Cardiology

Question 1

Stable vs unstable angina (Time till GTN relief)

Answer 1

20 mins

Question 2

Risk tool for ACS

Answer 2

GRACE 2 Score

Question 3

What is killip score

Answer 3

Use of fluid overload signs to predict 30 day mortality for ACS

Question 4

Type 1 MI

Answer 4

Secondayr to coronary artery disease

Question 5

Type 2 MI

Answer 5

Supply vs demand mismatch e.g. anaemia, bleed, prolonged tachyarrythmias (no plaque disruption)

Question 6

What is prinzmetal angina

Answer 6

Vasospastic angina, where coronary artery spasms and suddenly narrows.

Question 7

What is type 3 MI

Answer 7

Someone dies of MI before confirmation by raised trop (can be changed to 1 if thrombosis found on autopsy)

Question 8

1st line anti-anginal

Answer 8

Beta blocker or CCB monotherapy

Question 9

2nd line anti-anginal

Answer 9

If mono not tolerated switch, if mono tolerated add the other

Question 10

3rd line anti-anginal

Answer 10

If bitherapy not tolerated, ISMN, Ivabradine, nicorandil

Question 11

Never give to treat anginal

Answer 11

Beta-blocker + verapamil/diltiazem.

Question 12

Timing for trop levels

Answer 12

0h and 2h (if >250 no need to repeat)

Question 13

Immediate management ACS

Answer 13

Single/dual antiplatelet (300mg aspirin)
Give ticagrelor if trop rise (180mg)
Oxygen
GTN
Morphine

Question 14

2 main non cardiac causes of raised trop

Answer 14

Renal failure
Sepsis

Question 15

Ischaemic ECG changes

Answer 15

T wave peak or depression
ST elevation or depression

Question 16

V1 ECG region

Answer 16

Septal

Question 17

V2-V4 ECG region

Answer 17

Anterior

Question 18

What leads to assess bundle branch block

Answer 18

V1 + V6

Question 19

Why not thrombolise pts with MI presenting after 12 hours onset of symptoms

Answer 19

Risk of CA rupture (clot has organised)

Question 20

Everyone who has ACS gets a what

Answer 20

Echocardiogram

Question 21

Secondary management of MI

Answer 21

ACEi or ARB
Dual anti-platelet
Beta blocker
Statin

Question 22

Becks triad

Answer 22

Raised JVP
Hypotension
Muffled heart sounds

Question 23

Cushings triad

Answer 23

High systolic pressure/wide pulse pressure
Bradycardia
Irregular breathing

Question 24

AF causes

Answer 24

MITRAL AF

M - Mitral valve disease
I - Infection/IHD
T - Thyrotoxicosis
R - Raised BP
A - Alcohol
L - Lung pathology

Question 25

Explain Mobitx type 1

Answer 25

PR progressively increases followed by dropped beat

Question 26

Mobitz type 2

Answer 26

Intermittent failure of QRS, usually ratios e.g. 3 beats drop etc.

Question 27

Third degree heart block

Answer 27

Complete dissociation between P and QRS

Question 28

Mx heart block

Answer 28

If stable, observe If unstable (type 2 or complete) - IV atropine 500mcg. Can repeat up to 6 doses Transvenous cardiac pacing

Question 29

NYHA Class of HF

Answer 29

1 - No limitation 2 - Slight limitation 3 - marked limitation 4 - severe limitation (symptoms at rest) (of physical activity)

Question 30

Healthy ejection fraction

Answer 30

>50%

Question 31

Mid-range ejection fraction

Answer 31

40-50%

Question 32

Systolic HF (ejection fraction)

Answer 32

<40%

Question 33

Management of chronic HF

Answer 33

1st ACEi + Beta blocker (+loop diuretic if oedema) 2nd Aldosterone antagonist 3rd Digoxin

Question 34

Mx of acute pulmonary oedema

Answer 34

POND P - Position (upright) O - Oxygen N - Nitrates (IV isosorbide mononitrate) D - diuretic (IV Furosemide)

Question 35

Chronic limb ischaemia

Answer 35

Narrowing or occlusion of peripheral blood vessels FONTAINE Classification

Question 36

Test for chronic limb ischaemia

Answer 36

Beurgers test. Lift legs, if pink beyond 20 degrees then negative If pallor then positive

Question 37

Normal ABPI

Answer 37

0.9 - 1.2

Question 38

6 P's of limb ischaemia

Answer 38

Pain Paralysis Paraethesia Pulselessness Pallor Perishingly Cold

Question 39

Immediate management of acute limb ischaemia

Answer 39

IV Heparin + treat underlying cause

Question 40

Reperfusion injury

Answer 40

Sudden return of blood from anoxia Inflammatory response, oxidative damage and capillary leakage

Question 41

AAA definition

Answer 41

Dilation of >3cm

Question 42

If AAA <4.5cm

Answer 42

Rescan 12 months

Question 43

If AAA <5.5

Answer 43

Rescan 3 months

Question 44

If AAA >5.5cm

Answer 44

Surgical repair, 2WW referral

Question 45

What is Grey-Turners sign

Answer 45

Sign of AAA rupture Bleeding into retroperitoneal space, bruising on hips/back

Question 46

Varicose vein pathophysiology

Answer 46

Venous valvular insufficiency, backflow of blood and hence vein distension

Question 47

Hemosiderin

Answer 47

Haemoglobin breakdown, circular red discolouration

Question 48

Venous eczema

Answer 48

Pooling causes inflammation, skin becomes itchy dry + flaky

Question 49

Lipodermatosclerosis

Answer 49

Skin and soft tissue become fibrotic and tight. Stocking distribution

Question 50

Duplex USS

Answer 50

Speed and volume of blood flow assessing venous insufficiency

Question 51

PE management

Answer 51

Thrombolysis Alteplase Acute - DOAC e.g. Apixaban (2nd line LMWH e.g. Enoxaparin) Chronic - Anticoag for 3mo if caused 6mo if unprovoked