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PLAB > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Diagnostic Investigation for aortic stenosis

A

Echo

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2
Q

Ejection systolic murmur best heard at the 2nd right intercostal space, at the right sternal border which radiates to the carotid arteries,

A

Aortic stenosis

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3
Q

Aortic stenosis

A

Murmur is accentuated when sits upright

most common valvular heart disease in the UK

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4
Q

Elderly patient with exercise intolerance

or maybe asymptomatic

A

Aortic stenosis

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5
Q

respiratory alkalosis

A

Pulmonary embolism

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6
Q

initial investigation for PE

A

CTPA (CT pulmonary angiogram)

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7
Q

if CTPA cant be performed(renal impairment or allergy to contrast media)

A

V/Q scan

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8
Q

PE

A

Immediate administration of DOAC once PE is suspected (even prior to CTPA)

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9
Q

ECG changes in PE

A

S1Q3T3

SINUS TACHYCARDIA

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10
Q

Gold standard investigation PE

A

Pulmonary angiography (but CTPA has replaced it now)

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11
Q

First line treatment for most PE+ pts with active cancer

A

DOACS (apixaban or rivoraxaban)

3-6months

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12
Q

Pt with PE + severe renal impairment{15/antiphospholipid syndrome

A

LMWH + warfarin

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13
Q

first line treatment when there is massive PE when there is circulatory failure (hypotension)

A

Thrombolysis

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14
Q

wells score >4 ➝

A

Immediate CTPA

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15
Q

wells score ≤4 ➝

A

D-dimer test, if +ve ➝ Immediate CTPA

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16
Q

absolute CI to thrombolysis

A

CNS neoplasm,aortic dissection,stroke less than 3 months,active internal bleeding

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17
Q

Chest pain often relieved by sitting forwards

•Worsened by inspiration, lying flat, cough, swallowing, or movement of the trunk

A

Pericarditis

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18
Q

ECG changes in pericarditis

A

Saddle shaped ST elevation(upward concavity)

PR segment depression-most specific ecg marker for pericarditis

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19
Q

ECG J waves

A

hypothermia

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20
Q

ECG U waves

A

hypokalemia

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21
Q

Nicorandil

ivabradine ranolazine

A

Used for angina. its a potassium channel activator.

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22
Q

First line treatment for angina

A

Calcium channel blocker or beta blocker

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23
Q

Ivabradine

A

reduces heart rate(visual effects)

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24
Q

Transient ischaemic attack(facial weakness 4days ago now fine)

A 
Immediate treatment: aspirin + urgent referral to specialist (24hr)
further management: Clopidogrel (first line)
Carotid endarterectomy (}}70% stenosis)
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25
Q 
Presents as palpitations(300-400)
ECG: An irregularly irregular pulse
• Absent P wave
irregular QRS complex
variable R-R intervals
A

Atrial fibrillation

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26
Q

A fib + Hemodynamically unstable

A

Immediate DC cardioversion

or pharmacologic cardioversion

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27
Q

A fib Patient is hemodynamically stable

A

1st choice → beta-blockers or CCB (diltiazem or verapamil)
• Digoxin is used if there’s CHF
• Thromboprophylaxis is also used(warfarin plus NOACs)

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28
Q

Pansystolic murmur at apex 5th (intercostal space, left midclavicular line) which radiates to the axilla

A

Mitral Regurgitation

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29
Q

2-10 days post MI and the patient is

presented with pulmonary edema or after rheumatic fever. struggles to lie flat at night

A

Mitral Regurgitation
Left ventricular failure: dyspnea, orthopnea and paroxysmal nocturnal dyspnea
severe MR → right sided heart failure → edema and ascites

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30
Q

Anticoagulation after A fib(lifelong) if chads score greater) age hypertension previous stroke etc

A

Warfarin or NOAC

Aspirin is not recommended for reducing stroke risk in patients with A fib

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31
Q

Anaphylactic reaction

A

IM adrenaline O.i5 0.3 0.5 anterolateral aspect of middle third of thigh
give 2 inj 1:1000

