Cardiology

Question 1

Heart failure medication having no improvement on mortality

Answer 1

Digoxin

Question 2

4th line heart failure

Answer 2

1. Switch ACEi for sacubitril valsartan if HF EF <35%
2. Add hydralazine if Afro-Carribean
3. Add ivabradine if HF EF <35% and HR >75

Question 3

Clopidogrel MOA

Answer 3

Blocks ADP

Question 4

Aortic stenosis heart sounds

Answer 4

Quiet S2

Question 5

V5-V6 ST elevation

Answer 5

Lateral MI (Left Cx)

Question 6

V1-4 ST elevation

Answer 6

Anterior (LAD)

Question 7

II, III, aVF ST elevation

Answer 7

Inferior (RCA)

Question 8

Define ejection fraction

Answer 8

The difference in volume of blood at diastole and systole

EF: (EDV - ESV)/EDV

Question 9

Splitting of the first heart sound, where does this correspond with the ECG

Answer 9

R wave

Question 10

What is S1

Answer 10

Closure of mitral and tricuspid valves

Question 11

What is S2

Answer 11

Closure of the aortic and pulmonary valves

Question 12

Soft S1

Answer 12

immobile mitral stenosis
mitral regurgitation

Question 13

Split S1

Answer 13

RBBB
LBBB
VT
Ebsteins anomaly

Question 14

Variable S1

Answer 14

AF
Complete heart block

Question 15

Loud S2

Answer 15

Hypertension
Tachycardia
ASD

Question 16

Soft/absent S2

Answer 16

Severe aortic stenosis

Question 17

Fixed S2

Answer 17

ASD

Question 18

Wide split S2

Answer 18

RBBB, pulmonary stenosis

Question 19

Reversed split S2

Answer 19

LBBB
PDA
AS

Question 20

S3

Answer 20

Caused by rapid filling
MR
VSD

Question 21

S4

Answer 21

Filling of a stiff LV
LVH
HOCM

Question 22

Warfarin therapy
- small operation e.g. tooth extraction

Answer 22

Can continue as long as INR not above 2.0

Question 23

HOCM

Answer 23

Ejection systolic murmur that improves on squatting

Question 24

Signs of VT rather than sVT on ECG

Answer 24

• AV dissociation
• QRS complex >160ms
• fusion beats
• RSR complex

Question 25

Coarctation of the aorta, why would the RHS blood pressure be higher than the LHS

Answer 25

If the coarctation is proximal to the left subclavian artery origin

Question 26

If pressure in the RV > LV after MI, what is the cause

Answer 26

RV failure

Question 27

Carotid sinus syndrome

Answer 27

Can cause black outs, asystole momentarily, need to have a pacemaker

Question 28

Drug that shortens QT interval

Answer 28

Digoxin

Question 29

What is the dicrotic notch

Answer 29

Timed with aortic valve closure

Question 30

Co-arctation of the aorta BP in limbs

Answer 30

Legs will be much lower than arms

Question 31

Prominent X and Y waves on JVP

Answer 31

Restrictive cardiomyopathy

Question 32

Marfans murmur

Answer 32

Aortic regurgitaiton

Question 33

Electrolyte imbalance causing prolonged QT

Answer 33

Hypomagnesia

Question 34

Medication to avoid in AS

Answer 34

bisoprolol

Question 35

MOA tirofiban

Answer 35

Glycoprotein IIb/IIIa inhibitor - used in unatable angina/NSTEMI

Question 36

HOCM pulse

Answer 36

Jerky

Question 37

HOCM symptoms

Answer 37

double apex beat jerky pulse mid-systolic murmur

Question 38

HOCM management

Answer 38

Primary ICD

Question 39

HOCM genetic cause

Answer 39

Defect in the B myosin autosomal dominant

Question 40

Pulmonary oedema, hypotensive on a background of HF management

Answer 40

IV diuretics IV opiate O2 If remains hypotensive could consider dobutamine for BP support

Question 41

Poor prognostic indicator HOCM

Answer 41

Septal wall thickness >3cm

Question 42

Patent foramen ovale investigation

Answer 42

TOE with bubble study - note likely to present with DVT and stroke like symptoms

Question 43

WPW management

Answer 43

Radiofrequency ablation

Question 44

Pericarditis ECG post 1- 2 weeks

Answer 44

T wave flattening

Question 45

LHS or RHS murmurs heard best on inspiration

Answer 45

RHS heard best on inspiration LHS heard best on expiration

Question 46

Gradient of AS that you can observe if asymptomatic that will mean you have to surgically intervene

Answer 46

40mmHg

Question 47

AR

Answer 47

De Mussets sign: head bobbing Quinckes sign: nail pulse beating

Question 48

Histology of rheumatic fever

Answer 48

Aschoff bodies