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past questions > cardio > Flashcards

cardio Flashcards

1
Q

treatment for acute MI?

A

MONA: morphine, O2 (if sats are <94%), nitrates, aspirin

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2
Q

pharmacology of spironolactone?

A

inhibition of aldosterone receptor at K+/Na+ channel in the distal tubules

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3
Q

list some risk factors for hypertension

A

High caffeine consumption, Sedentary lifestyle, Smoking, Type A personality, alcohol, family history, increasing age

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4
Q

presentations of mitral regurgitation?

A

SOB, fatigue, pan-systolic high-pitched “whistling” murmur at apex, may radiate to left axilla

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5
Q

presentations of aortic stenosis?

A

syncope, angina, ejection systolic murmur

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6
Q

presentations of aortic regurgitation?

A

syncope, angina, early diastolic / austin flint murmur

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7
Q

presentations of mitral stenosis?

A

SOB, fatigue, low pitched, “rumbling” mid-diastolic murmur

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8
Q

MI ECG changes?

A

ST elevation, T wave inversion, abnormal Q wave

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9
Q

what underlying heart condition can predispose you to strokes?

A

atrial fibrillation

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10
Q

what framework determines heart attack risk in those with hypertension?

A

QRISK2 score

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11
Q

describe the correct order for the electrical conduction of the heart?

A

SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles

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12
Q

explain the pathophysiology of aortic stenosis

A

coarctation (narrowing) of the aortic valve typically either due to calcification or bicuspid valve

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13
Q

XR for mitral stenosis?

A

enlarged left and right atriums

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14
Q

List some clinical signs you might find on examination or on a chest X-ray in heart failure

A

ABCDE:
- Alveolar oedema
- kerley B lines
- Cardiomegaly
- Dilation of the upper lobe vessels
- pleural Effusion

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15
Q

What marker might you find in blood that could be indicative of heart failure?

A

BNP

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16
Q

List 3 investigations that you would want to do for initial investigations of infective endocarditis

A

blood cultures, echocardiogram, ECG, FBC (anaemia), urinalysis

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17
Q

Define atherosclerosis

A

build up of lipids, macrophages and smooth muscle cells in the intima of arteries

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18
Q

Other than chest pain, name 4 other symptoms or signs you may find on the history or examination in a STEMI

A

sweating, hypotension, N/V, dizziness, SOB, anxiety, palpitations, pallor

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19
Q

Name the 4 cardiac defects involved in Tetralogy of Fallot.

A

ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta

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20
Q

what does 1st degree HB show?

A

prolonged PR interval

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21
Q

what does 2nd degree type I (Mobitz I or Wenckebach) show?

A

progressive prolongation of the PR interval followed by a dropped QRS complex

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22
Q

what does 2nd degree type II (Mobitz II) show?

A

intermittent non-conducted P waves without progressive PR prolongation

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23
Q

what does 3rd degree HB show?

A

absence of AV conduction; no association between P waves and QRS complexes

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24
Q

define thrombosis

A

formation of a blood clot inside a blood vessel which obstructs flow

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25
Q

define embolism

A

blocked vessel caused by a foreign body e.g. blood clot or air bubble

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26
Q

define infarction

A

death of cells due to a reduced or absent blood supply

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27
Q

define ischaemia

A

restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell function

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28
Q

give 4 functions of the RAAS system

A
  • increased sympathetic activity and arteriolar vasoconstriction therefore increases HR/BP
  • increased tubular reabsorption of Na and Cl and K+ excretion
  • increased aldosterone secretion resulting in Na reabsorption in DCT
  • ADH secretion leading to H2O reabsorption
  • overall: salt and water retention and an increase in BP
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29
Q

what is the difference between essential and secondary hypertension?

A

Essential hypertension occurs independent of any identifiable cause, secondary hypertension occurs as a result of an identifiable cause

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30
Q

state 4 causes of secondary hypertension

A

renal artery stenosis, chronic renal disease, primary hyperaldosteronism, stress

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31
Q

which part of the heart is likely to be affected if there is ST elevation in leads V3 and V4?

