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MRCP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Rheumatic fever definition

A

AI disease
type II hypersensitivity
Abs to group A strep cross react w/cardiac tissue
affects joints, heart, brain, skin

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2
Q

Rheumatic fever

JONES MAJOR CRITERIA

A 
CASES
Carditis
Arthritis
Sydenham's Chorea
Erythema marginatum 
Subcutaneous nodules
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3
Q

Rheumatic fever

JONES MINOR CRITERIA

A

fever >38.5
arthralgia
high ESR / CRP
prolonged PR

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4
Q

Constrictive pericarditis is associated with

c

A

previous Cardiac surgery
Connective tissue disease
Radiotherapy

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5
Q

Signs of constrictive pericarditis

A

Kussmaul’s sign

pericardial knock

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6
Q

Kussmaul’s sign

A

JVP paradoxically rises on inspiration

seen in constrictive pericarditis

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7
Q

Pioglitazone SE

A

fluid retention in 10%

(especially if with NSAIDs, CCBs)

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8
Q

Sulphonylurea SE

A

photosensitivity rash

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9
Q

Statins, fibrates SE

A

myositis

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10
Q

Drugs causing photosensitivity rash

A

amiodarone, thiazides, ACEi, ARBs, sulphonylurea

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11
Q

Mx pulseless VT or refractory VF

A

amiodarone 200mg made up to 20ml 5% dextrose

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12
Q

Peripartum cardiomyopathy

When does it present

A

few weeks either side of delivery

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13
Q

Peripartum cardiomyopathy

Signs and Symptoms
Cause
Mx

A

Signs/Sx fo HF

Aetiology unknown / idiopathic

Mx = echo, diuretics, BB, vasodilators

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14
Q

Peripartum cardiomyopathy means higher risk of

A

ventricular arrhythmias and cardiac arrest

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15
Q

RFs for IE

A

valvular HD (stenosis, regurg)
congenital HD / surgically corrected CHD
previous IE
hypertrophic cardiomyopathy

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16
Q

Worse prognosis in IE if

A 
staph aureus acute IE
HF
IVDU
prosthetic valve infection 
aortic valve infection
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17
Q

Why would culture be negative in IE

A

ABx treatment
fungal infection
inadequate testing

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18
Q

Rhabdomyolysis definition

A

muscle symptoms and CK >10x ULN

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19
Q

Features of rhabdomyolysis

A

AKI
raised AST
brown urine
urine myoglobin

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20
Q

Blood tests for myopathy

A

CK

TFTs (hypothyroidism -> high cholesterol and high CK)

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21
Q

MOA statins

2

A

HMG CoA reductase inhibitors

Decrease hepatic cholesterol synthesis

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22
Q

HTN Mx

<55
not afrocarribean
T2DM

What if intolerance or high risk HF/HF?

A

ACE inhibitor

or ARB

HF - thiazide

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23
Q

HTN Mx

> 55 or afrocarribean

1st line

2nd line

A

1st line = CCB
(not ACEi as afro-carribean lower renin levels and less responsive to ACEi)

2nd line = thiazide

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24
Q

MOA cocaine induced MI

A

coronary artery vasospasm

as a-adrenergic receptor stimulation SM cells

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25
Q

Rx cocaine-induced MI

A

nitrates and calcium antagonists

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26
Q

Type MI and artery affected

I, aVL, V5-6

A

Lateral

Circumflex artery

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27
Q

Type MI and artery affected

V1-4

A

Anterior

LAD

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28
Q

Type MI and artery affected

II, III, aVF

A

Inferior

RCA

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29
Q

Most specific for MI on ECG

A

Q wave evolution

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30
Q

Causes of raised cardiac enzymes

A

MI
PE
Renal failure
Sepsis

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31
Q

MOA Ezetimibe

A

inhibits cholesterol absorption

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32
Q

Management symptomatic WPW

A

ablation

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33
Q

WPW ECG features

A

delta wave

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34
Q

Features atrial myxoma

A

rare benign cardiac tumour

usually left atrium

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35
Q

Signs of atrial myxoma

1/3

A

1/3 emboli
1/3 systemic infl (high ESR)
1/3 ASx

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36
Q

Signs atrial myxoma

A

LA dilatation
sudden death
mid diastolic click

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37
Q

What is Carney’s complex?

