Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1MRCP Part 1 > Cardiology and Respiratory > Flashcards

Cardiology and Respiratory Flashcards

1
Q

Features of EGPA

A

Asthma
Eosinophilia
Mononeuritis Multiplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ostium Primum

A

The septum primum splits the atria in the neonate/newborn: should seal off after birth
Failure = failure of fusion of the superior and inferior cardiac cushions
Associated with Down’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ostium Secundum

A

The septum secundum grows to cover the foramen ovale
Failure
1. Large foramen ovale
2. Inadequate growth of the secundum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ostium Primum VS Secundum

A

Primum
= less common, presents earlier
Associated with RBBB and LAD, prolonged PR interval

Secundum
= presents later, more common
Associated with RBBB and RAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

QT interval
- Measure on ECG
- Represents?

A

= start of QRS to the end of the T wave
Ventricular depolarisation adn repolarisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is an Epsilon wave?

A

= small deflection in QRS
Excitation in the R ventricle
= arrhythmogenic right ventricular cardiomyopathy
- Due to replacement of myocytes with fat, delay in excitation of myocytes in R ventricle, seen as separate deflection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cardiac Action Potenial

A

Na+ IN
Balance of Ca2+ IN and K+ OUT
K+ OUT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patent Ductus Arteriosus
Closure =
Maintain patency =

A

Closure = indomethacin
Open = prostaglandins
Why cannot give NSAIDs in pregnancy/end of pregnancy - close PDA, foetus dependent on that to allow bypass of lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Interventions with proven benefit in COPD (3)

A

Smoking Cessation
LTOT
Lung Volume Reduction Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

LBBB
- effect on systole
- heart sounds finding

A

= delayed closure of the aortic valve as action potential must go right to left
- Reversed split S2
- Quiet S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Marfan’s Syndrome
- Pathophysiology of aortic dissection

A

= dilated aortic root
- Aorta usually has x3 small pouches that sit above the aortic valve, which are the sinuses of valsalva
- Weakness of elastic lamina at junction of aortic media and annulus fibrosus (fibrous ring at aortic orfice to front and right of AV root)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PaO2/FiO2 ratio
- cut off value
- how to calculate

A

> 300 = suggests acute respiratory failure, helpful for determining oxygen pressures
- ABG PaO2 - if 7 = 70 divided by FiO2 if 40% VM = 0.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Type A Aortic Dissection

A

Proximal to brachiocephalic vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most likely cause of aortic stenosis in <65 years?

A

Bicuspid aortic valve (more prone to calcifcation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the greatest risk factors for restenosis following PCI?

A

Diabetes
Renal Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the greatest risk factor for stent thrombosis following PCI?

A

Premature anti-platelet withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What endocrine abnormality is associated with pulmonary TB?

A

Hyponatraemia due to SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most likely cause of endocarditis in recent valve surgery

A

Staph epidermidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Indication for CRT (2)

A

LVEF of <35%
AND
LBBB with QRS >130

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Deficiency in pulmonary hypertension
- diagnostic test

A

Relative deficiency of nitric oxide
= inhaled NO reverses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complete Heart Block in MI
- anterior vs inferior infarction

A

Anterior = doesn’t usually resolve, may need pacing
Inferior = may resolve once RCA is revascularised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Variable intensity in S1
- why?

A

Complete heart block
- variable PR interval
- S1 intensity decreases with PR prolongation (<diastolic ventricle pressures increase, mitral leaflets drift together)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cardiac conduction abnormality in myotonic dystrophy

A

Prolonged PR interval - disease of His-Purkinje system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Molecular cause of HOCM

A

Mutation in B-heavy chain protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TGA vs TOF

A

TGA = first days of life
TOF = first months of life
Both cyanotic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Long QT molecular problem
- result

A

Defect in alpha subunit of slow delayed rectifier K+ channel
= loss of function K+ channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MI secondary to cocaine use
- Mechanism
- Management

A

= increased O2 demand due to sympathomimetic drive, coronary artery vasoconstriction and vasospasm
- IV benzodiazepines: control BP and heart rate, reduce the above mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Most common organism in bronchiectasis

A

Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Raised eosinophils, brittle asthma, parenchymal infiltrates
- diagnosis
- management

A

allergic bronchopulmonary aspergillosis
- managed using PO steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Marker of disease progression in COPD

A

FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Calcium and QT interval

A

Hypocalcaemia - QT prolongation
Hypercalcaemia - QT shortening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What parameters should be measured when delivering MgSO4?
Why?

