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Finals > Cardiac Medicine 🫀✅ > Flashcards

Cardiac Medicine 🫀✅ Flashcards

1
Q

Two patients who have silent MI

A

Elderly women and TII DM

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2
Q

Use of Killip Class

A

Used to stratify risk post MI

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3
Q

Initial therapy for all ACS

A

MONA (morphine, oxygen if <94, nitrates, 300mg aspirin)

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4
Q

List 5 meds all ACS survivors should be on, and 1 extras they may be on

A

Aspirin, another antiplatelet (p2y12 inhib), statin, beta blockers, ACEi’s. Maybe nitrate

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5
Q

Antiarrythmics and other meds causing prolonged QT

A

Amiodarone, sotalol, class 1a’s, macrolides (except clarithromycin), TCAs, antipsychotics, chloroquine

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6
Q

How to investigate and manage Torsades de Pointes

A

ECG. IV MgSO4

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7
Q

After ACS, when do we give dual vs triple therapy.

A

Dual for 12 mo, or Triple for 6mo (only if PCI was done)

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8
Q

What is in the dual and triple therapy (following ACS)

A

Dual: aspirin or cloppy (and) NOAC or VKA = 6mo

Triple: aspirin (and) Cloppy (and) VKA or NOAC = 3mo

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9
Q

NSTEMI or unstable angina identified.
Management ?

A

MONA, then do GRACE score to determine if PCI best or not

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10
Q

If GRACE score is </=3%. Do what?

A

Conservative management with Tiggy

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11
Q

GRACE score of >3% and patient hemodynamically stable, do what?

A

PCI within 72hours, and prasgruel or tiggy, and UFH

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12
Q

GRACE score >3% and patient hemodynamically unstable. mx?

A

PCI immediately. And prasgruel or tiggy, and UFH

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13
Q

If a patient has a GRACE score less than 4%, yet is hemodynamically unstable… what do we do? (Unlikely scenario)

A

Do immediate PCI (stability takes priority)

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14
Q

In NSTEMI/unstable angina, when is fondaparinux given?

A

If PCI not planned

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15
Q

STEM I usually presents with how many minutes of pain

A

20 or more minutes

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16
Q

In STEMI, we give dual antiplatelet therapy before PCI. Which dual antiplatelet drugs do we use (consider if patient is already taking oral anticoagulant)

A

If patient already taking oral anticoagulant give clopidogrel and aspirin. If patient not taking oral anticoagulant give prasgruel and aspirin

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17
Q

If a patient has a STEMI, what determines whether they have a PCI or not

A

If PCI can be done within 120 minutes Then most likely should be done

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18
Q

If cannot do PCI within 120 minutes, what is the alternative treatment for an STEMI

A

Fibrinolysis And antithrombin

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19
Q

Which anti-platelet should be given alongside PCI

A

Prasgruel with Pci

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20
Q

Following fibrinolysis, Which antiplatelet should be given

A

tiggy

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21
Q

Three Cardinal features of angina pectoralis

A

Constricting discomfort in the chest, precipitated by exertion, relieved by rest or GTN

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22
Q

Pass meds Answer for best investigation for angina (stable)

A

CT coronary angiography

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23
Q

Aside from normal angina medication all patients should be taking which two medications

A

Aspirin and statin

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24
Q

What medication can be taken to abort angina attacks

A

GTN

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25
Q

 Which two medications are considered first line for angina management

A

CCB and beta blocker

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26
Q

For angina if give CCB and beta blocker together, CCB must be which type

A

Dihydropyridine

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27
Q

In angina if a CCB is used as monotherapy, which CCB should be used

A

Verapamil or diltiazem

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28
Q

Cardio respiratory arrest – cardiac arrest. It’s usually down to which four rhythm disturbances

A

Ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity and asystole

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29
Q

Which investigations are important for cardiac arrest

A

Continuous cardiac monitoring. Then consider full blood count, electrolytes, ABG, x-ray, toxicology. Aside from ECG, this is all done after Mx

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30
Q

Management of cardiac arrest

A

ABCD, CPR (30 compressions then 2 breaths) for 5 cycles. Defib is shockable rhythm… recall

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31
Q

If defib doesn’t work for pulseless ventricular tachycardia/Vfib… can give what?

