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Flashcards in Passmedicine Deck (122):
1

U waves seen on ECG

Hypokalaemia

2

J waves on ECG

Hypothermia

3

In hypokalaemia, you have no T, but a long PR and a long QT
And you are depressed

Hypokalaemia - small or absent T waves,
Long PR interval
Long QT
ST depression

4

Who should you avoid giving adenosine to?

Don't give to asthmatics - could cause bronchospasm

5

Which drugs interact with adenosine?

DEAR
Dipyridamoles - Enhance effect
Aminophylline - Reduces effect

6

Adenosine adverse effects

Bronchospasm
Chest pain
Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. wolff parkinson white)

7

Most common cause of aortic stenosis in younger patients (<65)

Bicuspid aortic valve

8

Most common cause of aortic stenosis in older patients (>65)

Calcification of the aortic valve

9

What does a narrow pulse pressure indicate?

Decreased cardiac output

10

Which syndromes are associated with VSD?

Down's syndrome
Patau syndrome
Edward's syndrome

11

Fragile X is associated with, which heart problem?

Mitral valve prolapse

12

William's syndrome is associated with which heart problem?

Supravavlular aortic stenosis

13

First line treatment for hypertension in a diabetic

ACE inhibitor

14

Investigation if you suspect a patient has aortic stenosis

Transthoracic echocardiogram

15

Which common drug, may cause skin necrosis (rare)

Warfarin
Patients are particularly at risk if they are given warfarin without LMWH, and it is most likely to occur in the first 3-5 days of treatment

16

1972 and protein C

Warfarin

17

Chest pain relieved when sitting forward

Pericarditis

18

ECG changes in pericarditis

Saddle shaped ST elevation
PR depression - most specific ECG marker for pericarditis

19

Acute management of SVT

Vagal manoeuvres
Adenosine 6mg-12mg-12mg (UNLESS ASTHMATIC - give verapamil instead)
Electrical cardioversion

20

Xanthomata are seen in what

Hyperlipidaemia
(eruptive xanthomata - due to high triglyceride levels and present as multiple red/yellow vesicles on extensor surfaces)

21

Does of adrenaline for baby - 6 years

150 micrograms, 0.15ml 1 in 1000

22

Does of adrenaline for 6 years to 12 years

300 micrograms, 0.3ml in 1 in 1000

23

Dose of adrenaline for adult and child >12 years

500 micrograms, 0.5ml 1 in 1000

24

Adverse effects of statins

Myopathy: includes myalgia, myositis, rhabdomyolysis and asymptomatic raised CK.

Risk factors for myopathy include advanced age, female sex, low BMI, presence of multisystem disease (e.g. diabetes)

25

ECG findings of Wolff parkinson white

Delta waves, short PR interval

26

Which drug are the most common cause of drug-induced angioedema

ACE inhibitors

27

ACE inhibitor mechanism of action

Inhibit conversion of angiotensin I to angiotensin II

28

Side effects of ACEis

Cough
Angioedema (may occur up to a year after starting treatment)
Hyperkalaemia
First-dose hypotension: more common in patients taking diuretics

29

Antagonists of the P2Y12 adenosine disphosphate receptor

Clopidogrel
Prasugrel

30

Statins interact with which drugs

Clarithromycin/erythromycin

31

The only shockable rhythms

Ventricular fibrillation and ventricular tachycardia

32

Where do thiazide diuretics work

Work at the beginning of the distal convoluted tubule (inhibit sodium reabsorption)

33

How long do thiazide diuretics take to work? And how long do they work for?

Begin to work after 1-2 hours, duration of action is 12-24 hours

34

Common adverse effects of thiazide diuretics

Dehydration
Postural hypotension
Hyponatremia, hypokalaemia, hypercalcemia
Gout
Impaired glucose tolerance
Impotence

35

What QRISK should you offer statins for?

Offer if QRISK>10%

36

Side effects of GTN

Hypotension
Tachycardia
Headache

37

How does GTN work?

Causes release of nitric oxide in smooth muscle, increasing cGMP, which leads to a fall in intracellular calcium levels

38

Management of aortic stenosis

Valve replacement if the patient is symptomatic
If not, then only replace when aortic valve gradient >36mmHg

39

When might you want to measure BNP levels in patients?

