MedEd Flashcards
1
Q
A 75 year old male with known colorectal carcinoma presents to A&E
with chest pain and shortness of breath. The pain is worse on breathing
in and coughing. What other sign/symptom would aid your diagnosis?
a Gradual onset chest pain
b Absent peripheral pulses
c Collapsing Pulse
d Haemoptysis
e Abdominal Pain
A
d Haemoptysis
2
Q
Mr B a 52 year old male presents to his GP with central, tight chest
pain. He has noticed the pain comes on when he is gardening or walking
to the bus stop in a hurry, but normally goes away when he rests. What
medication would the GP prescribe to treat his underlying condition?
a GTN spray
b Propanolol (Beta Blocker)
c Ramipril (ACEi)
d Aspirin
e Atorvastatin (Statin)
A
b Propanolol (Beta Blocker)
GTN is to control chest pain
3
Q
A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis? a Aortic Dissection b STEMI c Teitze’s Syndrome d Costochondritis e Pulmonary Embolism
A
a Aortic Dissection
4
Q
A 54 year old gentleman with a BMI of 27kg/m2 presents with burning chest pain. He finds that it is often worse in the evening and has noted a strange taste in his mouth. What is the most likely diagnosis? a Angina b Teitze’s Syndrome c Aortic Dissection d GORD e Pericarditis
A
d GORD
5
Q
def of angina
A
chest pain due to myocardial ischaemia
6
Q
what brings on angina
A
exercise
7
Q
what relieves angina
A
rest
8
Q
what is the pathophysiology of angina
A
atherosclerosis in coronary arteries (CAD)
9
Q
what is decubitus angina
A
chest pain when lying down
10
Q
what is printzmetal angina
A
chest pain due to coronary artery vasospasm
11
Q
what is unstable angina
A
chest pain at rest
12
Q
what is syndrome X
A
chest pain but with normal exercise tolerance and normal coronary angiograms
13
Q
history of ACS or angina
A
sudden onset central chest pain which is crushing and tight in nature
radiates to L arm/jaw
associated with sweating, nausea, SOB
exacerbated by exertion, relieved by rest
14
Q
how is angina diagnosed
A
triad of angina features
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
15
Q
what is typical angina?
A
all 3 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
16
Q
what is atypical angina?
A
2 of:
1 tight/crushing central chest pain which radiates to the L arm/jaw
2 precipitated by exercise
3 relieved by rest or GTN
17
Q
what should be done in the case of unstable angina
A
likely ACS
emergency admission into hospital required
18
Q
what should be done with stable angina but without known CAD
A
this could be an atypical angina complete investigations 1 CT coronary angiography 2 functional imagina 3 invasive coronary angiography
19
Q
how should atypical angina be investigated
A
exercise ECG or stress testing
or echo
20
Q
what is the medical management for angina
A
anti-anginals such as BB/CCBs
preventative or episodic treatment such as GTN spray
21
Q
when should an ambulance be called after adminstering GTN
A
If no relief after 5 minutes with 2nd spray
22
Q
def of aortic dissection
A
tear in tunica intima resulting in blood between the inner and outer tunica media (false lumen)
23
Q
what classification is used for aortic dissection
A
stanford classification
24
Q
how are aortic dissections classified
A
type a - tear in ascending aorta
type b - tear in descending aorta (after left subclavian branch)
25
what are risk factors for aortic dissection
ABCD
Atherosclerosis/Ageing
Blood pressure high
CTDs (SLE, marfans, ehlers-danlos)
Drugs (cocaine)
26
history of aortic dissection
sudden onset central tearing chest pain which radiates to the back
27
what history would you expect with a false lumen occluding the carotids
black out
| hemiparesis
28
what history would you expect with a false lumen occluding the coronary arteries
angina
| MI
29
what history would you expect with a false lumen occluding the renal artery
AKI
| renal failure
30
what history would you expect with a false lumen occluding the coeliac trunk
severe abdo pain
31
examination of aortic dissection
tachycardia
BP discrepancy >20mmHg between arms
WPP
murmur on the back radiated from the left scapulae to the abdomen
32
what are the signs of aortic insufficiency
