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Cardiology Flashcards

1
Q

SOB, experiencing weakness and tiredness

A

Pulmonary hypertension

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2
Q

high pitched decrescendo murmur

A

Pulmonary regurgitation and therefore pulmonary hypertension

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3
Q

treatment for pulmonary hypertension

A

oxygen therapy, diuretics and bosentan

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4
Q

secondary to pulmonary hypertension and causes oedema

A

right heart failure

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5
Q

Bosentan is an endothelin receptor antagonist. Endothelin is a

A

vasoconstrictor

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6
Q

SOB, jugular veins distend even when he inspires

A

Constrcitive pericarditis

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7
Q

budd chairi syndrome

A

blood clots in the hepatic vein or inferior vena cava

-flattened neck veins

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8
Q

supraventricular tachycardias are

A

narrow complex tachycardias QRS <120ms

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9
Q

long term hypertensions and painful burning sensation in both legs

A

coarctation of the aorta

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10
Q

patients present with hypertension in the upper extremities and hypotension in lower extremities

A

coarctation of the aorta

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11
Q

CXR-notching of ribs

A

coarctation of the aorta

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12
Q

renal artery stenosis

A

bruit on auscultation of abdomen and creatinine would be elevated

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13
Q

machine like murmur

A

patent ducts arteriosus

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14
Q

widely split s2

A

atrial septal defect

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15
Q

artery supplies the inferior aspect of the heart

A

posterior interventricular branch - branch off right coronary artery

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16
Q

what does alcohol and caffeine do to blood pressure

A

elevates it

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17
Q

what may cause an abnormally low bp

A

too large cuff

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18
Q

gold treatment for STEMI

A

aspirirn, ticagrelor, LMWH, followed by pci

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19
Q

most likely to be involved in a bundle branch block during an MI

A

Left anterior descending artery

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20
Q

ecg findings of atrial fib

A

absent p waves and irregular qrs complexes

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21
Q

long pr interval indicates

A

heart block

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22
Q

bifid p waves

A

left atrial hypertrophy

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23
Q

2 episodes of penumothorax, ectopia lentis, high arched palate, positive wrist and thumb sign

A

dilated aortic root

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24
Q

marfan syndrome is associated with

A

mitral valve prolapse and aortic aneurysms

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25
Q

coarctation of the aorta is associated with

A

turners syndrome

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26
Q

wide spread st eleveation which are saddle shaped due to the concave upwards shape

A

pericarditis

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27
Q

pacemaker where both atria and ventricles are sensed

A

DDD

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28
Q

pacemaker for chronic atrial fibrilation

A

VVI

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29
Q

when are AAI pacemakers used

A

when there is sinus node dysfunction and intact av conduction

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30
Q

amiodarone impacts

A

thyroid and lung functions

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31
Q

anterior papillary muscle attaches to the — and — cusps of the tricuspid valve

septal papillary muscle attaches to the — and —

posteriour papillary muscle -posterior and septal cups

A

anterior and posterior

anterior and septal

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32
Q

formation of the atrial septum

A

the septum secundum grows down to the right of the septum primum

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33
Q

is not a complication of an uncomplicated atrial septal defect

A

cyanosis

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34
Q

foramen ovale describes a passage through the

A

septum secundum

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35
Q

first month post MI patients cannot have sex but can

A

drink up to 14 units /alchol per week

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36
Q

normal cardiac axis

A

-30 to 90

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37
Q

dyspnoea, ascites, peripheral oedema

A

right sided heart failure

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38
Q

high pitched holosystolic murmur at the left sternal edge radiating to the right sternal edge

A
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39
Q

acutely unwell patients treatment that are SOB

A

sit her up and administer high flow 02

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40
Q

treatment of ventricular tachycardia with any of the follwing- MI, syncope, shock heart failure