Measure in patients who you think have heart failure, but no history of myocardial infarction

>400 = poor prognosis

(If they have previous MI then they require urgent referral, echo and specialist assessment)

40

Describe BNP levels and heart failure

High levels = don't confirm heart failure, but likely

Low levels = rule out heart failure

(Highly sensitive but varying specificity)

41

When might BNP levels be elevated?

In heart failure
But also LVH, myocardial ischaemia, atrial fibrillation, pulmonary hypertension, hypoxia, pulmonary embolism, right ventricular strain, COPD, liver failure, sepsis, diabetes and renal impairment,

May also be high in women, and particularly in people older than 70

42

What is BNP?

A hormone produced by left ventricular myocardium in response to strain

43

Antiplatelet regimen following stroke?

check ct first lol
300mg aspirin for 2 weeks then 75mg clopidogrel for life

44

Adrenaline dose for cardiac arrest

1mg

45

When do you give adrenaline in cardiac arrest?

Give after third shock, and then every 3-5 minutes (during alternate cycles of CPR)

46

Non-shockable rhythms

Pulseless electrical activity
Asystole

47

Initial treatment of PEA and asystole

Patients should immediately receive 1mg IV adrenaline and high quality CPR

48

Pericardial knock - loud S3

Constrictive pericarditis

49

Kussmauls sign

JVP increases during inspiration

50

What is pulsus paradoxus?

When stroke volume and systolic BP decrease during inspiration

51

When might you see pulsus paradoxus?

Cardiac tamponade

52

Becks triad

Associated with cardiac tamponade - muffled heart sounds, distended veins, low arterial blood pressure

53

Causes long QT and deafness

Jervell-Lange-Nielsen syndrome

54

Causes long QT but no deafness

Romano-Ward syndrome

55

Which electrolyte abnormalities can cause long QT?

Hypocalcaemia
Hypokalaemia
Hypomagnesaemia

56

Dietary advice for prevention of MI

Eat a mediterranean style diet - switch butter and cheese for plant based oils

57

Exercise advice for prevention of MI

20-30 minutes of exercise per day until patients are slightly breathless

58

When can you have sex after a heart attack?

Can have sex 4 weeks after an uncomplicated MI

59

A patient should avoid sildenafil if they are on which medications?

Avoid sildenafil if a patient is on nitrates or nicorandil

60

What is sildenafil used for?

Used to treat erectile dysfunction

61

If a patient has had an acute MI and has symptoms or signs of heart failure, which drug might you consider initiating?

An aldosteone antagonist (e.g. eplerenone)
Try to start 3-14 days after MI and after the ACE inhibitor

62

Best site for adrenaline injection?

Anterolateral aspect of middle third of thigh

63

The most important cause of ventricular tachycardia

Hypokalaemia (followed by hypomagnesaemia)

64

What precipitates Torsades de pointes?

Torsades de pointes is precipitate by elongation of the QT interval

65

Most common cause of monomorphic VT

Myocardial infarction

66

Which condition may be worsened by bendroflumethazide?

Gout

67

Name 2 rate controlling drugs

Atenolol and diltiazem

68

Drugs used in pharmacological cardioversion of atrial fibrillation?

If no structural/ischaemic heart disease - flecainide/amiodarone

Structural/ischaemic heart disease - amiodarone

69

ECG shows elevation in leads V1-V4, with reciprocal changes in the inferior leads, which vessel has been occluded?

100% occlusion of the left anterior descending artery

70

What does an aortic regurgitation murmur sound like?

Early diastolic, heard best in the aortic area on end expiration, radiates to the 4th intercostal space

71

Investigation for aortic stenosis

Echocardiogram

72

What is Wenckebach phenomenon?

2nd degree atrioventricular block mobitz type 1 - seen in athletic individuals

73

Treatment of Dressler's syndrome

NSAIDs preferably
(or a prolonged course of colchicine or steroids)

74

What is Dressler's syndrome?

Pericarditis that occurs a couple of weeks after MI

75

Most common cause of death following MI?

Ventricular fibrillation

76

Which beta blockers specifically reduce mortality in heart failure?

Carvedilol and bisoprolol

77

Which drugs improve mortality following heart failure?