A

Amiodarone or Lidocaine

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32
Q

Best two invx for suspected endocarditis

A

Blood cultures and echo

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33
Q

Empirical antibiotics for endocarditis:
1. If native valve
2. If native valve but penicillin allergic
3. Severe sepsis
4. prosthetic valve

A
  1. Amoxicillin (+/-) low dose gentamicin
  2. Vancomycin and low dose gentamicin
  3. Vancomycin and low dose gentamicin
  4. Vancomycin and low dose gentamicin and rifampicin
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34
Q

Treatment of native valve staphylococcus endocarditis

A

Flucloxacillin (of vanco and rifampicin if penicillin allergic)

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35
Q

Prosthetic valve endocarditis due to staphylococcus treatment

A

Flucloxacillin and rifampicin and low dose gentamicin (vanco and rifampicin and low dose gentamicin if penicillin allergic)

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36
Q

Endocarditis due to fully sensitive strep (treatment)?

A

Benzylpenicillin (vanco and low dose gentamicin if allergic)

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37
Q

Endocarditis due to more resistant strep (treatment)

A

Benzylpenicillin (and a low dose gentamicin)
“Ben went to sRepton”

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38
Q

Monomorphic VT usually due to…

A

MI

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39
Q

Polymorphic VT usually due to what…

A

Prolonged QT

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40
Q

What do you see on an ECG in VT?

A

Wide QRS, regular rhythm, no p wave, and more than 100 bpm. And for >120ms

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41
Q

When do you cardiovert a patient with VT?

A

If patient has adverse signs, like SBP < 90, chest pain, HF

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42
Q

If a patient with VT presents, and has no ‘adverse signs’, how do you manage?

A

Antiarrythmics. Amiodarone IV is good, lidocaine ok (not if left Vent impaired), never Verapamil. If this doesn’t work, then can cardiovert

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43
Q

More than how many PVCs in a row = vent tachycardia

A

3

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44
Q

First Invx for VT and VF

A

ECG

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45
Q

Management for Vfib

A

Defib, and then an implantable cardioverter defibrillator (ICD)

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46
Q

Main risk factor for TdeP

A

Prologued QT

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47
Q

If suspect HF, do what Invx?

A

BNP

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48
Q

If BNP is high in suspected HF patient, do what to further Invx?

A

Trans thoracic echo

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49
Q

Management of acute HF (clue = like pulmonary edema)

A

IV furosemide, O2, vasodilators (unless hypotension), CPAP. And continue regular chronic HF meds

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50
Q

First line Invx for chronic HF patient

A

BNP

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51
Q

First line treatment (regime) for Chronic HF with preserved ejection fraction

A

ACEI and Beta Blocker (can add aldosterone antag. If still symptomatic)

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52
Q

Good add on for HF patients (black patients)

A

Hydralazine and nitrates

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53
Q

If cannot have Beta blocker in HF therapy… what can be used as a substitute

A

Ivabradine

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54
Q

If a patient with HF has widened QRS on ECG… how do you treat

A

Needs cardiac desynchronisation

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55
Q

HF patients Vx schedule

A

Annual influenza and one off pneumococcal

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56
Q

If intolerant to ACEI for HF management, use what?

A

ARB

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57
Q

If ACEi BB spirino are given for HF, and symptoms persist. Do what?

A

Replace ACEI with ARNI

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58
Q

If ACEi BB spirino are given for HF, and symptoms persist, whilst heart rate above 75. Do what?

A

Add ivabradine

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59
Q

Best investigation for pulmonary edema to find cause?

A

ECG (maybe)

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60
Q

investigations for pulmonary edema

A

Chest x ray (recall signs), ECG, oxygen, ABGs, BNP

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61
Q

Management of acute pulmonary edema

A

Oxygen with venturi, diuretics, morphine, nitrates

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62
Q

Considered high blood pressure

A

140/90

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63
Q

How to confirm diagnosis of hypertension

A

24 hour blood pressure monitor.

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64
Q

Why do we need to do and ECG in hypertension patients

A

Check for left ventricular hypertrophy or IHD.

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65
Q

Why should a urinalysis be done in patients with hypertension

A

To check for hypertensive renal disease

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66
Q

Stage 1 hypertension is?

A

> = 135/85

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67
Q

When do you treat stage 1 hypertension?

A

Treat if less than 80, and if there is target organ damage, CVD, renal disease etc

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68
Q

Most effective lifestyle change to decrease hypertension risks

A

DASH diet

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69
Q

What is stage 2 hypertension

A

> = 150/95

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70
Q

Do we always treat stage 2 hypertension

A

Yes

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71
Q

If a patient aged <40 presents with hypertension, what should be done/considered

A

Consider 2° hypertension and thus refer to specialist

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72
Q

Patient less than 55. Best drug for hypertension

A

ACEi

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73
Q

Patient over 55, best drug for hypertension

A

CCB

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74
Q

Black patient with hypertension. Best treatment?

A

CCB

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75
Q

Patient with T2 DM history. Best treatment

A

ACEi

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76
Q

If patient cannot tolerate ACEi cough, give???

A

ARB

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77
Q

4 first line treatments for hypertension

A

ACEi, ARB, thiazide, CCB

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78
Q

If patient on CCB, ACEi, thiazide (step 3), and K+ is less than 4.5. Can add what?

A

Low dose spirinolactone

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79
Q

If patient on CCB, ACEi, thiazide (step 3), and K+ is more than 4.5. Can add what?

A

Alpha or beta blocker

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80
Q

Black patient on CCB for hypertension, and needs step up. Give what?

A

ARB!

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81
Q

First degree heart block treatment?

A

NO treatment needed

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82
Q

PR interval has to be >? Seconds (>? Small squares) in first degree heart block

A

> 0.2 Seconds (>5 Small squares)

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83
Q

Complete heart block is often due to what? (Related to MI)

A

RCA occlusion

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84
Q

Best invx to confirm heart blocks

A

ECG of course

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85
Q

Indications for pacemaker in heart block

A

Usually, 2°M II, and 3°. Or if symptoms severe (symptoms of respiratory acidosis )

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86
Q

WPW syndrome risk for what arrhythmia

A

VF

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87
Q

WPW is a type of ______ tachycardia

A

AV re-entrant tachycardia

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88
Q

3 findings of WPW on ECG

A

Short PR, delta wave, axis deviation (opposite to the pathway involved)

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89
Q

Definitive treatment for WPW

A

Radiofrequency ablation

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90
Q

Medical therapy for WPW? (First line). Then if you cannot use the first line?

A

That’s sooooo WPW. Sotalol (don’t use if Afib present).
Amiodarone and flecainude second line

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91
Q

More than __ ms (or __ small squares) is a long QT

A

440 ms or 10 small squares

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92
Q

Long QT can cause what arrhythmias

A

Torsades, VT or VF

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93
Q

Jervell Lange nielsen vs Romano ward

A

Jervell has deafness. Both are due to mutated potassium channels causing LONG QT

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94
Q

Investigation for long QT

A

ECG, echo, holster monitor, genetics test, electrolytes

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95
Q

Sotolol in prolonged QT?

A

No! Can prolongue it more

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96
Q

Management and treatment for prolonged QT

A

Avoid QT prolong drugs, avoid strenuous excserize; and ICD for high risk case

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97
Q

When do we give anticoagulant in AF. First line anticoagulant for AF? Why?

A

If CHADS VASc score says so. DOAC (apix, Dabi, edox, rivarox.) don’t need INR monitoring.

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98
Q

If patient has AF, and is stable. What meds should be given

A

Beta blocker or CCB (rate control) and a DOAC if CHAD VASc suggests to

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99
Q

When is cardioversion needed in AF

A

If patient is unstable

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100
Q

If the patient needs anticoagulant for AF, and has a valve disease. 1st line?

A

Warfarin

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101
Q

CHA2DS2 VASc stands for? Used for?

A

CHF, HTN, age > 75, diabetic, stroke history, vascular disease, age 65-74, Sex.
To assess need for anticoagulant I’m AF patients

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102
Q

CHADS VASc of 1 or more in man means?

A

Needs anticoagulant

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103
Q

CHADS VASc of 2 or more in woman means?

A

Anticoagulate

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104
Q

If patient has AF, and want to cardiovert. Started less than 48 hours ago. Do what?

A

Cardiovert .

