Cardiology

Question 1

True vs False aneurysm

Answer 1

all 3 layers of arterial wall

only one layer of fibrous tissue

Question 2

Risk for AAA

Answer 2

HTN, DM, smoking, Marfans

Question 3

AAA rupture where

Answer 3

1/5 rupture anteriorly –> peritoneal cavity (poor prog)

4/5 rupture posteriorly

Question 4

AAA surgery indication

Answer 4

symptomatic
> 5.5cm
increasing size

Question 5

EVAR

Answer 5

endovascular aneurysm repair - stent-graft via guidewire

Question 6

AAA pathology

Answer 6

increased enzyme/MMP activity
decreased elastin synthesis and amount decreases from chest downwards
Immune response
marfans, EDS, ECM degradation gene regulation?

Question 7

types of AAA

Answer 7

saccular - one side
fusiform - equal bulge
ruptured

Question 8

AAA screening

Answer 8

US men 65+

Question 9

AAA rupture presentation

Answer 9

sudden, catastrophic collapse

OR subacute - central abdominal paon, radiates to back, pulsatile mass - developing shock - hypotensive, tachycardic

Question 10

AAA management

Answer 10

low risk - US surveillance

high risk >5.5cm refer 2 weeks vascular surgery

Question 11

Aortic dissection

Answer 11

tear in aorta tunica intima

severe chest pain

Question 12

Aortic dissection features

Answer 12

severe chest pain 
radiates to back 
tearing 
pulse deficit/weak 
systolic BP varies between arms >20mmHg
aortic regurgitation 
hypertension

Question 13

Aortic dissection associations

Answer 13

HTN, trauma, bicuspid aortic valve, marfans, EDS, turners, noonans, pregnancy, syphillis

Question 14

Aortic dissection classification

Answer 14

type A - ascending aorta
type B - desc aorta, distal to L subclavian

type I - originates in ascending, propagates beyond
type II - originates & confined to ascending
type III - originates in descending, mostly extends distally

Question 15

Aortic dissection investigations

Answer 15

CXR - wide mediastinum
CTA - false lumen
TOE - if CT too late/risky

Question 16

Complications of AD tear

Answer 16

aortic regurg
MI
unequal amr pulses/bp
stroke
renal failure

Question 17

Aortic dissection management

Answer 17

type A - surgery manage BP 100-120 systolic while waiting

type B - conservative, reduce BP with labetol prevent progression

Question 18

Bradycardia treatment

Answer 18

Atropine 500mcg IV
If not enough max 3mg
transcut pacing
isoprenaline/adrenaline infusion

Question 19

First degree heart block?

Answer 19

PR interval fixed >200ms

regular rate

Question 20

Second degree T1 heart block?

Answer 20

PR progressively longer till dropped QRS complex

Question 21

Second degree T2 heart block?

Answer 21

P wave regular, AVN doesn’t always respond

Ventricular rate irregularly irregular

Question 22

Third degree heart block

Answer 22

P waves present but completely unsynchronised from QRSs

Question 23

Unstable tachycardia tx?

Answer 23

Shock, syncope, MI, HF

sync DC shocks (max 3)

Question 24

Ventricular tachycardia tx?

Answer 24

regular/broad complex

loading dose of amiodarone then 24hr infusion

Question 25

Atrial fibrillation tx?

Answer 25

irregular/narrow complex
if <48hr = cardioversion
if >48 = betablockers, CCBs

Question 26

AF features

Answer 26

asymptomatic
palps
fainting
chest pain 
congestive HF 
common in elderly

Question 27

Atrial flutter ECG

Answer 27

F flutter waves

Question 28

SVT tx?

Answer 28

vagal manœuvres
IV adenosine 6mg –> 12mg
(CI in asthmatic - use verapamil)
electrical cardioversion

Question 29

SVT prevention

Answer 29

beta-blockers

radiofreq ablation

Question 30

hypertension & diagnosis

Answer 30

24hr ABPM/HBPM
>135/86
clinical > 140/90

Question 31

Secondary causes of hypertension

Answer 31

renal disease
primary hyperaldosteronism 
cushings ...
acromegaly 
steroids, NSAIDs
pregnancy 
coarctation of aorta