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MSRA LS > CARDIO > Flashcards

CARDIO Flashcards

1
Q

On examination, he has a collapsing pulse and a laterally shifted apex beat. You also notice his head bobs in time with his pulse.

What would you expect to hear on auscultation of the precordium?

A

Aortic regurgitation typically causes an early diastolic murmur

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2
Q

murmur mitral regurgitation.

A

pansystolic murmur

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3
Q

patent ductus arteriosus murmur

A

continuous ‘machinery’ murmur

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4
Q

mitral stenosis murmur

A

late diastolic murmur

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5
Q

the vast majority of cases of bacterial endocarditis are caused by

A

gram positive cocci.

Common causes:
Streptococcus viridans
Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)
Staphylococcus epidermidis (in prosthetic valves)

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6
Q

Pulmonary embolism ecg changes

A

SI QIII TIII (deep S wave in lead I, Q wave in III, inverted T wave in III).

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7
Q

A 71-year-old woman presents to the emergency department as her smartwatch ECG recorder has indicated that she has had atrial fibrillation for the last three days. She has become slightly short of breath on exertion in the previous 24 hours. On assessment, her heart rate is irregular, with a heart rate of 98 bpm. Her blood pressure is maintained at 130/72 mmHg. She is not known to have atrial fibrillation and only takes amlodipine for grade I hypertension.

What is the most appropriate treatment approach?

A

Discharge on bisoprolol and apixaban and arrange cardioversion in four weeks

Acute onset of atrial fibrillation: if ≥ 48 hours - rate control initially, then if considered for long‑term rhythm control, delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks

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8
Q

ecg changes in II, III, aVF

A

inferior, right coronary

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9
Q

ecg changes in V1-V4

A

anteroseptal, Left anterior descending

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10
Q

first line in treatment of venous thromboembolism (VTE) in pregnancy

A

low molecular weight heparin (LMWH)

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11
Q

NSTEMI (managed conservatively) antiplatelet choice?
high bleeding risk vs no high bleeding risk

A

aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

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12
Q

indapamide - class of drug?

A

thiazide like

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13
Q

first-line anti-anginal for stable angina in a patient with known heart failure, if there are no contraindications

A

Bisoprolol

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14
Q

Wolff-Parkinson White management?

A

definitive treatment: radiofrequency ablation of the accessory pathway

medical therapy: sotalol (should be avoided if there is coexistent atrial fibrillation)
amiodarone, flecainide

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15
Q

Acute pericarditis on ECG

A

widespread ST elevation but the most diagnostic feature of the ECG is the PR depression - this is very specific for pericarditis and makes the diagnosis clear.

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16
Q

SVT - present as a younger person with palpitations

tx?

A

Acute management
1. vagal manoeuvres:
Valsalva manoeuvre: e.g. trying to blow into an empty plastic syringe
carotid sinus massage

  1. intravenous adenosine
    rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
    contraindicated in asthmatics - verapamil is a preferable option
  2. electrical cardioversion

Prevention of episodes
beta-blockers
radio-frequency ablation

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17
Q

If angina is not controlled with a beta-blocker.. what next to add?
also if they are on montherapy but cant tolerate the add on what med to add?

A

a longer-acting dihydropyridine calcium channel blocker- amlodipine, nifedipine

if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker then consider one of the following drugs:
a long-acting nitrate
ivabradine
nicorandil
ranolazine

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18
Q

Bendroflumethiazide causes what electrolite imbalance?

A

hyponatraemia and hypokalaemia

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19
Q

Atrial fibrillation management prior and post 48 hours?

A

If the atrial fibrillation (AF) is definitely of less than 48 hours onset patients should be heparinised. Patients who have risk factors for ischaemic stroke should be put on lifelong oral anticoagulation.
Otherwise, patients may be cardioverted using either:
electrical - ‘DC cardioversion’
pharmacology - amiodarone if structural heart disease, flecainide or amiodarone in those without structural heart disease

more than 48 hours then anticoagulation should be given for at least 3 weeks prior to cardioversion.

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20
Q

A 24-year-old attends her routine medical examination prior to starting her job as a professional footballer. She is fit and well with no significant family history.

On examination, her chest is clear and she has normal heart sounds. Her pulse is 62 beats per minute. Her ECG shows sinus rhythm with a prolonged PR interval of 215ms.

How should her ECG findings be managed?

A

First-degree heart block is a normal variant in an athlete. It does not require intervention

She has a prolonged PR interval; the normal range is 120-200 ms. A PR interval > 200ms (five small squares) is first-degree heart block.

