Cardiology

Question 1

What electrolyte abnormalities can cause a long QT interval?

Answer 1

1. Hypocalcaemia
2. Hypomagnasaemia
3. Hypokalaemia

Question 2

How would you describe Torsades de pointes?

Answer 2

It is a polymorphic ventricular tachycardia

Question 3

How do you treat torsades des pointes?

Answer 3

IV Magnesium infusion

Question 4

What causes Torsades de pointes?

Answer 4

Anything which causes QT prolongation
- Congenital long QT syndromes
- Antipsychotics
- Electrolyte abnormalities
- Anti-Arythmic medications
- Clarithromycin/erythromycin
- Hypothermia
- Subarachnoid haemorrhage

Question 5

What is the treatment for regular narrow complex tachycardia?

Answer 5

IV Adenosine (bolus)

Question 6

What is the treatment for broad complex tachycardia?

Answer 6

IV amiodarone

Question 7

First line treatment for SVT?

Answer 7

Vagal maneuvre

Question 8

What is the most common cause of death in patients following a myocardial infarction?

Answer 8

Ventricular fibrillation

Question 9

What is meant by “lone AF”?

Answer 9

AF in a patient:
- <60 years old
- No other heart condition
- Heart is structurally normal on echo

Question 10

How do you interpret ABPI measurements?

Answer 10

Ankle brachial pressure index

<0.5 severe arterial disease
0.5-0.8 arterial disease or mixed arterial and venous disease
0.8-1.3 no evidence of significant arterial disease
>1.3 suggests arterial calcification

Question 11

Abdominal Aortic Aneurysm
Cut offs for treatment?

Answer 11

abdominal aorta measures between 3.0 and 4.4 cm in diameter, – ultrasound scan should be repeated every year.

If the aorta measures between 4.5 and 5.4 cm in diameter - ultrasound scan should be repeated every three months.

If the aorta measures 5.5 cm or more in diameter, then the patient should be referred for vascular surgery.

Question 12

Causes of Pansystolic murmur?

Answer 12

• mitral regurgitation
• tricuspid regurgitation
• ventricular septal defect

Question 13

What is Beck’s triad?

Answer 13

Triad of cardiac tamponade
- raised JVP
- hypotension
- muffled heart sounds

Question 14

How does Papillary muscle rupture present?

Answer 14

• post MI if left ventricle affected (2-7 days later)
• acute mitral regurgitation (pan systolic murmur)
• pulmonary oedema
• cardiogenic shock

Papillary muscles attach to the tricupsid and mitral valve leaflets via chordae tendinae and prevent regurgitation

Question 15

What is the murmur of mitral stenosis?

Answer 15

Diastolic rumbling murmur best heard at the apex
Opening snap

Question 16

What is Brugada syndrome

Answer 16

• Mutation in cardiac sodium channels
• more common in East Asian people
• can present as sudden death
• or syncopal episode
• heart is structurally normal
• brugada sign on ECG

Treatment: ICD

Question 17

45 year old patient with hypertension who is NOT diabetic what is the first line treatment

Answer 17

Ace inhibitor or ARB

Question 18

75 year old patient with hypertension who is not diabetic what is the drug of choice?

Answer 18

Calcium channel blocker

Question 19

65 year old patient with hypertension and diabetes what is the drug of choice

Answer 19

Ace inhibitor or ARB regardless of age

Question 20

65 year old black woman with HTN

Answer 20

Black patients of any age - calcium channel blocker

Question 21

65 year old black woman with HTN was started on amlodipine but c/o ankle swelling - what alternative should you give her

Answer 21

THIAZIDE LIKE DIURETIC e.g. Indapamide

Question 22

What is the treatment for asyatole

Answer 22

Epinephrine

Question 23

What is the first line treatment for sinus bradycardia if the patient is haemodynamically unstable?

Answer 23

Atropine