Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

yr3 > cardio SBAs > Flashcards

cardio SBAs Flashcards

1
Q

Most definitive investigation for prosthetic valve endocarditis

A

Transoesophageal echocardiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Marfan’s syndrome (autosomal dominant) CVS criteria

A

Aortic dissection
Aortic dilatation
Mitral valve calcification
Mitral valve prolapse (with or WITHOUT regurg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Atrial myxoma on auscultation

A

Loud S3

Will present with non-specific symptoms of fever, SOB, syncope. Blood tests = raised ESR and TOE diagnoses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

62 year old man with enlarging pulsatile mass in left groin. 3 days previously he had had a coronary angiogram.

A

False aneurysm, most are due to iatrogenic trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Metabolic syndrome includes

A 
insulin resistance
IGT
central obesity
dyslipidaemia
hypertension

Risk of developing T2DM is 5x higher in those with metabolic syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

50 yr old man presents with typical history of exertional angina with ischaemic changes on resting ECG. Coronary angiography shows 70% stenosis of LAD, no lesions elsewhere. What should treatment be?

A

Those with LMS disease, 3 vessel disease or a reduced EF may benefit from CABG. Most single vessel disease can be adequately managed with PCI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Young male with hypertension and LVH likely diagnosis and presentations?

A

Coarctation of aorta
High BP
RF delay
Mid-systolic murmur in aortic area that radiates to back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnosis of phaeochromocytoma

A 
Urine metanephrines (metadrenalines)
Sensitive and specific

[Rx = a-blockers then b-blockers]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Constrictive pericarditis (chronic) signs + symptoms

A

Pleuritic chest pain
Quieter S1 and S2 sounds due to pericardium wall thickened
Increased JVP on inspiration (Kussmaul’s sign)
Pulsus paradoxus (low systolic BP >10mmHg on inspiration)
Hepatomegaly
Ascites, oedema, AF
Widespread saddle-shaped ST segments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cannon ‘a’ waves on JVP

A

Complete heart block
Single chamber ventricular pacing
Ventricular arrythmias (e.g. sustained VT - broad QRS)
Ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-sustained VT is defined by

A

> 5 consecutive heartbeats within 30secs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Torsades de pointes

A

irregular QRS complexes and prolonged QT interval

a type of polymorphic VT. Can develop into cardiac arrest. Rx: IV magnesium sulfate and ventricular pacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Variant (Prinzmetal’s) angina

A

random ST elevation (can be at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HOCM is associated with risk of sudden death. Treatment includes

A
  1. b-blockers

2. CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pregnant hypertensive patients Rx

A
  1. methyldopa (a2-receptor agonists)

2. b-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of left ventricular failure

A 
Exertional dyspnoea
Palpitations/AF
Atypical chest pain
Displaced apex beat
Bibasal crackles (pulmonary congestion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mitral regurg (backwars flow form LV to atrium in systole) common causes…

A

Rh heart diease
Infective endocarditis
Mitral valve prolapse (post-MI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Types of cardiomyopathy

A
  1. restrictive
  2. dilated
  3. hypertrophic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cardiac tamponade is caused by pericarditis. Tachycardia and pulus paradoxus are signs, along with Beck’s triad of…

A
  1. Increased JVP
  2. Decreased BP
  3. Muffled heart sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aortic dissection investigations and treatment

A

CXR - widening of aorta
CT/MRI scans - diagnostic. If confirmed, BP reduction and dampening of aortic systolic wave by b-blockers and consider urgent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A 12 year old boy presents with polyarthritis and abdominal pain. He had a sore throat about a week ago. Examination reveals an early blowing diastolic murmur at the L sternal edge. There are bilateral involuntary jerky movements worse when the patient is asked to make a movement. What is the likely diagnosis?

A

Rheumatoid fever.
Caused by an AI process post-strep (group A) infection.
5 major manifestations of acute rheumatic fever are carditis, polyarthritis, chorea, erythema marginatum and subcutaneous nodules.
Other signs can also be seen e.g. spooning sign and pronator sign.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A 16 year old boy presents with 5 month history of chest pain on exertion and two episodes of collapse in the last month. There is also progressive SOB on exertion and now he cannot walk up the stairs without stopping. Examination reveals a loud systolic murmur. What is the likely diagnosis?

A

Aortic stenosis
It can present with chest pain, dyspnoea and syncope
The pulse pressure is narrow and there may be an associated slow-rising and plateau pulse.
This is a congenital cause (HOCM causes pan-systolic murmur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 13 year old girl presents with increasing SOB, particularly when lying down at night to try to sleep. She has also noticed some ankle swelling. Examination reveals a raised JVP, tachycardia and an S3 gallop rhythm on cardiac auscultation. What is the likely cause?

