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AMC MCQ - Key points > Cardio Brief > Flashcards

Cardio Brief Flashcards

1
Q

Describe the significance of an opening snap on auscultation in a patient with mitral valve disease.

A

An opening snap indicates a non-calcified mitral valve.

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2
Q

What is the most common finding on cardiac examination in a patient with mitral valve disease?

A

Atrial fibrillation.

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3
Q

Do ejection systolic murmurs in aortic stenosis radiate to the carotid arteries?

A

Yes, ejection systolic murmurs in aortic stenosis radiate to the carotid arteries.

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4
Q

What is a characteristic auscultatory finding in atrial septal defect (ASD)?

A

Wide fixed splitting of S2.

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5
Q

What is the characteristic murmur in ventricular septal defect (VSD)?

A

Pan-systolic murmur radiating to the whole myocardium.

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6
Q

Describe the murmur heard in patent ductus arteriosus (PDA).

A

Continuous machinery murmur.

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7
Q

Do patients with coarctation of the aorta (COA) typically have delayed femoral pulsations?

A

Yes, patients with COA may have delayed femoral pulsations.

Pt with well developed UL& underdeveloped LL. Exam shows delayed femoral pulsation…

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8
Q

COA murmur…

A

at whole precordium radiating to back

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9
Q

What is the most common congenital heart disease causing cyanosis?

A

Tetralogy of Fallot (TOF).

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10
Q

What is the first step in managing cyanotic spells in TOF?

A

Placing the patient in a squatting position.

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11
Q

Describe the presentation of transposition of the great vessels (TGVs) in terms of cyanosis.

A

Cyanosis present since birth (1st day of life).
1st step in management… PG infusion (to maintain patency of PDA)

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12
Q

Heart failure symptoms few days after birth…

A

hypo-plastic left heart $

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13
Q

Fixed splitted S2……

A

ASD

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14
Q

What is the most important drug for aortic regurgitation (AR)?

A

Angiotensin-converting enzyme inhibitors (ACEI).

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15
Q

What is the most common association with atrial septal defect (ASD) in terms of conduction abnormalities?

A

Right bundle branch block (RBBB).

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16
Q

What is the most common complication of tetralogy of Fallot (TOF)?

A

Cyanotic spells.

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17
Q

Most common cyanotic heart disease….

A

TOF

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18
Q

3 day child with symptoms of HF and shock…

A

hypoplastic ventricle

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19
Q

Describe the murmur heard in coarctation of the aorta.

A

Murmur heard at the whole precordium radiating to the back.

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20
Q

Systolic murmur over aortic area with syncope…
Cyanosis since birth……
Cyanosis relieved by squatting….
Systolic murmur radiating to the back….coarctation of aorta
Continuous machinery murmur…..
Mid-diastolic rumbling murmur…………….
Decrescendo early diastolic murmur……..
Systolic murmur over apex radiate to axilla…
Systolic murmur over apex radiate to carotid…

A

Systolic murmur over aortic area with syncope…AS
Cyanosis since birth……TOG
Cyanosis relieved by squatting….TOF
Systolic murmur radiating to the back….coarctation of aorta
Continuous machinery murmur…..PDA
Mid-diastolic rumbling murmur……………. MS
Decrescendo early diastolic murmur…….. AR
Systolic murmur over apex radiate to axilla…MR
Systolic murmur over apex radiate to carotid…AS

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21
Q

What is the characteristic sound of the murmur in patent ductus arteriosus (PDA)?

A

Continuous machinery-like murmur.

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22
Q

What type of murmur is typically heard in mitral stenosis (MS) during mid-diastole?

A

Mid-diastolic rumbling murmur.

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23
Q

What type of murmur is typically heard in aortic regurgitation (AR) during early diastole?

A

Decrescendo early diastolic murmur.

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24
Q

Describe the radiation of a systolic murmur heard over the apex in mitral regurgitation (MR).

A

Radiates to the axilla.

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25
Q

Describe the radiation of a systolic murmur heard over the apex in aortic stenosis (AS).

A

Radiates to the carotid arteries.

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26
Q

What is the most common drug addiction associated with causing congenital heart disease?

A

Cocaine.

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27
Q

What is the most common substance associated with causing congenital heart disease?

A

Alcohol.

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28
Q

What is the most common congenital heart disease associated with Down syndrome?

A

Endocardial cushion defect.

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29
Q

What is the most common congenital heart disease associated with diabetes mellitus?

A

Ventricular septal defect (VSD).