WPP + collapsing pulse
| EDM
33
what is the gold standard for aortic dissection
gold standard investigation for intimal flap
34
what would you see on a CXR with aortic dissection
widened mediastinum and aortic notch visible
35
what might you see on an ECG with aortic dissection
LVH hypertrophy
36
def of pericarditis
inflammation of the pericardial sac
37
what are causes of pericarditis
```
CARDIAC RIND
Collagen vascular disease
Autoimmune/Aortic Aneurysm
Radiation
Drugs
Infection (viral or bacterial)
Acute renal failure
Cardiac infarction
Rheumatic Fever
Injury/idiopathic
Neoplasm
Dresslers syndrome
```
38
what are viral causes of pericarditis
Viral – coxsackie, flu, EBV, mumps
39
what are bacterial causes of pericarditis
pneumonia, strep, staph, TB, RF
40
history of pericarditis
sharp pleuritic central chest pain which can radiate to the neck and shoulders
associated with fever + SOB
worse when lying down, breathing in and coughing
better when leading forward
41
examination of pericarditis
pericardial friction rub "walking on snow"
soft S1
S4 gallop
42
complications of pericarditis
cardiac tamponade
| pericardial effusion
43
def of PE
sudden occlusion of pulmonary vessel due to thrombus formation
44
is ventilation of perfusion affected in PE
perfusion
45
history of PE
sudden onset SOB and pleuritic chest pain which can be left or right sided depending on where the thrombus lodges
associated with haemoptysis, leg swelling
made worse by coughing or breathing in
46
examination of PE
tachycardia + tachypnoea
cyanosis (if large)
leg swelling
47
how should a PE be managed
dependent on the wells score
if high (>4) then give LMWH until INR>2
then give warfarin
48
how should a PE be managed if the patient is haemodynamically unstable
thrombolysis or embolectomy
49
def of GORD
reflux of gastric contents into the oesophagus often as a result of a reduced LOS tone or hiatus hernia
50
history of GORD
slow onset of central burning, retrosternal chest pain which may radiate to the stomach and neck
associated with an acidic taste in mouth, sore throat and cough
often comes on after meals or when lying down
51
RFs for GORD
stress
obesity
pregnancy
52
invesitgations for GORD
ECG to exclude cardiac causes
| OGD, barium swallow
53
def of chostochondritis
temporary inflammation of the costal cartilages
54
causes of chostochondritis
idiopathic
strenuous lifting
infection
55
what sort of pain is chostochondritis
pleuritic chest pain with tenderness on the sides od the sternum
56
which chostosternal joints are typically affected in chostochondritis
3/4/5
57
what is teitzes syndrome
inflammation of the costal cartilage similar to chostochondritis however there is also palpable swelling
58
which chostosternal joints are typically affected in teitzes syndrome
2/3
59
what is the treatment for chostochondritis or teitzes syndromr
rest
NSAIDs
corticosteroid injections if severe
60
```
A 60 year old patient presents to A&E with central crushing chest pain, radiating to the jaw. His ECG is normal. What is the next step?
a Creatine Kinase
b Repeat ECG
c Discharge
d Exercise ECG
e Troponin
```
e Troponin
61
```
A 46 year old diabetic man presents to A&E following collapse. The patient is very distressed and is sweating. On the way to the hospital, his wife had to stop the car to allow him to vomit. His ECG is normal but his 12 hour troponins are positive. What is the most likely diagnosis?
a Inferior STEMI
b Anterior STEMI
c NSTEMI
d Unstable Angina
e Ventricular Wall Aneurysm
```
c NSTEMI (ECG can be normal in NSTEMI)
62
```
A 68 year old patient presents to A&E with sharp central chest pain. She was discharged 4 weeks ago following an MI. Her ECG shows saddle-shaped ST segments diffusely. What is the most likely diagnosis?
a Repeat MI
b Dressler’s Syndrome
c Pericarditis
d Ventricular Wall Aneurysm
e Heart Failure
```
b Dressler’s Syndrome
63
```
A 56 year old overweight man with a history of high cholesterol comes in complaining of central crushing chest pain that came on at rest. He has had a similar pain before but only when playing tennis. His ECG shows ST depression and a 12 hour troponin is negative.
