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Year 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Name x5 things you may want to look for at the bedside for a Cardiology patient.

A 
GTN spray
Oxygen
Number of pillows
IV fluids
Cardiac monitoring 
Cigarettes
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2
Q

What is a syndrome associated with Cardiological disease?

A

Marfan’s syndrome

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3
Q

Which murmur is malar flush associated with?

A

Mitral stenosis; backflow in pulmonary system = backflow

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4
Q

Why is Turner’s syndrome significant for cardiovascular examination?

A

Associated with Coarctation of aorta and bicuspid aortic valve.

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5
Q

Give a cardiac cause of clubbing

A

Infective endocarditis
Congenital cyanotic heart disease
(not heart failure)

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6
Q

Clubbing, poor dentition and splinter haemorrhages may all be associated with which condition?

A

Infective endocarditis

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7
Q

Give two signs associated specifically with infective endocarditis.

A 
Janeway lesions (non-tender)
Osler's nodes (tender)

Janeway -Caused by septic embolis.
Osler’s nodes - deposition of Immune complexes.

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8
Q

Arachnodactyly is associated with what?

A

Marfan’s syndrome?

spider fingers

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9
Q

What is the order of how to conduct a cardiac examination?

A

Hands, arms (pulses, radio-radial delay)

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10
Q

Would you see tachycardia or bradycardia in sepsis?

A

Tachycardia

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11
Q

What is a slow-rising carotid pulse associated with?

A

Aortic stenosis.

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12
Q

What is a collapsing pulse associated with?

A 
Aortic regurgitation 
(always ask about pain first - do on other arm).
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13
Q

What could cause a difference in blood pressure between two arms?

A

Aortic dissection.

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14
Q

What could cause a narrow pulse pressure instead of a wide pulse pressure?

A

Narrow pulse pressure; Aortic stenosis (lower systolic pressure so closer to diastolic)

Wider pulse pressure; aortic regurgitation.

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15
Q

What is a corneal arcus associated with?

A

Hyperlipidaemia

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16
Q

What is xanthelasma associated with?

A

Hyperlipidaemia

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17
Q

What disease is a high arched palate associated with?

A

Marfan Syndrome

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18
Q

What are the three things we look for in the eye in the cardiovascular examination?

A

Conjunctival pallor
Corneal arcus
Xanthelasma

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19
Q

What is the difference between the carotid pulse and the JVP?

A

The JVP is non palpable whereas the carotid pulse is palpable.

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20
Q

When may the JVP be raised?

A 
PQRST
Pulmonary hypertension
Quantity of fluid (fluid overload)
RHF
Superior vena cava obstruction
Tamponade
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21
Q

What is the scar where a CABG is performed is called?

A

Median sternotomy scar

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22
Q

Where is the aortic valve found?

A

Right side, 2nd ICS

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23
Q

Which valve is found in the apex beat?

A

Mitral valve (5th ICS, midclavicular line)

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24
Q

What system should you follow when describing murmurs?

A 
Site
Character
Radiation
Intensity
Pitch
Timing (systolic or diastolic)?
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25
Q

Where is an aortic stenosis murmur best heard?

A

Where the aortic valve would be; right sternal border, 2nd ICS.

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26
Q

How is an aortic stenosis murmur described?

A

Crescendo-decrescendo systolic ejection murmur.

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27
Q

Is bicuspid or tricuspid aortic valve abnormal?

A

Bicuspid valve.

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28
Q

Where is mitral stenosis murmur best heard?

A

Apex of the heart - midclavicular line, 5th ICS.

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29
Q

What do you hear in mitral stenosis murmur?

A

Loud S1 = diastolic murmur

A decrescendo-crescendo murmur.

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30
Q

What is mitral stenosis most commonly caused by?

A

Rheumatic heart disease

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31
Q

What is the crescendo part of the murmur in mitral stenosis caused by? Think of graph with pulse going down then up (the crescendo part).

A

Increased flow with atrial contraction; mitral valve is narrowed.

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32
Q

Give two causes of aortic regurgitation.

A

Bicuspid aortic valve

Rheumatic heart disease.

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33
Q

What are the three differentials of cardiac chest pain

A

Ischaemic heart disease
Pericarditis
Aortic dissection

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34
Q

What are the three respiratory causes of chest pain?

