Cardio 6

Question 1

pulmonary stenosis murmur heard best where?

Answer 1

second left intercostal space

radiates to shoulder

ejection systolic

Question 2

Left ventricular free wall rupture
is associated with?

Answer 2

cardiac tamponade and acute HF due to

pericardium to rapidly fill with blood

Question 3

when investigating aortic dissection
after Xray what do you look at?

if patients are unstable?

Answer 3

CT angiography
transoesophageal echocardiography

Question 4

what type of antibiotic can cause torsades desn pointes?

Answer 4

macrolide
azithromycin

Question 5

unstable angina is at rest
T/F?

Answer 5

true

Question 6

Aortic Dissection
management
Ascending aorta?

Answer 6

IV labetolol to control BP
> theatre
> surgery

Question 7

what is broad complex QRS?

how many small squares?

Answer 7

> 0.12 milliseconds

3 small squares

Question 8

common causes of broad complex?

Answer 8

Stable broad complex tachycardia
is VT unless proven otherwise

Question 9

Diagnosing bundle branch block
step 1
what would QRS show?

Answer 9

wide QRS > 3 small squares / >0.12 ms

Question 10

Dx BBB
left
which leads to look at?

Answer 10

1) wide QRS
2) Lead V1 / V6/ lead 1

cominant negative QRS in v1
broad slurred R in V6 / lead 1

Question 11

which antibiotic class reacts with statins?

what is the interaction?

Answer 11

macrolide such as erythromycin

increase risk of hepatotoxicity and rhabdomyolysis

Question 12

pedunculated heterogeneous mass on echocardiogram

Answer 12

atrial myxoma

Question 13

Atrial myxoma is a

Answer 13

benign tumour
left atrium (most likely)

Question 14

atrial myxoma presents with triad of?

Answer 14

mitral valve obstruction, systemic embolisation + constitutional symptoms

Question 15

following a TIA if a patient has Afib how to manage?

Answer 15

anticoagulate immediately once imaging has ruled out haemorrhage

Question 16

acyanotic congenital cardiac abnormality?

Answer 16

vetricular septal defect - pansystolic murmur

Question 17

congenital cardiac murmurs
patent ductus arteriosus

Answer 17

continuous machinery murmur

Question 18

congenital cardiac murmur

murmur which is more prominent at beginning of systole?

Answer 18

ejection systolic
atrial septal defect

Question 19

A murmur which is more prominent at the start of diastole

Answer 19

early diastolic

aortic and pulmonary regurg

Question 20

A murmur more prominent towards the end of systole

Answer 20

coarctation of the aorta / mitral valve prolapse

Question 21

coarctation of aorta?

Answer 21

aortic clicks
radio-femoral delay

Question 22

bisferiens pulse

Answer 22

mixed aortic valve disease

2 distinct systolic peaks

Question 23

statin monitoring

Answer 23

LFTs

baseline
3 months and
12 months

Question 24

Streptococcus sanguinis

group of viridans group of streptococci

Answer 24

a-hemolytic

commensal in mouth / dental disease

Question 25

ALT can be raised in statin use on LFT but what is the limit?

Answer 25

upto 3 times the upper limit of normal

Question 26

Management for complete heartblock?

Answer 26

pacemaker

Question 27

for pts with IHD history with a new onset AF how should antithrombotic medication be given?

Answer 27

they would be on a antiplatelet
but if stable say MI was 20 years ago

Question 28

causes of AS

> 65

<65

Answer 28

degenerative calcification most common in older

bicuspid aortic valve

Question 29

pt high bleeding risk

NSTEMI mx?

Answer 29

aspirin and clopidogrel

Question 30

1st degree heart block post MI

Answer 30

inferior leads affected

II, III, aVF

Question 31

af and anticoagulation

female, 64 and healthy?

Answer 31

do not offer anticoagulant <65 if no RF other than sex

Question 32

symptomatic bradycardia is managed with?

Answer 32

IV atropine

<60bpm

Question 33

Potential risk of asystole
bradycardic pt

Answer 33

complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds

Question 34

Mitral regurgitation

Answer 34

pansystolic

high pitched

blowing

Question 35

pericarditis cardinal features on ECG

causes?

Answer 35

widespread ST elevation w PR depression

infection: viral coxsackie, TB,
inflammation : SLE/ RA

malignancy

Question 36

complications post MI
pansystolic murmur

acute HF

Answer 36

ventricular septal defect
rupture of the interventricular septum

echo needed to confirm

corrective surgery required

Question 37

complications post MI

acute onset shortness of breath, bibasal crackles, raised jugular venous pressure, muffled heart sounds

Answer 37

left ventricular free wall rupture

Urgent pericardiocentesis and thoracotomy

Question 38

acute heart failure clinical signs

Answer 38

raised JVP

wheeze
bibasal crackles

displaced apex beat
S3

Question 39

when should warfarin be stopped before surgery?

Answer 39

5 days

INR <1.5

Question 40

current chest pain and abnormal ECG at a GP?

<12 hours chest pain

Answer 40

emergency admission to secondary care - ambulance w aspirin given

Question 41

patients on warfarin having emergency surgery:

Answer 41

25-50 units/kg four-factor prothrombin complex

if 5-6 hours to surgery give IV vitamin K

Question 42

heart failure with fluid overload

Answer 42

severe anaemia from a big bleed can cause this

inadequate perfusion of blood

Question 43

hypothermia VF?

Answer 43

rewarmed to 30 degrees

then shock

Question 44

Moderate-severe aortic stenosis is a contraindication to ACE-i

why?

Answer 44

vasodilator effect of an ACE inhibitor might lead to a reduction in the coronary perfusion pressure

cardiac ischaemia