A

familial multiple neoplasia (various tumours including myxoma)

primary adrenal hypercortisolism

lentigines and naevi of the skin

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38
Q

Mx of HF

1st line

2nd line

HF and AF

A

1st line = ACEi and BB (e.g. carvedilol)

2nd line = Spironolactone

HF and AF = digoxin

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39
Q

Statin muscle disorders

myalgia vs myositis

A

myalgia = muscle Sx + CK normal

myositis = muscle Sx + CK <10x ULN

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40
Q

cause statin induced myopathy

incidence statin myopathy and rhabdomyolysis

A

unknown aetiology

myopathy - 1 in 10,000
rhabdomyolysis 0.44 in 10,000

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41
Q

Ix for ?statin induced myopathy

A

CK

TFTs (hypothyroidism -> high triglycerides and high CK)

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42
Q

RFs for statin induced myopathy

A 
age >80 
female
low BMI
xs alcohol
vigorous exercise
untreated hypothyroidism
infection/surgery/trauma
cyt p450 inhibitors
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43
Q

drugs causing rhabdomyolysis

A

statins
neuroleptics
clofibrate, aminocaproic acids

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44
Q

fibrates MOA

A

decrease triglycerides

by increasing lipoprotein lipase activity

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45
Q

signs cholesterol emboli in legs

A

LL petichial rash
pulses intact (chol. crystals small)
high WCC and eosinophilia (infl reaction to cholesterol)

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46
Q

Rx of
Type A aortic dissection

Type B dissection

A

Type A - surgery

Type B - IV labetolol (aim SBP 100-120)

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47
Q

High urea leads to which kind of pericarditis? why?

A

fibrinous pericarditis

uraemia -> fibrin exudation onto pericardial surfaces

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48
Q

Lipid abnormalities in T2DM

A

High triglycerides

Small dense LDL molecules

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49
Q

Commonest cause of Mitral Regurg

A

Myxomatous degeneration

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50
Q

Commonest cardiomyopathy and cause of sudden death

A

Hypertrophic cardiomyopathy

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51
Q

What is hypertrophic cardiomyopathy?

A

LVH without identifiable cause

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52
Q

Likely cause death in LT haemodialysis pt?

Why?

A

MI

as dialysis -> arterial calcification

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53
Q

Cause myocarditis

A

Cocksackie B virus

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54
Q

Aliskiren (for HTN) MOA

A

renin inhibitor

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55
Q

5 days post MI

Pulmonary oedema + systolic murmur

Cause?
Ix?

A

Acute LV failure
(due to: mitral valve prolapse, VSD, acute pericardial effusion/ haemorrhage)

Ix = R heart catheterisation + oximetry
(to check LA pressures and confirm MV prolapse)

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56
Q

Previous MI

Persistent ST elevation, apex displacement, CP and LOC

Cause?

A

LV aneurysm post MI

LOC would be due to cardiac syncope or TIA from LV thrombus

57
Q

CI to thrombolysis for acute MI

A

recent surgery

would to angioplasty instead

58
Q

Rx Torsades de Pointes

A

IV Mg

59
Q

Flash pulmonary oedema

BG HTN

Arteriopath (e.g. smoker)

A

Renal artery stenosis

60
Q

Type of pain more specific for myocardial ischaemia

A

Jaw radiation

NB pain relief can occur with MI or oesophageal spasm

61
Q

Beck’s triad

sign of?

A

CARDIAC TAMPONADE

Raised JVP
Hypotension
Muffled heart sounds

AND pulsus paradoxus (> 10mmHg fall SBP on inspiration)

62
Q

TriCuspid valve JVP waveform

A

C wave

triCuspid

63
Q

PDA murmur

A

continuous machinery murmur

64
Q

What is eisenmenger’s syndrome?

Features?

A

Reversal L->R shunt causing pulmonary HTN and causes R-> shunt

Get peripheral cyanosis + toe clubbing

65
Q

Describe pathological Q waves

A

> 1mm wide
2mm deep
in V1-V3

66
Q

nicotinic acid

MOA

SEs

A

reduce cholesterol and triglyceride synthesis

increase HDL cholesterol

SE = vasodilation

67
Q

Mitral stenosis murmur

A

diastolic
loud first HS
opening Snap

68
Q

Commonest reason for bioprosthetic valve replacement

A

calcification prosthetic valve

69
Q

Commonest echo findings Marfan’s

A

dilatation aortic sinuses

-> dilated aortic root

70
Q

Glycaemic control for DM post MI

A

s/c insulin for 6 weeks

then switch to metformin

71
Q

Features significant PE

A

RV strain

high troponin

72
Q

cerebral infarct in young person

with no palpitations

Cause?

A

PFO (causes paradoxical emboli)

No palps hence unlikely AF

73
Q

Marker for early cardiac damage (in first 3h of MI)

A

GPBB

isoenzyme glycogen phosphorylase in cardiac muscle

74
Q

When does troponin I and T rise in MI

A

3-12 hours after CP onset

peak 24-48 hours

baselin at 5-14 days

75
Q

Features malignant hypertension

A

Papilloedema

Convulsions

Pulmonary oedema

76
Q

Rx malignant hypertension

A

IV nitroprusside

77
Q

Why is labetolol not first line in malignant HTN

A

can lower BP too rapidly

leading to cerebral infarcion in watershed areas

78
Q

Ebstein’s anomaly echo

A

Downward tricuspid valve displacement

Hypoplastic RV

ASD

79
Q

Cause Ebstein’s anomaly

A

Foetal lithium exposure

80
Q

Ebstein’s anomaly ECG features

A

RBBB

81
Q

Features tricuspid regurg

A

TRICUSPID REGURG

Pansystolic murmur

Raised JVP

Pulsatile hepatomegaly

82
Q

Dose Adr in cardiac arrest

A

10ml of 1 in 10,000

83
Q

CI to BB

A

asthma

heart block

84
Q

Causes of AS

A

calcified aortic valve
rheumatic disease (-> fibrosis)
bicuspid aortic valve - GET EJECTION SYSTOLIC CLICK

85
Q

SE 2 hours after taking atenolol

A

fatigue (common)

86
Q

ECG features hypercalcaemia

A

Bradycardia
Long PR
Short QT

87
Q

Causes pan-systolic murmu

A

Mitral regurg
Tricuspid regurg
VSD

88
Q

Hypocalcaemia ECG features

A

Long QT

89
Q

Mx Narrow complex tachycardia

A

if haemodynamically stable:

  • carotid massage
  • valsalva maneouvre
  • IV adenosine (unless asthma

if haemodynamically UNSTABLE
- DC cardioversion

90
Q

How to calculate EF

A

EF = Stroke volume/ end diastolic volume

91
Q

Artery supplying AVN and SAN

A

RCA

92
Q

MOA adenosine

A

coronary vasodilatation

depression SAN and AVN conduction

93
Q

Main factors affecting coronary blood flow

A

myocardial oxygen consumption

independently maintained regardless of BP

increase in O2 requirement -> more adenosine produced -> vasodilation

94
Q

Marfan’s syndrome inheritance

A

AD

95
Q

Features of Marfan’s syndrome

A 
Mv prolapse
 Aortic regurg
 Retinal detachment, glaucoma, cataracts, 
 dislocated lens 
 Flat feet 
 Arachnodactyly
pNeumothorax
 Scoliosis, pectus excavatum + carinatum
96
Q

Examples HTN disorders of pregnancy

A

Chronic HTN
Gestational HTN
Preeclampsia-eclampsia
Preeclampsia + chronic HTN

97
Q

Paracetamol OD:

Staggered doses

Single OD

A

Staggered - give NAC (high risk liver failure)

Single OD - level +/- NAC

98
Q

Rx benzodiazepine OD

A

Flumazenil

99
Q

Assessment opiate OD

A

Check for
respiratory depression

Pinpoint pupils

100
Q

Rx amitriptyline OD + VT and QRS widening

A

Sodium bicarb for VT + TCA OD

101
Q

What are biological assays for?

A

ASsess POTENCY of different preparations

102
Q

What is a sequential trial

A

Data analysed after results available

Trial continues until clear benefit seen

103
Q

Turner’s syndrome cardiac features

A

HTN in 10%

Aortic coarctation (low LL pulse, difference BP in UL and LL)

Horseshoe kidneys -> renal dysfunction

104
Q

Commonest congenital birth defect

A

VSD

105
Q

Brugada syndrome

A

structurally normal heart

ventricular arrhythmia

ECG ST elevation V1-3

106
Q

45M collapsed whilst jogging

ECG, bloods, CXR normal

Dx?
Prognosis?