A

Synchronised electric cardioversion

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41
Q

treatment of tachycardia and has no adverse effects

A

amiodarone

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42
Q

turners syndrome is associated with

A

coarctation of the aorta

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43
Q
  • palpable diastolic thrill over apex
  • opening snap
  • rumbling low diastolic murmur
A

mitral stenosis

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44
Q

pansystolic murmue heard over the left apex and radiating to the axilla

A

mitral regurg

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45
Q

echo- dilated left ventricle with poor wall motion

A

myocarditis

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46
Q

collapsing pulse and early diastolic murmur , corrigans signs

A

aortic regurg

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47
Q

pulsatile hepatomegaly

A

severe tricuspid regurg

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48
Q

tapping apex, malar flush

A

mitral stenosis

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49
Q

how does squatting affect murmurs

A

increases afterload and preload

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50
Q

Pateints with HCM may have

A

ejection systolic murmur decreased by squatting

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51
Q

jerky pulse, double apex beat

A

HCM

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52
Q

asymetrical hypertrophy of both ventricles

A

HCM

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53
Q

triad for pericardial effusion

A

hypotension , distended neck veins and muffled heart sounds

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54
Q

af treatment

A

rate control- beta blocker or calcium channel blocker

rhythm control - anticoagulant- apixaban

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55
Q

iv drug user, pan systolic murmur 4th left intercostal space( left sternal margin at the 5th costal cartillage)

A

tricuspid regurg most likely due to infective endocarditis

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56
Q

5th intercostal space mid clavicualr line

A

mitral valve

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57
Q

2nd intercostal space right sternal angle

A

aortic valve

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58
Q

slow rising pulse and ejection systolic murmur

A

aortic stenosis

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59
Q

alcohol excess can cause dilated cardiomyopathy, left ventricular dilation often results in mitral regurg which produces a

A

panasystolic murmur radiating to axilla

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60
Q

intra cardiac tumour causing transient left sided weakness

A

atrial myxoma

charactersitc murmur is atrial plop

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61
Q

splinter haemorrhages and pulses below finger nail suggests

A

aortic regurg due to infective endocarditis

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62
Q

how can the you acentuate murmur of aortic regurg

A

sitting the patient forward and asking them to hold their breath on expiration

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63
Q

treatment for broad complex tachycardia and low bp

A

DC cardioversion

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64
Q

irregularly irregular pulse

A

atrial fibrilation

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65
Q

— may cause atrial fib

A

hypERthyroidism

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66
Q

absolute contraindicatio to thrombolysis

A

brain neoplasm, acute pancreitis, oesophageal varices, recent surgery, recent stroke

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67
Q

valve at second left intercostal space

A

pulmonary

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68
Q

unstable angina is a type of

A

acute coronary syndrome

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69
Q

St elevation in inferioru leads, what artery

A

Right coronary artery

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70
Q

St elevation in v1-4

A

LAD

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71
Q

young people with syncope and palpitations,slurred upstroke and wide qrs

A

wolf parkinson white syndrome

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72
Q

small t waves

st depression

prominent u waves

A

hypokalaemia

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73
Q

tall tented t waves, widened qrs

A

hyperkalaemia

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74
Q

shortening of Qt interval- nausea, constipationn , confusion, bone pain

A

hypercalcaemia

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75
Q

prolongation of Qt interval and no effect on t wave

A

hypocalcaemia

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76
Q

ST elevation and unlikely to affect t waves -drowsiness, vomitting, nausea

A

hyponatremia

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77
Q

yellow plaques near eyelid -xanthelasma

A

high cholesterol

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78
Q

increase bilirubin is seen in

A

liver disease, haemolytic anaemias

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79
Q

low sodium diet contains

A

less than 2g

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80
Q

in atrial fib there is absent

A

a waves

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81
Q

endocarditis can cause tricuspid regurg that causes

A

right sided heart failure

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82
Q

systolic cv waves

A

tricuspid regurg

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83
Q

multiple pulmonary emboli w severe leg oedema

A

heart failure and cor pulmoanle secondary to pulmonary emboli leading to pulmonary hypertension