A

Reflexes
Respiratory Rate
= magnesium toxicity presents as muscle weakness, respiratory depression and arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Condition associated with coarctation of the aorta

A

Neurofibromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What medication should be avoided in HOCM?

A

ACE inhibitor
= these decrease afterload and preload
Want to INCREASE afterload/preload to stretch the myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Management of Torsades de Pointes

A

Magnesium Sulphate 2g IV STAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Anticoagulation following bioprosthetic valve

A

Aspirin only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Gene loci associated with bronchiectasis

A

HLA-DR1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Where is BNP secreted from?

A

Ventricular myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a side effect of verapamil?

A

Constipation
= relaxes smooth muscle, reduces gut motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

S2
- Fixed split S2
- Wide S2
- Reversed S2

A

= closure of aortic and pulmonary valve
Fixed = ASD
Wide = delay in closure of pulmonary valve
Reversed = delay in closure of aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Causes of wide split S2

A

= delay in closure of pulmonary valve
RBBB, pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Cause of reversed split S2

A

= delayed closure of aortic valve
LBBB, PDA, aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

S3
Timing
Cause (2)

A

Occurs after S2 - diastole
Seen in passive filling of the left ventricle with increased compliance
Cause = DCM, normal variant <30 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

S4
Timing
Cause (2)

A

Occurs before S1- diastole
Active filling of the left ventricle
Cause = HOCM, diastolic failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Cause of ejection systolic murmur (4)

A

Aortic stenosis
HOCM
ToF
ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Cause of late systolic murmur
Cause of pansystolic murmur (2)

A

MV prolapse
Harsh = VSD
Blowing = MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Continuous machine like murmur

A

Patent ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Pulse alternans

A

= LVSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ECG changes seen in hypokalaemia (4)

A

U waves
Flattened T waves
Prolonged PR
Prolonged QTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ECG changes seen in digoxin (4)

A

Bradycardia
Prolonged PR
ST depression
Short QTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management of left ventricular wall rupture post MI

A

NOAC to prevent thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Causes of prolonged PR interval (5)

A

Digoxin
Hypothermia
Hypokalaemia
Aortic Root Abscess
Myotonic Dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What medication should be avoided in heart failure?

A

Rate limiting CCB
e.g. verapamil, diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Glycoprotein 2B/3A inhibitors (3)

A

Abciximab
Tirofiban
Eptifibatide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Indication for drugs in HF
- Entresto
- Ivabradine
- Digoxin

A

Entresto = EF <35%
Ivabradine = EF <35% and HR >75
Digoxin = concomitant AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Maximum dose of atropine

A

3mg (i.e. 6x500 microgram rounds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Mobitz I vs Mobitz II

A

I = progressive PR prolongation until missed QRS
II = PR interval is constant in conducted beats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Ventricular escape rhythm

A

= broad QRS + rate 20-40

51
Q

What is the most common type of WpW syndrome?

A

Type B = right sided accessory pathway

51
Q

ECG sign in mitral stenosis

A

Bifid p wave

51
Q

What is the management of choice in mitral regurgitation?

A

Valve repair rather than valve replacement

52
Q

Junctional escape rhythm

A

= narrow QRS + rate 40-60

53
Q

Definition of pulmonary hypertension
- number of groups
- which group is:
A. Idiopathic
B. Respiratory disease

A

> 25mmHg
Groups 1-5
Idiopathic = group 1
Respiratory = group 3

53
Q

What would be a contra-indication to introducing spironolactone to control hypertension?

A

K+ >4.5

54
Q

+VE response to acute vasodilator testing in pulmonary hypertension

A

Calcium channel blocker

55
Q

Associations with coarctation of the aorta (3)

A

Turner’s syndrome
Bicuspid aortic valve
Neurofibromatosis

56
Q

Investigating angina
- 1st line
- 2nd line

A

1st = CT coronary angiogram
2nd = non-invasive functional imaging e.g. stress echo, myocardial perfusion scan

57
Q

Management of angina
- all patients
1st line
2nd line

A

All patients = statin, aspirin, GTN
1st = BB or rate limiting CCB
2nd = BB + long acting CCB
Should be on maximum dosing of each drug before next step

