotoixosis, phaemochromocytoma) 4. Anxious, stressed

Question 40

What are the DDx for SVT on an ECG?

Answer 40

re-entry cirucit: AVNRT and AVRT (after treatment would have a delta wave AVRT)

Question 41

Which ECGs have absent p waves?

Answer 41

1. SVT | 2. AF

Question 42

What are the differential diagnosis for Atrial Fibrillation on ECCG?

Answer 42

1. thyrotoxicosis 2. alcohol 3. Heart: muscles, valve, pericardium 4. Lungs: pneumonia, PE, cancer

Question 43

What are the DDx for ventricular tachycardia on ECG?

Answer 43

1. ischaemia 2. electrolyte abnormality 3. Long QT (congenital) - Broad complexes

Question 44

How do you treat a patient with SVT and BP of 120/80?

Answer 44

1. vagal maneuvers 2. adenosine (cardiac monitor) 3. DC cardioversion if evidence of haemodynamic compromise

Question 45

How do you treat a patient with acute fast AF and BP 120/80?

Answer 45

1. Rhythm control If onset >48hours, anticoagulate for 3-4 weeks before cardioversion 2. Rate control: -beta blocker -digoxin 3. Think of underlying cause 4. Think of complications (anticoagulation)

Question 46

What is the management of VT?

Answer 46

1. If no haemodynamic compromise: IV amidarone 2. Look for and treat underlying cause 3. ICD

Question 47

What is the management of pulseless VT?

Answer 47

defibrillate

Question 48

How can you tell left ventricular hypertrophy by voltage criteria?

Answer 48

1. Deep S waves and tall R waves | 2. S in V1 + R in V5 or V6 (whichever is larger) > 7 large squares

Question 49

How is ischaemia suggested on an ECG?

Answer 49

ST, T, Q waves

Question 50

How is arrhythmia or conduction defects suggested by ECG?

Answer 50

1. Rate, rhythm | 2. PR, QRS, QT

Question 51

How is ventricular strain or hypertrophy suggested by ECG?

Answer 51

1. Axis 2. R 3. S

Question 52

What is the S3 sound associated with?

Answer 52

ventricular filling

Question 53

What is the S4 sounds associated with?

Answer 53

ventricular hypertrophy

Question 54

How could you tell atrial septal defect in a heart sound?

Answer 54

fixed wide splitting of S2

Question 55

When do you give BiPaP?

Answer 55

if COPD with high CO2 and low pH

Question 56

When do you give CPAP?

Answer 56

improve oxygen

Question 57

What is the management of acute heart failure?

Answer 57

1. Sit up 2. Oxygen 3. Furosemide (IV) - GTN infusion - Treat underlying cause

Question 58

When do you not give adrenaline in Vfib?

Answer 58

temp below 30 degrees

Question 59

What is the ALS algorithim for VF/pulseless VT?

Answer 59

1. Shock 2. CPR (2min) 3. Assess rhythm 4. Adrenaline every 3-5min 5. Amiodarone after 3 shocks 6. Treat reversible causes

Question 60

What is the ALS algorithm for asystole/PEA?

Answer 60

1. CPR (2min) 2. Adrenaline every 3-5min 3. Correct reversible causes

Question 61

What are the DDx of pleuritic chest pain?

Answer 61

1. Pericarditis 2. PE 3. Pneumonia 4. Pnuermothroax 5. Plueral pathology - Sub diaphragmatic pathology