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32
Q

no relationship b/w P waves and QRS complex

A

Third degree block. Cannon waves in neck. Rx pacemaker

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33
Q

Fondaparinux

A

activates antithrombin 3

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34
Q

Most suitable initial investigation for someone having syncopial attacks

A

ECG

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35
Q

ECG old MI

A

persistent Q waves

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36
Q

MI ECG

A

Hyperacute T waves:first change
ST elevation:minutes–hours
Q waves:hour—indefinitely
T wave inversion:first 24 hours to few days

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37
Q

RBBB

A

MarroW V1 and V6

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38
Q

LBBB

A

WilliaM V1 and V6

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39
Q

Wolf Parkinson white

A

Delta waves

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40
Q

warfarin

A

inhibits reduction of vit k (1972c)
CI in pregnancy but allowed while breastfeeding
target inr 2.5 (if recurrent 3.5)
SE: hemorrhage,purple toes,skin necrosis

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41
Q

Management when INR is high

A

Major bleeding stop warfarin give IV vit K PCC or FFP

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42
Q

Chest pain radiating to back
Hypertension
Mediastinal widening on CXR
Assymetry of pulses

A

Aortic Dissection

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43
Q

target BP for a well-controlled diabetic

A

140/90

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44
Q

First line management of heart failure

A

ACE I and beta blockers(decrease mortality)

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45
Q

Rx of CCF

A

Please note acute management is different
ACE I and beta blockers(decrease mortality)
1st line → ACE-inhibitor and beta-blocker (e.g. Carvedilol)
- DM or signs of fluid overload → start with ACE-inhibitor
- Ejection fraction ≤40% → start with ACE-inhibitor
- Angina → start with beta-blocker
• 2nd line → Spironolactone )
• manegement of symptoms : furosemide
Digoxin → Heart failure + Atrial Fibrillation
alternative agent: ivabradine

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46
Q

1st line blood test for heart failure

A

NT-proBNP

high above 2000 specialist review and echo within two weeks

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47
Q

PLAB tip

A

Do NOT combine ARB and ACE I

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48
Q

DVLA

A

post MI can not drive for 4 weeks
htn continue driving
angioplasty 1 week
CABG 4 wks
post ACS 4 wks 1 wk if sucsfl angioplasty
angina- driving must cease if symptoms occur at rest
pacemaker insertion 1 wk
defibrillator 1 month to 6 months
catheter ablation post arrythmia 2 days off
aortic aneurysm more than 6.5 cm cease driving

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49
Q

ACE I SE

A

cough
hypotension(diuretics,aortic stenosis)
angioedema
hyperkalemia

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50
Q

hypertrophic cardiomyopathy

A

autosomal dominant disorder

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51
Q

hypertrophic cardiomyopathy

A

ejection systolic murmur increases on valsalva maneuver

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52
Q

hypertrophic cardiomyopathy ECHO

A

MR SAM ASH

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53
Q

Antibiotic prophylaxis for IE

A

not routinely recommended in the UK

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54
Q

Fever + new murmur

A

Endocarditis until proven otherwise

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55
Q

IE MC Causative organisms:

A 
Staph aureus(IVDU)
 Strept viridians(developing countries)(dental hygiene)
 Staph epidermidis- prosthetic heart valves
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56
Q

IE DX

A

BE FIVE PM

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57
Q

IE RX

A

amoxicillin + gentamicin
MRSA or penicillin allergy: vancomycin + gentamicin
Prosthetic valves; vancomycin + gentamicin + rifampicin

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58
Q

bendroflumethiazide

A

no longer used diuretic for HTN

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59
Q

a girl on microgynon30,chest pain, SOB,cough,tachcardia ecg s1q3t3
(alternatively a history of long travel or immobilisation can be given)

A

Pulmonary Embolism

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60
Q

absent left radial pulse

A

Takayasu Arteritis

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61
Q

scenario post MI ejection fraction less than 40.