A

Exercise-induced VT

(normal tests rule out structural HD and rhythm disturbance)

Has no impact on mortality

107
Q

75M

previous MI, on amiodarone

Long QT now

Mx?

A

Stop amiodarone (-> iatrogenic long QT)

108
Q

73M wt loss and palps for 3m

On Amiodarone

TSH low
total t4 high

Next Ix?

A

serum free T4 concentration

109
Q

51M Indian SOB wt loss

CXR calcification on cardiac outline

Cause?

A

TB ->constrictive pericarditis

tb likely to cause calcification

110
Q

75M just had stenting inferior MI

persistent low BP
ECG 2nd degree HB, HR 40, SOB

Rx?

A

temporary pacing wire (so can wait for MI to resolve)

111
Q

Target BP for anti HTN in pregnancy

A

135/85

112
Q

Good clinical indicators for ACS chest pain

A

typical pain >15 mins

nausea and sweating

113
Q

75M

AF
had anticoag then cardioverted

Drug most likely to maintain sinus rhythm?

A

Amiodarone

114
Q

54M
doxorubicin + trastuzumab fr breast Ca

Signs of HF

Cause?

A

Dilated cardiomyopathy

115
Q

Markers worse prognosis HF

A

high BNP
Anaemia
Hyponatraemia
High uric acid

116
Q

Pulsus alternans (alternation force of arterial pulse)

is sign of?

A

severe LV dysfunction

117
Q

jerky pulse sign of

A

HOCM

118
Q

Good marker to detect re-infarction 72h post MI

A

CK MB

119
Q

Rx for remission granulomatosis with polyangiitis

A

Methylprednisolone

Cyclophosphamide

120
Q

Commonest site VSD

A

Perimembranous septum

121
Q

Reversible causes dilated cardiomyopathy

A

selenium deficiency

122
Q

Carotid artery stenosis
80% R and 90% L

ASx

Next step in Mx?

A

D/c and OPT f/up

as ASx

123
Q

Wide fixed splitting second HS

A

uncomplicated ASD

124
Q

17F
Hx of collapses

Echo LV and septal hypertrophy and septum has ground glass appearance

A

HOCM

125
Q

2nd degree HB + RBBB

risk of?

A

complete HB

126
Q

High cholesterol and triglycerides

Normal ApoB

palmar xanthoma (orange creasis)

xanthomata elbows + knees

A

Type III hyper lipidaemia (remnant hyperlipidaemia)

occurs abnormal ApoE receptor function - needed to clear chylomicron remnant

127
Q

Very high triglycerides

N/H cholesterol

A

Chylomicronaemia

no increase risk atherosclerotic disease

128
Q

Pelvic artery calcification on XR after NOF fracture

Mx?

A

Do nothing

129
Q

when to start nicotinic acid for hyperlipidaemia

A

statin failing

specialist can add on nicotinic acid

130
Q

64F
blackouts
ECG complete HB
and p wave asystole (no QRS complexes)

A

transcutaneous pacing

131
Q

low frequency mid diastolic murmur

A

Austin flint murmur

in AR

132
Q

CI thrombolysis

A

previous haemorrhagic stroke

GI/ heavy vaginal bleeding

recent stroke or surgery

severe uncontrolled HTN

CPR >half hour

133
Q

Troponin I and T

levels rise at

peak at

baseline

A

rise 3-12 hr after pain

peak 24-48 hr

baseline after 5 days

134
Q

CK MB

levels rise at

peak at

baseline at

A

rise 3-12 hours

peak at 24 hours

baseline after 3 days

135
Q

cardiac marker quickest to return to baseline

A

CK MB

136
Q

Most sensitive early marker for MI

A

myoglobin

137
Q

Commonest cause mitral stenosis

A

rheumatic HD

CHD, calcification SLE…

138
Q

73M given cocaine injection for bronchoscopy

ECG shows anterior MI

Rx?

A

Nitrates (as MOA is vasoconstriction not thrombosis)

139
Q

amiodarone (MOA) blocks which channels

A

K channels

MRCP (12 decks)

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