07/06

Question 1

aortic vs pulmonary stenosis

Answer 1

pulmonary is louder on inspiration

Question 2

posterior MI ECG changes

Answer 2

tall R waves in leads V1-3

Question 3

CHADSVAC score

Answer 3

C- ongestive HF (1)
H- ypertension ( or treated hypertension) (1)
A2 age >75 (2)
      age 65-74 (1)
D- iabetes (1)
S2- prior stroke or TIA (2)
V- ascular disease (IHD, PAD) (1)
S- ex (female) (1)

0 = no treatment
1= males- consider anticoag, females (no treatment)
2 or more = coagulation

Question 4

how to differentiate between ascending/descending aortic dissection?

Answer 4

descending= normal heart sounds

ascending= aortic regurgitation

Question 5

signs of right sided heart failure

Answer 5

raised JVP
ankle oedema
hepatomegaly

Question 6

normal range LVEF

Answer 6

55-70%

Question 7

when are regional wall abnormalities seen

Answer 7

infarction

Question 8

acute management of SVT

Answer 8

vagal maneovures
IV adenosine 6, 12, 12 (verapamil in asthmatics)
cardioversion

Question 9

MOA of statin

Answer 9

inhibit HMG-CoA reductase- the rate limiting enzyme in hepatic cholesterol synthesis

Question 10

hypokalaemia ECG findingd

Answer 10

U waves
T waves have sine appearace
prolonged QTc
borderline PR

Question 11

antihypertensives to be avoided in diabetes

Answer 11

thiazides

Question 12

1st line anti-anginal for stable angine in a patient with known heart failure

Answer 12

atenolol

Question 13

pulsus paradoxus

Answer 13

fall in systolic BP of >10mmHg during inspiration- asthma + cardiac tamponade

Question 14

slow rising pulse

Answer 14

aortic stenosis

Question 15

jerky pulse

Answer 15

HOCM

Question 16

pulsus alterans

Answer 16

regular alteration of the force of the arterial pulse- left ventricular failure

Question 17

management of dyspnoea and anxiety in acute exacerbation of HF

Answer 17

morphine

Question 18

ECG in wpw

Answer 18

Possible ECG features include:
> short PR interval
> wide QRS complexes with a slurred upstroke - ‘delta wave’
> left axis deviation if right-sided accessory pathway*
> right axis deviation if left-sided accessory pathway*

Question 19

medical treatment WPW

Answer 19

definitive treatment: radiofrequency ablation of the accessory pathway

medical therapy: sotalol, amiodarone, flecainide

sotalol should be avoided if there is coexistent atrial fibrillation

Question 20

Complete heart block following an inferior MI is NOT an indication for ….

Answer 20

pacing, unlike with an anterior MI

Question 21

NSAIDs ______ PDA and prostaglandins _____ PDA

Answer 21

close

open

Question 22

management of asystole

Answer 22

ALS- CPR + check rhythm every two minutes + adrenaline every 3-5 minutes

Question 23

Management of NSTEMI

Answer 23

aspirin 300mg
fondaparinux if no immediate PCI planned

estimate 6-month mortality

if low risk- give ticagrelor
if immediate/high risk - give prasugrel or tecagrelor and unfractionated heparinq

Question 24

side effects of nitrates

Answer 24

hypotension
tachycardia
headaches
flushing

Question 25

what should be used when ACEi cant be tolerated

Answer 25

<55 = ARB

Question 26

NYHA classification

Answer 26

``` I= no symptoms, no limitation II= mild symptoms, slight limitation III= moderate symptoms, marked limitation (less than ordinary activity) IV= severe symptoms, pain at rest ```

Question 27

hypothermia ECG

Answer 27

``` bradycardia J wave 1st degree HB long QT atrial and ventricular arrythmias ```

Question 28

b blocker reducing mortality in HF

Answer 28

bisoprolol

Question 29

glycoprotein IIb/IIIa receptor antagonist

Answer 29

abciximab eptifibatide tirofiban

Question 30

adrenaline in ACS

Answer 30

non-shockable= ASAP, then alternate cycles shockable= after 3rd shock, alternating cycles

Question 31

amiodarone in ACS

Answer 31

given after third shock and considered after 5 shocks

Question 32

_____ must be temporarily stopped when a macrolide antibiotic is started

Answer 32

statins

Question 33

most common valve affected in encarditis

Answer 33

mitral valve 2) aortic 3) combined mitral + aortic 4) tricuspid 5) pulmonary

Question 34

signs of neurally mediated syncope

Answer 34

prodrome- sweating, pallor, N&V | transient LOC

Question 35

when should ACEi be stopped in patients with CKD

Answer 35

K >6

Question 36

long term management post-MI

Answer 36

``` ABCDs ACEi Beta Blocker Cholesterol lowering agent (Statin) Dual antiplatelet therapy ```

Question 37

pulse deficit in aortic dissection

Answer 37

In aortic dissection, a pulse deficit may be seen: > weak or absent carotid, brachial, or femoral pulse >variation in arm BP

Question 38

STEMI management: if patient is having PCI then _____ is given in _____ __ _____. If patient is on an anticoagulant then ________ used instead

Answer 38

STEMI management: if patient is having PCI then aspirin is given in addition to aspirin. If patient is on an anticoagulant then clopidogrel used instead

Question 39

de musset

Answer 39

head bobbing in aortic stenosis