Don’t worry about anticoagulating them first

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105
Q

If patient has AF, and want to cardiovert. Over 48 hours has elapsed. What options do we have to manage

A

Either anticoagulate patient for 4 weeks, then cardiovert. Or do transesophageal echo to check for thrombi in the atrial appendage

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106
Q

Paroxysmal AF definition

A

AF that terminates itself and lasts less than 7 days

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107
Q

Persistent AF, definition

A

Arrhythmia not self terminating and episodes last long than 7 days

108
Q

Permanent AF, definition

A

Continuous AF, that cannot be cardioverted. Accepted as the final rate

109
Q

Is the R-R interval regular in Afib or A flutter

A

A flutter

110
Q

A flutter patient who is stable. Management?

A

Beta blocker or CCB

111
Q

If want to ablate in A flutter, where to do this?

A

Tricuspid isthmus

112
Q

If want to ablate a patient with a fib, where to do this?

A

Confluence of the pulmonary veins

113
Q

Is a flutter more or less sensitive to cardioversion?

A

More, so can use lower energy levels

114
Q

Difference between Afib and SVT

A

SVT is regular and has p waves (may be hard to see though).

115
Q

Is supra ventricular tachycardia narrow or broad complex?

A

QRS is narrow

116
Q

SVT 1st line management?

A

Carotid sinus massage or valsalva

117
Q

Second line for SVT management. Tell me doses too

A

IV adenosine (6mg, then 12mg, then 18mg) (if the pervious didn’t work). if asthmatic, give verapamil instead

118
Q

If patient had SVT and is unstable. How do you manage

A

Cardiovert

119
Q

If you have a patient with SVT that is persistent to medical therapy. How do you manage?

A

cardioversion

120
Q

How to prevent episodes of SVT

A

Beta blocker

121
Q

Initial invx important for myocarditis suspicion

A

ECG (new ST and T wave changes), venupuncture for MB, troponin, BNP (all elevated), MRI is good!

122
Q

Gold standard for Dx of myocarditis

A

Endomyocardial biopsy. MRI not bad either

123
Q

Kaussmal sign is more seen in restrictive pericarditis or tamponade

A

Restrictive pericarditis

124
Q

Pulses paradoxus is more seen in restrict pericarditis or tamponade

A

Tamponade (but technically both)

125
Q

ECG changes for pericarditis

A

Saddle shaped ST elevation, in all leads. PR depression (sensitive)

126
Q

All patients with suspected acute pericarditis, should have what invx done? (Aside from ECG)

A

Echocardiogram

127
Q

First line and second line for pericarditis

A

NSAIDs and Colchicine

128
Q

When should a pericarditis patient be hospitalised

A

Fever > 38°C
• Subacute onset
• Anticoagulated
• Immunocompromised
• Hypotension
• Jugular venous
distension
• Large effusion

(many signs of tamponade)

129
Q

Mild mitral stenosis management

A

Diuretics

130
Q

Moderate to severe mitral stenosis management

A

Valuable repair/ or valvotomy

131
Q

To diagnose most/all valvulopathies, which invx should be done

A

Echo

132
Q

Management of mitral valve prolapse

A

Antiplatlet therapy (aspirin) and mitral valve repair

133
Q

Most common valve disease

A

AS (second is MR)

134
Q

Potential ECG and X-ray findings in MR patients

A

Broad P wave (due to atrial enlargement). And cardiomegaly

135
Q

Acute mitral regurgitation, management

A

Nitrates (increase forward flow), diuretics (decrease overload), inotropes, aortic balloon pump. Heart failure meds if the patient is in heart failure

136
Q

Is repair or replacement better for MR

A

Repair

137
Q

Aortic stenosis, asymptomatic patient. Valve pressure gradient <40. Mx?

A

Observe

138
Q

Aortic stenosis, asymptomatic patient. Sign a of systolic dysfunction and Valve pressure gradient >40. Mx?

A

Consider Sx

139
Q

Aortic stenosis, symptomatic patient. Mx?

A

Sx

140
Q

What disease commonly coexists with AS? And thus prior to surgery, what can be done

A

CVD! So do an angiogram before Sx. Can combine surgeries

141
Q

Best Sx for AS?

A

TAVI. Recall who gets metallic vs porcelain?

142
Q

When do balloon valvuloplasty for AS?

A

If severe and cannot do replacement

143
Q

Acute aortic valve regurgitation Mx

A

Emergency! Need to replace valve, but give inotropes and vasodilators first though

144
Q

Chronic/asymptomatic AR Mx

A

Vasodilation (reduce the regurgitate)

145
Q

Is WPW associated with HCM?

A

Yes!

146
Q

What can be seen on the echo of a HCM patient? And an ECG?

A

MR, systolic anterior motion (SAM) of the anterior mitral valve, asymmetrical septal hypertrophy. Mega sokolovs seen on ecg

147
Q

Why avoid nitrate, ACEI and inotropes on HCM?

A

All decrease preload and thus LVEDV (increases outflow obs)

148
Q

How do you treat dilated cardiomyopathy?

A

Treat like HF (ACEI, beta blocker, diuretic

149
Q

Important invx in shock patients

A

ABG (get lactate), BP monitoring, glucose,

150
Q

Management of septic patient OU CALF

A

Oxygen admin (keep above 94), Cultures taken, Abx broach spec, Fluid resus (bonus 500ml crystalloid over less than 15 mins), Lactate measurements, Urine output hourly

151
Q

Anaphylaxis management

A

Adrenaline (IM in thigh)

152
Q

How many cm greater than normal aorta diameter is considered aneurysmal ?

A

3cm or more

153
Q

Main risk factors for AAA

A

Smoking, HTN, atherosclerosis (not DM)

154
Q

First line invx for AAA

A

US

155
Q

Best invx for AAA

A

CT angio

156
Q

How to manage a stable patient with AAA

A

CTA to assess suitability for endovascular repair.

157
Q

How to manage an unstable AAA case?

A

Straight to theatre (Dx is clinical)

158
Q

Suspected Tamponade. 2 Invx to do?

A

ECG and echo

159
Q

A management of tamponade

A

Pericardiocentesis

160
Q

Murmur for ASD

A

Ejection systolic murmur, and fixed split S2. Smaller ones are louder

161
Q

Small ASD (pulm BF : systemic BF <1.5) Mx

A

No Tx needed

162
Q

Large ASD (pulm BF : systemic BF >1.5) or rt atria enlarged Mx

A

Corrective closure

163
Q

Murmur for VSD

A

Pansystolic murmur (louder=smaller)

164
Q

Main consequence of large VSDs

A

Heart failure in months

165
Q

Small asymptomatic VSD management

A

Close spontaneously usually… so monitor only

166
Q

Treatment or larger VSDs/symptomatic VSDs

A

Surgical correction, and HF meds

167
Q

S3 on <30 yo. Are you alarmed?

A

Not really, this is a normal finding here

168
Q

Mild pulmonary stenosis treatment?

A

Follow up only

169
Q

1st line treatment for moderate to severe pulmonary stenosis

A

Balloon valvuloplasty

170
Q

Pulmonary stenosis patient who is cyanotic. What Medical management should he get?

A

Oxygen and PGE1. Even before diagnosing cause

171
Q

If percutaneous balloon pulmonary valvuloplasty doesn’t work for patients with pulmonary stenosis… what can we do next

A

Surgical valvotomy

172
Q

When do we do surgical repair for AR

A

If symptomatic or with LVEF of <50%

173
Q

How can we medically delay surgery for AR patients

A

Vasodilator therapy

174
Q

Signs of PDA

A

Parasternal systolic murmur becoming a continuous machine like murmur supraclavicularly.
Subclavicular thrill and collapsible pulse

175
Q

Therapy to close a PDA

A

Indomethacin

176
Q

When do you give PGE1 in PDA

A

If you want to keep the PDA open (maintain shunt)

177
Q

Invx of choice for coarcted aorta

A

Echo to see the coarction. But best to do blood pressure measurements and radio femoral delay

178
Q

A radio femoral delay of what or more, is concerning?

A

20mmHg

179
Q

Transposition of the great vessels main risk factor

A

Maternal diabetes

180
Q

Management of ToGVs?

A

PGE to keep PDA, then Sx

181
Q

Tetralogy of fallout invx

A

Chest X-ray (boot), ecg (RV hypertrophy), echo

182
Q

Medication to relieve cyanotic episodes in tet of fallot

A

Beta blocker

183
Q

Examination sign for PAD

A

Absent dorsalis pedis and posterior tibial.

184
Q

ABPI less than X, indicates PAD

A

1

185
Q

ABPI < 0.5…. What does this mean?

