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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

6 causes of orthostatic hypotension

A 
Pregnancy
Postprandial or exercise induced venous pooling
Extended rest (deconditioning)
Nifedipine
Diabetic neuropathy
Parkinson's
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2
Q

Adult dose of adrenaline for analphylaxis

A

0.5ml of 1 in 1000 (500 micrograms) IM

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3
Q

2 changes on echo for HOCM

A

Asymmetric septal hypertrophy

Systolic anterior movement (SAM) of anterior leaflets of mitral valve

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4
Q

When to treat stage 1 hypertension in <80s (5 reasons)

A 
Diabetic
Renal disease
QRISK2 >20%
Established coronary vascular disease
End organ damage
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5
Q

Lifestyle advice for hypertension

A 
Salt
Caffeine
Smoking
Exercise
Alcohol 
Weight loss
Fruit and vegetables
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6
Q

PE scans and contraindications

A

CTPA unless renal impairment or allergy to contrast - then VQ scan

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7
Q

What drug can mask hypoglycaemic symptoms?

A

B blockers

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8
Q

Drugs that can cause long qt

A 
Amiodarone, sotalol, class 1a antiarrhythmics
TCAs, SSRI (citalopram), haloperidol
Methadone
Erythromycin
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9
Q

Non drug causes of long qt

A 
Anterior MI
Myocarditis
Hypothermia
SAH
Electrolytes - low calcium, potassium, magnesium
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10
Q

First ECG change for MI

A

Hyperacute T waves

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11
Q

Anaphylaxis salbutamol and adrenaline repeats?

A

Back to back salbutamol nebs

Adrenaline every 5 mins

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12
Q

BP targets for diabetics

A

130/80 if end organ damage (renal disease, retinopathy)

Otherwise 140/80

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13
Q

ABG changes with PE

A

pH high

pO2 and pCO2 low

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14
Q

Murmur with infective endocarditis

A

Pansystolic, left lower sternal border

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15
Q

Management of patients on warfarin needing emergency surgery

A

If in 6-8h, give 5mg IV vit k

If surgery immediately, 25-50u/kg 4 factor prothrombin complex

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16
Q

4 features of rheumatic fever

A

Erythema marginatum
Sore throat
Chorea
Polyarthralgia

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17
Q

Aortic stenosis top cause

A 
<65 = bicuspid valve
>65 = calcification
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18
Q

Mechanism of adenosine

A

Agonist of A1, inhibiting adenylyl cyclase so reduces cAMP and causes hyperpolarisation by potassium efflux

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19
Q

3 ADRs of adenosine

A

Bronchospasm
Chest pain
Enhance conduction down accessory pathways, increasing ventricular rate

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20
Q

Adrenaline dose for 6-12 year olds

A

300 micrograms 1 in 1000

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21
Q

Heart sounds for AS (2)

A

Split second heart sound

Ejection systolic murmur

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22
Q

heart sound for left heart failure

A

Third heart sound

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23
Q

Management of INR 5-8 on warfarin with no bleeding

A

Withold 1 or 2 doses and reduce maintenance dose

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24
Q

Features of constrictive pericarditis

A

Dyspnoea
Right heart failure - raised JVP, ascites, oedema, hepatomegaly
Loud S3 - pericardial knock
Kussmaul’s sign

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25
Q

Differentiate between constructive pericarditis and cardiac tamponsde

A

Kussmaul’s sign and calcification on CXR = pericarditis

Pulses paradoxus = tamponade

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26
Q

Rate control in asthmatic with AF

A

Calcium channel blocker (diltiazem) instead of usual b blocker

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27
Q

How does aspirin work

A

Antiplatelet - inhibits production of thromboxane a2

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28
Q

How does clopidogrel work

A

Antiplatelet - inhibits ADP binding to platelet receptor

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29
Q

How does enoxaparin work

A

Activates antithrombin 3 which potentiates inhibition of coagulation factors Xa

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30
Q

How does fondaparinux work

A

Activates antithromin 3 which potentiates inhibition of coagulation factors Xa

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31
Q

How does bivalirudin work

A

Reversible direct thrombin inhibitor

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32
Q

How do abciximab, eptifibatide and tirofiban work

A

Glycoprotein 2b/3a receptor antagonists

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33
Q

4th drug for hypertension with low potassium or high potassium

A

Spironolactone if low (<4.5)

High dose thiazides like (>4.5)

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34
Q

Anticoagulation if post-stroke with AF

A

5mg apixiban BD

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35
Q

Features of prinzmetal angina

A

Smokers
Young
Morning or at sleep
ST elevation

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36
Q

Difference between PR segment and interval

A

Segment is from end of p wave to beginning of q

Interval is beginning of p wave to beginning of q

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37
Q

Heart failure first line treatments

A

Ace inhibitor and b blockers

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38
Q

Heart failure 3rd drug

A

Aldosterone antagonist
ARB
Hydralazine and nitrate if afrocaribbean

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39
Q

HF symptoms persisting (2 treatments) not diuretic

A

Implantable cardioverter defibrillator

Digoxin

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40
Q

ACS immediate management

A 
Morphine
Oxygen
Nitrates (GTN)
Aspirin
Clopidogrel or ticagrelor
Anticoagulation - enoxiparin or fondaparinux
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41
Q

What is Buerger’s disease, what features and risk factors

A 
Thromboangiitis obliterans (small and medium vessel vasculitus)
Causes extremity ischaemia (intermittent claudication, ischaemic ulcers) superficial  thrombophlebitis and raynaud's
Risk factors: 20-40, male, smoker,
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42
Q

Features of WPW on ECG

A

Left axis deviation (right sided pathway)
Short PR
Wide qrs with delta wave

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43
Q

Management of WPW

A

Radio frequency ablation of pathway
Sotalol unless AF
Amiodarone
Flecainide

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44
Q

3 mechanisms contributing to bronchiectasis

A

Infection
Airway obstruction
Peribronchial fibrosis

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45
Q

Bronchiectasis on CXR

A

Tram track
Tubular opacities (mucous filled bronchi)
Ring opacities (dilated end on bronchi)
Compensatory overinflation of less affected lung
Lobar atelectasis from mucous plugging

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46
Q

What is kartagener syndrome

A

Dextracardia and bronchiectasis

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47
Q

Long term medication after STEMI

A

Dual antiplatelet
B blocker
ACEi
Statin

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48
Q

Bilateral hilar lymphadenopathy, Fever, cough and erythema nodosum

A

Sarcoidosis

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49
Q

When to start COPD patient on non invasive ventilation?

A

PCO2>6

Ph<7.35

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50
Q

Indications for NIV

A

Type 2 resp failure secondary to obstructive sleep apnoea, chest wall deformity, neuromuscular disease
Copd with resp acidosis
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

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51
Q

Dyspnoea, non productive cough, malaise, weight loss, hypercalcaemia

A

Sarcoidosis

52
Q

Obstructive sleep apnoea management

A

Weight loss
CPAP if moderate or severe
Intramural devices if CPAP not tolerated or mild (no day time sleepiness)

53
Q

What causes pulmonary oedema in cardiogenic shock?

A

High pulmonary pressures - treat with venodilators

54
Q

Joint pain and raised ACE

A

Sarcoidosis

55
Q

Contraindications to lung cancer surgery

A

SVC obstruction
FEV<1.5
Malignant pleural effusion
Vocal cord paralysis

56
Q

Prognostic score for risk stratifying potential TIA

57
Q

Prognosis of prostate cancer score

58
Q

Risk of patient developing pressure sore score

59
Q

Acute pancreatitis score

60
Q

Indication for long term oxygen therapy in COPD

A

2 ABGs with pO2 <7.3

61
Q

Cause of eruptive xanthoma

A

High triglyceride levels

62
Q

Paraneoplastic features of lung cancers

A

Adenocarcinoma - gynaecomastia
SCC - hypercalcaemia (PTHrP), hyperthyroid (TSH), clubbing and hypertrophic pulmonary osteoarthropathy
Bronchial adenoma - carcinoid
Large cell - bHCG

63
Q

COPD management after salbutamol

A

FEV1 <50 = LABA+ICS or LAMA

>50 LABA or LAMA

64
Q

Resp complication of pancreatitis

65
Q

Target sats if COPD with Normal pCO2

66
Q

Features of klebsiella pneumonia

A

Cavitating in upper lobes on CXR
Abscess and empyema, 30-50% mortality
Red currant jelly sputuml’
Diabetes and alcoholics