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84
Q

when is there jvp elevation

A

pulmonary hypertension

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85
Q

raised JVP, large A waves

A

pulmonary hypertension

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86
Q

anterior MI, hypotensive and bradycardic

A

complete heart block

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87
Q

canon a wave

A

complete heart block

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88
Q

pansystolic murmur, loudest at left sternal angle and does not radiate to axilla

A

Ventricular septal defect

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89
Q

investigation for renal artery stenosis

A

MRI

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90
Q

harsh pan-systolic murmur, loudest at lower left sternal edge and inaudible at apex and apex is not displaced and does not intensify on inspiration

A

Ventricular septal defect

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91
Q

soft, late systolic murmur at apex radiating to axilla

A

mitral valve prolapse

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92
Q

crescendo-descendo murmur

A

aortic stenosis

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93
Q

PDA is a connection between the

A

aorta and pulmonary artery

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94
Q

slow rising and weak pulse

A

bicuspid aortic valve

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95
Q

history of collapse indicates

A

stenosis

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96
Q

pan systolic murmur heard best at the apex . apex beat displaced laterally

A

mitral valve regurg

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97
Q

collapsing pulse

A

aortic valve regurg

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98
Q

will cause a pan systolic at the apex if there is a co existing mitral regurg, but would otherwise present with mid-systolic click

A

mitral valve prolapse

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99
Q

what should be given right away to limit valve destruction

A

antibiotics

100
Q

elevated jvp, large v waves, pan-systolic murmur at left sternal edge

-pulsatile hepatomegaly, left parasternal heave

A

tricupsid regurrg

101
Q

example of indication for permanent pacemaker

A

complete heart block

102
Q

triphasic systolic and diastolic rub

A

acute pericarditis

103
Q

fever, improved sitting forward, diffuse mild st elevation,

A

acute pericardidits

104
Q

soft blowing diastolic decrescendo murmur

A

aortic regurg

105
Q

opening snap

A

mitral stenosis

106
Q

high pitched pan systolic radiating to axilla

A

mitral regurg

107
Q

continous systolic-diastolic murmur , radiating to back

A

coarctation of the aorta

108
Q

muffled hearts sounds and pulsus paradoxus

A

cardiac tamponade

109
Q

prominent u waves

A

hypokalaemia

110
Q

digoxin toxicity on ECG

A

reversed tick st segment depression

111
Q

increasing PR interval followed by a dropped ventricular complex

A

Mobitz type I second degree heart block

112
Q

what drugs cause QT prolongation

A

phenothiazines, macrolides, quinolones, all type III anti-arrythmic drugs

113
Q

What else causes Qt prolongation

A

Hypokalaemia and bradycardia

114
Q

Excessive qt interval prolongation predisposes to

A

torsades de pointes or polymorphic ventricular tachycardia

115
Q

QRS axis of 150 degrees is what on ECG

A

Right axis deviation

(-30 to 90)

116
Q

delta wave

A

wolf parkinosn white syndrome

117
Q

Patient with heart failure and reduced ejection fraction should be commenced on

A

beta blocker

118
Q

frist line therapy for stable angina

A

calcium channel blocker or beta blocker, alongside nitrates

119
Q

drug for patients with persistent symptoms despite first line treatment for heart failure

A

Digoxin

120
Q

most appropriate treatment for high choelstrol

A

STart atorvastatatin, - not dietary advice

121
Q

advised to stop what class of drugs in chronic heart disease and heart failure

A

calcium channel blocker eg diltiazem

122
Q

first line investigation in primary care for heart failure

A

Serum brain natriuretic peptide and echo 6 weeks later except if had history of MI then should have echo right away

123
Q

most likely cause of a Q wave MI

A

Complete occlusive thrombus

124
Q

coronary artery stenosis is a cause of

A

stable angina

125
Q

pulmonary oedema, lowe limb pitting oedema, elevated JVP

A

heart failure

126
Q

mainfestations of heart failure due to diastolic dysfunction

A

LV hypertrophy, lack of cardiomegaly, LV dilation and S4 heart sound

127
Q

diastolic dysfunction because of LV hypertrophy causes

A

impaired LV relaxation, end-diastolic pressure increases, end-diastolic volume remains normal (as systolic is still intact)