A

Severe PAD, and needs urgent attention

186
Q

Best invx for PAD

A

Doppler US

187
Q

Edema, brown Pigmentation, eczema. These are all features of what kind of ulcer

A

Venous ulcer

188
Q

Painful ulcers, with cold feet, no palpable pulses, low ankle brachial pulse index. These are features of ulcer

A

Arterial ulcer

189
Q

Callous formation, ulcers on the plantar surface of the metatarsal head. Loss of sensation. These are features of what

A

Neuropathic ulcer ulcer

190
Q

An ulcer above the ankle near the medial malleolus is most likely seen in which ulcer

A

Venous ulcer

191
Q

Painful ulcers in the toes and the hill I’ll most likely scene in which ulcer

A

Arterial ulcer

192
Q

Deep venous insufficiency is related to what other pathology

A

DVT

193
Q

Superficial venous insufficiency is associated with which pathology

A

Varicose vein

194
Q

What can be seen on ultrasound Dr , for venous leg ulcers

A

Reflux of blood

195
Q

Management for venous leg ulcer

A

Four layer compression banding

196
Q

Main management for neuropathic ulcers

A

Cushion shoes to reduce also formation

197
Q

Two main causes of gangrene (two types of gangrene)

A

Infectious gangrene and ischaemic angry

198
Q

What to tell you if the gangrene is ischaemic rather than infectious

A

A low ankle brachial pulse index

199
Q

If a patient has gangrene and a low-grade fever and chills, is this likely ischaemic or infectious gangrene

A

Infectious

200
Q

How to manage infectious gangrene

A

Aggressive surgical debridement and IV antibiotics

201
Q

How to manage ischaemic gangrene

A

Revascularisation and treat the underlying disease

202
Q

Diagnosed DVT, first line treatment

A

DOAC (apix or ribarox)

203
Q

DVT suspected? Treatment?

A

DOAC! (Used to be heparin)

204
Q

DVT patient, and cannot treat with DOAC

A

LMWH, followed by Dabigatran or Warfarin

205
Q

Patient had anti phospholipid syndrome… and has DVT. How to Tx?

A

LMWH then warfarin

206
Q

Anticoagulant for how long in unprovoked DVT?

A

6 months

207
Q

Anticoagulant for how long in provoked DVT?

A

3 months

208
Q

Which scores -2 on wells score?

A

Alternative diagnosis is more likely than DVT

209
Q

Name as many scores on Wells

A
210
Q

Wells of X or more, suggest DVT likely

A

2 or more

211
Q

If Wells score of two points or more, next step management

A

Do proximal leg ultrasound within four hours. If cannot be done do d-dimer plus anticoagulation plus ultrasound within 24 hours

212
Q

If a patient with a Wales score of two or more, has a negative proximal leg ultrasound, what investigation should be done next

A

Demon

213
Q

If a patient has a wells score of one or less (for DVT ). Next step in management for patient

A

Do a D dimer within four hours

214
Q

If a patient had a wells score of one or less and DD dimer came back positive, what should be done next

A

Proximal leg ultrasound

215
Q

If patient had a Wells score of two or more, had a negative proximal leg ultrasound, but a positive D dimer. What should be done in this patient

A

Stop anticoagulation and repeat ultrasound in one week

216
Q

An ankle brachial pulse index of 0.6-0.9 coincides with what symptom

A

Intermittent claudication

217
Q

An ankle brachial pulse index of 0.3-0.6 coincides with what symptom

A

Pain at rest

218
Q

If a patient presents with signs of acute limb ischaemia what investigation should be performed, and what should be calculated

A

Doppler ultrasound, and ankle brachial pulse index

219
Q

Patient presents with acute limb ischemia. They have history of widespread vascular disease, and a history of claudication that has now suddenly deteriorated. Is it likely thrombus origin for embolus origin

A

Thrombus origin

220
Q

Patient presents with acute limb ischemia. They have no history of claudication, no history of peripheral vascular disease but a recent atrial fibrillation. Is this likely thrombus origin or embolus origin

A

Embolus origin

221
Q

Initial management for acute limb ischaemia

A

ABC, IV opioids, IV unfractioned heparin (chubby guy was right)

222
Q

Some definitive management for acute limb ischaemia

A

Thrombolysis, embolectomy, angioplasty, bypass surgery, amputation if irreversible

223
Q

First line investigation for chronic limb ischemia

A

Ultrasound with the Doppler

224
Q

Aside from ultrasound, which investigation must be done prior to treatment for chronic limb ischaemia

A

Magnetic resonance angiography

225
Q

What antiplatelet therapy can be used for chronic limb ischaemia

A

Aspirin or clopidogrel

226
Q

In aortic dissection what does anterior versus back pain signify

A

Backpain signifies descending aorta dissection, anterior chest pain signifies ascending aorta dissection

227
Q

Diagnosis of an aortic dissection is made by what (if patient is stable)

A

CTA

228
Q

Definitive treatment for coarctation of the aorta

A

Angioplasty or surgical resection

229
Q

If an aortic dissection patient is unstable, how do you investigate them

A

Trans-oesophageal echo, cannot do CT Angio in unstable patience

230
Q

Investigation of choice for varicose veins

A

Ultrasound with Doppler, Can see venous reflux

231
Q

Majority of patients do not require surgery for varicose veins. Name some conservative treatments

A

Leg elevation, weight loss, exercise, compression stockings

232
Q

Name five reasons for referral to secondary care in varicose vein patients

A

Significant pain or swelling, previous bleeding, skin changes, thrombophlebitis, healed or active ulcer

233
Q

Name three invasive treatments for varicose veins

A

Foam sclerotherapy, location or stripping surgery, and a thermal ablation using laser

234
Q

NSAIDs for myocarditis?

A

NO, CI

235
Q

Ischemic gangrene Mx if not too bad

A

Heparin

236
Q

Ischemic gangrene with threatened non viability

A

Revasc

237
Q

DVT stuff. What is the timeframe for doing dopplers and d dimers

A
238
Q

stable patient with aortic dissec… invx?

A

CTA

239
Q

unstable patient with aortic dissec… invx?

A

TOE

240
Q

A flutter (how to tell?)

A

regular RR!! Can be hard to tell from afib and heart block

241
Q

Troponin time frame

A

Rises in 2-4 hours. Falls after weeks

242
Q

CK-mB time frame in MI

A

Rises in 4-6 hours. Falls after 48 hours

243
Q

Mx for shockable cardiac arrest

A

shock, 2 mins CPR…. repeat. Do epinephrine after 3 shock

244
Q

Mx for non-shockable cardiac arrest

A

adrenaline, 2 mins CPR…. repeat

245
Q

HF patient. On ACEi, BB, Aldo antag. HR below 75… give what?

A

ARNI

246
Q

HF patient. On ACEi, BB, Aldo antag. HR above 75… give what?

A

Ivabradine

247
Q

HF patient. On ACEi, BB, Aldo antag. Black patient… give what?

A

hydralazine and nitrate

248
Q

At what EF, does HF pharmacy start

A

around <40

249
Q

When to focus on rate control only in AF?

A

Chronic/permanent A, patient stable

250
Q

First onset stable AF, how to Tx?

A

Rhythm control = flecainide 1st (amiodarone 2nd)

251
Q

Best invx for takutsobu

A

ventriculography

252
Q

ABPI calc

A

ankle/brachial SBP

253
Q

How long is the ischemic clock in acute limb ischemia?

A

6 hr

254
Q

Difference between acute limb ischemia in femoral, iliac, aortoiliac

A
255
Q

Afib vs 3rd degree AV block

A

p wave in 3rd degree. tachycardia in afib

256
Q

myocarditis Mx

A

rest and monitor

257
Q

HF with <35% EF… do what?

A

do angiogram to see if ischemic CM or not

258
Q

NSAIDS or CCB in HF?

A

NO

259
Q

When to thrombolyse patient with PE

A

if patient has low BP

260
Q

severe AS in older patient… best Tx

A

TAVI

261
Q

if patient with NSTEMI has HF, or low BP, or VT, or ongoing angina….. sign to do what?

A

angiogram and PCI to be done sooner! (all our GRACE)

262
Q

if NSTEMI patient has good EF/heart function… what to do

A

conservative (tiggy and fonda)

263
Q

when to do medical cardioversion in AF

A

in first 48 hours!!!

264
Q

Weird ECG is likely what??

A

3rd degree

265
Q

if do echo on patient with pericarditis… see fluid… what to do?

A

measure fluid then drain if large or tamponade

Finals (11 decks)

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