67
Q

Who is at risk and what is on CXR of pseudomonas aeruginosa

A

Bronchiectasis and CF, ventilated

Ground glass

68
Q

Features of mycoplasma pneumoniae

A

Flu like - headache, arthralgia, myalgia, dry cough

Patchy consolidatoin of 1 lobe

69
Q

Features of legionella pneumophilia

A

Flu like - fever, myalgia
Extra pulmonary ie hepatitis, diarrhoea, vomiting
Bi basal consolidatoin on cxr

70
Q

Mild, moderate, severe and very severe FEV1 readings in COPD

A

<0.7
50-70%
30-50
<30

71
Q

CXR COPD

A

Hyperinflation
Flat diaphragm
Bullae

72
Q

Causes of upper lobe pulmonary fibrosis

A 
CHARTS
Coal workers oneumonitis
Hypersensitivity pneumonitis or Histeocytosis
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis or Sarcoidosis
73
Q

Indications for chest drain in pleural infection

A

Frankly purulent or turbid/cloudy on sample
Cultured organisms
PH<7.2

74
Q

What kind of NIV in COPD?

75
Q

Most common bacteria in COPD exacerbations

A

H influenzae
Strep pneumoniae
Moraxella catarrhalis
Rhinovirus

76
Q

COPD exacerbation management

A

Increase bronchodilator frequency, maybe nebulise
Prednisolone 30mg for 7-14d
Abx if purulent or clinical signs of pneumonia

77
Q

Order of 6 drugs for acute asthma management

A 
Oxygen
Salbutamol nebs
Ipratropium nebs
Hydrocortisone IV or oral prednisone
Magnesium sulfate IV
Aminophylline or IV salbutamol
78
Q

Bronchiectasis management

A 
Physio
Postural drainage
Abx for exacerbations or long term
Bronchodilators
ImmunisAtions
Surgery if localised
79
Q

2 imaging for suspected lung cancer

A

CXR then CT contrast

80
Q

Electrolyte abnormality in sarcoidosis and why

A

Hypercalcaemia because macrophages in granulomas convert vit D to active form more

81
Q

Cannonball mets on cxr

A

Renal cell cancer

82
Q

Difference in emphysema in COPD or a1at def

A

Upper in COPD

Lower lobes in a1at

83
Q

R3current chest infections and subfertility

A

Ciliary dyskinesia - kartagener

84
Q

Complication of long qt

A

Ventricular tachycardia and sudden collapse or death

85
Q

Management of long qt

A

Avoid drugs and precipitates ie strenuous exercise
B blockers
Implantable cardioverter defibrillator

86
Q

ComplicToin of embolisation of left ventricular thromboembolism

87
Q

3 features of constructive pericarditis and one cause

A

Cardiac surgery

Dyspnoea
Peripheral oedema
Kussmaul’s sign

88
Q

Rate or rhythm control if AF with obvious reversible cause eg pneumonia?

A

Rhythm control

89
Q

Threshold for treating >80yo with hypertension

90
Q

Murmur scale and basic explanation

A 
Levine scale
1 very faint
2 slight
3 moderate
4 loud and thrill
5 very loud and very palpable thrill
6 extremely loud without stethoscope
91
Q

When is coarctation of the aorta diagnosed and how

A

At day 2 when PDA closes = heart failure and absent femoral pulses

92
Q

Second line treatment for AF rate control

A

Digoxin or diltiazem

93
Q

Diagnosis of pulmonary fibrosis

A

Spirometry
Reduced TLCO
High resolution CT

94
Q

Complications of asbestos

A 
Benign pleural plaques
Pleural thickening
Asbestosis - lower lobe
Lung cancer
Mesothelioma
95
Q

Artery affected in complete heart block after MI

A

Right coronary artery (AVN)

96
Q

What is malignant hypertension

A

Severe hypertension with potentially life threatening sx suggesting acute organ impairment - kidneys, eyes, heart

