Pass Medicine

Question 1

When starting ramipril, what is an acceptable increase in creatinine from baseline?

Answer 1

30%

Question 2

What are the common side effects of amiodarone? (10)

Answer 2

Bradycardia
Hyper/hypothyroidism
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Jaundice
Taste disturbance
Persistent slate grey skin discolouration
Raised serum transaminases
Nausea
Constipation (particularly at the start of treatment)

Question 3

What is the first line investigation for a patient with suspected stable angina?

Answer 3

Contrast-enhanced CT coronary angiogram

Question 4

What is hypertrophic obstructive cardiomyopathy (HOCM)?

Answer 4

HOCM is an autosomal dominant disorder that is a cause of sudden death in young people
Unexplained syncope is one of the indicators that sudden death may occur

Question 5

What is the management of hypertrophic obstructive cardiomyopathy? (5)

Answer 5

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis

Question 6

What ECG changes are seen in hypercalcaemia?

Answer 6

Shortening of the QT interval

Osborne (J) waves may also be seen in more severe cases

Question 7

Management for patient with K+ >6 on ACEi

Answer 7

Prompt cessation of ACEi

Question 8

Orthostatic Hypotension

Answer 8

Drop in SBP of at least 20 mmHg and/or

Drop in DBP of at least 10 mmHg after 3 minutes of standing

Question 9

Management of a patient having major bleed on warfain

Answer 9

Stop warfarin
Give 5mg vit k IV
Give prothrombin complex concentrate

Question 10

When is oral vitamin K indicated?

Answer 10

INR > 8 in the absence of bleed

Question 11

What is used to reverse a DOAC?

Answer 11

Idarucizumab

Question 12

What is the approximate half-life of adenosine?

Answer 12

10 seconds

Question 13

Drugs that reduce mortality in HF

Answer 13

ACE-inhibitors
Beta-blockers
Angiotensin receptor blockers
Aldosterone antagonists
Hydralazine and nitrates

Question 14

How many shocks can be given in cardiac arrest caused by hypothermia?

Answer 14

3 shocks until the patient is rewarmed to 30 degrees

Question 15

PE + Hypotension treatment

Answer 15

Thrombolyse - Alteplase

Question 16

Links to Streptococcus viridans

Answer 16

Classically linked to poor dental hygiene or following a dental procedure

Question 17

Links to Streptococcus bovis

Answer 17

most commonly linked with colorectal cancer

Question 18

Coxiella burnetti

Answer 18

Causes Q fever, an infection caught most commonly from farm animals. So, consider in any farmer or abattoir worker

Question 19

Staphylococcus epidermis

Answer 19

most commonly associated with patients who have undergone previous prosthetic valve surgery

Question 20

Most common cause of infective endocarditis

Answer 20

Staph Aureus

Question 21

Features of HYPOKALEMIA on ECG

Answer 21

U waves (small deflection following T wave)
Small or absent T waves
Prolonged PR interval
ST depression
Long QT

Question 22

What is a Q wave?

Answer 22

Small deflection following T wave
Usually same direction as T
Best seen in V2 and V3

Question 23

Investigation of choice for suspected PE + renal impairment

Answer 23

Ventilation perfusion scan

Question 24

First line management of acute pericarditis

Answer 24

NSAID and Colchicine

Question 25

What is pulsus paradoxus?

Answer 25

Abnormally large drop in BP during inspiration

Associated with Cardiac Tamponade

Question 26

What is Kussmauls sign

Answer 26

Raised JVP with inspiration

Associated with constrictive pericarditis

Question 27

Condition associated with radio-femoral delay

Answer 27

Coarctation of the aorta