128
Q

loud S1

A

mitral stenosis

129
Q

when might the opening snap be absent and S1 soft in mitral stenosis

A

if mitral valve is calcified or there is severe stenosis

130
Q

Mitral regurg and VSD cause what type of murmur

A

pan-systolic

131
Q

early diastolic murmur

A

aortic regurg

132
Q

what are these classical symptoms of - incrasing fatigue, wheezy , pitting ankle oedema

A

pulmonary heart disease, right ventricular failure, cor pulmonale

133
Q

pulmonary fibrosis can lead to

A

cor pulmoanle

134
Q

drugs known to cause pulmonary fibrosis

A

methotrexate, nitrofurantoin

135
Q

gradual-onset central chest pain, worse on inspiration adn lying flat, relieved by leaning forward. PR depression and concave ST segment elevation in most leads

A

acute pericarditis

136
Q

initial treatment for acute pericarditis if stable

A

ibuprofen

137
Q

winging of scapula due to damage of

A

long thoracic nerve

138
Q

pericarditis is a

A

post viral complication

139
Q

diffuse chest pain improves leaning forward, friction rub, St snegement elevation on most leads

A

pericarditis

140
Q

infective endocarditis iv drug users causative organism

A

staph aureus

141
Q

pulse of aortic regurg

A

collapsing due to wide pulse pressure

142
Q

pulse that can be found in cardiac tamponade

A

pulsus paradoxus

143
Q

pulsus paradoxus can be heard in

A

cardiac tamponade, severe asthma, constrictive pericarditis

144
Q

pulse of heart failure

A

pulsus alternans- pulse with regular rythm but with alternating beats that are weakk then strong

145
Q

aortic stenosis pulse

A

slow rising

146
Q

pulse in takayasu arteritis

A

absent

147
Q

what is the mechanism for 3 heart sounds and latter two heart sounds become further apart on inspiration

A

Increased return to the right heart during inspiration, which prolongs closure of the pulmonary valve- normal not pathological

148
Q

right to left shunting causes

A

cyanosis

149
Q

stiff left ventricle causes

A

third heart sound called S4 but this sound does not vary with inspiration

150
Q

atrial septal defect causes splitting of

A

S2

151
Q

pericarditis or pericardial effusion can have

A

pulsus paradoxus

152
Q

pericardial rub is used in the diagnosis of

A

pericarditis

153
Q

bp over – requires drug therapy

A

160/100

154
Q

heart rate of 180, regularly spaced narrow QRS compexes, no visible P waves. preceding Qrs complexes

A

paraoxysmal supraventricular tachycardia

155
Q

most common cause of PSVT

A

Atrioventricular nodal re-entrant tachycardia

156
Q

irregulary spaced qrs complexes

A

atrial fibrilation

157
Q

best jugular vein for measure of central venous pressure

A

right internal

158
Q

frist line treatment for wolf parkinson white syndrome if stable

A

vagal maoeuvres such as carotid sinus massage or Valsalva manoeuvre, if this fails then adenosine

159
Q

treatment for ventricular tachucardia secondary to MI

A

DC cardioversion with synchronised shock

160
Q

treatment for supraventricular tachycardia that have not responded to vagal manoeivres

A

adenosine

161
Q

pregnancy is a risk factor for developing

A

supraventricular tachycardia

162
Q

has atrial fib and develops palpitations

A

rhythm control- flecainide

163
Q

hyperkalaemia - tall tented T waves - treatment?

A

calcium chloride or calcium gluconate

164
Q

causes of mitral stenosis

A

rheumatic fever, maligant causes, SLE, left atrial myxoma

165
Q

what can mitral stenosis result in

A

left atrial hypertrophy, hoarseness, dysphagia and collapse of the left main bronchus

166
Q
  • malaise, weakness, low grade fever,
  • roth spots(retinal heamorrhages, with pale centres), Oslers nodes( painful red raised lesions on the hands and feet), Janeways lesions( raised papules on hands and feet)
A

Subacute bacterial endocarditis

167
Q

SBE is caused by

A

strep viridans, an oral commensal

168
Q

SLE may cause

A

janeways lesions but not all 3

169
Q

dilated cardiomyopathy is characterised by

A

dilation of all 4 heart chambers , increased end-diastolic volume, decreased contractility, depressed ejection fraction