97
Q

How does miliary TB travel through lung parenchyma

A

Pulmonary venous system

98
Q

What is granulomatosis with polyangitis

A

Necrotising granulomatous vasculiitis - upper and lower resp sx, glomerulonephritis, saddle shaped nose

99
Q

Marker for granulomatosis with polyangitis

100
Q

Management of secondary pneumothorax

A

<1cm - admit for high flow o2 for 24h
1-2cm - aspirate
>2cm - chest drain

101
Q

ECG indications for thrombolysis or PCI

A

ST elevation of >2mm in 2+ consecutive anterior leads V1-6
Or >1mm in 2 consecutive leads 2,3,avF,avL
New lbbb

102
Q

Hypertension therapy after A + C + D

A

Add thiazide (spironolactone if low K, high dose thiazide if high)
Or a blocker
Or b blocker

103
Q

What diuretic should be used first in hypertension

A

Indapamide or chlorthiazone

104
Q

When should a statin be given (what qrisk2)

105
Q

8 reversible causes of cardiac arrest

A 
4H 4T
Hypothermia
Hypoxia
Hypovolaemia
Hypo/erK, hypoglycaemia 
Tensoin pneumothorax
Tamponade
Toxins
Thrombosis
106
Q

What can and cannot be used for smoking cessation in pregnancy

A

Yes NRT
Varenicline harmful
Bupropion insufficient info

107
Q

Features on CXR of HF

A 
Alveolar oedema
kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
108
Q

Calcified nodule on CXR from previous tb

A

Ghon complex - latent Tb. Granuloma

109
Q

4 features of centor criteria and what do they suggest

A 
3+ = 40-60% chance group a b haemolytic strep
No cough
Exudate on tonsils 
Tender anterior cervical lymphadenopathy
Fever
110
Q

Management of torsades de pointes

A

Magnesium sulfate iv

111
Q

Lung and liver features of a1ar

A

Lung - panacinar emphysema (lower lobes)

Liver - cirrhosis, hepatocellular carcinoma, cholestasis in children

112
Q

Manage a1at

A

Physio, bronchodilators
IV a1at protein concentrates
Surgery - volume reduction, transplant

113
Q

Manage HOCM

A

Implantable cardioverter-defibrillator

114
Q

What presents at 1w old with reduced femoral pulses and what murmur is there

A

Coarctation of the aorta

Systolic in left sternal edge

115
Q

Features of idiopathic pulmonary fibrosis

A

50-70yo, 2x in men
Dry cough, Dyspnoea
Weight loss Bibasal inspiratory crackles
Finger clubbing

116
Q

COPD exacerbation and no CXR change?

Treatment

A

Haemophilus influenzae

Amoxicillin and prednisolone

117
Q

Specific chemicals affected by drugs in kidney disease (afferent and efferent arterioles) and why use in ckd

A

Afferent - prostaglandin E2 - NSAIDS
Efferent - angiotensin 2 - ACEi, ARB
ACEi and ARB for antihypertensiin and anti inflammatory, reduce glomerular perfusion pressure to prevent damage

118
Q

Features of pulmonary oedema on cxr

A 
Pleural effusion
Interstitial oedema
Bat wings
Upper lobe diversion
Kerley b lines
119
Q

Cause of raised TLCO

A 
Asthma
Pulmonary haemorrhage
Left to right shunt
Polycythaemia
Hyperkinetic
Male, exercise
120
Q

Cause of low TLCO

A 
Fibrosis
Pneumonia
Emboli
Oedema
Emphysema
Anaemia
Low cardiac output
121
Q

Heart failure pulse

A

Pulsus alternans - upstroke alternate strong and weak, - systolic dysfunctiom

122
Q

Inferior MI and aortic regurgitation murmur?

A

Proximal aortic dissection

123
Q

Features of boerhaave syndrome

A

Middle aged male alcoholics

Mackler triad: vomiting, thoracic pain, subcut emphysema

124
Q

Borders of triangle for chest drain insertion

A

Lat dorsi
Pec major
Line superior to nipple
Apex of axilla

125
Q

FEV cut offs for severity of COPD

A

Mild >80
Moderat 50-79
Severe 30-49
Very severe <30

126
Q

FEV/FVC for airflow obstruction

A

Less than 0.7

Finals (13 decks)

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