Cardiology

Question 1

Question:

What type of drug is Amiodarone? How does it work?
What are it’s indications, contraindications and drug interactions?

Answer 1

Answer:

Class III anti-arrhythmic
Slows nodal repolarisation by blocking sodium channels
Indicated in shock refractory VF/VT and stable VT
Contraindicated in heart block
Interacts with simvastatin (20mg max dose), increases plasma concentration warfarin (half the dose)

Question 2

Question:

What is Tetralogy of Fallot?

Answer 2

Answer:

1. Over-riding aorta
2. Right ventricular outflow obstruction
3. Right ventricular hypertrophy
4. Ventricular septal defect

Question 3

Question:

What are the symptoms of tetralogy of Fallot?

What are they signs?

Answer 3

Answer:

Cyanosis
Fainting when peripheral vascular resistance reduced (feeding, yawning)

Pulmonary ejection systolic murmur & systolic thrill

Question 4

Question:

What is the characteristic finding on auscultation of an ASD?

Answer 4

Answer:

Fixed splitting of the second Heart sound

Question 5

Question:

What are the different types of ASD?

Answer 5

Answer:

1.

Question 6

Question:

What ECG features are associated with Wolfe Parkinson White Syndrome?

Answer 6

Answer:

Short PR interval
Wide QRS
Delta waves (slurred upstroke of QRS)

Question 7

Question:

What are the echocardiographic features of HOCM?

Answer 7

Answer:

Septal hypertrophy 
Left ventricular outflow tract gradient
Premature aortic cusp closure
Obliteration of left ventricular cavity
Tip thickening of anger cusp mitral valve (strikes septum)

Question 8

Question:

What are the causes of dilated cardiomyopathy?

Answer 8

Answer:

Alcoholism
Vitamin deficiency
Viral infection (coxsackie, HIV)
Autoimmune
Muscular dystrophy 
Peripatetic
Haemochromotosis, sarcoidosis 
Uncontrolled tachycardia

Question 9

Question:

What are the causes of restrictive cardiomyopathy?

Answer 9

Answer:

Sarcoidosis
Haemochromotosis 
Amyloid
Scleroderma
Gaucher's
Glycogen storage disorder
Hypereosinophilia (Loffler's)
Carcinoid
Malignancy
Radiotherapy

Question 10

Question:

What are the signs of Atrial Myxoma?

Answer 10

Answer:

Tumour 'plop' in diastole
Intracardiac obstruction
Fever
LOW
Clubbing
Systemic embolism
Pulmonary hypertension

Question 11

Question:

What causes a third heart sound?

Answer 11

Answer:

Passive filling of the ventricles (slosh-ing-in)
Normal in young
Pathological in causes of rapid ventricular filling: mitral regurgitation, CCF, constrictive pericarditis

Question 12

Question:

What are the causes of a 4th heart sound:

Answer 12

Answer:

Pathological
Atrial contraction into a stiffened ventricle
LVH, HOCM, left ventricular ischaemia

Question 13

Question:

What are the causes of a split first heart sound?

Answer 13

Answer:

RBBB, LBBB, VT, inspiration, Epstein’s abnormality

Question 14

Question:

What are the causes of a split second heart sound?

Answer 14

Answer:

(Aortic then pulmonary)

ASD
Mitral regurgitation
RBBB
Pulmonary stenosis

Reversed split:
LBBB
Right ventricular pacing
PDA
Aortic stenosis

Question 15

Question:

What is a Bisheriens pulse and what causes it?

Answer 15

Answer:

Double shudder due to mixed aortic valve disease

Question 16

Question:

What causes a jerky pulse?

Answer 16

Answer:

HOCM

Question 17

Question?

What causes a pulses alternans?

Answer 17

Answer:

Severe left ventricular failure

Question 18

Question:

What is pulsus paradoxus and what causes it?

Answer 18

Answer:

Drop in systolic BP>10mmHg with inspiration:
Left ventricular compression, tamponade, constrictive pericarditis, severe asthma

Question 19

Question:

What are the causes of left axis deviation?

Answer 19

Answer:

LBBB
LVH
Primum ASD
Cardiomyopathy

Question 20

Question:

What are the causes of right axis deviation:

Answer 20

Answer:

RBBB
Right ventricular hypertrophy (pulmonary HTN, PE, large secumdum ASD, severe pulmonary stenosis, tetralogy Fallot)

Question 21

Question:

What are the contraindications to exercise stress testing?

Answer 21

Answer:

HOCM
Untreated severe HTN
Unstable angina
Severe aortic stenosis
Untreated CCF
Acute myocarditis or pericarditis
Pyrexia

Question 22

Question:

What indicates a positive exercise stress test?

Answer 22

Answer:

Anginal symptoms
Fall in BP>15mmhg or failure to inc BP
Arrhythmia
Failure to achieve target HR
ST segment depression