Ace inhibitors
Spironolactone
Beta-blockers
Hydralazine with nitrates

78

Name 2 aldosterone antagonists

Spironolactone
Eplerenone

79

Which patients need a pneumococcal booster vaccine every five years?

Patients with asplenia, splenic dysfunction or chronic kidney disease

80

How do thrombolytic drugs work?

Activate plasminogen to form plasmin

81

Examples of drugs used in thrombolysis?

Alteplase
Tenecteplase
Streptokinase

82

Side effects of thrombolysis?

Haemorrhage
Hypotension - more common with streptokinase
Allergic reactions - may occur with streptokinase

83

Why would you use a 24 hour holter ECG

To look for paroxysmal arrhythmia

84

Why would you use an electrophysiological study?

To trigger an arrhythmia so you can study it - also gives you the opportunity to treat the arrhythmia by delivering radiofrequency ablation to the extra pathway

85

Lenegres disease

Genetic idiopathic heart block, due to fibrosis and calcification of conduction system of heart

86

Investigation for cardiac tamponade

Echocardiogram

87

What is coarctation of the aorta associated with?

Associated with Turner's syndrome
Also associated with biscupid valve

88

Infection with what causes rheumatic disease?

Strep. pyogenes

89

Most common cause of infective endocarditis?

Staph aureus

90

Strongest risk factor for developing endocarditis?

Previous endocarditis

91

Used to determine the need to anticoagulate a patient in AF

CHA2DS2-VASc

92

DAS28

Measure of disease activity in rheumatoid arthritis

93

Used in the assessment of suspected obstructive sleep apneoa

Epworth scale

94

ABCD2

Prognostic score risk stratifying patients who've had a suspected TIA

95

NYHA

Heart failure severity scale

96

Child-Pugh classification

A scoring system used to assess the severity of liver cirrhosis

97

What is pulsus paradoxus?

When there is a greater than normal fall in systolic BP during inspiration (means faint or absent pulse in inspiration)

Seen in severe asthma and cardiac tamponade

98

What is pulsus alterans and when is it seen?

Weak arterial pulse and then strong arterial pulse
- seen in severe left ventricular failure

99

If someone has complete heartblock following an MI, which vessel is likely to be affected?

Right coronary artery

100

Persistent ST elevation after MI, what is this most likely to be?

Left ventricular thromboembolism

101

Treatment of Dresslers syndrome

NSAIDs

102

What is indapemide?

A thiazide-like diuretic

103

Why can you get hypertension in aortic dissection?

Because there is a catecholamine surge

104

Most common CXR finding of pulmonary embolism

Pulmonary embolism - normal CXR

105

Hypertrophic cadiomyopathy inheritance

Autosomal dominant

106

Management of Torsades de Pointes

IV magnesium sulphate

107

When should you take a statin?

Last thing in the evening

108

What does the PHQ-9 score assess?

Depressive symptoms

109

Can be used to evaluate the anxiety level of a patient?

HAD

110

Saddle shaped ST elevation

Pericarditis

111

Foods high in vitamin K

Broccoli, spinach, kale and sprouts (so avoid if you're on warfarin)

112

Foods which might trigger migraines

Caffeine, cured meats, dark chocolate

113

Foods high in potassium

Dried apricots, banana, butternut squash, avacado

114

How are proximal aortic dissections managed?

Aortic root replacement

115

A 35-year-old Singaporean female attends a varicose vein pre operative clinic. On auscultation a mid diastolic murmur is noted at the apex. The murmur is enhanced when the patient lies in the left lateral position

Mitral stenosis

116

Used in the assessment of suspected obstructive sleep apnoea

Epworth scale

117

Pulsus paradoxus

greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration
severe asthma, cardiac tamponade

118

If you have complete heart block following an MI, which vessel has been occluded?

Right coronary artery

119

How does amiodarone work?

Blocks potassium channels, which inhibits repolarisation and prolongs the action potential (also blocks sodium channels)

120

Wedge shaped opacification on CXR

Pulmonary embolism

121

What could cause torsades de pointes

Hypokalaemia
Hypomagnesaemia
Hypocalcemia
Hypothermia
MI
Post cardiac arrest
Raised ICP (subarachnoid haemorrhage)
Hypothyroidism

122

Contraindication to statin therapy

Pregnancy