cardio passmed

Question 1

history of asthma is a containindication for what medication

Answer 1

• beta blocker

- thus give a rate limiting calcium channel blocker to aid with rate control

Question 2

widespread joint hypermobility along with skin changes, indicated by striae would indicate

Answer 2

• collagen disorder

- commonly present in Ehlers-Danlos syndrome

Question 3

what type of murmur would mitral regurgitation produce ?

Answer 3

• pansystolic murmur

Question 4

mitral regurgitation has association collagen disorders

true/false

Answer 4

mitral regurgitation associated with collagen disorders such as Marfan’s and Ehlers-danlos syndrome

Question 5

what is bifascicular block

Answer 5

• combination of RBBB with left anterior or posterior hemiblock

Question 6

if a patient presents with regular broad complex tachycardia, palpable pulse and the adverse feature of shock (BP <90mmHg) therefore what is indicated

Answer 6

• DC cardioversion

Question 7

what is indicated for the termination of regular narrow complex tachycardias

Answer 7

• intravenous adenosine and vagal manoeuvres (carotid massage, valsalva manoeuvre)

Question 8

the following history is indicative of:

35 y/o female, sharp, stabbing chest pain behind breast bone. does not radiate. refutes feeling sweaty, has not experienced any nausea and vomiting. pain is worse at night when lying flat, improves slightly when sits up.

on auscultation you hear scratchy, rubbing S1 and S2 sounds.

Answer 8

pericarditis

Question 9

what ECG feature is the hallmark of pericarditis

Answer 9

saddle shaped ST elevation

Question 10

narrow peaking T waves are commonly found in

Answer 10

hyperkalaemia

Question 11

possible causes of ST elevation

Answer 11

• STEMI
• LBBB
• pericarditis

Question 12

tall R waves in leads V1-V3 are classic finding in

Answer 12

posterior myocardial infartions

Question 13

a non-posterior infarction would give what classic findings on ECG

Answer 13

• findings are reversed in posterior lead

- thus , non posterior infarction would give classic findings of pathological Q waves, ST elevation and T wave inversion

Question 14

anterior MI would causes changes suggestive of MI in leads

Answer 14

V3

V4

Question 15

A lateral MI would cause changes in leads I, aVL, V5 and V6

Answer 15

TRUE!

Question 16

best way to diagnose aortic dissection would be a

Answer 16

CT angiogram

Question 17

stanford classification of aortic dissection

Answer 17

• type A, ascending aortia 2/3 of cases

- type B , descending aorta, distal to left subclavian, 1/3rd

Question 18

debaky classification of aortic dissection

Answer 18

type 1 - ascending aorta to aortic arch

type 2 - originates in and confined to ascending aorta

type 3 - originates in descending aorta, rarely extends proximally

Question 19

treatment for unstable patient in ventricular tachycardia

• tachycardic
• hypotensive

Answer 19

synchronised DC cardioversion

Question 20

treatment for patient with stable ventricular tachycardia

Answer 20

intravenous amiodarone

chemical conversion of ventricular tachycardia in stable patient

Question 21

torsades de pointes

Answer 21

polymorphic ventricular t.cardia with prolonged QT interval.

Question 22

treatment of choice for patient with torsades de pointes

Answer 22

intravenous magnesium sulphate

Question 23

what might be useful investigation in clinically unstable patients with suspected aortic dissection

Answer 23

transoesophageal echocardiography (TOE)

Question 24

thiazide diuretics might result in what?

Answer 24

hypercalcaemia and hypocalciuria

Question 25

66 y/o male patient. already on ramipiril, amlodipine and indapamide.

in clinic his BP is 153/88mmHg and he states this is consistent with readings he has been taking daily for the last 14 days.

how would you manage?

Answer 25

patient already taking

• ACE inhibitor
• calcium channel blocker
• thiazide diuretic

thus is a case of poorly controlled hypertension.

If K+ greater than 4.5mmol/l then add alpha or beta blocker

is K+ less than 4.5mmol/l add low dose spironolactone.

Question 26

which drug is most likely to interact with warfarin and cause a raised INR level?

phenytoin 
rifampicin 
clarithromycin 
st.johns wort
carbamazepine

Answer 26

clarithromycin

inhibits cytochrome P450, can lead to accumulation of warfarin and raised INR.

Question 27

in general warfarin should usually be stopped how many days before planned surgery?

Answer 27

5 days before surgery

Question 28

inheritance pattern of hypertrophic obstructive cardiomyopathy

Answer 28

• autosomal dominant disorder