A

anterior

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32
Q

abnormalities in leads II, III, and aVF - Which coronary artery is most likely to be implicated?

A

right coronary

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33
Q

what is the treatment given post MI?

A

ACEi, dual antiplatelet therapy e.g. clopidogrel and aspirin/BBlocker, statin

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34
Q

what is given as acute management for supraventricular tachycardia?

A

valsalvar manoeuvre - nose and mouth is held during forceful expiration to stimulate the vagus nerve to return the heart into sinus rhythm

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35
Q

Which tool assesses starting anticoagulation in patients with stroke risk due to atrial fibrillation?

A

CHA2DS2-VASc

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36
Q

first line test for heart failure?

A

BNP

37
Q

What is the most appropriate diagnostic investigation for aortic stenosis?

A

echocardiogram

38
Q

define unstable angina

A

incomplete coronary artery occlusion usually by a thrombus, e.g. atherosclerotic plaque has ruptured which causes a clot to form and occlude the artery.

39
Q

4 signs if infective endocarditis?

A

janeway lesions, roth spots, splinter haemorrhages, osler nodes

40
Q

define cardiac tamponade

A

Accumulation of a large amount of fluid in the pericardial cavity that compresses the heart and reduces cardiac function

41
Q

would you see ascites in left sided heart failure?

A

no

42
Q

Which ECG abnormality is most associated with Wolff-parkinson-white syndrome?

A

delta wave

43
Q

what is the ductus arteriosus?

A

a vessel that connects the pulmonary arteries to the aorta in the fetus allowing oxygenated maternal blood to bypass the lungs

44
Q

state some signs of Dressler’s syndrome

A
  • central chest pain worse on breathing in or lying flat, relieved by leaning forward
  • fever
  • friction rub heard on auscultation
45
Q

what is Dressler’s syndrome

A
  • also known as postmyocardial infarction syndrome
  • a form of secondary pericarditis with or without pericardial effusion that occurs as a result of injury to the heart or pericardium.
46
Q

where do roth spots typically occur?

A

eye

47
Q

state some signs of right sided HF

A

raised JVP, pitting oedema, ascites

48
Q

first line investigation for stable angina?

A

CT coronary angiography

49
Q

what is treatment for stable angina?

A
  • GTN spray for acute attacks
  • beta blocker e.g. bisoprolol OR cardioselective CCB e.g. verapamil for long term prevention
50
Q

second line treatment for angina?

A

beta blocker + non-cardioselective CCB e.g. nifedipine

51
Q

why can you not combine a beta blocker with a cardioselective CCB?

A

risk of asystole

52
Q

what is the first line treatment in heart failure with reduced ejection fraction?

A

ACE-i and beta blocker

53
Q

what is the second line treatment in heart failure with reduced ejection fraction?

A

addition of spironolactone to ACE-i and beta blocker

54
Q

what is the first line treatment for hypertension in those with type 2 diabetes?

A

always an ACE-i

55
Q

what is the first line medication given to those with a fib to prevent a stroke?

A

DOAC or warfarin
-> warfarin is better if any previous valve surgery

56
Q

treatment of pericarditis?

A

NSAIDs + colchicine

57
Q

what does TIMI stand for?

A

thrombosis in myocardial infarction

58
Q

A common cause of MI is coronary artery disease, what causes this?

A

The coronary arteries get blocked by plaque build-up / deposits of cholesterol

59
Q

What does the ST elevation indicate?

A

complete blockage of coronary artery

60
Q

How does MI lead to contracted scar formation of the heart?

