Cardio/Resp/Cardiothoracic/AMIA/Vascular

Question 1

What are the features of the different types of heart block?

Answer 1

1st degree - prolonged PR interval that stays constant

2nd degree Type 1 - prolonged PR interval which increases until there is a dropped beat

2nd degree Type 2 - prolonged PR interval that remains constant and there are dropped beats

3rd degree - no relationship between P and QRS waves

Question 2

What is INR and what does it measure?

Answer 2

International Normalised Ratio - it is a ratio of the patients prothrombrin time to a control samples prothrombin time

• Used to assess the pathway of coagulation and determine how well the blood is clotting
• Also used to monitor warfarin dosage

Question 3

What is the target range for INR value in a patient on warfarin?

Answer 3

2-3

Question 4

What can be the reasons for a raised INR (i.e. an increased prothrombin time)?

Answer 4

Vitamin K deficiency

Warfarin therapy

Malabsorption

Question 5

In what patient group is a higher INR desirable?

Answer 5

Patients who have a mechanical heart valve

Question 6

What is an ICD and what is it used for?

Answer 6

Implantable Cardiac Defibrilator

ICD’s are used to prevent sudden cardiac death in patients at risk of developing ventricular fibrilation

Question 7

What is the general rule about syncope/blackouts and notifying the DVLA?

Answer 7

Vasovagal syncope with reliable prodrome = no driving restrictions

Syncope/TLOC with likely cardiovascular origin = License revoked for 6 months

Signs indicating likely cardiovascular origin:

• Abnormal ECG
• Evidence of structural heart disease
• Greater than 1 episode within 6 months

Question 8

What medication can cause INR values to be raised and why does it happen?

Answer 8

Clarithromycin

It inhibits cytochrome P450 enzyme in the Liver and this causes warfarin metabolism to decrease and therefore the INR value to increase

Question 9

If INR becomes very high, how can this be treated?

Answer 9

Give Vitamin K IM 20mg

Question 10

If a patient has a bleed due to increased warfarin levels, what should the patient be given?

Answer 10

Vitamin K

Clotting factors

FFP

Question 11

What are the different classes of antibiotics and give a few examples of each?

Answer 11

B-lactams - penicilins & cephalosporins

Glycopeptides (Gram +ve - Vancomycin

Aminoglycosides (Gram -ve) - Gentamicin

Macrolides (Gram +ve) - Erythromycin, Clarithromycin

Question 12

What supplements need to be given to patients on loop diuretics and why?

Answer 12

Potassium supplements

Loop diuretics work by increasing the secretion of potassium (this draws water out of the body)

Question 13

What is syncope and what are the different categories of disease that can cause syncope?

Answer 13

Syncope = transient loss of consciousness resulting in fainting

Vasovagal - neurologically induced drop of blood pressure usually preceded with an aura (sweating, seeing stars or ringing in ears)

Cardiac - Arrythmias, aortic stenosis & mitral stenosis, sick sinus syndrome

Blood pressure - postural hypotension

Metabolic - DKA, Hyper/hypokalaemia, Hyponatraemia

Neurological - Epilepsy or stroke

Respiratory - Massive PE

Question 14

What does an ECG show in a patient with a PE?

Answer 14

S1 Q3 T3

S1 - Large s wave in lead I

Q3 - Q wave in lead III

T3 - Inverted T wave in lead III

Question 15

What are the initial steps that you must take when assessing a patient who has suffered a syncope event?

Answer 15

ABCD

A - Airway (Is the patient speaking to you? If yes, then airway is clear. If patient not talking then look, listen and feel)

B - Breathing (Look, listen and feel for breathing - assess for 10 seconds)

C - Circulation (assess carotid pulse when checking for B)

D - Disability (Conscious level of patient and serious injuries)

Question 16

How does hyperkalaemia appear on an ECG?

Answer 16

Broad, tented QRS complexes

Question 17

How is hyperkalaemia treated?

Answer 17

1 - Calcium gluconate

2 - Insulin & glucose (moves potassium into cells)

3 - Salbutamol (moves potassium into cells)

4 - Diuretics (excrete potassium from body)

Question 18

What isoprenaline used for?

Answer 18

Treatment of bradycardia

Question 19

How is hypernatraemia treated?

Answer 19

IV or oral fluids (dextrose or saline)

Question 20

How does hypercalcaemia appear on an ECG?

Answer 20

Shortened QT interval

Question 21

How is hypercalcaemia treated?

Answer 21

Hydration

Increased salt intake

Forced diuresis

Question 22

What is a DIC?

Answer 22

Disseminated Intravascular Coagulation

• Blood clots form throughout the body, blocking small blood vessels
• Chest pain, SOB, leg pain, problems speaking
• Clotting factors and platelets get used up, leading to bleeding (into skin, urine or stool)

Question 23

What are the common causes of a DIC?

Answer 23

Surgery

Sepsis

Major trauma

Cancer

Question 24

What are the findings of a blood test in DIC?

Answer 24

Low platelets

Low fibrinogen

High INR

Question 25

What scoring system is used to assess chest pain?

Answer 25

HEART score

H - History

E -ECG

A - Age

R - Risk factors (smoking, hypertension, hyperlipidaemia, DM, +FH)

T - Troponin

Question 26

What happens to a patient with a HEART score of 0-3 and a -ve troponin?

Answer 26

Discharged

Question 27

What happens to a patient with a HEART score of 4-6?

Answer 27

Exercise tolerance test

Angiogram

Question 28

What is dual-antiplatelet therapy?

Answer 28

Aspirin + clopidogrel/ticagrelor