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
2
Q
What is a syndrome associated with Cardiological disease?
A
Marfan’s syndrome
3
Q
Which murmur is malar flush associated with?
A
Mitral stenosis; backflow in pulmonary system = backflow
4
Q
Why is Turner’s syndrome significant for cardiovascular examination?
A
Associated with Coarctation of aorta and bicuspid aortic valve.
5
Q
Give a cardiac cause of clubbing
A
Infective endocarditis
Congenital cyanotic heart disease
(not heart failure)
6
Q
Clubbing, poor dentition and splinter haemorrhages may all be associated with which condition?
A
Infective endocarditis
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.
8
Q
Arachnodactyly is associated with what?
A
Marfan’s syndrome?
spider fingers
9
Q
What is the order of how to conduct a cardiac examination?
A
Hands, arms (pulses, radio-radial delay)
10
Q
Would you see tachycardia or bradycardia in sepsis?
A
Tachycardia
11
Q
What is a slow-rising carotid pulse associated with?
A
Aortic stenosis.
12
Q
What is a collapsing pulse associated with?
A
Aortic regurgitation (always ask about pain first - do on other arm).
13
Q
What could cause a difference in blood pressure between two arms?
A
Aortic dissection.
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.
15
Q
What is a corneal arcus associated with?
A
Hyperlipidaemia
16
Q
What is xanthelasma associated with?
A
Hyperlipidaemia
17
Q
What disease is a high arched palate associated with?
A
Marfan Syndrome
18
Q
What are the three things we look for in the eye in the cardiovascular examination?
A
Conjunctival pallor
Corneal arcus
Xanthelasma
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.
20
Q
When may the JVP be raised?
A
PQRST Pulmonary hypertension Quantity of fluid (fluid overload) RHF Superior vena cava obstruction Tamponade
21
Q
What is the scar where a CABG is performed is called?
A
Median sternotomy scar
22
Q
Where is the aortic valve found?
A
Right side, 2nd ICS
23
Q
Which valve is found in the apex beat?
A
Mitral valve (5th ICS, midclavicular line)
24
Q
What system should you follow when describing murmurs?
A
Site Character Radiation Intensity Pitch Timing (systolic or diastolic)?
25
Where is an aortic stenosis murmur best heard?
Where the aortic valve would be; right sternal border, 2nd ICS.
26
How is an aortic stenosis murmur described?
Crescendo-decrescendo systolic ejection murmur.
27
Is bicuspid or tricuspid aortic valve abnormal?
Bicuspid valve.
28
Where is mitral stenosis murmur best heard?
Apex of the heart - midclavicular line, 5th ICS.
29
What do you hear in mitral stenosis murmur?
Loud S1 = diastolic murmur
| A decrescendo-crescendo murmur.
30
What is mitral stenosis most commonly caused by?
Rheumatic heart disease
31
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).
Increased flow with atrial contraction; mitral valve is narrowed.
32
Give two causes of aortic regurgitation.
Bicuspid aortic valve
| Rheumatic heart disease.
33
What are the three differentials of cardiac chest pain
Ischaemic heart disease
Pericarditis
Aortic dissection
34
What are the three respiratory causes of chest pain?
Pulmonary embolism
Pneumonia
Pneumothorax
35
Name four causes of collapse
```
HYPOGLYCAEMIA (Number 1!)
Vasovagal
Arrhythmia
Outflow obstruction
Postural hypotension
Seizure
```
36
Name x1 thing important to acknowledge before, during and after a collapse.
```
Before = aura?
During = tongue biting?
After = Confusion
```
37
DNEFG relates to what?
Don't ever forget glucose!!
| In cause of syncope
38
Name three valve defects which cause systolic murmurs.
Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation
39
What ECG change could you see in Sepsis?
Sinus tachycardia
40
How do we manage AF after 4 hours?
DC Cardioversion
41
How do we manage AF before 4 hours?
Beta blocker, digoxin
42
Where do we give IV amiodarone?
VT
43
When would we hear S4 heart sound?
LVH
44
How do we manage VF?
Shock, CPR, assess rhythm.
Adrenaline every 3-5 minutes
Amiodarone after 3 shocks.
45
What are the 5 Ps of pleuritic chest pain?
- Pneumonia
- PE
- Pericarditis
- Pneumothorax
- Pleural effusion
46
Name three features of Marfan's syndrome
Disproportionately longer arms and legs
High arched palate
Arachnodactyly (spinder fingers - longer fingers)
47
Give two causes of first/second degree heart block
Increased vagal tone e.g. in athletes, coronary artery disease, digoxin toxicity.
48
Give two causes of third degree heart block
Fibrosis around the Bundle of His
LBBB/RBBB (blockage of both)
Aortic Stenosis
Trauma
49
In which leads is T wave inversion normal?
Leads III, avR and V1.
50
When can a U wave maybe be seen?
Hypokalaemia.
51
Describe precisely how calcium levels between a shorter and longer QT interval.