A

Pulmonary embolism
Pneumonia
Pneumothorax

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35
Q

Name four causes of collapse

A 
HYPOGLYCAEMIA (Number 1!)
Vasovagal
Arrhythmia
Outflow obstruction
Postural hypotension
Seizure
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36
Q

Name x1 thing important to acknowledge before, during and after a collapse.

A 
Before = aura?
During = tongue biting?
After = Confusion
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37
Q

DNEFG relates to what?

A

Don’t ever forget glucose!!

In cause of syncope

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38
Q

Name three valve defects which cause systolic murmurs.

A

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

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39
Q

What ECG change could you see in Sepsis?

A

Sinus tachycardia

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40
Q

How do we manage AF after 4 hours?

A

DC Cardioversion

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41
Q

How do we manage AF before 4 hours?

A

Beta blocker, digoxin

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42
Q

Where do we give IV amiodarone?

A

VT

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43
Q

When would we hear S4 heart sound?

A

LVH

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44
Q

How do we manage VF?

A

Shock, CPR, assess rhythm.
Adrenaline every 3-5 minutes
Amiodarone after 3 shocks.

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45
Q

What are the 5 Ps of pleuritic chest pain?

A
  • Pneumonia
  • PE
  • Pericarditis
  • Pneumothorax
  • Pleural effusion
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46
Q

Name three features of Marfan’s syndrome

A

Disproportionately longer arms and legs
High arched palate
Arachnodactyly (spinder fingers - longer fingers)

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47
Q

Give two causes of first/second degree heart block

A

Increased vagal tone e.g. in athletes, coronary artery disease, digoxin toxicity.

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48
Q

Give two causes of third degree heart block

A

Fibrosis around the Bundle of His
LBBB/RBBB (blockage of both)
Aortic Stenosis
Trauma

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49
Q

In which leads is T wave inversion normal?

A

Leads III, avR and V1.

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50
Q

When can a U wave maybe be seen?

A

Hypokalaemia.

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51
Q

Describe precisely how calcium levels between a shorter and longer QT interval.

A

Short QT: hypercalcaemia

Long QT: hypocalcaemia

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52
Q

What may we try to feel for in an abdominal aortic aneurysm and where?

A

Pulsatile mass just above the umbilicus

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53
Q

What is the scar from a AAA repair?

A

Midline laparotomy

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54
Q

How do we calculate ankle brachial pulse index? (ABPI)

A

Measure systolic pressure in arms (both arms and take highest value)

Measure systolic pressure in legs (dorsalis pedis and posterior tibialis and take highest value)

Leg/arm

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55
Q

What is the difference between intermittent claudication and critical limb ischaemia?

A

Intermittent claudication = relieved at rest

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56
Q

Which are the four types of ulcers?

A

Arterial, venous, neuropathic, pressure

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57
Q

Which ulcers are not as well demarcated - arterial or venous?

A

Venous; blood vessels are more diffuse

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58
Q

‘Severe shearing pain, ripping, tearing and radiating to the back’ are phrases indicative of what condition?

A

Acute thoracic aortic dissection.

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59
Q

What may aortic dissection be a complication from?

A

Marfan’s syndrome

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60
Q

A saddle shaped ST elevation indicates what?

A

Pericarditis.

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61
Q

Is pericarditis caused more commonly by viral or bacterial causes?
Which medications are used for pericarditis?

A

Viral causes.

NSAIDs are used to treat pericarditis.

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62
Q

Which medications would you avoid in Wolffe Parkinson White syndrome?

A

Verapamil and bisoprolol - Calcium channel blockers and beta blockers.
Do not want further medications which will block the AVN.

instead; flecainide, amiodarone

63
Q

What is the standard treatment for MI?

A 
MONA
M - morphine
O - oxygen
N - nitrates
A - aspirin
64
Q

Which drug type if metoclopramide and why may it be used in an M.I.?

A

An antiemetic; opiate analgesia for MI can induce vomiting.

65
Q

What sign on the X-ray may be seen in aortic dissection?

A

Widened mediastinum.

66
Q

How do we treat aortic dissection?

A

Oxygen and antihypertensives.

67
Q

What is the most common cause of sudden death in HCM?

A

arrhythmias

68
Q

What is a key sign on the X-ray in pulmonary oedema?

A

Batwings.

69
Q

What may be pink cheeks be a sign of?

A

Mitral stenosis.

70
Q

What type of murmur is mitral regurgitation?

A

Pansystolic murmur

71
Q

In splenomegaly, how might we investigate infective endocarditis?

A

Ultrasound

72
Q

Ventral septal defects can cause what type of murmurs?