a Inferior STEMI
b Anterior STEMI
c NSTEMI
d Unstable Angina
e Ventricular Wall Aneurysm
```
d Unstable Angina (if troponin is negative it is unstable angina, even with ST depression)
64
what is ACS
an umbrella term for unstable, NSTEMI, STEMI
65
what is a STEMI
ST elevation MI
| complete occlusion of coronary artery resulting in myocardial infarction
66
what would be seen on an ECG with a STEMI
ST elevation
| new onset LBBB
67
what is a NSTEMI
non-ST elevation MI
| partial occlusion of coronary artery resulting in myocardial ischaemia (permanent myocardial damage)
68
what is raised in a NSTEMI (and STEMI)
creatine kinase and troponin
69
what is not raised in unstable angina
troponin or CK
70
what would be seen on an ECG with NSTEMI
MAY have ST depression, T wave inversion or normal ECG
71
what are the ischaemic complications of MI
repeat MI
| post-infarction angina
72
what should be measured if a repeat MI is suspected
CK-MB rather than troponins
73
what does post-infarction angina normally occur
hours to days post MI
74
what are the mechanical complications of MI
HF
papillary muscle rupture
ventricular aneurysm
75
why does HF occur post MI
damaged cardiac tissue
76
what are signs of papillary muscle rupture post MI
new and loud PSM (MR) which radiates to the axilla
77
how does ventricular aneurysm occur post MI
from weakened ventricular wall from damaged cardiac tissue
78
what can a ventricular aneurysm post MI cause
blocking blood from heart
79
what are the arrythmic complications of MI
infarcted and damaged tissue can change electrical characteristics leading to formation of re-entry circuits such as:
1 VT
2 VF
3 complete heart block
80
how is pericarditis associated with MI
often develops soon after MI due to a inflammatory response to necrotic tissue
81
how is dresslers syndrome associated with MI
occurs weeks after MI due to antibodies forming against circulating myocardial antigens
82
```
A 50 year old man presents to his GP with central chest pain. The ECG shows a STEMI. His sats are 96%. What medication should the GP give whilst waiting for an ambulance?
a Fondaparinux 2.5mg
b Oxygen
c Propanolol
d Aspirin/Clopidogrel 300mg
e Ramipril
```
d Aspirin/Clopidogrel 300mg
83
```
A 70 year old female with known hypertension and hypercholesterolaemia presents with central crushing chest pain, which radiates to the left arm. The pain started 2 hours ago. Her ECG shows LBBB. What is the most appropriate management.
a Thrombolysis
b Angiography
c Fibrinolysis
d PCI
e CABG
f Fondaprinux
```
d PCI
84
```
A 78 year old woman is bought to A&E following chest pain. Her ECG shows ST depression and T-wave inversion. 12 hour troponins are positive. What is the most appropriate management?
a PCI
b Fibrinolysis
c Fondaparinux
d CABG
e Thrombolysis
f Angiography
```
c Fondaparinux
85
```
A man is being discharged following an MI. Which of the following drugs should not make up a part of his post MI management?
a ACEi
b Aspirin
c Clopidogrel
d Heparin
e Statin
f B-Blocker
```
d Heparin
86
what is the management of ACS
```
ABCDEFG
1 oxygen (if sats <90%)
2 3As
-antiplatelets (aspirin + clopidogrel)
-analgesic (morphine)
-anti-ischaemic (GTN)
```
87
what is the principle aim of STEMI management
coronary reperfusion therapy (open coronary vessels to allow blood flow to the myocardium)
88
what are therapies for coronary reperfusion after STEMI
PCI
| fibrinolysis
89
when would PCI be used after a STEMI
if patient presents within 12hrs of onset of symptoms and it can happen before fibrinolysis could be given (within 2hrs)
90
what would fibrinolysis be used after a STEMI
patient presents within 1 hours of symptoms
91
what is the management of STEMI if a patient presents >12hrs after onset of symptoms
coronary angiography with follow up PCI if indicated
92
what is the management for an NSTEMI/unstable angina
IMMEDIATE aspirin + antithrombin therapy (fondaparinux with low bleeding risk, LMWH as an alternative if pts are undergoing coronary angiography within 24hrs of admission)
93
what is the score used to determine 6month mortality of NSTEMI patients
GRACE Risk
94
what is the treatment for high risk NSTEMI/unstable angina
```
IV glycoprotein IIb/IIIa inhibitors
coronary angiography (+ follow on PCI if indicated)
```
95
what are names of IV glycoprotein IIb/IIIa inhibitors
tirofiban/eptifibatide
96
what is the treatment for low risk NSTEMI/unstable angina
conservative management without angiography
| unless ischaemia demonstrated by persistant symptoms
97
what is the ongoing medical management for ACS
1 ACEi
2 Dual antiplatelet therapy (aspirin + clopidogrel)
3 statin
4 BB
98
what is the surgical management for ACS
CABG may indicated for triple vessel disease or left mainstem disease >50%
99
A 55 year old gentleman with a history of systemic hypertension presents to A&E with breathlessness on exertion & orthopnoea. Examination reveals cardiomegaly & a displaced apex beat to the left.