A

heart failure so give ACE I AND beta blocker

62
Q

Pulsus Paradoxus

A

Cardiac tamponade

Asthma

63
Q

Slow rising pulse

A

Aortic stenosis

64
Q

Collapsing pulse

A

aortic regurgitation

PDA

65
Q

jerky pulse

A

hypertrophic cardiomyopathy

66
Q

Atypical MI

A

Abdominal pain plus jaw pain

67
Q

MI diagnosis

A

NSTEMI we need cardiac enzymes to make the diagnosis

STEMI ECG is essential and cardiac enzymes are not needed to make the diagnosis

68
Q

MCC of death post MI

A

cardiac arrest due to ventricular fibrillation

69
Q

VSD and MR post MI

A

an ECHO to differentiate because both presesnt with pan systolic murmur

70
Q

Post MI management

A

CABAS

sexual activity after 4 weeks

71
Q

MCC valvular cause of syncopial attack

A

Aortic stenosis

Dx Echo

72
Q

Post MI stroke and persistent ST elevation

A

ventricular thromboembolism (aneurysm)\

73
Q

Pt with heart failure symptoms and bradycardia:

A

Give atropine as SINUS BRADYCARDIA
do transvenous pacing if risk of asystole
(mobitz type 2 or complete heart block)

74
Q

Torsades de points

A

Erythromycin clarithromycin ciprofloxacin amiodarone sotalol SSRIs TCA chloroquine
Rx IV MgSO4

75
Q

Statin + erythromycin/clarythromycin

A

myopathy

76
Q

First line for treatment of angina

A

Beta blocker and calcium channel blocker-first line
aspirin + statin should be prescribed
glyceryl trinitrate to abort

77
Q

post PE INR 1.8

A

needs immediate anti coagulation with fast acting LMWH. warfarin dose also increased to 6 mg. INR should be closely monitered and LMWH discontinued when INR is normal

78
Q

DVLA (group 2 bus or lorry) post MI

A

Notify DVLA stop driving for 6 weeks then DVLA will assess and decide

79
Q

recent sore throat infection,fever,arthralgi, jerky movements, erythema marginatum

A

Rheumatic fever

Dx ASO titres

80
Q

Rheumatic fever

A

Pancarditis(that means including endocarditis)mitral regurgitation or mitral stenosis

81
Q

cardiac arrest

A

1 mg adrenaline

82
Q

factors which reduce BNP

A

ACE I, ARB diuretics

raised levels in ckd

83
Q

choking-

A

if person responds and answers encourage him to cough
if severe- 5 back blows
5 abdominal thrusts and repeat
if unconscious call ambulance and start cpr

84
Q

starting an anti psychotic

A

ECG should be done to see for long QT

85
Q

WPW syndrome

A

short PR interval
wide QRS complex with delta waves
axis deviations

86
Q

does not improve mortality in CHF

A

digoxin diuretic

87
Q

pt comes with chest pain first step

A

ECG

88
Q

PT WITH PALPITATIONS AND MISSED BEAT

A

VENTRICULAR ECTOPICS

89
Q

Pts with MI and diabetes

A

stop anti diabetic drugs andstart continuous infusion

90
Q

Drugs to avoid in WPW syndrome

A

Ca channel blockers and digoxin

91
Q

Rx WPW syndrome

A

radiofrequency ablation- first line
sotalol avoid in A fib
amiodarone
flecainide

92
Q

NYHA class IV CCF

A 
symptoms even at rest 
class III comfortable at rest but less than ordinary activity results in symptoms
93
Q

following a stroke

A

aspirin 300 mg 2 weeks

clopidogrel 75 mg lifelong

94
Q

Following ST elevation MI

A

Dual antiplatelet therapy
Beta blocker
ACE I
Statin

95
Q

proximal aortic dissection

A

aortic root replacement

96
Q

PEA and asystole are nonshockable rhythms

A

unresponsive to defibrillation

97
Q

Cardiac arrest

A

IV adrenaline 1:10000 IV

98
Q

beta blockers in CHF

A

carvedilol and bisoprolol

99
Q

Atrial myxoma

A

mid diastolic murmur dyspnea syncope

100
Q

narrow complex tachycardia

A

SVT

101
Q

SVT Rx

A

acute management
vagal maneuvers-first line
adenosine 6,12,12 CI in asthma
cardioversion

to control future:
beta blockers
ablation

102
Q

Pt reports 3 episodes of collapse

A

ECG then holter ECG

103
Q

atenolol and verapamil

A

should not be prescribed together

104
Q

A fib plus ‘structural abnormality’