A

Systolic murmurs.

73
Q

Which medications are contraindicated in ventral septal defects?

A

Beta blockers, thrombolysis.

74
Q

Where else would you not want to use beta blockers?

A

Shock!

75
Q

With homelessness and alcohol misuse, which condition should we be thinking of?

A

TB.

76
Q

What is a common cause of mitral stenosis?

A

Rheumatic fever.

77
Q

Splinter haemorrhages may be indicative of what?

A

Infective endocarditis.

78
Q

Which is the test used specifically for TB?

A

Acid-fast bacilli (AFBs).

79
Q

Which is the most common valve affected from IV drugs?

A

The tricuspid valve.

80
Q

Which are the tests we use in diagnosing DVT?

A

D-dimer, doppler US (doppler to assess blood flow).

81
Q

Which factor is positive in infective endocarditis?

A

Positive rheumatoid factor.

82
Q

How should the oxygen saturation between the right atrium and right ventricle compare?

A

The oxygen saturations should be the same between the RA and RV.

83
Q

Rheumatic fever is caused by which bacteria?

A

Streptococcus A.

84
Q

Give two main signs seen in Infective endocarditis?

A

Hepatosplenomegaly

Clubbing

85
Q

What is the disadvantage of using D dimers to diagnose DVT?

A

Not specific.

86
Q

Aminophylline is what type of drug?

When may it be urgently required?

A

Phosphodiesterase Inhibitor - administered IV in severe asthma.

87
Q

Give two specific signs seen in rheumatic fever.

A

Pericardial rub

Sydenham’s chorea.

88
Q

Why are platelets large in thrombocytopenia?

A

The bone marrow attempts to produce new platelets which are immature.

89
Q

Which is usually the most predominant haemoglobin in normal patients?

A

HbA

90
Q

Which type of anaemia do we often see in Sickle cell anaemia?

A

Haemolytic anaemia.

91
Q

Which is a main complication in sickle cell disease in terms of anaemia?

A

Vaso-occlusive crisis due to haemolytic anaemia.

92
Q

What is a key sign on blood film of plasmodium falciparum?

A

Ring on blood cell

93
Q

What do transferrin levels look like in iron deficient anaemia?

A

Low transferrin levels.

94
Q

What is ITP?

A

Idiopathic thrombocytopenia purpura - usually isolated, no other clinical features.

95
Q

What is TTP?

A

Thrombotic thrombocytopenia purpura - can cause haemolytic anaemia.

96
Q

What is the commonest cause of aortic stenosis?

A

Calcification.

2nd = bicuspid valve.

97
Q

Which type of murmur is aortic stenosis?

A

Ejection systolic murmur

Slow rising.

98
Q

Which type of murmur is mitral regurgitation?

A

Pan systolic murmur

Listen to the axilla with bell of diaphragm.

99
Q

What is koilonychia?

A

Spoon shaped nails

100
Q

What type of murmur is seen in mitral stenosis?

A

Mid diastolic murmur.

101
Q

Why are left sided murmurs louder than right on expiration?

A

As you breathe out the intrathoracic pressure increases which causes pulmonary veins to constrict and increase blood flow to the left side of the heart.

102
Q

What is the main side effect of calcium channel blocker?

A

Oedema, flushing.

103
Q

Malar flush is associated with which valve dysfunction?

A

Mitral stenosis.

104
Q

What is a main side effect of spironolactone?

A

Gynaecomastia.

105
Q

In OSCE, when must you repeat a blood pressure measurement?

A

If blood pressure is more than 15 mmHg.

Always record the higher blood pressure reading from one of the arms.

106
Q

When do we give calcium channel blockers as a first line therapy for hypertension?

A

> 55 years old

Afro-caribbean individuals.

107
Q

Which medication do we give first in phaeochromocytomas?

A

Alpha blockers, then beta blockers.

108
Q

Marfan’s syndrome can cause which valvular dysfunction?

A

Aortic regurgitation.

109
Q

William’s syndrome can cause which valvular dysfunction?

A

Aortic stenosis.

110
Q

Rheumatic fever is caused by which bacteria?

A

Streptococcus Group A

111
Q

How do we treat rheumatic fever?

A

IM Benzylpenicillin

112
Q

What are the exceptions to giving someone an ACE inhibitor as first line therapy for hypertension?

A

Over 55 years of age
Afro-Caribbean
Diabetic (Give CCB)

113
Q

What is a significant postural BP drop?

A

Drop of systolic more than 20mmHg.
OR if systolic itself is less than 90mmHg
Drop in diastolic of more than 10mmHg

114
Q

When may you see hypervolaemia?

A

Cardiac failure, nephrotic syndrome, cirrhosis.

115
Q

Which are the left sided murmurs - when are they louder?

A

Mitral, aortic. Louder on expiration

116
Q

Which are the right sided murmurs - when are they louder?

A

Tricuspid, pulmonic - Louder on inspiration

117
Q

What causes S4?

A

Sound of atrial contraction into a thickened ventricle: LVH.

118
Q

What is a sign of chronic hypertension?

A

Retinopathy, LVH.

119
Q

Where is erythema nodosum seen?

A

Sarcoidosis
Streptococcal infection
TB
UC/Crohn’s disease

120
Q

What pulse is seen in aortic stenosis?

A

Slow rising pulse.

121
Q

What is the commonest cause of aortic stenosis?

A

Rheumatic heart disease
NOT bicuspid.
Second = bicuspid calcification.

122
Q

A thrill in the aortic area can indicate what?

A

Aortic stenosis.

123
Q

Ejection systolic murmurs can radiate where?

A

Carotid artery and apex.

124
Q

A softened heart sound can be a result of what?

A

Calcification

125
Q

Which medication do we use to treat SVTs?

A

Adenosine NOT amiodarone.

126
Q

Which drug is used to treat SVTs?

A

Adenosine (after vagal manouevres)

127
Q

Phosphodiesterase inhibitors have antiplatelet activity. true or false.

A

True; causes vasodilatation.

128
Q

Name three causes of a raised JVP.

A

Right sided heart failure
Tricuspid regurgitation
Constrictive pericarditis

129
Q

Name four causes of a systolic murmur

A

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

130
Q

Which murmur is pansystolic?

A

Mitral regurgitation.

131
Q

Name two systemic conditions where we may see sinus tachycardia.

A

Sepsis

Hypovolaemia.

132
Q

Give an example of an AVRT

A

WPW.

133
Q

How do we manage SVTs?

A

Vagal maneouvre
Adenosine
DC cardioversion if there is haemodynamic compromise.

134
Q

How do we manage VT?

A

Where there is no haemodynamic compromise = IV amiodarone.

135
Q

The third heart sound is due to what?

A

Impaired ventricular filling

136
Q

The fourth heart sound is due to what?

A

Ventricular hypertrophy

137
Q

An atrial septal defect may cause what kind of heart sound?

A

S2

associated with an ejection systolic murmur.

138
Q

Can we defibrillate VF?

A

Yes + pulseless VT.
Shock+CPR
Adrenaline 3-5 minutes
Amiodarone after 3 shocks

139
Q

How do we treat asytolic/PEA?

A

NO SHOCK.

CPR + adrenaline

140
Q

Name three differentials of pleuritic chest pain.

A 
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
141
Q

Do we see pulmonary oedema or pleural effusion in heart failure?

A

Pleural effusion.

142
Q

How do we treat a SVT in someone who is haemodynamically not compromised?

A

Vagal manouevres.

143
Q

How do we treat a SVT in someone who is haemodynamically compromised?

A

DC Cardioversion.

144
Q

What type of murmur is mitral regurgitation?

A

Pansystolic

145
Q

Which condition is associated with higher anti mitochondrial antibodies?

A

Primary Biliary Cirrhosis (PBC)

146
Q

Coca-coca coloured urine is associated with which condition?

A

= Bood in urine

= nephritic syndrome

147
Q

Protein +++ in urine can indicate what?

A

Nephrotic syndrome

148
Q

Name three of the most common nephritic syndromes

A

Post-streptococcal glomerulonephritis
IgA nephropathy
Rapidly progressive glomerulonephritis.

149
Q

Which nephritic syndrome is associated with post URTI?

A

IgA nephropathy.

150
Q

Which antibody is associated with PSC? Primary sclerosing cholangitis?

A

P-ANCA.

151
Q

What is PSC often associated with?

A

IBD i.e. Ulcerative Colitis.

152
Q

List four major criteria of Rheumatic Fever

A

Carditis
Arthritis
Chorea
Subcutaneous nodules

153
Q

Ankle oedema is associated with which type of heart failure?

A

Right-sided heart failure

154
Q

How may left sided heart failure present on auscultation of the lungs?

A

Bi-basal crepitations.

Year 3 (13 decks)

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