Cardiology

Question 1

First line management of acute pericarditis?

Answer 1

NSAID and colchicine

Question 2

Most appropriate drug for rate control in AF?

Answer 2

Beta blockers e.g. bisoprolol
(Asthma is a contra-indication for beta blockers)

Digoxin if patient has co-existent heart failure

Question 3

What electrolyte imbalances are important causes of ventricular tachycardia?

Answer 3

• Hypokalaemia

- Hypo-magnesiumaemia

Question 4

What is the next step when treating someone with SVT after vagal manouvres?

Answer 4

Adenosine

Question 5

What is used to treat Torsades de pointes?

Answer 5

IV magnesium sulfate

Question 6

What medication can be given to patients who require anticoagulation but do not want regular monitoring?

Answer 6

DOACs eg. rivaroxaban

Question 7

How to treat a haemodynamically unstable patient with atrial fibrillation?

Answer 7

Immediate electrical cardioversion followed by thromboprophylaxis

(If he was clinically stable and had AF >48 hours then risk of stroke means thromboprophylaxis followed by cardioversion)

Question 8

Treatment for patients with tachycardia along with signs of shock, myocardial ischaemia or heart failure?

Answer 8

Up to three synchronised DC shocks

Question 9

What are the NICE guideline recommendations for patients with acute phase of an ischaemic stroke with underlying AF?

Answer 9

Aspirin 300mg OD for 2 weeks

Then consideration of anticoagulants (warfarin or DOAC) for further stroke prevention) - in the absence of haemorrhagic stroke

Question 10

Which anti-platelet medications should be given after a stroke?

Answer 10

Aspirin 300mg OD for 2 weeks then 75mg clopidogrel OD for life

(Unless patient has indication for anticoagulant e.g. AF)

Question 11

Initial drug therapy for Afro-Carribean with hypertension?

Answer 11

Calcium channel blocker e.g. amlodipine

Question 12

What is the half-life of adenosine?

Answer 12

8-10 seconds

Question 13

Which antibiotic interacts with warfarin to give a raised INR?

Answer 13

Clarithromycin

Question 14

What investigation is most helpful in diagnosing infective endocarditis?

Answer 14

Blood cultures

Set of three cultures

Question 15

According to NICE guidelines, which medications should a patient be put on following a STEMI?

Answer 15

• Beta blocker
• ACE inhibitor
• Dual anti-platelet therapy
• Statin

Question 16

What is the next step in management in a STEMI patient who has undergone fibrinolysis with persistent ischaemia?

Answer 16

Transfer for PCI

Question 17

Best initial management for a 50-year-old caucasian man with hypertension?

Answer 17

Ramipril (ACE inhibitor)

Question 18

What is the main ECG abnormality seen with hypercalcemia?

Answer 18

Shortening of the QT interval

Question 19

What is the treatment for sinus bradycardia with adverse features?

Answer 19

500mg IV atropine

Question 20

What is the next management step in a patient with suspected PE (due to sore, red calf, post-surgical)? CTPA is negative

Answer 20

Proximal leg vein ultrasound

Question 21

What drug do macrolide antibiotics (clarithromycin) interact with?

Answer 21

Statins

Question 22

What chemical biomarker is the best for detecting re-infarction?

Answer 22

CK-MB

• Remains elevated for 3-4 days following an MI
• Troponin may be elevated for 10 days

Question 23

What are the features of Dressler’s syndrome?

Answer 23

Dressler’s syndrome = autoimmune reaction to proteins formed in healing post-MI

• Central, pleuritic chest pain that is worse when lying flat (recurrent pericarditis) and fever
• Raised ESR
• Recurrent pleural effusions
• Treatment with NSAIDs

Question 24

Features of left ventricular free wall rupture following an MI?

Answer 24

• Sudden heart failure
• Raised JVP
• Muffled/quiet heart sounds

Free wall rupture due to weakening following MI = tamponade = triad of raised JVP, pulses paradoxus, muffled/quiet heart sounds

Question 25

What class of drugs can be responsible for deterioration in bone health?

Answer 25

Loop diuretics e.g. furosemide | - Hypocalcemia is a side effect

Question 26

What electrolyte disturbance is caused by ACE inhibitors?

Answer 26

Hyperkalaemia

Question 27

What electrolyte disturbance may be caused by thiazide diuretics?

Answer 27

Hypercalcemia

Question 28

Management of STEMI patient if PCI centre is 3 hours away by ambulance?

Answer 28

Urgent fibrinolysis Fibrinolysis should be offered within 12 hours of onset if PCI cannot be delivered within 120 minutes

Question 29

What is the most common cause of mitral stenosis?

Answer 29

Rheumatic fever

Question 30

What is the initial management of pulmonary embolism?

Answer 30

DOAC Rivaroxaban

Question 31

What are the anti-platelet choices for NSTEMI?

Answer 31

- Aspirin plus - Ticagrelor (if low bleeding risk) - Clopidogrel (if high bleeding risk)

Question 32

What complication of an MI is seen in patients who develop acute heart failure with a pan-systolic murmur?

Answer 32

Ventricular septal defect

Question 33

In which situations may nitrates be contra-indicated?

Answer 33

Hypotension (<90mmHg)

Question 34

Changes in which leads on ECG indicate ischaemic changes in the left circumflex artery?

Answer 34

I, aVL, V5-6

Question 35

What is the investigation for stable angina of suspected coronary artery disease aetiology after ECG?

Answer 35

Contrast enhanced CT angiography

Question 36

Most common ECG change with pulmonary embolism (PE)?

Answer 36

Sinus tachycardia

Question 37

How long before surgery should warfarin be stopped?

Answer 37

5 days before surgery | Aim for INR to be <1.5

Question 38

What effect would warfarin have on PT and APTT?

Answer 38

Prolonged PT | Normal APTT