Valvular, Genetic, Inflammation

Question 1

Causes of mitral stenosis

Answer 1

Rheumatic fever (majority of the time)
Congenital causes

Question 2

Definition of mitral stenosis (size)

Answer 2

Orifice less than 2 square cm

Question 3

What does severity of mitral stenosis depend on?

Answer 3

Trans-valvular pressure gradient

Trans-valvular flow rate

Question 4

Treatment of mitral stenosis

Answer 4

Diuretics and restrict sodium intake

Anticoagulation

Question 5

Is acute mitral regurgitation an emergency?

Answer 5

Yes

Question 6

Most common valvular disease

Answer 6

Aortic stenosis

Question 7

Treatment of aortic stenosis

Answer 7

Surgical

Question 8

Aortic regurgitation causes

Answer 8

Aorta disease

Valve leaflet pathology

Question 9

Is acute aortic regurgitation an emergency?

Answer 9

Yes

Question 10

Treatment for aortic regurgitation

Answer 10

Surgical

Vasodilator therapy delays requirement of surgery

Question 11

Conditions patients must meet before CABG

Answer 11

Adequate lung function
Adequate mental function
Adequate hepatic function
Ascending aorta OK
Distal coronary targets OK
LVEF >20%

Question 12

What vessels are used for a graft in CABG?

Answer 12

Reversed saphenous vein
Internal mammary vein
Radial arteries

Question 13

What 2 valves are more commonly operated on in adults?

Answer 13

Aortic and mitral

Question 14

What are the 3 most common valve conditions requiring surgery?

Answer 14

Senile tricuspid AS
Bicuspid AS
Degenerative MR

Question 15

What sort of infection is rheumatic fever related to?

Answer 15

Streptococcal infections

Question 16

What is the hallmark of pathology in rheumatic fever?

Answer 16

Pancarditis

Question 17

Treatment of rheumatic fever

Answer 17

Aspirin and bed rest

Question 18

Presentation of chronic rheumatic heart disease

Answer 18

Gradually progressive mitral valve disease and/or aortic valve disease

Question 19

Commonest cause of endocarditis

Answer 19

Strep viridans

Question 20

What sort of endocarditis does strep viridans lead to?

Answer 20

Subacute bacterial endocarditis

Question 21

Second commonest cause of endocarditis

Answer 21

Staph aureus

Question 22

What sort of endocarditis does staph aureus lead to?

Answer 22

Acute bacterial endocarditis

Question 23

Is cure more likely with strep viridans or staph aureus endocarditis?

Answer 23

Strep viridans

Question 24

What’s more likely to be cured with antibiotics alone, native valve or prosthetic valve enocarditis?

Answer 24

NVE. 90% chance vs 50%

Question 25

How long are antibiotics given after op for endocarditis?

Answer 25

6 weeks IV antibiotics

Question 26

Audibility of aortic stenosis

Answer 26

Murmur usually easily heard

Question 27

Audibility of aortic regurgitation

Answer 27

Murmur usually difficult to hear. Louder the murmur, the more severe it is

Question 28

Audibility of mitral stenosis

Answer 28

Murmur usually difficult to hear. Louder the murmur, the more severe it is

Question 29

Audibility of mitral regurgitation

Answer 29

Murmur usually easy to hear. If murmur loud then MR usually severe

Question 30

Type of surgical procedure indicated if severe valve disease

Answer 30

Valve replacement

Question 31

What size indicates surgery for mitral stenosis?

Answer 31

Orifice <1.5cm squared

Question 32

Where is blood drained from and returned to in cardiopulmonary bypass?

Answer 32

Drained from RA, returned to ascending aorta

Question 33

Max time limit for patient to be on cardiopulmonary bypass

Answer 33

12 hours

Question 34

Type of embolism that can be involved as complication of open thoracic surgery?

Answer 34

Air embolism

Question 35

Pros and cons of biological and mechanical prosthetic valves

Answer 35

Biological: no warfarin, wears out after 15 years Mechanical: warfarin required, lasts >40 years

Question 36

2 commonest signs/symptoms of infective endocarditis

Answer 36

Fever | Heart murmur

Question 37

What criteria is used for diagnosis of infective endocarditis?

Answer 37

Modified Duke criteria

Question 38

Indications for surgery in IE

Answer 38

Heart failure with valvular dysfunction or cardiac complications Uncontrolled infection Prevention of embolism

Question 39

Effect of rheumatic heart disease on valve leaflets

Answer 39

Leaflet thickening, calcification, restricted movement

Question 40

Pretest scoring system for DVT

Answer 40

Wells scoring system

Question 41

Pretest scoring system for PE

Answer 41

Wells scoring system

Question 42

Treatment for DVT and PE

Answer 42

Anticoagulation is main treatment Vascular surgery for massive DVT Thrombolysis for massive PE

Question 43

How long is anticoagulation given for provoked vs unprovoked DVT and PE?

Answer 43

Provoked: 3 months Unprovoked: usually lifelong

Question 44

3 aims of treatment of DVT and PE

Answer 44

Prevent clot extension Prevent clot embolisation Prevent clot recurrence

Question 45

3 causes of congenital heart disease

Answer 45

Copy number variation Single nucleotide variation Teratogens

Question 46

How does genetics of down syndrome present? | 3 ways

Answer 46

95% maternal non-disjunction 3% translocation 2% mosaic

Question 47

Common cardiac problem associated with down sydrome

Answer 47

Atrio-ventricular septal defects (in 12%)

Question 48

Percentage of Turner syndrome that are mosaic

Answer 48

30%

Question 49

Common cardiac problem associated with turner sydrome

Answer 49

Coarctation of aorta

Question 50

Mnemonic for 22q11 deletion syndrome

Answer 50

``` Cardiac malformation Abnormal face Thymic hypoplasia Cleft palate Hypoparathyroidism 22q11 deletion ```

Question 51

Percentage of 22q11 deletion patients that have schizophrenia

Answer 51

22%

Question 52

What 2 syndromes does 22q11 deletion encompass?

Answer 52

DiGeorge and Shprintzen

Question 53

Common cardiac problem associated with Williams sydrome

Answer 53

Aortic stenosis

Question 54

What deficiency is ventricular septal defects associated with?

Answer 54

Folate deficiency

Question 55

Is marfans dominant or recessive?

Answer 55

Autosomal dominant

Question 56

Gene and chromosome mutated in marfans

Answer 56

Fibrillin 1 gene on chromosome 15

Question 57

Management of marfans

Answer 57

At least annual review | ECHO

Question 58

When is surgery offered for marfans?

Answer 58

Sinus of valsalva exceeds 5.5cm or 5% growth per year

Question 59

2 conditions that come under long QT syndrome

Answer 59

Romano-ward syndrome | Jervell Lange-Neilsen

Question 60

Effects of brugada syndrome

Answer 60

Sudden cardiac death, ventricular fibrillation/tachycardia | Enlarged LV/poor LV function

Question 61

Management of brugada syndrome

Answer 61

Avoid fever, excess alcohol, overeating | ICD

Question 62

Affect of hypertrophic cardiomyopathy on heart rhythm

Answer 62

Arrhythmia

Question 63

Screening system for genetic diseases

Answer 63

NICCS

Question 64

Most common cause of myocarditis

Answer 64

Viral infection

Question 65

Most common causes of pericardial disease

Answer 65

Viral or idiopathic

Question 66

Most important causes of pericardial disease to pick up

Answer 66

Bacterial, post-MI, perforation, neoplasia