170
Q

alcoholic, enlarged globular heart, reduced ejection fraction

A

dilated cardiomyopathy

171
Q

VVI pacemaker used in

A

atrial flutter and AF

172
Q

DDD pacemakers used in

A

second degree heart block

173
Q

treatment if got too low sodium

A

restrict fluid intake

174
Q

drug used in acute coronary syndrome without st segment elevation

A

fondaparinux

175
Q

fast rythm with wide complexes

A

ventricular tachycardia

176
Q

broad complexes are – in origin

A

ventricular

177
Q

after cardioversion, x can be given

A

amiodarone

178
Q

one kidney larger than the other

A

renal artery stenosis

179
Q

what drug class can lead to kidney failure

A

ace inhibitor

180
Q

patient presents with hypertension associaetd with too much sodium and not enough potassium. Hypertension resistant to treatment

A

conn syndrome

181
Q

history of neurofibromatosis, hypertension and conplains of sweating, palpitations and intermittent headaches

A

PHAEOCHROMOCYTOMA

182
Q

WHERE TO DETECT TRICUSPID VALVE AND RIGHT VENTRICLE

A

4TH INTERCOSTAL SPACE , LEFT PARASTERNAL AREA

183
Q

FIRT LINE TREATMENT FOR SYMPTOMATIC, MITRAL STENOSIS IF VALVE IS MOBILE AND NOT CALCIFIED

A

BALLOON VALVULOPLASTY

184
Q

IS SEVERE MITRAL STENOSIS — WOULD BE FIRST LINE

A

MITRAL VALVE REPLACEMENT

185
Q

FIRST LINE OPTIONS FOR HEART FAILURE

A

ACEI, BETA BLOCKERS, ALDOSTERONE ANTAGONISTS(SPIRONOLACTONE)

186
Q

Hypertension and patient not liked ccb so give

A

thiazide diuretic - indapamide - increases bone mineral density

187
Q

what valve is located between the left ventricle and ascending aorta

A

aortic

188
Q

aortic valve composed of

A

right, left, posterior cusps

189
Q

anterior and posterior cusps

A

mitral valve

190
Q

antrior, posterior and septal cusps

A

tricuspid valve

191
Q

right, left and anterior cusps

A

pulmonary valve

192
Q

recently pregnant presents with, SOB, pitting ankle oedema, rigth axis deviation

A

primary pulmonary hypertension

193
Q

signs of primary pulmonary hypertension

A

ecg shows right ventricular strain(right axis deviation, incomplete right bundle branch block), raised pulmonary artery systolic pressure

194
Q

when microscopic changes of acute MI first become visible

A

12-24 hrs after infarct

195
Q

perihilar shadowing/ bat wings

A

oedema

196
Q

patchy shadowing in lower zones

A

pneumonia

197
Q

blunting of costophrenic angles

A

pleural effusions

198
Q

when is cardiothoracic ration normal

A

0.5 or less

199
Q

if cardiothoracid ratito greater than 0.5 hints towards

A

heart failure

200
Q

widening of the carina would suggest

A

enlargement of the left atrium

201
Q

chest pain described as heavy but cardio,resp examiation normal and ecg normal, what etst would you order

A

12hr Troponin T assay

202
Q

purple striae on abdomen, moon face, hypertensive

A

cushing syndrome - excess cortisol

203
Q

hypertensive, large hands and feet, prominent jaw and brow

A

acromegaly -excess of growth hormone

204
Q

contraceptivec pill, systolic murmur , weak foot pulses , unequal upper limb pulses

A

coarctation of the aorta

205
Q

hyperthyroidism (thyrotoxicosis)- increases basal metabolic rate causing weight loss, diahorrea and atrial fibrilation