```
Myocardial Infarction
Left Ventricular Failure
Constrictive pericarditis
Right Ventricular Failure
Congestive Cardiac Failure
```
Left Ventricular Failure
100
A 62 year old gentleman presents with fatigue, breathlessness & anorexia. On examination his JVP is noted as being elevated, he has hepatomegaly & swollen ankles.
```
Myocardial Infarction
Left Ventricular Failure
Constrictive pericarditis
Right Ventricular Failure
Congestive Cardiac Failure
```
Congestive Cardiac Failure
101
definition of HF
cardiac output>body's demands
102
what is low-output HF
decreased cardiac output
103
what is high-output HF
increased body demand
104
what causes low-output HF
excessive
105
what are causes of LVF
IHD
HTN
dilated cardiomyopathy
MR
106
what are causes of RHF
LVF
pulmonary HTN
lung disease
TR
107
what three features are characteristic of LVF
SOB
orthopnoea
PND
108
what are characteristic features of RVF
peripheral oedema
ascites
raised JVP
109
what could pulsation in the neck and face indicate
TR
110
what signs are there with LVF
stony dullness (pleural effusion)
bibasal crepitations
displaced apex beat (cardiomegaly)
S3
111
what signs are there with RVF
raised JVP
hepatomegaly
pitting oedema
112
what are the bedside investigations for HF
history + examination
| peak flow + spirometry
113
what bloods would be taken when investigating HF
BNP
| NTproBNP (N-terminal pro BNP)
114
what is N-terminal pro BNP
a prohormone for BNP
115
what imaging investigations are taken when investigating HF
12 lead ECG
TTE echo doppler
CXR
116
what are the diagnostic investigations of HF
BNP + echo
117
what is done if investigating HF and the pt has a Hx of MI
only complete echo
118
what is done if investigating HF and pt has no Hx of MI
BNP + echo
119
what is BNP
brain natriuretic peptide
120
what secretes BNP
ventricular myocardium in response to LV pressure
121
what reflects myocyte stretch
increased GFR and reduced renal Na resorption
122
what is the benefits and negatives of BNP testing
sensitive test - can rule out HF
| poorly specific test - cannot diagnose HF
123
what is the next step in investigations if BNP is high (investigating HF)
arrange echo
124
what are features of HF on a CXR
```
Alveolar oedema 'bat wings'
B (Kerley B lines)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
```
125
what do kerley B lines indicate
interstitial oedema
126
A 62 year old man, 3 months after an MI, taking aspirin, atenolol and simvistatin, whose echocardigram shows worsening left ventricular function. Select the single most appropriate means of reducing cardiovascular risk
```
Spironolactone
Anticoagulation Therapy
Sublingual Gtn
ACE inhibitor therapy
Furosemide
```
ACE inhibitor therapy
127
what classification is used for HF
New York Heart Association Classification
128
what are the gradings in hte NYHA Classification
NYHA I
NYHA II
NYHA III
NYHA IV
129
what does NYHA I mean
HF present
| no SOB
130
what does NYHA II mean
HF present
| comfortable at rest but SOB on ordinary activity
131
what does NYHA III mean
HF present
| SOB with less than ordinary activity
132
what does NYHA IV mean
HF present
| SOB at rest
133
what is the first line medical management for HF
ACEi + BB
134
what is the second line medical management for HF following ACEi + BB
ARB (mild-moderate HF)
| spironolactone (moderate-severe HF or MI in past month)
135
when would a Hydralazine/nitrate combo be used for second line HF treatment
moderate-severe afro-carribean
136
what is the second line medical management for HF
digoxin
| cardiac resynchronisation therapy
137
what are the two groups of causes of HTN
primary (idiopathic)
| secondary
138
what are renal causes of HTN
```
intrinsic
-glomerulonephritis
chronic pylonephritis
renovascular
-renal artery stenosis
```
139
what is the cause of renal artery stenosis in young and old
old - atheromatous
| young - fibromuscular
140
what are endocrine causes of HTN
```
cushings
conns
phaeo
acromegaly
hyperparathyroidism
```
141
what does headache with or without visual disturbances indicate
malignant HTN
142
what is the definition of malignant HTN
>200/130 mmHg
143
A 40 year old man with diabetes, proteinuria and hypertension of 148/98 mmHg
```
Β-blocker
Calcium Channel Blocker
Losartan
ACE-I
Thiazide Diuretic
```
ACE-I
144
why are ACEi good in HTN with proteinuria
ACEi are renoprotective
145
A 53 year old lady with hypertension was on an antihyperstive treatment by you, but has developed a dry cough and refuses to take the drug anymore. He is otherwise well. What is the Culprit?
