Cardio 5

Question 1

In african / caribbean patients when initiating second line antihypertenisve

should you start a ACEi / ARB?

Answer 1

ARB - losartan

Question 2

biggest risk factor for aortic dissection?

Answer 2

HTN
bicuspid aortic valve
collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
Turner’s and Noonan’s syndrome
pregnancy

Question 3

what is aortic dissection?

Answer 3

tear in the tunica intima of the wall of the aorta

Question 4

INR 5.0-8.0 (no bleeding)

Answer 4

withhold warfarin 2 doses maybe

Question 5

INR >8 and not bleeding

Answer 5

oral vitamin K
stop warfarin

Question 6

holosystolic murmur
no change with inspiration

high pitched and blowing in character?

Answer 6

mitral regurgitatiopn

Question 7

Beta-blockers should only be stopped in acute heart failure?

Answer 7

HR <50
2/3 degree heart block
shock

Question 8

All patients with suspected chronic heart failure should have

Answer 8

NT-proBNP test

Question 9

what are the indications for emergency valve surgery in infective endocarditis?

Answer 9

severe valvular incompetence

aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

Question 10

why does MI cause acute mitral valve regurgitation?

Answer 10

rupture of the tendinous cords that usually hold the valve in place

Question 11

subclavian steel syndrome

Answer 11

posterior circulation symptoms
dizziness and vertigo

percutaneous transluminal angioplasty / stent

Question 12

reversal agent for dabigtran?

Answer 12

Idarucizumab

Question 13

reversible of apixaban / rivaroxaban

Answer 13

andexanet alfa

Question 14

Phytomenadione

Answer 14

vitamin K
> warfrain

Question 15

HOCM
louder on valsalva

quieter on?

Answer 15

squatting

preload increases

increased amount of blood within the ventricles reducing the proximity of the mitral valve

Question 16

prosthetic heart valves antithrombotic therapy?

bi prosthetic

Answer 16

aspirin
> reduces platelet aggregation
>adequate protection against thromboembolism

Question 17

mechanical heart valve antithrombotic?

Answer 17

warfarin and aspirin

Question 18

Target INR
aortic:
mitral:

Answer 18

aortic: 3.0
mitral: 3.5

Question 19

what leads categorise a posterior MI?

Answer 19

leads V1-V3

V2- dominant R wave

> st segment depression

Question 20

inferolateral MI?

Answer 20

leads II
III
aVF

Question 21

persistent ST elevation following an MI with no chest pain?

Answer 21

left ventricular aneurysm

Question 22

ventricular septal defect post MI

Answer 22

acute heart failure associated with a pan-systolic murmur

Question 23

Pulseless ventricular tachycardia

Answer 23

high rate of electrical activity, leading to the heart being an ineffective pump, and not being able to support circulation

wide complex tachycardia

Question 24

difference between myoglobin and CK-MB as MI markers?

Answer 24

myoglobin first to rise but
CK -MB more accurate

Question 25

Prosthetic heart valves how to decide which type of valve to give > aortic stenosis?

Answer 25

mechanical in younger patients as they last longer biprosthetic in older pts

Question 26

no postural drop what is postural drop?

Answer 26

symptomatic fall of >20 diastolic drop of >10 or fall to <90

Question 27

how many sets of blood cultures recommened in infective endo?

Answer 27

3 sets

Question 28

patient treated with PCI post procedure complaining of intense pain haemodynamic instability

Answer 28

urgent CABG suggests PCI was ineffective

Question 29

conservative management of an nstemi

Answer 29

aspirin and Ticragrelor if low bleeding risk Clopidogrel if high bleeding risk

Question 30

In ALS if drugs cannot be given IV how to give?

Answer 30

intraosseous route (IO) proximal tibia

Question 31

However, aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower ____

Answer 31

BNP HF

Question 32

Dobutamine

Answer 32

ionotropic agent severe left ventricular dysfunction

Question 33

when starting medication for reduced ejection fraction HF how to initiate the meds?

Answer 33

start ACEi / beta blocker but one at a time

Question 34

Jones criteria

Answer 34

rheumatic fever post strep

Question 35

people who have had PCI should be given what antiplatelets?

Answer 35

DAPT aspirin > prasugrel >ticragrelor >clopidogrel

Question 36

SVT if adminstering adenosine ?

Answer 36

6mg 12mg 18mg then consider DC cardiovert

Question 37

what is first line anti statin?

Answer 37

atorvastatin > simvastatin

Question 38

which antihypertensives are assocuated with ototoxicity?

Answer 38

loop diuretics