18 November

Question 1

What is crescendo angina?

Answer 1

Comes on at rest/ with minimal exertion/increasing in frequency

Question 2

What is variant angina?

Answer 2

Angina comes on at rest

Question 3

What is decubitus angina?

Answer 3

Angina precipitated by lying flat

Question 4

What is first line management of angina- in terms of symptom relief?

Answer 4

Beta blocker
CCB- if dual therapy them amlodipine
GTN

Question 5

What other medication should be commenced in the presence of angina?

Answer 5

Statin
Aspirin

For secondary prevention

Question 6

What does this ECG show?

Answer 6

Posterior MI

Question 7

What vessel is affected in posterior MI?

Answer 7

Right coronary artery or left circumflex

Question 8

What vessel is affected in anterior MI?

Answer 8

Left anterior descending artery

Question 9

What vessel is affected in lateral MI?

Answer 9

Circumflex artery

Question 10

What vessel is affected in inferior MI?

Answer 10

Right coronary atery

Question 11

What vessel is affected in anterolateral MI?

Answer 11

Left coronary artery

Question 12

What are causes of ejection systolic murmur?

Answer 12

Aortic stenosis
Pulmonary stenosis
Hypertrophic cardiomyopathy
Aortic sclerosis
Flow murmur

Question 13

What is the screening for known AAA?

Answer 13

<3cm- no action
3-4.4cm- US every 12 months
4.5-5.4cm- Scan every 3 months
>5.5cm- 2 week referral for intervention

Question 14

What is lights criteria for pleural effusion?

Answer 14

If protein content 25-35g/Dl- exudate is likely if one of the following met
1) Pleural fluid protein divided by serum protein >0/5
2_ Pleural fluid LDH divided by serum LDH >0/6
3) Pleural fluid LDS more than 2/3 upper limit of normal serum LDH

Question 15

What is the CHADsVASc score?

Answer 15

Congestive Heart Failure- 1
Hypertension-1
Age >75 2 points
Diabetes mellitus 1 point
Stroke 2 points
Vascular disease 1 point
Age 65-74 1 point
Sex (female) 1 point

Question 15

What are the ECG findings of hypertrophic cardiomyopathy?

Answer 15

Left ventricular hypertrophy
T wave inversion
Deep Q waves
AF can be seen

Question 16

What are features of HCM?

Answer 16

Exertional dyspnoea
Syncope
Angina
Sudden death
Jerky pulse
Double apex beat- inappropriate filling during diastole
Ejection systolic murmur- worsens with Valsava

Question 17

what is atrial myxoma?

Answer 17

Non cancerous tumour of the upper left or right of the heart

More common in women

Question 18

What are features of atrial myxoma?

Answer 18

Weakness
Numbness
Chest pain
SoB
Leg swelling
Fever
Night sweats

Question 19

What are causes of LBBB?

Answer 19

MI
HTN
Aortic stenosis
Cardiomyopathy
Idiopathic fibrosis
Digoxin toxicity
Hyperkalaemia

Question 20

What are ECG signs of hyperkalaemia?

Answer 20

Tall tented T waves
Flat P waves
Widened QRS complex

Question 21

What is the management of heart failure?

Answer 21

1) ACE inhibitor, betablocker
2) Aldosterone antagonist
3) Specialist- digoxin/ivabradine/hydralazine

Question 22

What are side effects of amiodarone?

Answer 22

Grey/blue discolouration of skin
Hypo/hyperthyroidism
Hepatitis
Cough
Dyspnoea
Fibrosis
Peripheral neuropathy
Arrythmias
Conduction disorders
Hypotension

Question 23

What are absolute contraindications for thrombolysis?

Answer 23

Previous intracranial bleed
Iscahemic stroke <6months
Cerebral neoplasm
AV malformation
Recent major trauma/surgery/head injury <3 weeks
Aortic dissection
Active bleeding/bleeding disorder
GI bleeding
Non compressible punctures <24 hours e.g. liver biopsy

Question 24

what murmur is aortic regurg?

Answer 24

Early diastolic murmur
Heard best during expiration and patient sitting forward