A

CCF (congestive cardiac failure)

SOB with orthopnoea due to the sudden increase in pre-load, indicates LV failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A 70-year-old diabetic male presents with severe pain in his L foot. The pain is at rest and is alleviated by hanging his leg off the foot of the bed at night. O/E: advanced gangrene with superimposed infection of the left foot with absent dorsalis pedis and posterior tibial pulses. What is the likely diagnosis?

A

There is advanced gangrene here - complication of necrosis. It can be due to ischaemia, trauma or infection. With severe limb sepsis, amputation is needed.
Diabetes (high glucose, impaired immunity, peripheral neuropathy and arterial disease) is a RF here for infectious and ischaemic gangrene. Absent pulses and symptoms = critical limb ischaemia, with diabetic chronic peripheral arterial disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Necrotising faciitis may cause infectious gangrene. Common causative organism is

A

Streptococcus pyogenes

26
Q

Causative organism of gas gangrene

A

Clostridium perfringens

27
Q

A 65-year-old female presents with sudden-onset pain in her L calf. She is taking digoxin and verapamil for her ‘funny’ heart beat. O/E, the left leg is pale, cold and painful. What is the likely diagnosis?

A

The patient’s arrhythmia led to an embolus that has resulted in acute limb ischaemia.
There is a sudden decrease in limb perfusion with threatened tissue viability. An emergency vascular assessment needs to be done with duplex USS.
Rx = anticoagulation, thrombolysis, ±embolectomy

28
Q

Ankle brachial pressure index (ABPI) results less than or equal to 0.9 are diagnostic for…

A

Peripheral vascular disease

n.b. test may not be accurate if patient has non-compressible arteries (diabetic patients and obese)

29
Q

5 Ps of limb ischaemia

A 
pale
perishingly cold
paralysis
paraesthesia
pulseless
30
Q

A 55-year-old obese smoker presents with pain in his legs on walking 800 metres, which is immediately relieved by rest. His ankle-brachial pressure index (ABPI) is 0.9. What is the likely diagnosis?

A

This is peripheral vascular disease with classic symptoms of intermittent claudication. ABPI should be performed in symptomatic patients. This patient has only presented with claudication which is not severely lifestyle limiting so treatment is not always required. Monitor development of ischaemic symptoms or CVS complaints.

31
Q

A 65-year-old man collapsed in his home. He had excruciating pain in his lower back. O/E: the patient is pale and cold with shut-down peripheries. There is a palpable epigastric mass. What is the likely diagnosis?

A

This is a history of a ruptured AAA. This patient has blood loss and is in haemorrhagic shock.
As this AAA has ruptured = urgent surgical repair, with standard resuscitation: ABCDE

32
Q

A 45-year-old T1DM lady is brought in unconscious. She has been ill and neglected to take insulin. The right leg is wrapped up in bandages. When these are removed, there is evidence of gangrene (tissue is dry, black and cold) . There is fixed mottling of the skin up to the mid-shin level. What is the diagnosis?

A

Atherosclerosis is associated with DM and causes dry gangrene due to chronic impairment of blood flow. Evidence of non-viability and irreversibility of affected limb: major tissue loss, sensory loss with rest pain, inaudible arterial Doppler signals and muscle weakness. Fixed mottling does not blanch on pressure and is associated with a limb which is beyond salvage.

33
Q

A 40-year old gentleman with a history of diabetes mellitus and CHD presents with pain in his buttocks after walking only 100m. He has had difficulty to maintain an erection. O/E: femoral pulses are absent.

A

Leriche’s syndrome - involves abdominal aorta +/ both iliac arteries

Triad: buttock claudication, impotence, reduced/absent femoral pulses.

34
Q

An ambulance crew is dispatched to attend a 999 call made by passers-by. A 71-year-old diabetic lady at a bus stop collapsed, could not get up and was complaining of back pain. After basic investigations, she was taken to hospital. Subsequent CT showed no abnormalities. What is the diagnosis?

A

Atypical MI which is more common in diabetics and the elderly, due to autonomic neuropathy. These are ‘silent’ MI and should be excluded in all causes of collapse. An ECG is indicated here after the clear CT scan.

35
Q

A 62-year-old diabetic lady presents with recurrent ulceration of the gaiter area of the left leg. The ulcer is well circumscribed, irregular in shape and of partial thickness. There is a brown discolouration and ‘eczema’ over both calves. What type of ulcer is this?

A

Venous ulcers - usually from deep venous insufficiency and follows trauma.
They are on medial gaitre region with oedema, brown skin discolouration due to haemosiderin deposition, lipodermatosclerosis and an inflammatory response - eczema-like thickening and hardening of the skin. The skin is drawn tightly around the ankle. Shape is irregular with granulation tissue base (sloughy) and sloping edges.

