Cardio

Question 1

26 y/o

pc: 48 hr hx intermittent sharp central chest pain

worse on exertion, and on lying supine

ECG: widespread ST elevation

indicative of:

Answer 1

pericarditis

- often relieved by sitting forwards

Question 2

important sign on auscultation of a patient with pericarditis:

Answer 2

pericardial rub

Question 3

immediate management of thoracic aortic dissection:

Answer 3

• IV labetalol (BP reduction)
• IV morphine (sympathetic tone reduction)

definitive management
- EVAR

Question 4

what is anti-phospholipid syndrome?

Answer 4

• antiphospholipid antibodies
• blood more prone to clotting
• thrombosis!

Question 5

this is a type of non-bacterial endocarditis where there are growths on the valves of the heart:

Answer 5

Libmann-Sacks endocarditis

- mitral valve commonly associated

Question 6

what is Tietze syndrome?

Answer 6

rare inflammatory disorder

characterised by chest pain

and swelling of cartilage of one or more upper ribs.

Question 7

in a patient with tachycardia without any adverse features i.e. uncompromised, what is the first line treatment:

Answer 7

amiodarone 300mg loading dose IV

then infusion 900mg over 24 hrs.

Question 8

slurred upstroke to QRS complex known as

Answer 8

delta wave

reflects ventricular pre-excitation

Question 9

ECG of what condition would most likely show

• RBBB
• tall, broad P waves

Answer 9

tall, broad P waves –> atrial enlargement

Ebstein’s anomaly
- young adults with fatigue, palpitations, cyanosis and breathlessness on exertion

Question 10

this condition typically presents in young patients with episodes of syncope and palpitations :

ECG –> delta waves

Answer 10

wolf-parkinson white syndrome

re-entry circuit –> tachyarrhythmias

Question 11

left ventricular dilatation often results in what:

Answer 11

mitral regurgitation

Question 12

what murmur does mitral regurgitation produce:

Answer 12

pan-systolic

best heard over apex, radiating to axilla

Question 13

causes of mitral regurgitation:

notes

Answer 13

IF CREEP

I - infective endocarditis
F - functional (left ventricular dilation)

C - cardiomyopathy/congenital
R - rheumatic fever / ruptured chordae tendinae
E - elderly calcification
E - ehlers danlos syndrome
P - papillary muscle dysfunction / rupture

Question 14

causes of aortic regurgitation:

notes

Answer 14

IM DR CRASH

I	Infective endocarditis
M	Marfan syndrome
D	Dissection (aortic)
R	Rheumatic fever
C	Congenital
R	Rheumatoid arthritis
A	Ankylosing spondylitis
S	Systemic lupus erythematosus (SLE)
H	Hypertension

Question 15

visible capillary pulsations on nail bed is known as

Answer 15

Quincke’s sign

Question 16

58 y/o

pc: malaise, fever, night sweats, exertional dysponea
oe: splinter haemorrhages + quinckes sign

indicative of:

Answer 16

aortic regurgitation secondary to infective endocarditis

Question 17

what type of murmur is heard in aortic regurgitation:

Answer 17

early diastolic murmur

accentuated by patient sitting forward

Question 18

pericarditis treatment

Answer 18

analgesia NSAIDs (ibuprofen)

for 1-2 weeks until pain resolves

Question 19

example of a drug used for anti-coagulation in acute coronary syndrome without ST segment elevation

Answer 19

fondaparinux

- factor Xa inhibitor

Question 20

which sign would be consistent with pulmonary oedema?

Answer 20

perihilar shadowing

‘bat wing’ distribution

suggestive of alveolar oedema

Question 21

describe mobitz type 1 heart block

Answer 21

progressive lengthening of the PR interval over several complexes

Question 22

ECG shows dissociated P waves and QRS complexes indicative of:

Answer 22

third degree heart block

Question 23

collapsing pulse and early diastolic murmur is suggestive of:

Answer 23

aortic regurgitation

Question 24

in a patient under 70, aortic stenosis most commonly caused by:

Answer 24

bicuspid valve

Question 25

the following triad is indicative of what:

• hypotension
• tachycardia
• muffled heart sounds

Answer 25

becks triad

indicates pericardial effusion

Question 26

which artery supplies the left atrium?

Answer 26

circumflex artery

Question 27

give an example of a drug shown to reduce mortality in severe heart failure:

Answer 27

spironolactone

Question 28

patient presents with AF, 48hrs.

haemodynamically stable.

most appropriate management:

Answer 28

investigate for reversible causes of AF
- hyperthyroidism and alcohol

bloods

cxr

if no reversible causes found

• medical cardioversion!
• —-> IV FLECANIDE

Question 29

ECG changes in hyperkalaemia:

Answer 29

• peaked T waves
• widening of QRS complex
• decreased amplitude of P wave

Question 30

Retinal haemorrhages with pale centres are known as :

Answer 30

Roth spots

- seen in infective endocarditis

Question 31

high pitched diastolic decrescendo murmur, accentuated on inspiration.

moderate peripheral oedema

cxr normal

indicative of:

Answer 31

pulmonary regurgitation

pulmonary hypertension
- SOB, weakness, oedema –> may lead to right heart failure

Question 32

management of pulmonary hypertension

Answer 32

diuretics

oxygen therapy

bosentan
- endothelin receptor antagonist

Question 33

endothelin is an example of a

Answer 33

vasoconstrictor

Question 34

pericarditis with fever and pleuropericardial chest pain several weeks following MI is known as :

Answer 34

Dressler syndrome

- autoimmune

Question 35

murmur:

pmh rheumatic fever, loud first heart sound and rumbling mid-diastolic murmur

Answer 35

mitral stenosis

Question 36

first heart sounds occurs due to :

Answer 36

• closure of the AV valves
• as ventricles contract
• coincides with QRS complex

Question 37

which valve is auscultated at the left sternal border in the fourth intercostal space:

Answer 37

tricuspid

Question 38

which valve is best heard over left sternal border at second intercostal space:

Answer 38

pulmonary

Question 39

what is kartagener’s syndrome:

Answer 39

congenital syndrome of ciliary dysfunction

cilia do not beat properly

Question 40

what is the correct statin dose for secondary prevention in patients with previous MI:

Answer 40

Atorvastatin 80mg OD

Question 41

which layer of the pericardium adheres to the heart muscle

Answer 41

visceral layer

known as epicardium

Question 42

patient with hypertrophic cardiomyopathy will have what type of murmur:

Answer 42

ejection systolic

DECREASED BY SQUATTING
- increases afterload and preload making murmurs louder

Question 43

large amount of fluid in the pericardial sac is known as :

Answer 43

cardiac tamponade

immediate management
- prepare for pericardiocentesis

Question 44

normal cardiac axis is from:

Answer 44

-30 to 90 degrees

Question 45

25 y/o

pc: headache, dizziness and claudication
oe: hypertension in upper limbs, hypotension in lower

characteristic of:

Answer 45

aortic coarctation

• notching of inferior margins of ribs

Question 46

atrial flutter is what type of tachycardia:

Answer 46

supraventricular

• narrow complex
• sawtooth appearance

Question 47

this leads to an elevated JVP with large V waves + pan-systolic murmur at left sternal edge

Answer 47

tricuspid regurgitation

• pulsatile hepatomegaly
• left parasternal heave

Question 48

marfans syndrome associated with what cardiac abnormality:

Answer 48

aortic root dilatation

Question 49

Tricuspid regurgitation presents with:

Answer 49

loud pansystolic murmur