Cardiology

Question 1

Electrolyte abnormality/ies caused by Bendroflumethiazide?

Answer 1

Hyponatraemia and hypokalaemia

Question 2

Electrolyte abnormality/ies caused by Spironolactone?

Answer 2

Hyperkalaemia

Question 3

Atropine vs adenosine vs amiodarone

Answer 3

Atropine = atrUPine (you want to increase heart rate)

Adenosine = aDOWNosine (you want to decrease heart rate SVT)

Amiodarone = amioDOWN (you want to decrease heart rate VF/pulseless VT after 3 shocks)

Question 4

Most common abnormal finding in PE ECG?

Answer 4

Sinus tachycardia

Question 5

Newly diagnosed over 65 year old patient with hypertension who has a background of type 2 diabetes mellitus

Answer 5

ACE inhibitor

(Prescribe ACEi for hypertension with T2DM regardless of age)
(otherwise, over 55 without T2DM should get a CCB e.g. amlodipine)

Question 6

Poorly controlled hypertension, already taking an ACE inhibitor - what to add?

Answer 6

CCB or Thiazide-like diuretic

i.e. amlodipine or indapamide

Question 7

Beck’s triad (features of cardiac tamponade)

Answer 7

1. Muffled heart sounds
2. Persistent hypotension
3. Raised JVP

Question 8

Pulseless electrical activity - shockable or not?

Answer 8

Not shockable - give IV** adrenaline

(give IM adrenaline for anaphylaxis, IV for PEA)

VF/pulseless VT - not shockable

Question 9

Cause of aortic stenosis in under 65s and over 65s =

Answer 9

Under 65s = Bicuspid aortic valve
Over 65s = Degenerative calcification

Question 10

VF/pulseless VT + 3 shocks delivered

Next step in management?

Answer 10

IV amiodarone 300mg

Question 11

Right HF signs:

Answer 11

Elevated JVP
Bilateral ankle oedema
Hepatomegaly

Question 12

Hypothermia sign on ECG

Answer 12

J waves

Question 13

Treatment for chronic AF?

Answer 13

DOAC e.g. rivaroxaban

Question 14

What is dual antiplatelet therapy?

Answer 14

Aspirin 300mg + clopidogrel/ticagrelor

Question 15

Central, pleuritic chest pain and fever 4 weeks following a myocardial infarction + elevated ESR =

Answer 15

Dressler’s syndrome

Question 16

Left or right valves - which are louder on inspiration?

Answer 16

L’E’ft valves = louder during ‘E’xpiration
R’I’ght valves = louder during ‘I’nspiration

Question 17

Broad complex, regular tachycardia seen on ECG - diagnosis + treatment ?

Answer 17

Ventricular tachycardia

300mg amiodarone IV

Question 18

The carotid sinus baroreceptors convey information regarding blood pressure via which cranial nerve?

Answer 18

Glossopharyngeal (CN IX)`

Question 19

Main function of autoregulation

Answer 19

Maintaining constant blood flow in organs such as the kidney and brain

Question 20

What is ejection fraction?

And what is the normal range / the concerning range?

Answer 20

The percentage of blood pumped out of the ventricle with each contraction

Normal = 50 - 55%
Concerning = <40%

Question 21

What binds to troponin-C to begin muscle contraction?

Answer 21

Calcium ions

Question 22

Acute pericarditis management ?

Answer 22

NSAID + colchicine

(until normalisation of inflammatory markers - normally 1/2 weeks)

Question 23

Wellen’s syndrome:
1. What is it?
2. Investigations + findings

Answer 23

1. Stenosis of LAD - warning of impending MI
2. ECG (shows deeply inverted/biphasic T waves in V2-V3)
   + coronary angiogram

Question 24

HF management ?

Answer 24

1st line = ACE-I and beta-blocker

Consider ARB if intolerant to ACE-I.
Consider hydralazine if intolerant to ACE-I/ARB.

For fluid overload, prescribe loop diuretics (e.g. furosemide or bumetanide)

Question 25

Wide-complex tachycardia with regular rhythm - dx + tx ?

Answer 25

Ventricular tachycardia - treat with IV amiodarone

Question 26

Narrow-complex tachycardia with regular rhythm - dx + tx ?

Answer 26

Supraventricular tachycardia - treat with IV adenosine

Question 27

Marfan's associated with which valvular abnormality?

Answer 27

Aortic regurgitation mARfan's

Question 28

Which test confirms diagnosis of myaesthenia gravis?

Answer 28

Acetylcholine receptor antibodies

Question 29

fixed elongated PR interval and dropped QRS complexes - post-MI

Answer 29

Mobitz Type 2

Question 30

progressive elongation of the PR interval which eventually results in a missed QRS complex

Answer 30

Mobitz Type 1

Question 31

Concerning ECG finding in hypocalcaemia?

Answer 31

Long QT interval

Question 32

1st to 4th line management of hypertension

Answer 32

1. ACEi 2. CCB (can be switched to ARB if poorly tolerated) 3. Thiazide-like diuretic e.g. indapamide 4. Spironolactone if K+ is < 4.5 / Doxazocin (alpha-blocker) or beta-blocker if K+ if > 4.5

Question 33

Cardiac tamponade - Beck's triad = ?

Answer 33

Hypotension, raised JVP, muffled heart sounds

Question 34

Raised JVP = ?

Answer 34

FLUID OVERLOAD do not give them fluids even if super low BP

Question 35

Management of aortic dissection, types A and B

Answer 35

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

Question 36

Exertional dizziness + ejection systolic murmur =

Answer 36

Aortic stenosis

Question 37

Prophylactic medication for angina = ?

Answer 37

a beta-blocker or a rate-limiting calcium channel blocker - rate-limiting CCB = non -dines (verapamil, diltiazem)

Question 38

Treatment of torsades de pointes =

Answer 38

IV magnesium sulphate

Question 39

Bradycardia doesn't respond to drugs or transcutaneous pacing - next step in management ?

Answer 39

Transvenous pacing