21
Q

Chronic heart failure: drug management

A

first-line treatment for all patients is both an ACE-inhibitor and a beta-blocker

Second-line treatment is an aldosterone antagonist : spironolactone and eplerenone

third-line treatment should be initiated by a specialist. Options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy

22
Q

vaccine for CHF?

A

offer annual influenza vaccine

offer one-off pneumococcal vaccine:
adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years

23
Q

knoen to have lon qt
presenting now- look at ecg
treatment?

A

iv mag sulphate

broad complex tachycardia at approximately 200 beats per minute. It is characteristic of ventricular tachycardia. At the beginning and end of the ECG trace, the amplitudes of the QRS complexes differ and are characterised as being polymorphic. This pattern is known as Torsades de Pointes (TdP).

24
Q

adverse effects of Nicorandil?

A

anal ulcers, headache, flushing

Nicorandil is a vasodilatory drug used to treat angina.

25
Q

Which scores measures the risk of stroke in someone with atrial fibrillation?

A

The CHA2DS2-VASc score is used to determine the need to anticoagulate a patient who has atrial fibrillation.

26
Q

management for symptomatic bradycardia if atropine fails?

A

external pacing

27
Q

Warfarin management for increased INR?
Major bleeding

INR>8.0 and minor bleeding

INR >8.0 and no bleeding

INR 5 to 8 and minor bleeding

INR 5 to 8 no bleeding

A

Major bleeding intacranial hemorrhage :
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

INR > 8.0 and Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

INR > 8.0 and No bleeding
Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

INR 5.0-8.0 and Minor bleeding
Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

INR 5.0-8.0 and No bleeding
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

28
Q

35-year-old male presents his general practice with pain in his foot and lower limb which is worse at night. He describes that the pain improves when he hangs his leg over the edge of the bed. On further questioning, he also notes that he has been getting ‘pins and needles’ in his fingers and they feel very cold. He has no past medical history but smokes 25 cigarettes per day.

diagnosis?

A

Young male smoker with symptoms similar to limb ischaemia - think Buerger’s disease aka thromboangiitis obliterans

29
Q

primary hyperaldosteronism key features?

A

hypokalemia, htn

30
Q

falsely low BNP result?

A

Being on ramipril for his blood pressure

31
Q

percutaneous coronary intervention for an ST-elevation myocardial infarction.
After 12 hours he becomes pale, clammy, and bradycardic. The ECG shows complete disassociation between the atria and ventricles.

What coronary artery is most likely to have been affected?

A

RCA- complete heart block

32
Q

scoring Acute pancreatitis

A

ranson criteria

33
Q

Used to help assess the whether induction of labour will be required

A

bishop

34
Q

assessment of suspected obstructive sleep apnoea

A

epsworth

35
Q

Measure of disease activity in rheumatoid arthritis

A

DAS28

36
Q

stoke medication?

A

Aspirin 300 mg daily for 2 weeks should be given immediately after an ischaemic stroke is confirmed by brain imaging.

clopidogrel 75 mg daily should be given long-term

37
Q
A

chronic hypoxaemia- persistent low between pa02 7.3 or 7.3 to 8 secondary to polycythemia

38
Q

child, runny nose last week, now coughing fits, occasional strange sounds when gasping for breath between coughs?

A
39
Q

severe haemoptysis and nosebleeds, found to have renal failure? what could be causing this?

A

Granulomatosis with polyangiitis (GPA

40
Q

aortic aneurysm - what size to inform DVLA?

A

larger then 6cm needs to be informed
6.5 cant drive

41
Q

explain presentation of TOF?

A

most common cyanotic heart condition
large VSD, overriding aorta. blood shunted from RV to LV due to RV obstruction. cyanosed blood pumped.

squatting reduces obstruction and reducing the shunt r to l

42
Q

turners syndrome- cold feet and caludication?

whats the issue?

A

coarctation of the aorta- narrowing so difficult to supply to the extremities

43
Q

contraindication for ECG stress test

A

unstable angina, electrolyte inbalance, recent MI within last 2-7 days, AS, HF secondary and pulmonary oedema

44
Q

digoxin ecg?

A

can be 1st degree heart blck, ST depression, Twave inversion

45
Q

aortic dissection, imaing?

A

transthoracic echocardiograpthy

46
Q

sick sinus syndrome?

A

sinus brady, postual drop on standing and lying BP

47
Q

ventiruclar fib description

A

irregular rhythm, unidentifiable QRS complexes or p waves

48
Q

polymorphic ventricular tachycardia description?

A

normal QT, AV dissociation , broad qrs

49
Q

reason for pacemaker

A

bradycardia

MSRA LS (22 decks)

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