Short QT: hypercalcaemia
| Long QT: hypocalcaemia
52
What may we try to feel for in an abdominal aortic aneurysm and where?
Pulsatile mass just above the umbilicus
53
What is the scar from a AAA repair?
Midline laparotomy
54
How do we calculate ankle brachial pulse index? (ABPI)
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
55
What is the difference between intermittent claudication and critical limb ischaemia?
Intermittent claudication = relieved at rest
56
Which are the four types of ulcers?
Arterial, venous, neuropathic, pressure
57
Which ulcers are not as well demarcated - arterial or venous?
Venous; blood vessels are more diffuse
58
'Severe shearing pain, ripping, tearing and radiating to the back' are phrases indicative of what condition?
Acute thoracic aortic dissection.
59
What may aortic dissection be a complication from?
Marfan's syndrome
60
A saddle shaped ST elevation indicates what?
Pericarditis.
61
Is pericarditis caused more commonly by viral or bacterial causes?
Which medications are used for pericarditis?
Viral causes.
| NSAIDs are used to treat pericarditis.
62
Which medications would you avoid in Wolffe Parkinson White syndrome?
Verapamil and bisoprolol - Calcium channel blockers and beta blockers.
Do not want further medications which will block the AVN.
instead; flecainide, amiodarone
63
What is the standard treatment for MI?
```
MONA
M - morphine
O - oxygen
N - nitrates
A - aspirin
```
64
Which drug type if metoclopramide and why may it be used in an M.I.?
An antiemetic; opiate analgesia for MI can induce vomiting.
65
What sign on the X-ray may be seen in aortic dissection?
Widened mediastinum.
66
How do we treat aortic dissection?
Oxygen and antihypertensives.
67
What is the most common cause of sudden death in HCM?
arrhythmias
68
What is a key sign on the X-ray in pulmonary oedema?
Batwings.
69
What may be pink cheeks be a sign of?
Mitral stenosis.
70
What type of murmur is mitral regurgitation?
Pansystolic murmur
71
In splenomegaly, how might we investigate infective endocarditis?
Ultrasound
72
Ventral septal defects can cause what type of murmurs?
Systolic murmurs.
73
Which medications are contraindicated in ventral septal defects?
Beta blockers, thrombolysis.
74
Where else would you not want to use beta blockers?
Shock!
75
With homelessness and alcohol misuse, which condition should we be thinking of?
TB.
76
What is a common cause of mitral stenosis?
Rheumatic fever.
77
Splinter haemorrhages may be indicative of what?
Infective endocarditis.
78
Which is the test used specifically for TB?
Acid-fast bacilli (AFBs).
79
Which is the most common valve affected from IV drugs?
The tricuspid valve.
80
Which are the tests we use in diagnosing DVT?
D-dimer, doppler US (doppler to assess blood flow).
81
Which factor is positive in infective endocarditis?
Positive rheumatoid factor.
82
How should the oxygen saturation between the right atrium and right ventricle compare?
The oxygen saturations should be the same between the RA and RV.
83
Rheumatic fever is caused by which bacteria?
Streptococcus A.
84
Give two main signs seen in Infective endocarditis?
Hepatosplenomegaly
| Clubbing
85
What is the disadvantage of using D dimers to diagnose DVT?
Not specific.
86
Aminophylline is what type of drug?
| When may it be urgently required?
Phosphodiesterase Inhibitor - administered IV in severe asthma.
87
Give two specific signs seen in rheumatic fever.
Pericardial rub
| Sydenham's chorea.
88
Why are platelets large in thrombocytopenia?
The bone marrow attempts to produce new platelets which are immature.
89
Which is usually the most predominant haemoglobin in normal patients?
HbA
90
Which type of anaemia do we often see in Sickle cell anaemia?
Haemolytic anaemia.
91
Which is a main complication in sickle cell disease in terms of anaemia?
Vaso-occlusive crisis due to haemolytic anaemia.
92
What is a key sign on blood film of plasmodium falciparum?
Ring on blood cell
93
What do transferrin levels look like in iron deficient anaemia?
Low transferrin levels.
94
What is ITP?
Idiopathic thrombocytopenia purpura - usually isolated, no other clinical features.
95
What is TTP?
Thrombotic thrombocytopenia purpura - can cause haemolytic anaemia.
96
What is the commonest cause of aortic stenosis?
Calcification.
| 2nd = bicuspid valve.
97
Which type of murmur is aortic stenosis?
Ejection systolic murmur
| Slow rising.
98
Which type of murmur is mitral regurgitation?
Pan systolic murmur
| Listen to the axilla with bell of diaphragm.
99
What is koilonychia?
Spoon shaped nails
100
What type of murmur is seen in mitral stenosis?
Mid diastolic murmur.
101
Why are left sided murmurs louder than right on expiration?
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
What is the main side effect of calcium channel blocker?
Oedema, flushing.
103
Malar flush is associated with which valve dysfunction?