A

Death of heart muscle cells occur due to lack of oxygen, this leads to necrosis. This happens over about 2 weeks with a scar forming due to formation of granulation tissue

61
Q

Name 2 risk factors for developing Mitral Valve Stenosis

A
  • Rheumatic fever
  • Untreated streptococcus infections
  • increasing age
62
Q

Name 1 class of drug used to manage Mitral Valve Stenosis and give 1 example

A
  • Beta Blockers + example: e.g. bisoprolol/ propranolol etc.
  • Diuretics + example: e.g. Furosemide (Salt + loop diuretic) / Bendroflumethiazide (thiazide diuretic) etc.
63
Q

Name 2 surgical interventions that can be used to treat Mitral Valve Stenosis

A
  • Percutaneous mitral balloon valvotomy
  • Mitral valve replacement
64
Q

What cardiac arrhythmia is often associated with Mitral Valve Stenosis?

A

a fib

65
Q

Give 2 investigations the GP might request for HTN, and the relevant features of them that indicate it.

A
  • Urinalysis: protein/albumin:creatinine ratio/haematuria
  • Blood tests, serum creatinine/eGFR
  • Fundoscopy/ophthalmoscopy, retinal haemorrhage/papilloedema
  • ECG/Echocardiography: left ventricular hypertrophy
66
Q

How might the size of a kidney change with hypertension?

A

reduced size

67
Q

What class of drug is used to treat Infective Endocarditis and how long is this treatment given for?

A

antibiotics for 4-6 weeks

68
Q

what does the CHADS VASc score stand for?

A
  • Congestive Heart Failure
  • Hypertension
  • Age (75+=2)
  • Diabetes
  • Stroke/ TIA/ Thromboembolism
  • Vascular disease
  • Age (65-74)
  • Sex category (female=1)
69
Q

what are the 3 cardinal signs of HF?

A

SOB, fatigue, ankle oedema

70
Q

first line management for acute coronary syndrome?

A

fibrinolysis with IV tenecteplase

71
Q

which 2 structures are required to prevent the ventricles from contracting at very high rates in a fib?

A

annulus fibrosus and AVN

72
Q

describe the management of AF

A
  • Haemodynamically unstable – cardioversion with synchronised DC shock + anticoagulation.
  • Haemodynamically stable – either: Rate control (Beta blockers / CCBs) + anticoagulation
    OR Rhythm control (cardioversion) -> beta blockers + anticoagulation
73
Q

gold standard investigation for heart failure?

A

echocardiogram

74
Q

define atrial fib and how it is different to atrial flutter

A

irregularly irregular atrial rhythm at 300-600bpm, a flutter is fast but regular atrial rhythm

75
Q

What are the two main things seen on an ECG for a patient with AF?

A
  • no P wave
  • irregularly irregular
  • rapid QRS complex
76
Q

suspects Wolff-Parkinson-White syndrome. If their suspicions are correct what should the ECG show?

A

Wide QRS, short PR, delta wave

77
Q

What type of arrhythmia is Wolff-Parkinson-White syndrome?

A

atrioventricular re-entry tachycardia

78
Q

What is the normal length of the PR interval on an ECG?

A

0.12-0.2s

79
Q

what is the appropriate first line medication to treat a patient with heart failure?

A

BBlocker + ACEi

80
Q

What is the correct method of action of clopidogrel?

A

P2Y12 inhibitor

81
Q

What is the gold standard test used to diagnose unstable angina?

A

angiography

82
Q

what is the first line treatment for unstable angina?

A

GTN spray and either B-blocker or CCB

83
Q

which cardiac murmur presents with malar flush and what does it sound like?

A

mitral stenosis, diastolic murmur

84
Q

give an example of a CCB

A

amlodipine

85
Q

what is beck’s triad?

A

for cardiac tamponade symptoms:
- hypotension,
- distended jugular veins,
- muffled heart sounds

86
Q

what is the name of the treatment to relieve pressure in cardiac tamponade

A

pericardiocentesis

87
Q

give 3 diagnostic tests of cardiac tamponade

A

ECG, CXR, echocardiogram

88
Q

state some signs/symptoms of cardiac tamponade

A
  • decreased exercise tolerance
  • progressive dyspnoea at rest.
  • ankles oedema
  • raised JVP
  • pulsus paradoxus.
89
Q

what is pulsus paradoxus?

A

bp decreases with inhalation

past questions (11 decks)

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