Cardiology

Question 1

One drug to prescribe patients with chronic heart failure with reduced ejection fraction to improve survival?

Answer 1

ACEi (or ARB air not tolerated) or Beta-blocker. Start one at a time

Question 2

After MI, which drugs prescribed to reduce mortality?

Answer 2

Dual antiplatelet (aspirin plus clothes or ticagrelor), statin, ACEi and B blocker

Question 3

New AF. CHA2DS2-VASc score = 2. What anticoagulation?
Also how to calculate CHA2DS2-VASc?

Answer 3

DOAC - first line. Ie Apixaban, rivaroxaban
CHA2DS2-VASc:
CHF: yes=1, no=0
HTN : yes=1, no=0
Age: <65=0, 65-74 =1, >/=75 = 2
Diabetes : yes=1, no=0
Sex: 1 for female, 0 for male
Stroke/TIA/VTE : yes=1, no=0

Offer anticoagulation tx if score is 2 or more. Consider offering to men with score of 1 taking into account bleeding risk

Question 4

Appearance of venous vs arterial ulcers?

Answer 4

Venous: irregular margins, rolled skin edges, red granulation tissue, yellow slough at base. Surrounding skin shows characteristic changes of chronic venous insufficiency ie oedema, hyperpigmentation. Typically ankle to mid calf.

Arterial: location generally pressure points, toes/feet, lateral malleolus/tibial. Punched out and deep, unhealthy wound bed, minimal exudate unless infected. Surrounding skin thin/shiny, cool, pallor, weak/absent pulses

Question 5

Aortic regurgitation murmur - description, where best to hear, causes?

Answer 5

Early diastolic decrescendo murmur.
Best heard at left parasternal border, 3rd/4th intercostal space
(Can present with a bounding pulse or wide pulse pressure)
Causes: bicuspid aortic valve, endocarditis, rheumatic fever, aortic root dilatation,

Question 6

Score used to ascends risk of death in ACS

Answer 6

GRACE

Question 7

Score to assess bleeding risk and what it contains

Answer 7

ORBIT
Older age (>/=75)
Reduced Hb (<130 for men, <120 women, or hx anaemia)
Bleeding hx ie GIB, haemorrhagic stroke
Insufficient renal function (eGFR<60)
Treatment with antiplatelets

All score 1 point except Reduced Hb/anaemia which scores 2

Question 8

Superventricular tachycardia
- definition?
-management?

Answer 8

Narrow complex tachycardia, rate >100, QRS complex <120ms
-Vagal manoeuvres (avoid in elderly due to risk of stroke from emboli)
-Valsalva manoeuvre
-if above fails, IV adenosine/verapamil
-if above fails, DC cardioversion
Maintenance = B-blockers/verapamil

Question 9

Ventricular tachycardia
- definition?
- management?

Answer 9

Broad complex tachycardia, faster than 120bpm, arising distal to bundle of His
- Pulseless: unsynchronised defibrillation
- otherwise, synchronised cardioversion

Question 10

Brugada syndrome:
-who it typically affects
-how it presents/symptoms
-signs on ECG
-treatment

Answer 10

-young males from SE Asia
-often asymptomatic. Syncope in 3rd-4th decade
-ECG Brugada sign: ‘coved’ STE >2mm in >1 of V1-V3 followed by negative T wave
-Implantable cardioverter-defibrillator (ICD)

Question 11

Corresponding coronary arteries to these ECG leads?
1) Lateral (1, aVL, V5-V6)
2) Inferior (II, III, aVF)
3) anterior (V1-V2)

Answer 11

1) Circumflex
2) Right coronary artery
3) Left anterior descending (LAD)

Question 12

70 y/o woman, crushing retrosternal pain which radiates to jaw. Has had on and off for 3 years, prev cardiac Ivx normal. What is the diagnosis?
What investigation can you do and what would it show?

Answer 12

Oesophageal spasm
Barium swallow - corkscrew oesophagus due to multiple simultaneous contractions

Question 13

Patient who had cardiac catheterisation this morning via femoral artery presents with cold foot. She has a pulsatile mass over her femoral artery with loss of distal pulses. Dx?

Answer 13

FemoralPSEUDOaneurysm
(Haematoma, with pulsatile mass, femoral bruit and loss of distal pulses.)

Question 14

Which of the following is NOT a complication of MI?
1. Heart block
2. Tachyarrhythmias
3. L ventricular failure
4. Pericarditis
5. Mitral stenosis

Answer 14

5. Mitral stenosis
   (mitral REGURGITATION happens, due to rupture/ischaemia of the papillary/chordal muscles!)

Question 15

Patient with stable angina. Which drug to start?

Answer 15

B blocker or CCB ie verapamil.
Also GTN spray

Question 16

Most common congenital defect in Down’s syndrome?

Answer 16

ASD
(Others include VSD, PDA and Fallot’s tetralogy)

Question 17

How does mitral stenosis present?
What type of murmur and where best to hear?

Answer 17

-fatigue, dyspnoea, palpitations, malar flush, AF
-rumbling mid-diastolic murmur (loudest with expiration and patient on left side)

Question 18

How does mitral stenosis present?
What type of murmur and where best to hear?

Answer 18

-fatigue, dyspnoea, palpitations, malar flush, AF
-rumbling mid-diastolic murmur (loudest with expiration and patient on left side)

Question 19

25 y/o pt with hypertension confirmed with home measurements. No evidence of diabetes/heart/renal disease or organ damage. What should you do?

Answer 19

Refer for further investigations for all patients below 40 with no evidence of diabetes/heart/renal disease or organ damage!! Ie renal causes, vascular or endocrine disorders

Question 20

Post MI, which antiplatelet to start?

Answer 20

DAPT (aspirin plus P2Y12 inhibitor ie clopidogrel, prasugrel, ticagrelor)

Question 21

Following an ACS, all patients should be offered?

Answer 21

dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin