Cardiology

Question 1

JVP A wave

Answer 1

Atrial contraction

Question 2

JVP C wave

Answer 2

invisible flicker in x descent due to closure of tricuspid valve

Question 3

JVP X descent

Answer 3

atrial stretch and drop in pressure due to downward movement of heart

Question 4

JVP V wave

Answer 4

passive filling of blood into right atrium against closed tricuspid valve

Question 5

JVP y descent

Answer 5

opening of tricuspid valve abd passive movement of blood from right atrium to right ventricle.

Question 6

Absent A waves

Answer 6

atrial fibrrilation (no coordinataed contractions)

Question 7

Large A waves

Answer 7

tricuspid stenosis
right heart failure
pulmonary hypertension

Question 8

Cannon A waves

Answer 8

AV dissociation
- Atrial flutter and atrial tachycardias
- 3rd degree heart block
- VT, V ectopics

Question 9

Giant v waves

Answer 9

tricuspid regurgitation

Question 10

Steep x descent

Answer 10

Tricuspid stenosis
Tamponade (cardiac restriction)

Question 11

Steep y descent

Answer 11

cardiac contriction

Question 12

Slow y descent

Answer 12

Tricuspid stenosis

Question 13

Early diastolic murmur

Answer 13

Aortic regurg

Question 14

Aortic regurg

Answer 14

dyspnoea, orthopnoea etc
wide pulse pressure
nail bed pulsation (Quincke)
history of rheumatic fever

Question 15

Machine like murmur

Answer 15

PDA

Question 16

Ejection systolic murmur

Answer 16

AS
PS
ASD
Tetralogy
HOCM

Question 17

Late systolic murmur

Answer 17

MV prolapse
Coarctation

Question 18

Pansystolic murmur

Answer 18

MR
TR
VSD

Question 19

Thiazide diuretic mechanism

Answer 19

inhibit sodium-chloride symporter in distal distal part of distal convoluted tubule -> high sodium load to distal part of distal tubule -> physiological secretion of potassium
THIAZIDE -> LOW POTASSIUM

Question 20

Risk of asystole in bradycardia

Answer 20

complete HB with borad QRS
recent asystole
Mobitz II
V-pause >3s

Question 21

When to pace in HF?

Answer 21

All of:
NYHA III- IV
LV EF >35% with dilated ventricle on optimal medical therapy
QRS >130ms

Question 22

Beck triad of tamponade

Answer 22

Hypotension
muffled heart sound
distended neck veins

Question 23

S3

Answer 23

Audible in children and young adults
Pathological in MR, VSD, CCF, pericarditis - anything that results in rapid LV filling

Question 24

HOCM poor prognostic features

Answer 24

young at diagnosis
family history of sudden death
syncopal symptoms
VT on Holter
abnormal BP changes on exertion

Question 25

Pericarditis ECG changes

Answer 25

Saddle ST elevation PR depression

Question 26

Bisferiens pulse

Answer 26

mixed aortic valve disease

Question 27

Collpasing pulse

Answer 27

Aortic regurgitation

Question 28

Slow rising

Answer 28

Aortic stenosis

Question 29

Jerky pulse

Answer 29

HOCM

Question 30

Alternanas pulse

Answer 30

Severe LVSD - ejection fraction reduced meaning end diastolic volume elevated - > stretch of myocytes meaning ejection fraction of next beat is improved -> alternating strong and weak pulses

Question 31

Pulsus paradoxus

Answer 31

excessive reduciton in pulse with inspiration (left ventricular compression, tamponade, severe asthma as venous return in compromised

Question 32

LONG QT syndrome channels?

Answer 32

Long QT usually due to loss of function or blockage of potassium channels

Question 33

RILE (murmurs)

Answer 33

- Right sided murmur heard best on inspiration - Left sided murmur heard best on expiration

Question 34

PR prolongation

Answer 34

IHD DIg toxicity Hypokalaemia Aortic root abscess Lyme Sarcoid idiopathic

Question 35

AF in WPW

Answer 35

Avoid AV node blockers (may degenerate in to VF as accessory pthway preferred) i.e. bblockers, digoxin, verapamil

Question 36

HOCM and ACEI?

Answer 36

Avoid (anything that reduce preload/afterload such as nitrate, ACEI, nifedipine-type calcium antagonists

Question 37

loop diuretic mechanism

Answer 37

inhibit Na-K-Cl cotransporter in thick ascending limb of loop of henle reducing absorption of NaCl

Question 38

Ostium primum ASD

Answer 38

RBBB with LAD

Question 39

Ostium secundum ASD

Answer 39

RBBB with RAD

Question 40

most sensitive ecg finding in pericarditis

Answer 40

PR depression