Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRACP clinical exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

3 causes of dominant a wave

A
  1. Pulmonary stenosis
  2. Pulmonary hypertension
  3. Rarely tricuspid stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cause of dominant v wave

A

Tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 causes of cannon a wave

A
  1. Complete heart block
  2. AV dissociation due to due to VT with retrograde atrial conduction
  3. Paroxysmal nodal tachycardia with retrograde atrial conduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

4 causes of elevated central venous pressure

A
  1. RV failure
  2. TR
  3. Pericardial disease - effusion, constrictive pericarditis
  4. SVC obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is an anacrotic arterial pulse?

A

Small volume with slow upstroke plus a wave on the upstroke. Caused by aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

5 causes of collapsing pulse

A
  1. Aortic regurgitation
  2. Hyperdynamic circulation
  3. Arteriosclerotic aorta especially in aortic patients
  4. PDA
  5. Peripheral AV aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a bisferiens pulse?

A

Anacrotic plus collapsing pulse. Caused by aortic stenosis plus AR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alternans pulse

A

Alternating strong and weak beats. Caused by LVF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does left parasternal impulse indicate?

A
  1. RVH

3. L atrial enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where do you listen for the PDA murmur?

A

Below the L clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mechanism of third heart sound and its causes

A

Mechanism: possibly tautening of the mitral or tricuspid cusps at the end f rapid diastolic filling.

LV S3 (lounder at apex and on expiration)

  1. Physiological if aged <40 or pregnant
  2. LVF
  3. AR
  4. MR
  5. VSD
  6. PDA

RV S3 (louder at the LSE and on inspiration)

  1. RVF
  2. Constrictive pericarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mechanism of fourth heart sound and its causes

A

Mechanism: a high atrial pressure wave is probably reflected back from a poorly compliant ventricle. Always abnormal If heard.

LV S4

  1. AS
  2. Acute MR
  3. HTN
  4. HOCM
  5. IHD

RV S4

  1. PHTN
  2. Pulmonary stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cause of fixed splitting

A

Atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 main causes of mitral stenosis

A
  1. Rheumatic heart disease
  2. Rarely congenital- eg parachute valve, with all chordae inserting into one papillary muscle
  3. SLE
  4. RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 clinical signs of severity of MS

A
  1. Small pulse pressure
  2. Early opening snap, which indicates raised LA pressure
  3. Length of the mid diastolic rumbling murmur, as it persists as long as there is a gradient
  4. Soft S1 (which indicates immobile valve cusps)
  5. Presence of PTHN, as indicated by prominent a wave, RV impulse, TR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 signs of left atrial enlargement on chest xray

A
  1. Double density sign
  2. Oblique distance between outer ridge of the left atrium to the mid point of the left main bronchus >7cm
  3. Increased carinal angle >90 degrees
  4. Convexity of the left atrial appendage on PA film

Remember, that LA is the posterior structure on CXR.
R heart border - RA
Inferior border - RV
L heart border - LV, with minor contribution from left atrial appendage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Indications for surgery for MS

A

Exertional dyspnoea and falling valve area <1cm2 with signs of increasing right heart pressures

Need to be performed before pulmonary oedema or major haemoptysis have occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

6 causes of CHRONIC mitral regurgitation

A
  1. Degenerative disease
  2. Mitral valve prolapse
  3. Rheumatic heart disease
  4. Papillary muscle dysfunction due to LVF or IHD
  5. CTD such as RA, ankylosing spondylitis
  6. Congenital - endocardial cushion defect, parachute valve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

4 causes of ACUTE mitral regurgitation

A
  1. Infective endocarditis
  2. MI
  3. Surgery
  4. Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

5 clinical signs of severity of MR

A
  1. Enlarged LV
  2. Soft first heart sound
  3. Small volume pulse
  4. Signs of LVF
  5. Signs of PHTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Effects of following on murmur of mitral valve prolapse:

  1. Valsalva manoeuvre
  2. Handgrip
  3. Squatting
A
  1. Valsalva manoeuvre - decreases preload, therefore murmur is longer and click is earlier
  2. Handgrip - increases afterload - murmur is shorter
  3. Squatting - increases preload, murmur is shorter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of CHRONIC AR

A

Can be divided into VALVULAR causes and AORTIC ROOT causes

Valvular causes

  1. Rheumatic heart disease
  2. Bicuspid aortic valve
  3. Seronegative arthropathy

Aortic root causes

  1. Marfans syndrome
  2. Aortitis due to seronegative arthropathies, RA, syphilis
  3. Dissecting aneurysm
  4. Age
23
Q

6 clinical signs of severity in chronic AR

A
  1. Collapsing pulse
  2. Wide pulse pressure
  3. Length of decrescendo murmur
  4. Third heart sound
  5. Signs of LVF
  6. Palpable thrill
24
Q