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30
Q

Describe the clinical presentation of a patient with marked differences between upper body and lower body blood pressure, including delayed femoral pulses.

A

This presentation is indicative of coarctation of the aorta (COA).

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31
Q

What is the most common complication associated with mitral stenosis (MS)?

A

Atrial fibrillation (AF).

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32
Q

What is the first step in managing transposition of the great vessels (TGVs)?

A

Prostaglandin infusion.

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33
Q

Do patients with pericarditis typically experience chest pain that improves with sitting and leaning forward?

A

Yes, patients with pericarditis often have chest pain that improves with sitting and leaning forward.

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34
Q

What is the most common cause of myocarditis?

A

Viral infections, particularly coxsackie virus.

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35
Q

Pericarditis.
TTT…………………. NSAIDs

A

TTT…………………. NSAIDs

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36
Q

Describe the treatment of uremic pericarditis.

A

Dialysis

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37
Q

What is the best investigation for constrictive pericarditis involving a calcified pericardium?

A

CT scan
calcified pericardium)

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38
Q

What is the main treatment for constrictive pericarditis

A

Pericardiectomy

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39
Q

What are the clinical signs of a patient with pericardial effusion and tamponade? What is the next step in management?investigation

A

Distant heart sounds, elevated JVP, hypotension. Next step: chest x-ray

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40
Q

How is pericardial effusion typically managed?

A

Pericardiocentesis

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41
Q

Describe the presentation of a patient with rheumatic fever who is an immigrant from Iraq or Aboriginal.

A

Erythema marginatum, elevated ASO titer, prolonged PR interval on ECG

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42
Q

What is the next step in management for a patient with rheumatic fever presenting with rash, migratory arthritis, and a history of upper respiratory tract infection?

A

Oral penicillin

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43
Q

What are the most important ECG findings in rheumatic fever?

A

Prolonged PR interval

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44
Q

List the organisms commonly causing Infective Endocarditis based on different scenarios.

A

Strep viridians (most common overall and after dental procedures), Staphylococcus (in drug addicts and after cardiac catheterization),
Strep fecalis (after gastrointestinal or genitourinary procedures),
Strep bovis (associated with colon cancer)

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45
Q

What is the recommended next step if a patient with Infective Endocarditis has blood cultures growing Strep bovis?

A

Colonoscopy

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46
Q

Which heart valve is most commonly affected in drug addicts with Infective Endocarditis?

A

Tricuspid valve

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47
Q

What is the most common valve lesion in drug addicts with Infective Endocarditis?

A

Tricuspid regurgitation

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48
Q

What is the first most important investigation for Infective Endocarditis?

A

Trans-esophageal Echo (to detect vegetation)

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49
Q

What is the second most important investigation for Infective Endocarditis?

A

Blood culture (to identify the causative organism)

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50
Q

Describe the prophylaxis criteria for Infective Endocarditis.

A

Significant cardiac defect (e.g., prosthetic valve, previous IE) and dental procedures. Prophylaxis involves taking Amoxicillin 1 hour before and half an hour after the procedure

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51
Q

Prophylaxis against IE… 2 conditions

A

MUST be met;
- Significant cardiac defect (prosthetic valve, previous IE)
- Dental procedure

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52
Q

Prophylaxis against IE…

A

Amoxicillin 1h before & ½ an hour after procedure

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53
Q

What are the most common causes of dilated cardiomyopathy?

A

Alcohol (most common) and viral infections (especially coxsackie virus)

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54
Q

Describe the typical presentation of a young patient with hypertrophic obstructive cardiomyopathy (HOCM).

A

Syncope, arrhythmias, or sudden death during exercise with a family history of sudden death during exercise at a young age

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55
Q

What is the genetic inheritance pattern of hypertrophic obstructive cardiomyopathy (HOCM)?

A

Autosomal dominant

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56
Q

What exacerbates the symptoms of HOCM?

A

Exercise, dehydration, valsalva maneuver, or standing

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57
Q

What is the most common cause of death in patients with HOCM?

A

Obstruction

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58
Q

What is the second most common cause of death in patients with HOCM?

A

Arrhythmias

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59
Q

What are the most common types of arrhythmias seen in patients with HOCM?

A

Ventricular tachycardia and ventricular fibrillation

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60
Q

What is the preferred investigation for diagnosing hypertrophic obstructive cardiomyopathy (HOCM)?

A

Echo

61
Q

Describe the treatment of choice for Hypertrophic Obstructive Cardomyopathy (HOCM)

A

1st line: Beta-blockers, 2nd line: Calcium channel blockers

62
Q

What is the treatment for arrhythmias in HOCM?

A

Implantable defibrillator

63
Q

Define the 1st most common risk factor for Ischemic Heart Disease (IHD)

A

Hypertension

64
Q

What is the 2nd most common risk factor for Ischemic Heart Disease (IHD)?

A

Smoking

65
Q

How does a young smoker with recurrent attacks of typical chest pain present?

A

Variant angina

66
Q

1st MC RF of IHD……………………………….……..
2nd MC RF of IHD……………………………………..
Highest risk of MI in pt with IHD……………….

A

1st MC RF of IHD……………………………….…….. HTN
2nd MC RF of IHD…………………………………….. Smoking
Highest risk of MI in pt with IHD………………. Angina (not HTN)

67
Q

What is the treatment for variant angina?

A

Stop smoking, nitrates during attack

68
Q

What is the next step if a patient with a history of typical chest pain has a normal ECG?

A

Exercise ECG

69
Q

What do nitrates do in the treatment of Ischemic Heart Disease (IHD)?

A

Relieve chest pain

70
Q

Pt with DM, HTN, hyperlipidemia lose consciousness, lab shows serum glucose of <40
which medication is responsible…

A

bb

71
Q

Do beta-blockers mask or cause signs of hypoglycemia?

A

Mask the signs of hypoglycemia but do not cause it

72
Q

Describe the important findings in an ECG during Myocardial Infarction (MI)

A

ST segment elevation

73
Q

What does ST elevation in leads II, III, and aVF indicate in MI?

A

Inferior wall infarction

74
Q

How soon does Myoglobin appear as a cardiac enzyme in MI?

A

The earliest to appear

75
Q

Which enzyme is the most accurate in diagnosing MI?

A

Troponin

76
Q

What is the best enzyme to detect re-infarction?

A

CK-MB

77
Q

What is the definitive treatment of Myocardial Infarction (MI)?

A

Angioplasty

78
Q

What is the best treatment in case of late presentation of MI?

A

Heparin

79
Q

Medication decrease mortality…for heart

A

BB, ACE-Is& statin

80
Q

What is the best investigation/treatment for myocardial aneurysm?

A

Echo/Surgery

81
Q

After MI, when is it safe to consider an operation?

A

No operation for 6 months

82
Q

What should be done in emergent surgery for a patient with a history of angioplasty and stent in the last 6 months?

A

Don’t stop clopidogrel (high risk of thrombosis)

83
Q

What should be done in elective endoscopy for a patient with a history of angioplasty and stent in the last 6 months?

A

Don’t stop clopidogrel (high risk of thrombosis)

84
Q

Describe the management of a female on oral contraceptive pills who develops hypertension

A

1st: stop OCP, 2nd: re-evaluate

85
Q

What should be done if a patient has a blood pressure reading above 140/90 for the first time?

A

Ask the patient to come back in 1-2 weeks

86
Q

What is the best investigation for hypertension?

A

Ambulatory monitoring

87
Q

What is the best investigation for paroxysmal arrhythmia?

A

Holter monitor

88
Q

What are the important investigations for arrhythmia?

A

Thyroid function tests, complete blood count, and electrolytes

89
Q

What is the first lifestyle modification in the treatment of hypertension?

A

Weight loss

90
Q

What is the second lifestyle modification in the treatment of hypertension?

A

Low sodium diet

91
Q

What is the best initial drug for hypertension?

A

Thiazides

92
Q

What is the first-line drug for a patient with diabetes mellitus and proteinuria ?

A

ACE Inhibitors

93
Q

Describe the treatment for hypertension in a patient with unilateral renal artery stenosis.

A

ACE inhibitors

94
Q

What is the recommended treatment for hypertension in a patient with bilateral renal artery stenosis?

A

Angioplasty and stent

95
Q

What medication is indicated for hypertension in a patient with osteoporosis?

A

Thiazides

96
Q

How should hypertension in a patient with hyperthyroidism be managed?

A

Beta blockers

97
Q

What is the recommended treatment for hypertension in a patient with benign prostatic hyperplasia (BPH)?

A

Alpha blockers

98
Q

Describe the treatment approach for hypertension in a patient with heart failure.

A

ACE inhibitors

  1. Lifestyle Modifications:
    • Low-sodium diet
    • Regular physical activity
    • Weight management
    • Limiting alcohol intake and smoking cessation
  2. Medications:
    • ACE Inhibitors/ARBs: First-line for blood pressure control and heart failure management.
    • Beta-Blockers: Used to manage heart failure symptoms and control hypertension.
    • Diuretics: Particularly loop diuretics, to manage fluid overload.
    • Aldosterone Antagonists: For additional blood pressure control and heart failure management.
    • Hydralazine and Nitrates: For patients intolerant to ACE inhibitors/ARBs.
  3. Monitoring and Follow-up:
    • Regular blood pressure monitoring
    • Periodic assessment of kidney function and electrolytes
    • Adjustment of medication based on patient response

For more detailed guidelines, refer to the RACGP guidelines.

99
Q

What are the recommended medications for hypertension during pregnancy?

A

Alpha methyldopa and labetalol

100
Q

What is the initial treatment for hypertensive emergency?

A

Hospitalization and first-line: Labetalol / Second-line: Sodium nitroprusside

  1. Initial Assessment:
    • History and Physical Examination: Assess for symptoms of end-organ damage such as chest pain, shortness of breath, headache, visual changes, and neurological deficits.
    • Blood Pressure Measurement: Confirm elevated BP (systolic BP ≥180 mmHg and/or diastolic BP ≥120 mmHg).
  2. Immediate Management:
    • Admission to Intensive Care Unit (ICU): For continuous monitoring and management.
    • Intravenous Antihypertensive Therapy:
      • First-Line Agents: Start with IV labetalol or sodium nitroprusside.
      • Alternative Agents: Nicardipine, esmolol, or hydralazine may be used based on the clinical scenario and patient’s condition.
  3. Monitoring and Adjustment:
    • Continuous BP Monitoring: Monitor BP closely, aiming for a controlled reduction.
    • Adjust Medications: Titrate IV medications to achieve a gradual BP reduction. The initial goal is to reduce mean arterial pressure (MAP) by no more than 25% within the first hour, then to 160/100-110 mmHg over the next 2-6 hours.
  4. Identify and Treat Underlying Causes:
    • Investigations: Perform relevant investigations such as blood tests, ECG, chest X-ray, CT scan, or MRI as needed to identify any underlying causes or complications.
    • Specific Treatments: Address underlying causes like renal artery stenosis, pheochromocytoma, or aortic dissection if identified.
  5. Transition to Oral Medications:
    • Once BP is stabilized and target BP is achieved, transition from IV to oral antihypertensive medications.
    • Follow-Up: Arrange for close follow-up to monitor BP and adjust treatment as needed.

For more detailed guidelines, refer to the RACGP Hypertension Management Guidelines.

101
Q

Describe the most common risk factor for digitalis toxicity.

A

Hypokalemia

102
Q

What are the typical presentations of digitalis toxicity?

A

Vomiting, abdominal pain, colored vision, arrhythmia on ECG

103
Q

What is the most important ECG finding in digitalis toxicity?

A

Down-sloping ST segment with sagging appearance

104
Q

How should a patient on digoxin with arrhythmia be managed?

A

Stop digoxin and administer potassium

105
Q

What is the most common cause of left-sided heart failure (LHF)?

A

Myocardial infarction (MI)

106
Q

What is the most common cause of right-sided heart failure (RHF)?

A

Left-sided heart failure (LHF)

107
Q

Describe the most important sign of left-sided heart failure (LHF).

A

Bilateral basal lung crepitations

108
Q

Describe the most important sign of right-sided heart failure (RHF).

A

Systemic congestion

109
Q

What is the preferred imaging modality for evaluating heart failure?

A

Echocardiography

110
Q

What does a positive hepatojugular reflux indicate in the context of heart failure?

A

Hepatomegaly due to congestive heart failure
+ve in hepatomegally DT congestive HF

111
Q

What does a negative hepatojugular reflux indicate in the context of liver pathology?

A

Absence of congestive heart failure
… -ve in hepatomegally DT liver pathology

112
Q

Describe the essential medications for heart failure management.

A

ACE inhibitors, beta blockers, aldosterone antagonists

113
Q

What is the most dangerous type of lipids?

A

LDL

114
Q

What is the key feature on examination to suggest familial hypercholesterolemia?

A

Tendon xanthomas (not xanthelasma)

115
Q

What is the first-line treatment for hyperlipidemia?

A

Statin

116
Q

What is the mechanism of action of statins?

