29/2 - LOOK BACK AT THIS FORGOT LOTS

Question 1

What clinical signs are associated with cardiac tamponade?

Answer 1

Pulsus paradoxus - absence of radial pulse on inspiration

Question 1

What electrolyte imbalance is associated with tornade de pointes (occurs when QT gets too big)?

What other ECG changes are you likely to find?

How is torsades de pointes managed?

Answer 1

Hypomagnesaemia and hypokalaemia

U waves
small T-waves
PR prolongation
ST depression
Long QT

Magensium sulphate

Question 2

What kind of murmur would be associated with a ventricular septal defect?

Answer 2

Pansystolic murmur - heard best at left sternal edge

Question 3

What artery is affected in each of the following STEMIS
- Inferior
- Anterior/septal
- Lateral

Answer 3

Inferior - RCA
Anterior/septal - LAD
Lateral - LCx

Question 4

What is a common contraindication of GTN?

Answer 4

Hypotension
Viagra

Question 5

NSTEMi is initially managed the same way as a STEMI - what changes at the end?

Answer 5

LWMH or fondaparinux given (antithrombin treatment)

Some sent for angiogram within 72hrs

Question 6

HF can occur due to problems with the systolic (IHD, dilated CM, myocarditis) or diastolic (restrictive CM, cardiac tamponade).

What EF is each associated with?

Answer 6

Systolic problems (blood can’t get out) - reduced EF (<50%) = HFrEF

Diastolic problems (blood can’t get in) - preserved EF (>50%) = HFpEF

Question 7

How is HF managed acutely and chroniclly?

What improves mortality?

Answer 7

Acute - POND

Position
Oxygen
Nitrates
Diuretics

Chronic - LABA
Loop dieuritic - med that doesn’t improve mortality
ACEi
Beta-blocker
Aldosterone antagonist - spirolocatone

SGLT-2i also improve mortality

Question 8

HF on CXR

Answer 8

ABCDE

Alveolar oedema
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusion

Question 9

Given max dose of atropine in a pt with life-threatening bradycardia and no response. What is next step?

Answer 9

Transcutaneous pacing

Max dose = 500mcg x 6 = 3mg

Question 10

If a patient has life threatening tachycardia with pulse (shock, syncope, MI, severe HF) what is the first management?

Answer 10

Synchronised DC shock - up to 3 times

Question 11

What is the pathway in CPR?

Answer 11

2 min CPR and assess rhythm and deliver shock (if Vfib or pulseless Vtach)

Amiodarone 300mg after 3rd shock

Adrenaline 1mg after 3rd shock (unless unshockable then immediate) then every 3 mins

Question 12

What are the causes of AF?

Answer 12

PIRATES (imagine a pirate tapping irregularly irregular beat)

PE, pulmonary disease, post-op
IHD, idiopathic
Rheumatic valvular disease (mitral stenosis or regur)
Anaemia, alcohol, age, autonomic tone
Thyroid disease (hyperthyroidism)
Elevated BP, electrocution
Sleep apnea, sepsis, surgery

Question 13

Symptoms of AS

Answer 13

SAD

Syncope
Angina
Dysponea

Question 14

What does the CHAzDSzVAS score assess?

What does it stand for again?

Answer 14

Stroke risk

Congestive HF
HTN
Age >75 (2 points)
Diabetes
Stroke, TIA or thromboemobolism
Vascular disease
Age 65-74
Sex (female)

Question 15

What contraception advice should be given to both MEN and WOMEN about methotrexate use?

Answer 15

use contraception during use and at least 6 months AFTER treatment finished