```
Β-blocker
Calcium Channel Blocker
Losartan
Spironolactone
ACE-I
```
ACE-I
146
what is a SE of CCB
peripheral oedema
147
what is a SE of spironolactone
gynaecomastia
148
what are SEs of ACEi
cough (increased bradykinin)
hyperkalaemia
renal failure (RAS)
angioedema
149
what are SEs of ARB
vertigo, urticarial
150
what are SEs of thiazides
```
reduced K (ECG changes)
reduced Na (confusion)
```
151
what are SEs of spironolactone
increased K
| gynaecomastia
152
what are SEs of BB
bronchospasm
| HF
153
what is the first line treatment for malignant HTN
IV labetalol
154
what can malignant HTN cause
CCF
| encephalopathy
155
what are features of encephalopathy
headache
focal CNS
seizures
comas
156
what is the most appropriate investigation to confirm diagnosis of stable angina
exercise ECG
157
is CT coronary angiogram invasive or non-invasive
non-invasive
158
is coronary angiogram invasive or non-invasive
invasive
159
what are the most sensitive and specific cardiac enzymes (markers) of myocardial necrosis (MI)
troponin (T+I)
160
what is happening to the troponin levels 3-12hrs post MI
rising
161
what is happening to troponin levels for 24-48hrs post MI
peaked
162
what is happening to troponing levels for the 5-14days post MI
decreasing
163
when does CK-MB peak post MI
within 36hrs
164
what is looked for in bloods with DVT/PE
d-dimer (sensitive but not specific)
165
what imaging is completed for investigating DVT/PE
USS of proximal leg vein
166
when is a DVT likely
>2 on Wells score
167
when is PE likely
>4 on Well score
168
what is the gold standard investigation for PE
CT pulmonary angiogram
169
what is the Westermark-sign/Hampton Hump associated with
PE
170
what might be seen on ECG with PE
normal
tachycardia
RBBB
inverted T waves in V1-4
171
what is rarely seen on ECG with PE
S1Q3T3
172
what is d-dimer
fibrin degradation product which is a breakdown product of a clot
173
what does a new murmur and fever indicate until proven otherwise
infective endocarditis
174
what is acute infective endocarditis
endocarditis on normal valves
175
what is subacute infective endocarditis
endocarditis on abnormal valves
176
what is streptococcus viridans infective endocarditis associated with
dental work
177
what is s aureus infective endocarditis associated with
IVDU
178
what is staphylococcus epidermidis infective endocarditis associated with
prosthetic valves
179
what bloods are completed for infective endocarditis
```
blood culture (x3)
FBC (raised WCC)
raised CRP
```
180
what imaging is completed for infective endocarditis
echo
181
what criteria is used to diagnose infective endocarditis
Dukes Criteria
182
what are major positives of Dukes Criteria
positive blood culture (2 separate cultures)
positive echo (vegetations)
new valvular regurgitation
183
what are minor positives of Dukes Criteria
```
predisposition (dental work, IVDU)
fever >38 degrees
vascular or immunological signs (splinter haemorrhages etc)
positive blood culture
positive echo
```
184
what is more sensitive out of TTE and TOE
TOE
185
30 year old women returning from holiday. Sudden onset chest pain with shortness of breath, coughed blood. She has no other lung disease. What investigation would you do to confirm diagnosis?
```
12-lead ECG
CT Pulmonary Angiogram
D-dimer
Spirometry
Chest X-ray
```
CT Pulmonary Angiogram
186
A 35 year old lady presents with severe pain in her right calf. She has recently returned from a family holiday in Australia. She is taking no other medication other than the OCP. What investigation would you do first.