A
206
Q

paplitations after holidy and ecg shows atrial fib, most likely cause

A

alcohol excess

207
Q

post Mi, high cholestrol and family history give

A

high dose atorvastatin

208
Q

3 p’s for vasovagal syncope

A

posture - she was standing

provoking factors- was inn a warm crowded environment

prodromal symptoms- complained of dizziness before collapse

209
Q

what ecg finding isi common in young athletes

A

prolonged PR interval

210
Q

pain worse lying down and is releiveed by leaning forward, radiates to left shoulder =

LOW BP, QUIET HEART SOUNDS, RAISED JVP=

A

PERICARDITIS

CARDIAC TAMPONADE

so cardiac tamponade secodnary to pericarditis

treatment - urgent pericardiocentesis

211
Q

LMWH IS AN IMPORTANT STEP IN MANAGING

A

PULMONARY EMBOLUS

212
Q

loud first heart sound, plopping sound in early diastole, clubbed , cxr- intra cardiac calcification within the left atrium

A

left atrial myxoma

213
Q

mid-diastolic murmur, low volume pulse, clinically in a fib

A

mitral stenosis

214
Q

displaced apex beat and pansystolic murmur

A

mitral regurg

215
Q

patent come in with papitations and diagnosed with AF - no other medical conditions, give

A

IV flecainide

216
Q

most common risk factor for af

A

alcohol

217
Q

what artery supplies the left atrium of the heart

A

circumflex artery

218
Q

Lad artery supplies

A

interventricular septum and both ventricle s

219
Q

left ventricle is supplied by

A

left marginal artery

220
Q

–supplies both ventricles and interventricualr septum

A

posterior interventricular branch

221
Q

gols standard investigation for suspicion of cardiac chest pain

A

CT

222
Q

new onset acute atrial fibrilation if deny carioversion and are unstable

A

flecainide (sodium channel blocker)

223
Q

treatment for ventricular tachycardia secodnary to digoxin toxicity

A

Digibind

224
Q

-syncopal attacks, palpitations after night out, biphasic T waves, saddle shaped St segments

A

Brugada syndrome

225
Q

brugada syndrome is associated with – arrythmias

A

ventricular

226
Q

long term mamangemet for syncopal episodes

A

implantable cardiac defibrillator

227
Q

type 2 diabetes and cardiovascular disease

A

atorvastatin

228
Q

primary prevention of cardiovascualr disease

A

atorvastatin

229
Q

management if suspect unstable angina

A

HOSPIRAL FOR URGENT ELECTIVE ANGIOGRAM - as they are at high risk of MI

230
Q

Treatment of second degree heart block accompanied by acute MI, complete heart block, or symptomatic Mobitz II block what is indicated

A

Temporary pacing and primary PCI

231
Q

rheumatic fever symptoms

A

inflamed, painful joints, very fast heart beat follwing sore throat

232
Q

pyrexia, night sweats, changes to fingernails

A

infective endocarditis

233
Q

these are significant signs of:

-low volume pulse

narrow pulse pressure

slow rising carotid pulse

undisplaced apex beat

soft or absent A2

ejection systolic murmur +4th heart sound

pulmonary oedema

A

aortic stenosis

234
Q

for hypertension, if already taking aspirin, statin, aceI, calcium channel blocker, whats next

A

thiazide like diuretic eg indapamide

235
Q

if got hypertension potentially diabetes(pees alot) and under 55 you should give

A

AceI- has renal protective effect for diabetes

236
Q

treatmet for pregnancy induced hypertension

A

Labetalol, alternatives- methyldopa, nifedipine

237
Q

treatment of joint hypertension and angina first line for over 55

A

CCB

238
Q

uniform left ventricular hypertrophy is hallmark of

A

untreated hypertension

239
Q

chest pain worse lying down and widespread st elevation

A

pericarditis

240
Q

would you preferably place electrode of ecg on boney prominence

A

yes

241
Q

avF should be put on left

A

foot

242
Q

right arm electrode

A

red and aVR

243
Q

history chronic resp infections, diastolic murmur, opening snap loudest at the 5th right intercostal in mid clav line

A

kartagener syndrome

244
Q

abnormal cilia in kartageners syndrome can lead to infertility

A
245
Q

best diagnsotic test for aortic stenosis

A

echocardiogram and doppler

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