Cardiology

Question 1

What other investigation must you do before you order a CTPA for suspected PE?

Answer 1

CXR

Question 2

Once ventricular fibrillation is identified, what is the first thing you do?

Answer 2

One shock, followed by 2 minutes of CPR

Question 3

How does fluconazole affect INR in a patient taking warfarin?

Answer 3

It increases the INR (blood too thin)

Fluconazole is a CYP450 inhibitor, ∴ warfarin is not metabolised and builds up in the system

Question 4

Hypokalaemia causes QT ___?

Answer 4

Prolongation

Question 5

First line medication for preventing anginal attacks?

Answer 5

Β-blocker or RL calcium channel blocker (e.g. verapamil, diltiazem)

Never prescribe RL-CCB and β-blockers together

If prescribing both, use a non-RL-CCB (e.g. nifedipine)

Question 6

How does clarithromycin affect INR in a pt on warfarin?

Answer 6

It increases INR. Clarithromycin is an enzyme inhibitor.

Question 7

Symptomatic bradycardia, atropine (3g) failed, next step?

Answer 7

External pacing

Question 8

Non-shockable rhythm identified. What is the first step?

Answer 8

1mg adrenaline, then commence CPR for 2 minutes

Question 9

When do you give adrenaline in VT/VF?

Answer 9

1mg adrenaline after CPR has commenced after the THIRD DC shock

Question 10

How does phenobarbital affect INR?

Answer 10

Decreases it (blood is thicker)

Question 11

PR interval in WPW syndrome?

Answer 11

Shortened

Question 12

AF <48h, electrical cardioversion planned. What do you need to do?

Answer 12

Start anticoagulants immediately alongside DC cardioversion

Anticoagulant should be rapid onset (e.g. heparin) and can be stopped when sinus rhythm is restored

Electrical cardioversion is also preferred to pharmacological cardioversion, especially if SHD present

Question 13

PE Well’s ≤ 4 + D-dimer negative?

Answer 13

Stop anticoagulation and consider alternative diagnosis

Question 14

Ejection systolic murmur, fixed split S2, and louder on inspiration?

Answer 14

ASD

Question 15

Major bleeding on warfarin?

Answer 15

Stop warfarin, IV 5mg vitamin K + prothrombin complex concentrate

Question 16

Cardiac arrest, PE suspected cause. What additional drug do you give?

Answer 16

Alteplase

Question 17

What do you do about anticoagulation in a patient who had a catheter ablation for their AF?

Answer 17

Continue long term anticoagulation

Question 18

Acute SOB + hypotension in someone with suspected MI?

Answer 18

Acute mitral regurgitation due to rupture of papillary muscle ⇒ backflow of blood from LV into LA during systole ⇒ prevents pulmonary veins draining into LA ⇒ pulmonary congestion ⇒ oedema

Question 19

Most appropriate next step in someone with paroxysmal AF (first presentation, booked appt when felt palpitations but now resolved)?

Answer 19

Calculate CHA2DS2-VASc and consider DOAC

Single episode of paroxysmal AF should still prompt consideration of anticoagulation

Question 20

Tall R waves in V1 and V2?

Answer 20

Posterior myocardial infarction, typically a LCA occlusion

Replace leads on the posterior chest wall and repeat ECG

Question 21

STEMI pt, having PCI. What anticoagulation do you give them?

Answer 21

Pci = Prasugrel (+aspirin)
If already antiCoagulated = Clopidogrel

Prasugrel is a more effective anticoagulation with regards to stent insertion, but therefore causes more bleeding. Clopidogrel is less effective so if already on anti-coag, you don’t want to push them over the edge into a bleeding problem, so you give them the lesser of two anticoagulants.

Question 22

Criteria for aortic valve replacement in AS?

Answer 22

• If symptomatic, replace

- If asymptomatic but valvular pressure gradient >40, consider for replacement

Question 23

What electrolyte disturbances (urine + serum) can thiazide diuretics cause?

Answer 23

Hypercalcaemia and hypocalciuria

Question 24

Pt with non-small cell lung cancer, comes in with nausea, third, constipation, joint pain, and fatigue. What might his ECG show?

Answer 24

Short QT interval. Pt likely has hypercalcaemia.

Squamous cell carcinomas of lung produce PTHrP ⇒ hypercalcaemia

Question 25

Intermittent limb claudication, absent/weak peripheral pulses, young woman ⇒ ?

Answer 25

Takayasu’s arteritis

Question 26

3 possible causative agents of pericarditis

Answer 26

Enteroviruses (e.g. coxsackie, echovirus) - MOST COMMON
Mumps
Rubella
Hepatitis B 
Influenza

Question 27

Acute pericarditis + erythema nodosum (or other skin lesions) + eye problems + genital/oral ulcers = ?

Answer 27

Behcet’s

Question 28

Atherosclerosis risk factors: MR SHAHED

Answer 28

Male
Race
Smoking
Hypertension
Age/alcohol/AF
Hyperlipidaemia
Exercise/eating (poor)
Diabetes

Question 29

Collapsing pulse + early diastolic murmur = ?

Answer 29

Aortic regurgitation

May also find Corrigan’s sign and wide pulse pressure