36
Q

Punched out lesions

A

Arterial ulcers

37
Q

A 60-year-old obese man presents with a ulceration on the sole of the right foot, beneath the metatarsal heads. The ulcer is deep and penetrating, however the skin around it appears well perfused. There is no pain and ankle reflexes are absent bilaterally. What is the diagnosis?

A

This is diabetic neuropathy (microvascular complication of DM due to peripheral nerve dysfunction).

Complications: painless neuropathic ulcer at weight loading sites, to the Charcot foot. Treat neuropathic pain with gabapentin, pregabalin, duloxetine

38
Q

Types of aortic dissection (Stanford classification)

A

Type A - ascending aorta

Type B - descending aorta

39
Q

What order are valves affected in infective endocarditis

A

Mitral
Aortic
Tricuspid
Pulmonary

40
Q

Roth spots

A

Petechiae on retina

Occurs in infective endocarditis

41
Q

Infective endocarditis medical Rx before surgery (valve replacement)

A

Clinical suspicion + Strep - benzylpenicillin + gentamicin
Staph + HACEK - flucloxacillin/vancomycin + gentamicin
Enterococci - ampicillin + gentamicin
Culture - vancomycin + gentamicin

42
Q

Absent ‘a’ waves on JVP waveform

A

Atrial fibrillation

Dysfunctional atrial systole (contraction)

43
Q

Large ‘a’ waves on JVP waveform (n.b. this is not cannon ‘a’ waves)

A

Pulmonary hypertension/stenosis

44
Q

Large ‘v’ waves in JVP waveform

normally v wave = atrial (venous) filling when tricuspid valve is closed.

A

Tricuspid regurgitation

45
Q

Pansysytolic murmur heard best at lower L sternal edge during inspiration, in a patient with pulsatile hepatomegaly suggests…

A

Infective endocarditis with tricuspid regurgitation

Common in IVDU
Giant systolic ‘v’ waves seen in JVP

46
Q

Elevated JVP with absent pulsation is caused by…

A

SVC obstruction

bronchial carcinoma is a cause of this. other symptoms: early morning headache, facial congestion, oedema with upper limb involvement.

47
Q

Jerky pulse suggests

A

HOCM
Mitral regurg
Mixed aortic valve disease

48
Q

Pulsus paradoxus occurs in

A

Constrictive pericarditis

Cardiac tamponade

49
Q

Loss of sensation in acute limb ischaemia signifies…

A

limb is not viable

50
Q

Causes of heart block

A 
MI/ischaemic heart disease - commonest
Infection - Rh fever, IE
Drugs - digoxin, b-blockers, CCBs
Infiltration - sarcoid, amyloid, tumours
Degeneration
51
Q

Target blood pressures in:
HTN patient
HTN diabetic without proteinuria
HTN diabetic with proteinuria

A

HTN - <140/90
HTN diabetic w/o proteinuria - <130/80
HTN diabetic w/ proteinuria - <125/75

52
Q

Severe HTN (diastolic BP >140mmHg) Rx

A

Atenolol or nifedipine

53
Q

In patients who cannot undergo exercise ECG can do pharmacological stress testing. This uses drugs such as

A

Dipyridamole
Adenosine
Dobutamine

These induce tachycardia

54
Q

Tests to confirm group A strep presence (i.e. cause of rheumatic fever)

A

Bloods - FBC (WCC), high ESR/CRP, high anti-streptolysin O titre
Throat swab - GAS cultures, rapid strep Ag test
ECG - carditis
Echocardiogram

55
Q

Causes of tricuspid regurg

A

Congenital: Ebstein anomaly, cleft valve in ostium primum defect
Functional: RV dilation, valve prolapse
Rheumatic heart disease
Infective endocarditis
Other: carcinoid syndrome, trauma, cirrhosis

56
Q

Infective endocarditis common causative organisms

A

Streptococcus
Staphylococcus
Enterococcus
Other: HACEK - haemophilus, actinobacillus, cardiobacterium, eikenella, kingella

57
Q

Strep bovis in IE is associated with

A

GI malignancy

colonoscopy is important

58
Q

Define:
Janeway lesions
Osler’s nodes

A

Janeway lesions - painless palmar macules, blanch on pressure.
Osler’s nodes - tender nodules on finger/toe pads.

59
Q

Patients with multiple recurrent pulmonary embolism may have symptoms associated with

A

Pulmonary hypertension

R heart failure

60
Q

Carvallo sign

A

Pansystolic murmur louder on inspiration

i.e. in tricuspid regurg

61
Q

CXR shows double shadow right heart broder, prominent left atrial appendage and left main bronchus elevation. What is the likely diagnosis?

A

Mitral stenosis

advanced with these signs of elevation of L main bronchus, double R heart border, carina widening, prominent L atrial appendage. mitral valve may also be calcified and pulmonary oedema.

yr3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions