Cardio RACGP

Question 1

Serious causes of chest pain - Life threatening

Answer 1

Acute coronary syndrome
Pneumothorax
Pulmonary embolism
Aortic dissection

Question 2

What ECG finding should I not give GTN?

Answer 2

ST elevation in V1, V2 and V3 - right ventricular infarction. GTN can reduce preload enough to cause significant haemodynamic compromise

Question 3

Which suspected acute coronary syndrome patients to send to hospital and how?

Answer 3

If STEMI, ongoing chest pain, dyspnoea, syncope, presyncope or palpitations - ambulance
All other patients with symptoms in last 24 hours should be referred immediately to ED and told not to drive themselves.

Question 4

Management of acute coronary syndrome while awaiting ambulance

Answer 4

Oxygen if sats <93% (<88j% if COPD)
GTN unless right ventricular infarct suspected or recent use of phosphodiesterase type 5-inhibitor. give 0.3-0.6mg tablet sublingual 5 minutely for 3 doses
300mg aspirin
Fentanyl if required for pain relief

Question 5

What drug can be taken for premature ejaculation?

Answer 5

Setraline 3-5 hours prior or regularly

Question 6

What has best evidence for treatment of PTSD

Answer 6

Specialist administered trauma focused psychological therapy

Question 7

Which melanoma patients should be referred for wide local excision and sentinel node biopsy

Answer 7

Melanoma >1.0mm thickness

>0.75mm + other high risk pathological features

Question 8

Features of melanoma

Answer 8

Asymmetrical
irregular Borders
Colour variation
Larger Diameter

EFG
Elevated, dome shaped, growing

Any lesion that continues to grow in size, shape, colour or elevation over a period of one month should be biopsied.

Question 9

What risks of surgical excision should you inform the patient of

Answer 9

Bleeding, Haematoma, infection, wound dehiscence, flap failure, numbness, scar, possibility of further surgery