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MRCP Hyunie > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pt taking ACE,CCB + Thiazide for HTN - ?Next step

A

K+ > 4.5mmol/l - add an alpha- or beta-blocker

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2
Q

Long QT Causes

A

ABCDE
A- antiarrhythmic
B- Brain -SAH
C- Congenital (Romano-Ward/Jervell-Lange-Nielsen)
D- Drugs - Antidepressants/Antipsychotics
E- Electrolytes - Hypo K+Ca2+Mg2+

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3
Q

What patients are contraindicated Adenosine

A

Asthmatics - bronchospasm

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4
Q

Aortic Dissection Types and Mx

A

Type A - Ascending -> Control BP + Surgery
Type B - Descending -> Control BP (IV labetalol)

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5
Q

Mechanism of Aspirin

A

COX 1 inhibitor to stop PG production

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6
Q

Mechanism of Ticragelor/Clopidogrel

A

Inhibit the P2Y12 receptor on platelets

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7
Q

Mechanism of dipyradamole

A

Inhibits phosphodiesterase

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8
Q

Mechanism of Abciximab

A

Gp2a/3a inhibitor

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9
Q

Diagnosis: Young strokes in particular migraine strokes

A

PFO - Patent foramen ovale

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10
Q

Pulmonary hypertension test and treatment

A

Test: Vasodilator Test
Rx:
+VE test : calcium channel blockers
-VE test (majority of people) : endothelin receptor A (ambrisentan), Phosphodiesterase inhibitor (sildenafil)

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11
Q

What mutation is seen in Brugada Syndrome

A

SCN5A gene - encode the myocardial sodium ion channel protein

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12
Q

Ebstein’s anomaly cause and sign

A

Cause: Lithium in utero
Sign: Tricuspid regurgitation -> pansystolic murmur

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13
Q

Features of Syndrome X

A

Normal coronary angiogram
ECG changes on exercise stress testing

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14
Q

What does BNP do to the heart

A

Vasodilator = decreases cardiac afterload

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15
Q

What mumur in Atrial Septal Defects (ASD) and what conditions are associated (x3)

A

Ejection Systolic Murmur - louder on inspiration - Fixed Split S2
Found in Down’s Syndrome, Ebstein’s anomaly and fetal alcohol syndrome

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16
Q

What murmur in Mitral valve prolapse and what conditions are associated? (x2)

A

Systolic murmur - best heard in apex - mide to late systole / pansystolic
Ehler-Danlos and Marfan’s syndrome

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17
Q

First line antihypertensive for pregnancy-induced hypertension

A

Labetalol

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18
Q

Imaging features of Arrhythmogenic right ventricular cardiomyopathy

A

Right ventricular myocardium replaced by fatty and fibrofatty tissue

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19
Q

Imaging features of HOCM

A

Septal hypertrophy and disorganisation of muscle fibre arrangement

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20
Q

Mechanism of action of Ticagrelor

A

REVERSIBLE binding of platelet P2Y12 ADP receptor to prevent signal transduction

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21
Q

Mechanism of action of Clopidogrel

A

IRREVERSIBLE binding of platelet P2Y12 ADP receptor to prevent signal transduction

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22
Q

Four Features of Tetralogy of Fallots (TOF)

A
  1. Ventricular septal defect (VSD)
  2. Rt ventriacular hypertrophy
  3. Rt ventricular outflow tract obstruction / Pulmonary stenosis
  4. Overriding aorta
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23
Q

What are the cardiac features of Takayasu arteritis

A

Young asian woman
Generalised Sx
Blood pressure difference >20mmHg
Carotid bruits + aortic diastolic murmur (AR)

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24
Q

Murmur feature of severe AS

A

Soft second heart sound
- reduced mobility
- increased calcification

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25
When is statin contraindicated?
Pregnancy Macrolides
26
What is the mechanism of statin
Inhibits the action of HMG-CoA reductase - rate limiting enzyme in hepatic cholesterol synthesis
27
What heart sound do you get from Dilated Cardiomyopathy and why?
S3 - rapid filling of the ventricles There are impaired contraction + dilation of ventricles causing early diastolic filling
28
What heart sound do you get from HCOM
S4- forceful contraction of atria against stiffened ventricles
29
What conditions are associated with Aortic Regurgitation (x4)
1. Rheumatic fever 2. Ankylosing spondylitis 3. Marfan's 4. Syphilis
30
DVLA rules for CABG, Angioplasty(elective), ACS, PPM,ICD - to treat/prophylactic,Ablation,AA,Heart transplant
CABG- 4 weeks Angioplasty(elective) - 1 week ACS - 4 weeks PPM- 1 week ICD - to treat- no driving/prophylactic- 4 weeks Sustained VT - 6 months Ablation-2 days AA- no driving if more than 6.5cm Heart transplant-6 weeks
31
Dilated cardiomyopathy caused by this deficiency
Selenium-Keshan Disease
32
What pulse pattern do you have in Left Ventricular Failure?
Pulsus alternans - strong and week due to dysfunction
33
What pulse pattern do you have in HOCM?
Jerky pulse SOMETIMES - bisferiens pulse (double pulse)
34
What medication do you give in patients who had Acute MI + signs of HF and Lt Ventricular Dysfunction after ACE-i
Aldosterodne antagonist - eplerenone
35
ECG changes in hypokalaemia
U waves TWI ST depression Long QT Prolonged PR
36
What signs are associated with aortic regurgitation
Quincke's sign -pulsating nail bed Corrigan's sign- collapsing pulse
37
Mechanism of Verapamil
Non-dihydropyridine calcium channel blocker Blocks conduction through the AV node + no effect on accessory pathway
38
What is Eisenmenger's syndrome
LEFT -> RIGHT shunt reversed due to pulmonary hypertension
39
What are associated with Eisenmenger's syndrome
VSD ASD PDA
40
What is the aim of endothelin receptor antagonists in pulmonary HTN
Reduce pulmonary vascular resistance leading to reduced RV systolic pressure
41
What conditions are associated with wpw
Ebstein anomaly Hocm Mitral valve prolapse Thyrotoxicosis
42
What is the common ticragelor side effect?
Dyspnoea
43
Gold standard investigation for pulmonary hypertension
Cardiac catheterIsation
44
Aortic stenosis causes in over 65
Calcification
45
Aortic stenosis causes in under 65
Bicuspid aortic valve
46
PDA management and when
Neonate (postnatal period) Ibuprofen, indomethacin- inhibits prostaglandin synthesis therefore closing the connection
47
What medication to avoid in HOCM
ACE inhibitor - reduce preload
48
Familial hypertriglyceridaemia features
EruptiveXANTHOMA
49
Familial hypercholesterolaemia features
Tendon xanthoma
50
Features - leftventricular aneurysm
Persistent ST elevation following recent MI, no chest pain
51
Digoxin ECG changes (x4)
1. Downslope ST depression (reverse tick) 2. Flattened inverted T waves 3. Shortened QT 4. Arrhythmia - av block / bradycardia
52
Cyanotic heartdisease
TGA Tetralogy of fallot
53
Acyanotic heartdisease
ASD VSD PDA
54
Second line Angina Rx
Nicorandil (K channel opener and nitrate)
55
BNP actions (x3)
1. Vasodilator (decrease cardiac afterload) 2. Diuretic and natriuretic 3. Suppresses both sympathetic tone and RAAS
56
What causes bisferiens pulse
1. two peaks in systole 2. HCOM 3. AR
57
What causes collapsing pulse
*any high output state* PDA AR Anaemia Hypothyroidism Sepsis AV fistula
58
What causes pulsus paradoxus
Exaggerated decrease in pule amplitude due to inspiration - Cardiac tamponade - Severe asthma
59
Side-effects of bendroflumathiazide (x4)
Glucose tolerance Pancreatitis Agranulocytosis Photosensitive rash
60
What causes parasternal heave
RVH TR - backflow from atrium causes high ventricular pressure
61
What increases and decreases warfarin effect?
Increase: Cranberry Decrease: St John's wort
62
What is the mechanism of action of Dabigatran?
Direct thrombin inhibitor
63
What is the mechanism of action of Heparin?
Activates anti-thrombin III (indirect factor X inhibitor)
64
What is the mechanism of action of Clopidogrel?
P2Y12 inhibitor
65
What is the mechanism of action of Abciximab?
Glycoprotein IIb/IIIa inhibitor
66
Whati s the mechanism of action of Rivaroxaban/Apixaban?
Direct factor X inhibitor
67
JVP cannon waves - Regular - Irregular
Regular - VT - AVNRT Irregular - CHB
68
When to stop Exercise tolerance test
Exhausted Low BP 3 mm ST depression 2 mm ST elevation BP 230 mmHg HR falling
69
What would indicate Mitral stenosis is still mobile?
mid-diastolic murmur with and OPENING snap - forceful opening of valve when pressure in the LA > LV
70
Loffler Syndrome
Eosinophillic infiltrates causing restrictive cardiomyopathy
71
Most common cause of restrictive cardiomyopathy
Amyloidosis
72
SVT medication class
Na channel blockers Ca channel blockers
73
VT medication class
K Channel blockers
74
Most common site for primary cardiac tumours
Left atrium (Atrial myxoma)
75
Mitral Stenosis Causes and HS
Mid-diastolic rumbling murmur Rheumatic fever, IE Can cause malar flush:chronic hypoxia
76
Mitral Regurgitation Causes and HS
Pan-systolic murmur IHD,HF,Age,IE,Connective tissue
77
Aortic Stenosis Causes and HS Radial features
Ejection systolic murmur, high pitched Slow-rising pulse, Narrow pulse pressure Age-related,Rheumatic heart disease
78
Aortic Regurgitation Causes and HS Radial features
Early diastolic murmur Corrigan's pulse (collapsing pulse) HF,age-related,Connective tissue
79
Gene + syndrome tetralogy of fallot involved in
Chromosome 22 deletion + Di-george syndrome
80
What is VSD associated with
Fetal alcohol syndrome Down's syndrome
81

MRCP Hyunie (7 decks)

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