Cardiology 2

Question 1

Symptoms mitral stenosis

Answer 1

Only present with >50% stenosis
Dypnoea, fatigue, palpitations, cough, chest pain
Can present like chronic bronchitis

Question 2

TIPPQRS mitral stenosis

Answer 2

Mid diastolic
Heard best at apex
Patient expiring on left hand side
Rumbling
Opening snap
Malar flush
AF
Loud 1st heart sound

Question 3

Treatment mitral stenosis

Answer 3

If in AF-rate control
Antibiotic prophylaxis (against rheumatic fever or other procedures)
Balloon valvuloplasty
Open mitral valvotomy or valve replacement

Question 4

TIPPQRS mitral regurgitation

Answer 4

Pansystolic murmur
Loudest at apex
Blowing
Radiating to axilla
3rd heart sound
AF
Thrusting displaced apex
Quiet heart sounds

Question 5

Causes of Aortic stenosis

Answer 5

Rheumatic heart disease

Calcified bicuspid/tricuspid valve

Question 6

TIPPQRS aortic stenosis

Answer 6

Ejection systolic
Loudest over 2nd intercostal space
Cresendo-descendo
Radiating to carotids
4th heart sound
Slow rising pulse
Narrow pulse pressure

Question 7

Management aortic stenosis

Answer 7

Prompt valve replacement

Question 8

TIPPQRS aortic regurgitation

Answer 8

Early diastolic
Left lower sternal edge
Leaning forward and expiring
Breath-like
3rd heart sound
Collapsing pulse
Quinke's/Corrigen's/de Musset's
Wide pulse pressure

Question 9

Arterial questions for peripheral vascular disease?

Answer 9

How far can you walk?
How long do you need to rest?
Pain at rest?
Physical changes (cool, pale, ulcers)
CVD risk factors

Question 10

Venous questions for peripheral vascular disease?

Answer 10

Risk factors (pregnancy/trauma/fractures/surgery)
PMH thrombophilia, DVT, PE
Varicose veins
Physical changes (swelling, eczema, pigmentation, ulcers)

Question 11

Arterial disease on exam

Answer 11

Pallor/mottling/gangrene
Scars and hair loss
Punched out ulcers, deep, pale base
Feet/toes ulcer location
Nail disease

Question 12

Venous disease on exam

Answer 12

Varicose veins
Haemosiderosis
Oedema
Lipodermatosclerosis
Eczema
Ulcers in the medial gaiter area with lots of exudate, painless with irregular borders

Question 13

Differentials of arterial PVD

Answer 13

Spinal stenosis
Osteoarthritis
Peripheral neuropathy

Question 14

Differentials of venous PVD

Answer 14

HF
Cirrhosis
Nephrotic syndrome

Question 15

What is a normal ABPI measurement?

Answer 15

ABPI >1.2= calcified arteries
ABPI 1-1.2= normal
0.5-1 = intermittent claudication
0.3-0.5= critical ischaemia and rest pain
<0.3= ulceration and gangrene

Question 16

Management of vascular disease

Answer 16

Risk factor management
Antiplatelet therapy (arterial)
Weight loss
Amputation (arterial)
Endovascular surgery

Question 17

What are the types of hyperlipidemia?

Answer 17

1. Primary (increased LDL only)
2. Familial primary hyperlipidaemia
3. Secondary (cushings/hypothyroid/cholestasis/nephrotic syndrome)
4. Mixed hyperlipidemia

Question 18

Management hyperlipidemia

Answer 18

Lifestyle advice
Medication if CVS >20%
1. Simvastatin 40mg po nocte
2. Fibrates

Question 19

Major criteria Jones

Answer 19

Joints (migratory polyarthritis)
Carditis
Nodes (subcutaneous)
Erythema marginatum
Sydenhams chorea

Question 20

Minor criteria Jones

Answer 20

Fever
Arthralgia
ESR
Prolonged PR interval
Previous rheumatic fever

Question 21

Acute management rheumatic fever

Answer 21

Penicillin 10 days (erythromycin if allergic)
Bed rest until CRP normalises
Emergency valve replacement if chordae teninae rupture/valve damage

Question 22

Secondary prophylaxis rheumatic fever

Answer 22

IM penicillin every 4 weeks
( twice daily oral penicillin or erythromycin if this not possible)
Minimum 10 years

Question 23

Drugs which cause long QT

Answer 23

Erythromycin
Ondansetron
Fluconazole
Clozapine
Lithium
Methadone