```
INR
Proximal Leg Vein USS
D-dimer
FBC
Thrombophilia screen
```
D-dimer
187
An 80 year old man with a history of ischaemic heart disease trips over a paving stone & fractures his hip. An ambulance takes him to A&E. 1 hour after arrival, he develops crushing central chest pain. Select the single most appropriate investigation
```
V/Q Scan
Cardiac Troponin
Chest X-ray
Coronary Angiogram
Transthoracic Echo
```
Cardiac Troponin
188
50 yr old man attends A&E with SOB, fever and hyperdynamic regular pulse of 100. BP 160/60 mmHg. He has a murmur at the left sternal edge. On further enquiry it is found he attended for a routine dental procedure 2 months ago. Which 2 of these investigations could you use to confirm diagnosis.
```
CT Pulmonary Angiogram
Urinalysis
Blood Cultures
Fundoscopy
TOE Echocardiogram
```
Blood Cultures
| TOE Echocardiogram
189
A lady with no history of a previous heart attack is complaining of swelling in her legs which goes all the way up to her thighs, and she feels may be extending into her lower stomach. She says she feels depressed and thinks these are side-effects of the medications she is on. You notice that she has pulsation in her neck and her face appears engorged.
```
Echocardiogram
BNP
CT Angiogram
Coronary Angiogram
Chest X-ray.
```
BNP
190
what is the order in which all heart sounds occur
```
S4
S1 - lub
Split S1
S2 - dub
Split S2
S3
```
191
what causes HS1
closure of mitral and tricuspid valves
192
what causes HS2
closure of aortic and pulmonary valves
193
why can HS1 be heard as a split HS1
mitral valve closure followed very quickly by tricuspid valve closure
194
why can HS2 be heard as a split HS2
closure of aortic valve followed very quickly by pulmonary valve closure
195
what is paradoxical splitting of HS2
results from delayed onset or prolongation of LV systole (contraction)
196
what is persistant splitting of HS2
results from delayed onset or prolongation of RV systole or shortened LV systole
197
where is the normal HS sequence does HS3 occur
following HS2
198
what causes HS3
passive LV filling when blood strikes a compliant LV
199
'tenessee' is applied to which added HS
HS4
200
'kentucky' is applied to which added HS
HS3
201
where in the normal HS sequence does HS4 occur
just before HS1
202
what causes HS4
forceful atrial contraction during pre-systole that ejects blood into a hypertrophied ventricle which cannot expand further
203
Which of the following does not cause a systolic murmur?
```
Atrial septal defect
Ventricular septal defect
Hypertrophic obstructive cardiomyopathy (HOCM)
Aortic regurgitation
None of the above
```
Aortic regurgitation
204
what are pan systolic murmurs
regurgitation murmurs
1 triscupid regurgitation
2 mitral regurgitation
3 VSD
205
what are late systolic murmurs
valve prolapses
206
what are early diastolic murmurs
regurgitation murmurs
1 aortic regurg
2 pulmonary regurg
207
what are mid-diastolic murmurs
mitral stenosis
| tricuspid stenosis
208
```
You perform a cardiovascular examination on an elderly gentleman who reports episodes of collapsing and often wakes up short of breath at night. Upon auscultation you discover an ejection systolic murmur, which radiates to the carotids.
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Mitral stenosis
```
Aortic stenosis
209
where does mitral regurg radiate to
axilla
210
where does aortic stenosis radiate to
carotids
211
what can aortic stenosis present with
SAD
syncope
angina
dyspnoea (exertional or PND)
212
what is notable of the BP in aortic stenosis
NPP
213
what would be seen on an ECG with aortic stenosis
LVH
214
```
A 53-year-old woman with Atrial Fibrillation is reviewed by her cardiologists. On inspection the patients cheeks appear quite flushed. Auscultation reveals a very loud S1 and a mid diastolic murmur.
Mitral stenosis
Graham Steele
Mitral regurgitation
Aortic regurgitation
Austin Flint
```
Mitral stenosis
215
what is a graham steell murmur
associated with pulmonary regurg
| early diastolic mumur
216
what is an austin flint murmur
severe aortic regurg
turbulent blood hits the anterior leaflets of mitral valve
mid-diastolic mumur
217
what sort of murmur is heard in mitral stenosis
mid-diastolic murmur
218
what three features/conditions is mitral stenosis commonly associated with
AF
RF
flushed cheeks
219
which HS is loud in mitral stenosis
HS1
220
```
49-year-old women presents with 3 month history of increasing SOB on exertion. She has no chest pain, cough or ankle swelling. On examination: BP 158/61 and there are crackles at the bases of both lungs. On Auscultation you hear a diastolic decrescendo murmur loudest at the left sternal edge.
Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis
Tricuspid regurgitation
```
Aortic regurgitation
221
what is notable of the BP in aortic regurg
WPP
222
what symptoms does aortic regurg present with
similar symptoms to HF
SOB
PND
syncope
223
what is notable of the pulse in aortic regurg
collapsing pulse AKA corrigans pulse AKA water hammer pulse
224
what is quinckes sign
pulsation of the nail beds, associated with AR
225
what is de mussets sign
bobbing of the head in synchrony with the heart rate associated with AR
226
what is beckers sign
visible pulsations of the retinal arteries and pupils
227
what does the P wave indicate
atrial depolarisation
228
what does the PR interval indicate
time between beginning of atrial depolarisation and start of ventricular depolarisation
229
what does the QRS indicate
depolarisation of ventricles
230
what does the ST segment indicate
isoelectric segment representing time between the end of ventricular depolarisation and start of repolarisationw
231
what does the T wave indicate
repolarisation of the ventricles
232
```
You perform a routine ECG on an elderly man and you find that the PR interval is 210ms in length. What does this recording suggest?
1st Degree Heart Block
Mobitz Type I
Mobitz Type II
Mobitz type B
Complete heart block
```
1st Degree Heart Block
233
what is the definition of 1st degree heart block
PR>0.2seconds
234
what are the symptoms associated with second degree heart block
syncope
| dizziness
235
what is second degree heart block mobitz I (wenkebach)
progressive elongation of PR interval until a QRS is dropped
| irregular
236
what commonly causes second degree heart block mobitz I?
BBs
| inferior MI
237
what is second degree heart block mobitz II
intermittent non-conducted P waves without progressive prolongation of the PR interval
regular
238
what commonly causes second degree heart block mobitz II?
his-purkinje system disease often due to MI
239
what is third degree heart block
complete heart block
| complete dissociation between the p waves and the QRS complexes
240
what are features of third degree heart block
bradycardia
| hypotension
241
what propagates the ventricles in third degree heart block
accessory pathway called His bundle acts as an independent pacemaker
this accounts for the bradycardia
242
```
A 10-year-old boy is brought to A&E with palpitations. On examination his HR is 250. He is later diagnosed with Wolff-Parkinson-White syndrome. Which one of the following is a feature of WPW syndrome?
Severe chest pain
Accessory pathway bundle of Kent
Delta wave on ECG at admission
Long PR intervals
Narrow QRS
```
Accessory pathway bundle of Kent
| Delta wave on ECG at admission is only found in sinus rhythm, not in tachycardia
243
what is a supraventricular tachycardia
tachycardia arising from above the bundle of His
| a re-entry circuit
244
what are the different types of SVT
AV nodal reentry tachycardia
| AV reentry tachycardia
245
what is AVNRT
re-entry circuit around the AV node
tachycardia caused by electrical activity going round and round in the AV node, repeatedly activating and propagating down the ventricular pathways causing ventricular contraction
246
what is AVRT
accessory pathway is bundle of kent
this is WPW syndrome
tachycardiac caused by electrical activity going round and round between the atria and the ventricles vias the accesory pathway (bundle of kent)
247
what would be found on ECG with an SVT in tachycardia
regular
no p waves
narrow complex tachycardia
248
what would be found on ECG with an SVT in sinus rhythm
```
short PR interval
AVRT only (WPW syndrome) has a delta wave
```
249
what is a ventricular tachycardia
tachycardia originating in the ventricles
250
how does VT lead to VF
VT may impair cardiac output which may result in decreased myocardial perfusion with progression to VF
251
what are signs of ventricular tachycardia on ECG
tachycardia
| broad QRS
252
what is AF
disorganised atrial electrical activity and contraction
253
what is seen on ECG with AF
irregularly irregular rhythm
no p waves
fibrillatory waves may be seen