A

HMG-CoA reductase inhibition

117
Q

Pt on statin, BB, ACE-I, aspirin develop myopathy… Cause:

A

Statin

118
Q

How should statin-induced myopathy be managed in a patient on statin, beta blocker, ACE inhibitor, and aspirin?
Inv of choice in suspected statin- induced myopathy

A

Check CK levels

119
Q

What are the important side effects of statins?

A

Myopathy (check CK levels) and hepatitis (check AST, ALT levels)

120
Q

What are the dangerous combinations involving statins?

A

Statin and gemfibrozil leading to severe rhabdomyolysis

121
Q

What are the dangerous combinations involving nitrates and sildenafil?

A

Severe hypotension

122
Q

What are the dangerous combinations involving allopurinol and azathioprine?

A

Severe toxicity

123
Q

Describe the presentation of a patient with severe chest pain radiating to the back.

A

Aortic dissection

124
Q

What is the most common risk factor for aortic dissection?

A

Hypertension

125
Q

What is typically seen on X-ray in a patient with aortic dissection?

A

Wide mediastinum

126
Q

What is the imaging modality of choice for a stable patient with aortic dissection?

A

CT angiography

127
Q

What is the preferred imaging modality for an unstable patient with aortic dissection?

A

Transesophageal echocardiography

128
Q

What is the initial step in the treatment of aortic dissection?

A

Lowering blood pressure (beta blockers are the best initial choice)

129
Q

What is the most common medication causing orthostatic hypotension?

A

Diuretics

130
Q

What is the first-line treatment for orthostatic hypotension?

A

IV fluids

131
Q

What is the seond-line treatment for orthostatic hypotension?

A

Stop the offending drug

132
Q

Inv of choice…orthostatic hypotension?

A

Upright tilt table test

133
Q

Pt with BPH loses conscious while micturating…

A

Situational syncope

134
Q

What is the next step when a patient presents with sudden tearing chest pain referred to the back and hypertension?

A

Next step is to perform a chest X-ray to check for a wide mediastinum, which could indicate aortic dissection.

135
Q

Describe the recommended lipid profile targets for a patient on statin therapy.

A

Total Cholesterol should be less than 4 mmol/l, LDL less than 2 mmol/l, HDL more than 1 mmol/l, and TG less than 2 mmol/l.

136
Q

Define situational syncope and provide an example.

A

Situational syncope is when a patient loses consciousness in a specific situation, such as a person with benign prostatic hyperplasia fainting while urinating.

137
Q

What is the drug of choice and its dosage for managing lipid profiles?

A

Statin at the maximum tolerated dose is the drug of choice for lipid management.

138
Q

How should a patient with diabetes type 2 and any cardiovascular risk factor be managed in terms of statin therapy?

A

Add statin therapy regardless of the lipid profile.

139
Q

Do patients with hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis (AS) share any similarities in terms of syncope presentation?

A

Both HOCM and AS patients may experience sudden syncope, especially during exercise, and are at risk of sudden death.

140
Q

Describe the differences in murmur characteristics between HOCM and AS.

A

HOCM presents with a systolic murmur over the sternal border without radiation, while AS has a systolic murmur over the aortic area that may radiate to the carotid.

141
Q

HOCM….. murmur
HOCM murmur….noooo or radiation
AS….murmur
Chest pain…..more where

A

HOCM…..systolic murmur over sternal border
HOCM murmur….noooo radiation
AS….systolic murmur over aortic area radiate to carotid
Chest pain…..more with Aortic stenosis

142
Q

What is the best assessment for determining obesity-related cardiovascular disease risk?

A

The waist-hip ratio is the best assessment for evaluating the impact of obesity on cardiovascular disease risk.

143
Q

What is the recommended approach for a patient with hypertension, diabetes, and a history of smoking?

A

The next best step is to conduct a cardiovascular risk assessment for the patient.

144
Q

Do patients with vasovagal syncope typically experience a quick or delayed recovery after an episode?

A

Patients with vasovagal syncope usually have a quick recovery after the episode.

145
Q

vasovagal

A

Gradual
delayed
Prolonged standing - emotional stress - painful stimuli.

146
Q

arrythmia

A

sudden
Quick
Exercise

147
Q

MI and surgery:

Stent and urgent operation:

A

MI and surgery:
No operation before 6 months
Stent and urgent operation:
Do not stop clopidogrel…..risk of thrombosis

148
Q

Sudden tearing chest pain referred to the back and HTN………
Next step………

A

aortic dissection
CXR……..wide mediastinum

AMC MCQ - Key points (49 decks)

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