Cardiology

Question 1

Which ECG leads represent the inferior aspect of the heart?

Answer 1

II, III, aVF

Question 2

Which ECG leads represent the anterolateral aspect of the heart?

Answer 2

I, aVL, V5, V6

Question 3

Which ECG leads represent the anteroseptal aspect of the heart?

Answer 3

V2, V3, V4

Question 4

Which ECG leads represent the anterior aspect of the heart?

Answer 4

V2-V6

Question 5

Which ECG leads represent the posterior aspect of the heart?

Answer 5

Read upside down, V1-V3

Question 6

State at least 3 causes of right axis deviation

Answer 6

Anterolateral MI, right ventricular hypertrophy, PE, left posterior hemiblock in Wolff Parkinson White, ASD secundum

Question 7

State at least 3 causes of left axis deviation

Answer 7

Inferior MI, left ventricular hypertrophy, left anterior hemiblock in Wolff Parkinson White, ASD primum

Question 8

State at least 5 causes of AF

Answer 8

Ischaemic heart disease, rheumatic heart disease, thyrotoxicosis, hypertension, alcohol, pneumonia, PE, hypokalaemia, RA

Question 9

State at least 5 contraindications to thrombolysis

Answer 9

Aortic dissection, GI bleeding, previous allergic reaction, recent surgery, brain tumour, previous stroke, severe hypertension systolic over 200, trauma

Question 10

Name at least 4 causes of high output heart failure

Answer 10

Anaemia, arteriovenous malformation, thyrotoxicosis, thiamine deficiency (beriberi), pregnancy, Pagets disease of bone

Question 11

State 3 causes of right ventricular failure

Answer 11

Left ventricular failure, cor pulmonale, tricuspid valve disease, pulmonary valve disease

Question 12

State 4 causes of left ventricular failure

Answer 12

Ischaemic heart disease, idiopathic dilated cardiomyopathy, systemic hypertension, mitral valve disease, aortic valve disease

Question 13

Describe the New York Heart Association classification of heart failure

Answer 13

1 - no limitation of activity
2 - comfortable at rest, dyspnoea on normal activity
3 - marked limitation of ordinary activity
4 - dyspnoea at rest, discomfort with all activity

Question 14

State 3 cardiogenic causes of acute pulmonary oedema

Answer 14

MI, arrhythmia, fluid overload

Question 15

State 3 non-cardiogenic causes of acute pulmonary oedema

Answer 15

ARDS, upper airway obstruction, head trauma

Question 16

State at least 5 causes of cardiogenic shock

Answer 16

MI, hyperkalaemia, endocarditis, aortic dissection, Rhythm disturbance, tamponade, tension pneumothorax, massive PE

Question 17

State 5 causes of cardiac tamponade

Answer 17

Trauma, lung or breast cancer, pericarditis, MI, TB

Question 18

Describe Becks triad of signs of cardiac tamponade

Answer 18

Hypotension, raised JVP, muffled heart sounds

Question 19

Describe the Keith Wagener classification of hypertensive retinopathy

Answer 19

1. Tortuosity and silver wiring
2. AV nipping
3. Flame haemorrhage and cotton wool spots
4. Papilloedema

Question 20

State 4 causes of aortic stenosis

Answer 20

Senile calcification, bicuspid valve, Williams syndrome, rheumatic fever

Question 21

Describe the signs of aortic stenosis on examination

Answer 21

Slow rising pulse, narrow pulse pressure, aortic thrill, ejection systolic murmur in 2nd ICS sitting forward in end expiration and radiating to carotids

Question 22

Describe the signs of aortic regurgitation on examination

Answer 22

Collapsing pulse, wide pulse pressure, displaced apex from volume overload, end diastolic murmur loudest at the upper left sternal edge sitting forward in end expiration, may be an Austin Flint murmur, may have De Mussets sign (head nodding) or Quinckes (capillary pulsation in nail beds)

Question 23

Describe the Austin Flint Murmur

Answer 23

Rumbling mid diastolic murmur at the apex due to a regurgitant jet fluttering the anterior mitral valve cusp in severe aortic regurgitation

Question 24

Describe the signs of mitral stenosis on cardiac examination

Answer 24

AF, malar flush, left parasternal heave, tapping apex (palpable S1), early diastolic opening snap, rumbling mid diastolic murmur loudest in the left lateral position in end expiration and radiating to the axilla, may have a Graham Steel murmur (end diastolic murmur secondary to pulmonary regurgitation)

Question 25

Describe the signs of mitral regurgitation on cardiac examination

Answer 25

AF, left parasternal heave, displaced apex, soft S1, blowing pansystolic murmur loudest on the left lateral position in end expiration

Question 26

Describe the signs of tricuspid regurgitation on cardiac examination

Answer 26

Raised JVP with giant V waves, right ventricular heave, pansystolic murmur at the lower left sternal edge in inspiration, pulsatile hepatomegaly, jaundice

Question 27

What are Oslers nodes?

Answer 27

Painful, purple papules on finger pulps

Question 28

What are Janeway lesions?

Answer 28

Painless palmar macules

Question 29

State the major components of the Jones criteria for diagnosing rheumatic fever

Answer 29

Pancarditis, arthritis, subcutaneous nodules, erythema marginatum, Sydenhams chorea

Question 30

State the minor Jones criteria for diagnosing rheumatic fever

Answer 30

Fever, raised ESR or CRP, arthralgia (without arthritis), Prolonged PR interval (without carditis), previous rheumatic fever

Question 31

State 4 drug causes of acute pericarditis

Answer 31

Penicillin, isoniazid, procainamide, hydralazine

Question 32

Describe the features of cardiac myxoma

Answer 32

Rare, benign cardiac tumour usually found in the left atrium. Causes clubbing, fever, weight loss, raised ESR, and similar signs to mitral stenosis (mid diastolic murmur, systemic emboli, AF) but varies with posture

Question 33

State the causes of restrictive cardiomyopathy

Answer 33

SSHAPEN - sarcoid, systemic sclerosis, haemochromatosis, amyloidosis, primary (endocardial fibrosis), eosinophilic endocarditis (Loefflers), neoplasia (carcinoid)

Question 34

State the causes of dilated cardiomyopathy

Answer 34

Alcohol, pregnancy (peri and post partum), Muscular dystrophy, glycogen storage disease, SLE, myocarditis, doxorubicin, cyclophosphamide, thryotoxicosis