cardiology

Question 1

Congenital heart disease

cyanotic: most common at birth, Fallot’s most common overall

Answer 1

TGA

Question 2

Congenital heart disease

cyanotic: most common overall

Answer 2

most common at birth, Fallot’s

Question 3

acyanotic: most common cause

Answer 3

VSD

Question 4

HOCM
mitral valve prolapse
Ebstein's anomaly
thyrotoxicosis
secundum ASD

Answer 4

Associations of WPW

Question 5

Management WPW

definitive treatment:

Answer 5

radiofrequency ablation of the accessory pathway

Question 6

in the majority of cases, or in a question without qualification, Wolff-Parkinson-White syndrome is associated with ?deviation

Answer 6

left axis

Question 7

Management WPW medical therapy:

Answer 7

sotalol**, amiodarone, flecainide

Question 8

sotalol should be avoided in WPW if there is coexistent

Answer 8

atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

Question 9

WPW ECG

Answer 9

short PR interval

wide QRS complexes with a slurred upstroke - ‘delta wave’

Question 10

Hypertension - NICE now recommend ?monitoring to aid diagnosis

Answer 10

ambulatory blood pressure

Question 11

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

Answer 11

Stage 1 hypertension

Question 12

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

Answer 12

Stage 2 hypertension

Question 13

Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

Answer 13

Severe hypertension

Question 14

Patients with established CVD should take atorvastatin ? dose

Answer 14

80mg on

Question 15

treatment indicated for: ABPM/HBPM >= 135/85 mmHg (i.e. stage 1 hypertension)
and??

Answer 15

treat if

Question 16

treatment indicated? ABPM/HBPM >= 150/95 mmHg (i.e. stage 2 hypertension)

Answer 16

offer drug treatment regardless of age

Question 17

hypertension Step 1 treatment

Answer 17

patients 55-years-old or of Afro-Caribbean origin: calcium channel blocker

Question 18

NICE recommend that all heart failure patients should take.

Answer 18

both an ACE-inhibitor and a beta-blocker

Question 19

mgt Aortic dissection

type A - ascending aorta -

Answer 19

control BP(IV labetalol) + surgery

Question 20

mgt Aortic dissection type B - descending aorta -

Answer 20

control BP(IV labetalol)

Question 21

Atrial fibrillation: rate control

Answer 21

• beta blockers preferable to digoxin

Question 22

Factors favouring rate control

Answer 22

Older than 65 years

History of ischaemic heart disease

Question 23

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation

Answer 23

sotalol
amiodarone
flecainide

Question 24

HOCM most common defects involve a mutation in the gene encoding

Answer 24

β-myosin heavy chain protein or myosin binding protein C.

Question 25

Step 2 treatment hypertension

Answer 25

ACE inhibitor + calcium channel blocker (A + C)

Question 26

Step 3 treatment hypertension

Answer 26

add a thiazide diuretic (D, i.e. A + C + D) NICE now advocate using either chlorthalidone (12.5-25.0 mg once daily) or indapamide (1.5 mg modified-release once daily or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide

Question 27

Aortic stenosis management:

Answer 27

AVR if symptomatic, otherwise cut-off is gradient of 50 mmHg

Question 28

acute pericarditis ECG changes

Answer 28

widespread 'saddle-shaped' ST elevation | PR depression: most specific ECG marker for pericarditis

Question 29

management of patients following a myocardial infarction (MI)

Answer 29

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

Question 30

An ECG should be performed 90 minutes following thrombolysis to assess whether there has been a greater than 50% resolution in the ST elevation if there has not been adequate resolution then

Answer 30

rescue PCI is superior to repeat thrombolysis

Question 31

ST-elevation myocardial infarction (STEMI) In the absence of contraindications, all patients should be given

Answer 31

aspirin clopidogrel: the two major studies (CLARITY and COMMIT) both confirmed benefit but used different loading doses (300mg and 75mg respectively) low molecular weight heparin

Question 32

ST-elevation myocardial infarction (STEMI). Only offer supplemental oxygen to:

Answer 32

people with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94-98% people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88-92% until blood gas analysis is available.

Question 33

ST-elevation myocardial infarction (STEMI) Glycaemic control in patients with diabetes mellitus i

Answer 33

regular monitoring of blood glucose levels to glucose below 11.0 mmol/l

Question 34

ECG II, III, aVF

Answer 34

Inferior Right coronary

Question 35

V1-V4

Answer 35

Anteroseptal Left anterior descending

Question 36

V4-6, I, aVL

Answer 36

Anterolateral Left anterior descending or left circumflex

Question 37

aVL +/- V5-6

Answer 37

Lateral Left circumflex

Question 38

Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys →

Answer 38

renal artery stenosis - do MR angiography

Question 39

Turner's syndrome - most common cardiac defect is

Answer 39

bicuspid aortic valve

Question 40

Prevention of SVT Episodes

Answer 40

Prevention of episodes beta-blockers radio-frequency ablation

Question 41

Isolated systolic hypertension

Answer 41

calcium channel blockers would be first-line.

Question 42

Complete heart block following an inferior MI ? pacing

Answer 42

is NOT an indication for pacing, unlike with an anterior MI

Question 43

*post-INFERIOR MI complete heart block

Answer 43

is common and can be managed conservatively if asymptomatic and haemodynamically stable

Question 44

A number of drugs have been shown to improve mortality in patients with chronic heart failure:

Answer 44

ACE inhibitors (SAVE, SOLVD, CONSENSUS) spironolactone (RALES) beta-blockers (CIBIS) hydralazine with nitrates (VHEFT-1)

Question 45

*digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties. Digoxin is strongly indicated if there is coexistent

Answer 45

atrial fibrillation

Question 46

sawtooth' appearance as the underlying atrial rate is often around 300/min the ventricular or heart rate is dependent on the degree of AV block. For example if there is 2:1 block the ventricular rate will be 150/min flutter waves may be visible following carotid sinus massage or adenosine

Answer 46

Tachycardia with a rate of 150/min ?atrial flutter

Question 47

atrial flutter curative for most patients

Answer 47

radiofrequency ablation of the tricuspid valve isthmus