GENERAL

Question 1

How should query stable angina be investigated?

Answer 1

CT coronary angiogram

Question 2

What medication should be started in heart failure?

Answer 2

ACE-inhibitor and a beta-blocker

Question 3

If someone with heart failure is continuing to get symptoms on an ACE-inhibitor and a beta-blocker, which medication should be added?

Answer 3

spironolactone

Question 4

Which drug can’t be used with a beta-blocker? why?

Answer 4

verapamil

risk of complete heart block

Question 5

What is pulsus paradoxus?

Answer 5

> 10 fall in SBP with inspiration

sign of tamponade

Question 6

Which heart failure drugs have a prognostic benefit?

Answer 6

selective beta blockers
ACE-inhibitors
spironolactone

Question 7

Which heart failure drugs have a symptomatic benefit only?

Answer 7

loop diuretics
digoxin
nitrates

Question 8

What are the causes of RAD?

Answer 8

normal
inspiration
RBBB
RV hypertrophy

Question 9

What are the causes of LAD?

Answer 9

expiration
LBBB
left anterior hemiblock

Question 10

What are the causes of AF?

Answer 10

PIRATES
PE
ischaemia
respiratory disease
atrial enlargement
thyroid disease
ethanol
sepsis

Question 11

ST elevation in which lead indicates inferior MI??

Answer 11

II, III and aVF

Question 12

ST elevation in which lead indicates anterior MI?

Answer 12

v1-4

Question 13

ST elevation in which lead indicates lateral MI?

Answer 13

I, avL, v5, v6

Question 14

Which vessel supplies inferior heart?

Answer 14

right coronary artery

Question 15

Which vessel supplies anterior heart?

Answer 15

LAD

Question 16

which vessel supplies high lateral heart (I, aVL)?

Answer 16

LAD

Question 17

which vessel supplies low lateral heart (v5,v6)?

Answer 17

circumflex

Question 18

What causes palpitations?

Answer 18

ectopic beats
supraventricular tachycardia
paroxysmal AF
sick-sinus syndrome
VT
anxiety
thyrotoxicosis

Question 19

What ECG changes indicate posterior MI?

Answer 19

tall R waves in v1,v2

Question 20

Name some complications of MI

Answer 20

DARTH VADER
death
arrythmia (VT)
rupture (septum, free wall or papillary muscle)
tamponade 
heart failure

valve disease
aneurysm
dressler's
embolism
regurgitation (mitral)

Question 21

What effect does digoxin have on the heart?

Answer 21

-ve chronotrope (Dec hr)

+ve inotrope (inc force of contraction)

Question 22

How fast can atria go?

Answer 22

300-600 bpm

Question 23

How does digoxin work?

Answer 23

affects NA/K ATP pump at AV node to slow conduction and stimulates vagal nerve

Question 24

Which murmur is pansystolic?

Answer 24

mitral regurgitation, tricuspid regurgitation

Question 25

Which murmur is ejection systolic?

Answer 25

aortic stenosis

Question 26

Which murmur is associated with a narrow pulse pressure?

Answer 26

aortic stenosis

Question 27

Which murmur is associated with a collapsing pulse?

Answer 27

aortic regurgitation

Question 28

Which murmur is rumbling, mid-diastolic murmur?

Answer 28

mitral stenosis

Question 29

Which murmur is high-pitched, early diastolic?

Answer 29

aortic regurgitation

Question 30

Fx of mitral stenosis

Answer 30

malar flush tapping apex beat loud S1

Question 31

Fx of mitral regurgitation

Answer 31

heave | split S2

Question 32

Triad of aortic stenosis

Answer 32

chest pain, syncope + heart failure

Question 33

Fx of tricuspid regurgitation

Answer 33

ascites peripheral oedema hepatomegaly

Question 34

New murmur + fever suggests

Answer 34

infective endocarditis

Question 35

What drugs should be started for secondary prevention of MI?

Answer 35

``` 5: dual antiplatelet (aspirin + clopidogrel) beta blocker ACE-inhibitor statin ```

Question 36

Manage NSTEMI

Answer 36

oxygen nitrates (gtn then iv isosorbide then morphine if ongoing pain + antiemetic) aspirin and clopidogrel fondaparinux or heparin if high bleeding risk beta blocker

Question 37

Manage STEMI

Answer 37

oxygen nitrates + morphine + anti-emetic aspirin PCI or thrombolysis - prasugrel if PCI and not on an anticoagulant, clopidogrel if PCI and on an anticoagulant

Question 38

Signs of left sided heart failure

Answer 38

shortness of breath on exertion orthopnoea paroxysmal nocturnal dyspnoea wheeze and cough

Question 39

Signs of right sided heart failure

Answer 39

hepatomegaly raised JVP ankle oedema