3 indications for AR surgery

A
  1. Symptoms - exertional dyspnoea
  2. Worsening LV function such as low EF
  3. Progressive increase in LVEDD >55mm
25
Q

5 clinical signs of severity in AS

A
  1. Palpable thrill
  2. Length, harshness and lateness of the peak of systolic murmur
  3. Fourth heart sound
  4. Signs of LVF
  5. Paradoxical splitting - delayed LV emptying leads to P2 before A2
26
Q

5 clinical signs of pulmonary stenosis

2 causes?

A
  1. Peripheral cyanosis due to low cardiac output
  2. JVP showing giant a wave due to right atrial hypertrophy
  3. RV heave
  4. Thrill over the pulmonary area
  5. Harsh ejection systolic murmur maximal at the pulmonary area and on inspiration

Causes include congenital cause, carcinoid syndrome

27
Q

6 Clinical signs of coarctation of aorta

A

Most common occurs just distal to the origin of the left subclavian artery

  1. Better developed upper body
  2. Radiofemoral delay
  3. Hypertension in the arms only
  4. Chest collateral vessels
  5. Mid-systolic murmur over the praecordium and back
  6. Features of Turner’s syndrome
28
Q

Features to look for in Marfanoid habitus

A
  1. Arachnodactyly
  2. Joint hypermobility
  3. Blue sclerae
  4. High arched palate
  5. Pectus carinatum/excavatum
  6. AR or mitral valve prolapse on auscultation
  7. Arm span will exceed the height
29
Q

7 causes of oedema

A
  1. Drugs - eg CCB
  2. CHF, constrictive pericarditis
  3. Renal - nephrotic syndrome
  4. Cirrhosis
  5. Malabsorption or starvation (assess nutrition)
  6. Thyroid myxoedema
  7. Protein losing enteropathy
30
Q

Cardiac causes of clubbing

A
  1. Infective endocarditis

2. Cyanotic congenital heart disease

31
Q

Causes of loud S1

A

Occurs when mitral or tricuspid valve cusps remain wide open at the end of diastole and shut forcefully with the onset of ventricular systole without diminution in flow towards the end of diastole.

Occurs in:

  1. Mitral stenosis
  2. Reduced diastolic filling time (eg tachycardia, any cause of short AV conduction time)
32
Q

Causes of soft S1

A
  1. Prolonged diastolic filling time (first degree HB)
  2. Delayed onset of LV systole (LBBB)
  3. Failure of the leaflets to coapt normally (MR)
33
Q

5 causes of increased normal splitting (wider on inspiration)

A

Any cause which delays RV emptying

  1. RBBB (delayed RV depolarisation)
  2. Pulmonary stenosis
  3. VSD (increased RV volume load)
  4. Mitral regurgitation (due to more rapid left ventricular emptying causing earlier aortic valve closure)
34
Q

3 causes of pansystolic murmur

A
  1. MR
  2. TR
  3. VSD
35
Q

Cause of late systolic murmur

A

Typical of mitral valve prolapse or papillary muscle dysfunction where mitral regurgitation begins in midsystole.

36
Q

Explain the physiological changes with Valsalva manoeuvre as it relates to changes in murmur intensity

A

Initial rise in intrathoracic pressure and transient increase in LV output and blood pressure occurs

During straining phase, systemic venous return and hence filling of the R and L ventricles fall resulting in decrease in stroke volume and rise in heart rate. Given that stroke volume and arterial blood pressure fall, most cardiac murmurs become softer, but systolic murmur of HOCM increases and murmur of mitral valve prolapse begins earlier.

37
Q

Evidence of severe AS on echocardiogram

A
  1. Area <1cm
  2. Gradient mean >40 mmHg
  3. Velocity >4m/s
38
Q

Evidence of severe MS

A
  1. Stenosis <1cm
  2. Gradient >10mmHg
  3. RVSP >50 mmHg
39
Q

Management of MS

A

Medically:

  1. Rate control and warfarin if AF present
  2. Diuretics
  3. Endocarditis prophylaxis

Surgically:

  1. Valvotomy
  2. Valve replacement if concurrent MR, class III or IV symptoms and pulmonary hypertension.
40
Q

5 Clinical signs of severity of MR

A
  1. Third HS due to rapid ventricular filling from regurgitated blood from the atrium
  2. Small volume pulse
  3. LV enlargement and failure
  4. Pulmonary HTN
  5. Soft S1, early A2
41
Q