Mitral stenosis.
104
What is a main side effect of spironolactone?
Gynaecomastia.
105
In OSCE, when must you repeat a blood pressure measurement?
If blood pressure is more than 15 mmHg.
| Always record the higher blood pressure reading from one of the arms.
106
When do we give calcium channel blockers as a first line therapy for hypertension?
>55 years old
| Afro-caribbean individuals.
107
Which medication do we give first in phaeochromocytomas?
Alpha blockers, then beta blockers.
108
Marfan's syndrome can cause which valvular dysfunction?
Aortic regurgitation.
109
William's syndrome can cause which valvular dysfunction?
Aortic stenosis.
110
Rheumatic fever is caused by which bacteria?
Streptococcus Group A
111
How do we treat rheumatic fever?
IM Benzylpenicillin
112
What are the exceptions to giving someone an ACE inhibitor as first line therapy for hypertension?
Over 55 years of age
Afro-Caribbean
Diabetic (Give CCB)
113
What is a significant postural BP drop?
Drop of systolic more than 20mmHg.
OR if systolic itself is less than 90mmHg
Drop in diastolic of more than 10mmHg
114
When may you see hypervolaemia?
Cardiac failure, nephrotic syndrome, cirrhosis.
115
Which are the left sided murmurs - when are they louder?
Mitral, aortic. Louder on expiration
116
Which are the right sided murmurs - when are they louder?
Tricuspid, pulmonic - Louder on inspiration
117
What causes S4?
Sound of atrial contraction into a thickened ventricle: LVH.
118
What is a sign of chronic hypertension?
Retinopathy, LVH.
119
Where is erythema nodosum seen?
Sarcoidosis
Streptococcal infection
TB
UC/Crohn's disease
120
What pulse is seen in aortic stenosis?
Slow rising pulse.
121
What is the commonest cause of aortic stenosis?
Rheumatic heart disease
NOT bicuspid.
Second = bicuspid calcification.
122
A thrill in the aortic area can indicate what?
Aortic stenosis.
123
Ejection systolic murmurs can radiate where?
Carotid artery and apex.
124
A softened heart sound can be a result of what?
Calcification
125
Which medication do we use to treat SVTs?
Adenosine NOT amiodarone.
126
Which drug is used to treat SVTs?
Adenosine (after vagal manouevres)
127
Phosphodiesterase inhibitors have antiplatelet activity. true or false.
True; causes vasodilatation.
128
Name three causes of a raised JVP.
Right sided heart failure
Tricuspid regurgitation
Constrictive pericarditis
129
Name four causes of a systolic murmur
Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation
130
Which murmur is pansystolic?
Mitral regurgitation.
131
Name two systemic conditions where we may see sinus tachycardia.
Sepsis
| Hypovolaemia.
132
Give an example of an AVRT
WPW.
133
How do we manage SVTs?
Vagal maneouvre
Adenosine
DC cardioversion if there is haemodynamic compromise.
134
How do we manage VT?
Where there is no haemodynamic compromise = IV amiodarone.
135
The third heart sound is due to what?
Impaired ventricular filling
136
The fourth heart sound is due to what?
Ventricular hypertrophy
137
An atrial septal defect may cause what kind of heart sound?
S2
| associated with an ejection systolic murmur.
138
Can we defibrillate VF?
Yes + pulseless VT.
Shock+CPR
Adrenaline 3-5 minutes
Amiodarone after 3 shocks
139
How do we treat asytolic/PEA?
NO SHOCK.
| CPR + adrenaline
140
Name three differentials of pleuritic chest pain.
```
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
```
141
Do we see pulmonary oedema or pleural effusion in heart failure?
Pleural effusion.
142
How do we treat a SVT in someone who is haemodynamically not compromised?
Vagal manouevres.
143
How do we treat a SVT in someone who is haemodynamically compromised?
DC Cardioversion.
144
What type of murmur is mitral regurgitation?
Pansystolic
145
Which condition is associated with higher anti mitochondrial antibodies?
Primary Biliary Cirrhosis (PBC)
146
Coca-coca coloured urine is associated with which condition?
= Bood in urine
| = nephritic syndrome
147
Protein +++ in urine can indicate what?
Nephrotic syndrome
148
Name three of the most common nephritic syndromes
Post-streptococcal glomerulonephritis
IgA nephropathy
Rapidly progressive glomerulonephritis.
149
Which nephritic syndrome is associated with post URTI?
IgA nephropathy.
150
Which antibody is associated with PSC? Primary sclerosing cholangitis?
P-ANCA.
151
What is PSC often associated with?
IBD i.e. Ulcerative Colitis.
152
List four major criteria of Rheumatic Fever
Carditis
Arthritis
Chorea
Subcutaneous nodules
153
Ankle oedema is associated with which type of heart failure?
Right-sided heart failure
154
How may left sided heart failure present on auscultation of the lungs?
Bi-basal crepitations.
