Cardiology

Question 1

Aortic dissection

Answer 1

type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)

Question 2

A sinusoidal ECG pattern

Answer 2

Severe hyperkalaemia

Question 3

A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds

Answer 3

left ventricular free wall rupture

Question 4

Beck’s triad of falling BP, rising JVP and muffled heart sound

Answer 4

Cardiac Tamponade
(Percutaneous balloon pericardiotomy)

Question 5

If a pleural effusion fluid protein/serum protein ratio is >0.5, the effusion is an exudate

Answer 5

Pulmonary malignancy

Question 6

Long QT syndrome

Answer 6

usually due to loss-of-function/blockage of K+ channels

Question 7

A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound

Answer 7

left ventricular aneurysm

Question 8

STEMI management

Answer 8

fibrinolysis should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes

Question 9

in addition to an ACE inhibitor (or ARB) and beta-blocker, what should be prescribed to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure?

Answer 9

Offer a mineralcorticoid receptor antagonist (spiralactone)

Question 10

A man presents with central, pleuritic chest pain and fever 4 weeks following a myocardial infarction. The ESR is elevated

Answer 10

Dressler’s syndrome

Question 11

raised JVP, ankle oedema and hepatomegaly

Answer 11

right-sided heart failure

Question 12

first-line treatment for regular broad complex tachycardias without adverse features

Answer 12

IV amiodarone

Question 13

Beta-blockers should only be stopped in acute heart failure when?

Answer 13

the patient has heart rate < 50/min, second or third degree AV block, or shock

Question 14

Patients with bradycardia and signs of shock

Answer 14

equire 500micrograms of atropine (repeated up to max 3mg)

Question 15

symptomatic bradycardia if atropine fails

Answer 15

External pacing

Question 16

In the context of a tachyarrhythmia, a systolic BP < 90 mmHg

Answer 16

DC cardioversion

Question 17

The most common heart lesion associated with Duchenne muscular dystrophy?

Answer 17

dilated cardiomyopathy

Question 18

key investigation for a suspected perforated peptic ulcer

Answer 18

An erect chest x-ray

Question 19

third heart sound?

Answer 19

A third heart sound, or S3, is often associated with conditions that lead to rapid filling of the ventricles. This can happen in dilated cardiomyopathy, a condition characterised by dilation and impaired contraction of the left or both ventricles

Question 20

Screening for an abdominal aortic aneurysm

Answer 20

consists of a single abdominal ultrasound for males aged 65

Question 21

Diastolic murmur + AF

Answer 21

?mitral stenosis

Question 22

Atrial fibrillation: rate control

Answer 22

beta blockers preferable to digoxin

Question 23

S3 (third heart sound) is considered normal?

Answer 23

< 30 years old

Question 24

pulse pressure is wide and there is an early diastolic murmur at the left sternal edge.
Raised JVP, Pitting oedema

Answer 24

Aortic regurgitation