2 main types of apex beat

A
  1. Pressure loaded - due to systolic overload. Forceful and SUSTAINED impulse (eg: AS, HTN)
  2. Volume loaded - forceful but UNSUSTAINED impulse (eg: in AR, MR)
42
Q

Indications for MR surgery

A
  1. Class III or IV symptoms
  2. LV dysfunction
  3. Progressive increase in LV dimensions

Repair of a prolapsing posterior and often anterior leaflet is now undertaken earlier than valve replacement

If valve is repaired, mechanical is chosen usally (tissue valve in the mitral position have a relatively short life)

43
Q

Signs of Marfan’s syndrome

A 
Arachnodactyly
Joint hypermobility
Lens dislocation/lens replacement
High arched palate
Pectus carinatum/excavatum

CVS:
AR/MVP, coarctation of aorta

Check the back for kyphoscoliosis

Arm span will exceed the height
Upper segment to lower segment ratio will be less tha 0.85 (upper segment is from the crown to symphysis pubis, and lower segment is from the symphysis pubis to the ground)

44
Q

Cholesterol target in IHD

A

Total cholesterol <4 mmol/L

LDL <1.8 mmol/L

45
Q

Difference between streptokinase and tPA

A

Streptokinase is much cheaper, repeated administrations are not advisable as antibodies to streptokinase develop within few days and may case an allergic reaction to the second dose.

Alteplase have been shown to have small survival advantage probably as they are more effective at opening up clotted vessels, but slight increase in cerebral haemorrhage

Both are effective upto 12 hours after the onset of an infarct.

46
Q

Compare and contrast LIMA grafts vs SVG

A

LIMA grafts have a higher long term patency rate (>90% at 10 years) vs SVG (50% at 10 years)

47
Q

Bacterial causes of infective endocarditis

A

Strep viridans - usually presents subacutely

Strep faecalis - more common in older men with prostatism and younger women with UTI

Strep bovis - associated with colon polyps and carcinoma

Staph aureus - particularly in drug addicts

Staph epidermidis - more common with recent valve replacement

Gram negative HACEK group - more common with prosthetic valves:
Haemophilus
Acinobacter
Cariobacterium hominius
Eikonella spp
Kingella kingae
48
Q

Diagnostic criteria of infective endocarditis

A

According to Duke’s criteria: 2 major, 1 major/3 minor, or 5 minor criteria

Major criteria

  1. Typical organism in 2 separate blood cultures
  2. Evidence of endocardial involvement on echocardiogram

Minor criteria

  1. Predisposing cardiac condition/IVDU
  2. Fever
  3. Vascular phenomena or stigmata
  4. Serological or acute phase abnormalities
  5. Echo is abnormal but does not meet major criteria
49
Q

Indications for valve surgery in infective endocarditis

A
  1. Resistant organism (eg fungi)
  2. Valvular dysfunction leading to mod-severe cardiac failure
  3. Persistent positive blood cultures despite treatment
  4. Invasive paravalvular infection causing conduction disturbances, or paravalvular abscess/fistula
  5. Recurrent major embolic phenomena
50
Q

Indications for antibiotic prophylaxis to prevent IE

A
  1. Previous IE
  2. Prosthetic heart valve
  3. Congenital heart malformations
  4. Cardiac transplant with valve disease

For following procedures:

  1. Dental procedure or oral surgery
  2. GI/GU procedure - no prophylaxis is recommended
51
Q

Contraindications for heart transplantation

A
  1. Substance abuse - alcohol and smoking
  2. CKD
  3. Pulmonary parenchymal disease
  4. Advanced liver disease
  5. Advanced age
52
Q

Why is diltiazem used together with cyclosporine?

A

Diltiazem is cyclosporin sparing agent - dramatically reduces cyclosporin metabolism therefore the cost of treating patients.

53
Q

Management post cardiac transplantation

A
  1. Biannual cardiac catheterisation to check for intimal proliferation causing IHD in the transplanted heart (form of rejection) - usually asymptomatic as heart is denervated
    - Once lesions causing 40% coronary stenosis have occurred, the prognosis is quite poor.
    - Once MI has occurred, 2 year survival rate is only 10-20%
    - Cholesterol management is stilli mportant
  2. Blood pressure control and management
  3. Increased risk of malignancy - skin cancers, PTLD (either primary infection or reactivation of EBV) - treated with acyclovir or interferon
  4. Endomysial biopsies if there are any signs of acute rejection (such as pericarditis)

FRACP clinical exam (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions