Cardiology

Question 1

when is indomethacin given for patent ductus arteriosus

Answer 1

postnatal period

Question 2

What type of congential heart disorder is PDA?

Answer 2

Non cyanotic

Question 3

what type of murmur does PDA make?

Answer 3

machinery like murmur

Question 4

What is PDA a connection between?

Answer 4

Pulmonary trunk and descending aorta?

Question 5

What other features does PDA have?

Answer 5

left subclavicular thrill, machinery like murmur, large volume, bounding, collapsing pulse, wide pulse pressure, heaving apex beat

Question 6

What drug do you avoid in VT?

Answer 6

Verapamil may precipitate cardiac arrest, severe hypotension, and can lead to worsening VT

Question 7

When is pulmonary artery hypertension diagnosed?

Answer 7

Resting mean pulmonary artery pressure > 25mmHg

Question 8

What age and sex does pulmonary artery hypertension commonly present?

Answer 8

Females between 30-50 years old

Question 9

What features in history can lead to diagnosis of PAH?

Answer 9

Progressive exertional dysponea, other features: exertional syncope, exertional chest pain, peripheral odema, cyanosis

Question 10

what features on examination lead to diagnosis of PAH?

Answer 10

Right ventricular heave, loud P2, Raised JVP with prominent A waves, tricuspid regurgitation, cyanosis

Question 11

What testing is central to deciding a good management strategy in PAH?

Answer 11

Acute vasodilator testing, this helps decide which patients show a significant fall in pulmonary arterial pressure following the administration of vasodilators such as intravenous epoprostenol or inhaled nitric oxide.

Question 12

If there is a positive response to acute vasodilator testing (a minority of patients) in PAH, what management should be used?

Answer 12

oral calcium channel blockers

Question 13

If there is a negative response to acute vasodilator testing (the vast majority of patients) in PAH, what management should be used?

Answer 13

prostacyclin analogues: treprostinil, iloprost
endothelin receptor antagonists: bosentan, ambrisentan
phosphodiesterase inhibitors: sildenafil

Question 14

what are poor prognostic factors in IE?

Answer 14

Staphylococcus aureus infection
prosthetic valve (especially ‘early’, acquired during surgery)
culture negative endocarditis
low complement levels

Question 15

After how long should an ECG be done after thrombolysis to assess whether 50% reduction in sT elevation

Answer 15

90 minutes
if there has not been adequate resolution then rescue PCI is superior to repeat thrombolysis
for patients successfully treated with thrombolysis PCI has been shown to be beneficial. The optimal timing of this is still under investigation