06/06/2021

Question 1

Investigation for pulmonary embolism in patient with renal impairment

Answer 1

V/Q scan

Question 2

Infective endocarditis valve in IVDU

Answer 2

tricuspid valve

Question 3

what does the management of bradycardia depend on

Answer 3

1. identifying presence of ‘adverse signs’

2. identifying the potential risk of asystole

Question 4

what indicates haemodynamic compromise in bradycardia

Answer 4

• shock
• syncope
• myocardial ischaemia
• heart failure

Question 5

management of bradycardia with adverse signs

Answer 5

atropine 500mcg IV

Question 6

what are the risk factors for asystole

Answer 6

• complete heart block with broad complex QRS
• recent asystole
• mobitz type II AV block
• ventricular pause > 3 seconds

Question 7

management of AF with collapse

Answer 7

immediate DC cardioversion followed by thromboprophylaxis

Question 8

sign of pulmonary hypertension

Answer 8

loud second heart sound

Question 9

splitting of first heart sound

Answer 9

mitral valve closes significantly before the tricuspid, inspiration is a cause of this

Question 10

soft second heart sound

Answer 10

aortic stenosis

Question 11

reversal of dabigatran

Answer 11

idarucizumab

Question 12

reversal of warfarin

Answer 12

vit K

Question 13

reverse unfractionated heparin

Answer 13

protamine sulphate

Question 14

eisenmeger

Answer 14

reversal of a left to right shunt

Question 15

Aortic stenosis management: ____ if symptomatic, otherwise cut-off is gradient of __ mmHg

Answer 15

AVR

40

Question 16

pharmacological managment of orthostatic hypotension

Answer 16

Fludrocortisone and midodrine are pharmacological options for treatment of orthostatic hypotension

Question 17

ECG changes for thrombolysis or percutaneous intervention:

Answer 17

> ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6)
OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block

Question 18

Poorly controlled hypertension, already taking an ACE inhibitor and a thiazide diuretic

Answer 18

add a CCB

Question 19

The long saphenous vein passes anterior to the ————- and is commonly used for _______ ________

Answer 19

The long saphenous vein passes anterior to the medial malleolus- and is commonly used for venous cutdown

Question 20

management of angina

Answer 20

1) aspirin + statin
2) sublingual GTN
3) beta blocker or CCB (verapamil or diltiazem if monotherapy, long acting dihydropyridine CCB (nifedipine) if used with bblocker)
4) if dual therapy not adequaate then PCI or CABG

Question 21

ST elevation + PR depression

Answer 21

pericarditis

Question 22

what foods should those on warfarin avoid

Answer 22

broccoli, sprouts, spinach, kale (high Vit K)

Question 23

inferior MI plus aortic regurg murmur

Answer 23

ascending aorta dissection

Question 24

what is contraindicated in ventricular tachycardia

Answer 24

verapamil- precipitate cardiac arrest

Question 25

anti-anginal causing GI ulceration

Answer 25

nicorandil

Question 26

secondary prevention of MI

Answer 26

dual antiplatelet therapy (aspirin + second antiplatelet) ACE inhibitor beta-blocker statin

Question 27

coarctation of the aorta presentation

Answer 27

acute circulatory collapse at 2 days of age when duct closes- heart failure & absent femoral pulses systolic murmur under left clavice and over back

Question 28

types of aortic dissection

Answer 28

Type A- ascending aorta- control BP (IV labetaolol + surgery) Type B- descending aorta- control BP (IV labetalol)

Question 29

long-term management of unprovoked pulmonary embolisms

Answer 29

6 months apixaban

Question 30

investigating aortic dissection in clinically unstable patients

Answer 30

transoesophageal echogardiography

Question 31

which antibiotic can cause long QT syndrome

Answer 31

erythromycin

Question 32

system used in the assessment of suspected obstructive sleep apnoea

Answer 32

epworth scale

Question 33

system used to determine the need to anticoagulate a patient in atrial fibrillation

Answer 33

CHA2DS2-VASc

Question 34

system used to measure disease activity in rheumatoid arthritis

Answer 34

DAS28

Question 35

acute pulmonary oedema management

Answer 35

IV diuretics- furosemide

Question 36

Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l

Answer 36

Add an alpha or beta blocker

Question 37

when should treatment with statins be discontinued?

Answer 37

if serum transaminase concentrations rise to and persist at 3 times the upper limit of reference range

Question 38

persistent ST elevation following recent MI, no chest pain-

Answer 38

left ventricular aneurysm

Question 39

management of major bleeding in warfarinised patients

Answer 39

stop warfarin, give IV vit K 5mg, prothrombin complex concentrate

Question 40

For patients of black African or African–Caribbean origin taking a calcium channel blocker for hypertension, if they require a second agent consider

Answer 40

angiotensin receptor blocker in preference to an ACE inhibitor

Question 41

risk factors for silent MI

Answer 41

diabetes | elderly

Question 42

massive PE + _______ = thrombolyse

Answer 42

hypotension

Question 43

standford B

Answer 43

site of the dissection is the descending aorta.

Question 44

Management of stanford B dissection

Answer 44

Appropriate first line medical management is IV beta blockade and analgesia. If blood pressure and heart rate remain raised then vasodilators may be considered

Question 45

drugs that reduce mortality in patients with LVF

Answer 45

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

Question 46

management of torsades des pointes

Answer 46

IV magnesium sulphate

Question 47

Anteroseptal

Answer 47

V1-V4 | Left anterior descending

Question 48

Inferior

Answer 48

II, III, aVF | Right coronary

Question 49

Anterolateral

Answer 49

V4-6, I, aVL | Left anterior descending or left circumflex

Question 50

Lateral

Answer 50

I, aVL +/- V5-6 | Left circumflex

Question 51

Posterior

Answer 51

Tall R waves V1-2 | Usually left circumflex, also right coronary

Question 52

when is 3rd heart sound considered normal?

Answer 52

<30

Question 53

MOA of bumetanide

Answer 53

Furosemide - inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle

Question 54

signs and symptoms of malignant hypertension

Answer 54

> Papilloedema > Retinal bleeding > Increased cranial pressure causing headache and nausea > Chest pain due to increased workload on the heart > Haematuria due to kidney failure > Nosebleeds which are difficult to stop

Question 55

patients who require anticoagulation but do not want regular monitoring

Answer 55

NOACs

Question 56

HOCM is associated with sudden death in young athletes due to .....

Answer 56

ventricular arrythmia

Question 57

dabigatran reversal

Answer 57

idarucizumab

Question 58

offer both .... ..... as licensed first line treatment for heart failure

Answer 58

ACE inhibitor + beta blocker

Question 59

if symptoms of HF persist after 1st line treatment then consider;

Answer 59

aldosterone antagonist angiotensin receptor blocker hydralazine + nitrate

Question 60

if symptoms of HF persist despite 1st and 2nd line treatment consider

Answer 60

cardiac resynchronisation therapy | digoxin

Question 61

A patient with AF + an acute stroke (not haemorrhagic) should have anticoagulation therapy started....

Answer 61

two weeks after the event

Question 62

when are nitrates contraindicated

Answer 62

aortic stenosis- risk of profound hypotension

Question 63

pulmonary embolism ABGs

Answer 63

hyperventilation, causing a drop in arterial carbonic dioxide partial pressure and thus alkalosis

Question 64

warfarin ___ be used in breastfeeding

Answer 64

can

Question 65

target of INR

Answer 65

2. 5 - DVT, PR, APS, A FIB, Cardioversion etc 3. 5 - recurrent DVT or PE