CARDIO

Question 1

A PE is likely if a 2-level PE Wells score is more than 4. Give the criteria in the PE Wells score and how many points for each.

Answer 1

3 points = DVT signs
3 points = alt diagnosis less likely than PE

1.5 = HR >100
1.5 = immobilisation for >3 days, or surgery in previous 4 weeks
1.5 = Previous DVT/PE

1 = Haemoptysis
1 = malignancy (current treatment or last 6 months, or palliative)

Question 2

A patient presents with new hypertension of 181/121. What would they have to present with to be considered for admission for specialist assessment?

Answer 2

Retinal haemorrhage / papilloedema

New onset confusion, chest pain, signs of heart failure or AKI

Suspected phaeochromocytoma - labile/postural hypotension, headache, palpitations, pallor, diaphoresis.

Question 3

A patient presents with new hypertension of 181/121. What would they have to present with to be considered for urgent end organ damage investigations (and which ones) but not admission?

Answer 3

No acute symptoms requiring referral present.

Bloods
Urine ACR
ECG

If end organ damage is identified, treat immediately.

If no target organ damage seen, repeat clinic BP in 7 days.

Question 4

What two signs would you see on ECG in bifascicular block?

Answer 4

RBBB

Left axis deviation

Question 5

Poor prognosticators in ACS:

Answer 5

Age
Heart failure
PVD
Reduced BP
Killip class - pulmonary oedema / cardiogenic shock
Initial serum creatinine
Elevated initial cardiac markers
Cardiac arrest on admission
ST deviation

Question 6

Torsades de pointes is a polymorphic ventricular tachycardia. What other ECG abnormality is it associated with?

Answer 6

Long QT interval

Question 7

Torsades de pointes may deteriorate into VF and hence lead to sudden death. What is the management of torsades?

Answer 7

IV magnesium sulfate

Question 8

Drug causes of QT prolongation:

Answer 8

TCAs
Antipsychotics
Chloroquine
Erythromycin
Antiarrhythmics e.g. amiodarone, sotalol

Question 9

Physiological / pathological causes of QT prolongation:

Answer 9

Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Myocarditis
Hypothermia
SAH
Congenital syndromes

Question 10

Half life of adenosine:

Answer 10

8-10 seconds

Question 11

Why do neurological symptoms sometimes occur in aortic dissection?

Answer 11

1) Intimal tear of the dissection progressing to branch arteries

2) Mass effect of the expanding aorta e.g. Horner’s syndrome occurring due to compression of the sympathetic trunk

Question 12

Which leads should bbb be seen in?

Answer 12

V1 or V6

Question 13

Concurrent use of clopidogrel and ? make the clopidogrel less effective?

Answer 13

Omeprazole

Esomeprazole

Question 14

Most common cause of death following MI?

Answer 14

Ventricular fibrillation