A

amiodarone(not flecanide)

105
Q

pansystolic murmue

A

IE

106
Q

muffled heart sounds,distended neck veins,hypotension

A 
Becks triad(cardiac tamponade)
(chest was clear)
107
Q

Indication of valve replacement in aortic stenosis

A

Symptomatic patients

108
Q

SE of beta blockers

A

Sleep disturbances
Cold peripheries
Bronchospasm

109
Q

pulmonary edema due to CHF

A

CPAP if medical intervention fails

110
Q

Dizziness plus vertigo plus right arm pain

A

subclavian steal

111
Q

VF

A

1 shock followed by two minutes of CPR

112
Q

Post A fib give warfarin or NOACs

A

WARFARIN

113
Q

Diuretics

A

Hearing loss,hypotension,hyponatremia,hypokalemia gout

114
Q

Dx when the pt is blacking out/syncope

A

ECG and BP reading when pt is standing or lying down

115
Q

statin after MI

A

atorvastatin 80 mg

116
Q

straight left heart border

A

mitral stenosis

117
Q

NSTEMI

A

anti thrombotic plus fondaparinux

118
Q

Statins

A

Myopathy and liver disease (LFTS at baseline 3 months and 12months

119
Q

Mobitz type 2 block

A

initial: atropine
Definitive: pacing

120
Q

Becks triad muffled heart sounds,distended neck veins,hypotension trachea was central

A

cardiac tamponade most appropriate management pericardiocentesis
initial:IV fluids

121
Q

Pulsus paradoxus

A

cardiac tamponade

122
Q

QRISK greater than 10 and age less than 64

A

Statin

123
Q

Family hypercholesterolemia

A

cholesterol greater than 7.5 and family history

124
Q

Family hypercholesterolemia

A

Statin or ezetimibe

125
Q

Papillary muscle rupture post MI

A

results in mitral regurgitation pansystolic murmur apex

126
Q

3rd degree heart block atropine given whats the next step

A

temporary pacing(not permnanent)

127
Q

ejection systolic murmur louder when patient sits upright

A

aortic stenosis

128
Q

V fib

A

Pulse can not be felt

129
Q

atrial fibrillation

A

atenolol

130
Q

normal alcohol intake in the uk

A

less than 14 units

131
Q

Investigation of choice for cardiac tamponade

A

echo

132
Q

artey dominance in 85% of the population

A

RCa

133
Q

ccb s/e

A

pitting edema

gingival hyperplasia

134
Q

atrial flutter

A

saw-tooth waves on V1

can be irregular too

135
Q

hyperkalemia greater than 6.5

A

Start calcium gluconate (even if no ECG changes)

6 to 6.4 only if ecg changes

136
Q

hyperkalemia greater than 6.5

A

Start calcium gluconate (even if no ECG changes)

6 to 6.4 only if ecg changes

137
Q

crepitations in both lung fields plus chf features

A

pulmonary edema to confirm the Dx chest x ray

and to find the underlying cause: echo

138
Q

unstable centre pulsatile mass plus absent femoral pulse

A

ruptured aortic aneurysm

139
Q

ruptured aortic aneurysm investigation

A

U/S or CT

140
Q

Medication to avoid in CKD IHD HF

A

NSAIDs

141
Q

Postural hypertension diagnosis

A

BP monitoring(not ambulatory)

142
Q

ventricular aneurysm

A

persistently raised ST

143
Q

a new onset LBBB

A

MI

144
Q

yellow haloes plus arrythmias

A

DIGOXIN toxicity

145
Q

pain worse on inspiration

A

Pericarditis

146
Q

young pts plus recurrent palpitations and regular pulse

A

SVT

147
Q

old pts plus some heart dysfunction plusrecurrent palpitations and regular pulse

A

VT

148
Q

Broad complex

A

VT

149
Q

Narrow complex

A

SVT A fib

150
Q

straight left heart border on CXR

A

Mitral stenosis(associated with A fib)

PLAB (2 decks)

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