Passmedicine Flashcards
(122 cards)
1
Q
U waves seen on ECG
A
Hypokalaemia
2
Q
J waves on ECG
A
Hypothermia
3
Q
In hypokalaemia, you have no T, but a long PR and a long QT
And you are depressed
A
Hypokalaemia - small or absent T waves,
Long PR interval
Long QT
ST depression
4
Q
Who should you avoid giving adenosine to?
A
Don’t give to asthmatics - could cause bronchospasm
5
Q
Which drugs interact with adenosine?
A
DEAR
Dipyridamoles - Enhance effect
Aminophylline - Reduces effect
6
Q
Adenosine adverse effects
A
Bronchospasm
Chest pain
Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. wolff parkinson white)
7
Q
Most common cause of aortic stenosis in younger patients (<65)
A
Bicuspid aortic valve
8
Q
Most common cause of aortic stenosis in older patients (>65)
A
Calcification of the aortic valve
9
Q
What does a narrow pulse pressure indicate?
A
Decreased cardiac output
10
Q
Which syndromes are associated with VSD?
A
Down’s syndrome
Patau syndrome
Edward’s syndrome
11
Q
Fragile X is associated with, which heart problem?
A
Mitral valve prolapse
12
Q
William’s syndrome is associated with which heart problem?
A
Supravavlular aortic stenosis
13
Q
First line treatment for hypertension in a diabetic
A
ACE inhibitor
14
Q
Investigation if you suspect a patient has aortic stenosis
A
Transthoracic echocardiogram
15
Q
Which common drug, may cause skin necrosis (rare)
A
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
Q
1972 and protein C
A
Warfarin
17
Q
Chest pain relieved when sitting forward
A
Pericarditis
18
Q
ECG changes in pericarditis
A
Saddle shaped ST elevation
PR depression - most specific ECG marker for pericarditis
19
Q
Acute management of SVT
A
Vagal manoeuvres
Adenosine 6mg-12mg-12mg (UNLESS ASTHMATIC - give verapamil instead)
Electrical cardioversion
20
Q
Xanthomata are seen in what
A
Hyperlipidaemia
eruptive xanthomata - due to high triglyceride levels and present as multiple red/yellow vesicles on extensor surfaces
21
Q
Does of adrenaline for baby - 6 years
A
150 micrograms, 0.15ml 1 in 1000
22
Q
Does of adrenaline for 6 years to 12 years
A
300 micrograms, 0.3ml in 1 in 1000
23
Q
Dose of adrenaline for adult and child >12 years
A
500 micrograms, 0.5ml 1 in 1000
24
Q
Adverse effects of statins
A
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