58
Q

Cannon A wave =

A

= closed tricuspid valve
e.g. VT, complete heart block

59
Q

Kussmaul’s wave =

A

= paradoxical JVP rise on inspiration
e.g. constrictive pericarditis

60
Q

Eisenmenger’s
- pathophysiology

A

1st left to right shunt, causing pulmonary hypertension
THEN
right to left shunt as pulmonary pressures exceed LV pressure
= cyanosis

61
Q

Tetralogy of Fallot =

A

Overriding aorta
VSD
Pulmonary stenosis
Right ventricular hypertrophy

62
Q

Poor prognostic factors in endocarditis (3)

A

Staph aureus
Prosthetic valve
Culture negative

63
Q

Causes of pericarditis (4)

A

Uraemia
Viral infections
TB
Post MI

64
Q

Presentation of atrial myxoma (5)

A

Weight loss
PUO
Fatigue
SOB
Clubbing
= left atrial pedunculated mass

65
Q

Driving following ACS

A

4 weeks

66
Q

Driving following ICD
- symptomatic i.e. sustained VT
- prophylaxis

A

Symptomatic = 6 months
Prophylaxis = 1 month

67
Q

If Q Risk >10 =

A

Start atorvastatin 20mg as primary prevention
Lifestyle advice

68
Q

DCCV successful - what is the plan for anti-coagulation?

A

4 weeks

69
Q

Causes of low transfer factor (5)

A

= low rate of diffusion
Fibrosis
PE
Pneumonia
Pulmonary Oedema
Emphysema

70
Q

Causes of high transfer factor (3)

A

Asthma
Haemorrhage
Pregnancy

71
Q

Causes of Upper Lobe Fibrosis

A

CHARTS
C - coal miners lung
H - hypersensitivity pneumonitis
A - ankylosing spondylitis
R - radiation
T - TB
S - silicosis/sarcoidosis

72
Q

Cause of Lower Lobe Fibrosis

A

ACID
A - asbestosis
C - CTD
I - idiopathic
D - drugs

73
Q

Investigation findings in Pulmonary Fibrosis

A

Restrictive spirometry
Low TLCO/KO

74
Q

Genetic finding in Kartegener Syndrome

A

Dynein arm defect
= primary ciliary dyskinesia

75
Q

First line investigation in adult asthma

A

Spirometry with bronchodilator reversibility
and FENO testing

76
Q

Severe VS Life threatening Asthma
- PEF

A

Severe = PEF 33-50%
Life threatening = PEF <33

76
Q

What is a positive FeNO test?

A

> 40 parts per billion

77
Q

Difference between asthma and COPD on spirometry

A

COPD = no significant reversibility on spirometry

78
Q

Indications for LTOT (2)

A

paO2 = <7.3 kPa
paO2 = 7.3-8.0 + RVH/pulmonary hypertension

78
Q

Aspergilloma investigation finding =

A

= rounded crescent sign

79
Q

When do you use PERC score?

A

In low risk Wells, if negative then can R/O PE

79
Q

Management of Primary PTX
- <2cm + not symptomatic

A

Discharge with F/U

79
Q

Management of Primary PTX
- >2cm or SOB

A

Aspirate
Discharge with follow up
- if unsuccessful then chest drain + admit

79
Q

Features of allergic bronchopulmonary aspergillosis (4)
Investigation of choice
Management

A

Bronchiectasis
Wheeze
Cough
Eosinophilia
= RAST will be positive to aspergillus
Initially steroids then itraconazole

80
Q

Indications for VQ scan in suspected PE (2)

A

Pregnancy
Renal impairment <eGFR 25

80
Q

Management of Secondary PTX
- <1cm

A

Observe for 24 hours

80
Q

Markers of good prognosis in sarcoidosis (2)

A

Rapid onset
Erythema nodosum

81
Q

Management of Secondary PTX
- >2cm or SOB

A

Chest drain

81
Q

Management of Secondary PTX
- 1-2cm + not SOB

A

Aspirate then chest drain

81
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis?

A

Acute = type III reaction
Chronic = becomes type IV reaction

81
Q

What is the mechanism of hypercalcaemia in sarcoidosis?

A

Over production of 1,25(OD)2D3 by macrophages

82
Q

Skin features of sarcoidosis (2)

A

Erythema nodosum
Lupus pernio

83
Q

Genetic fault in CF

A

Deletion at dF508 on chromosome 7 in CFTR gene

83
Q

Spirometry finding in sarcoidosis

A

Restrictive spirometry

84
Q

Causes of bronchiectasis (5)
- most common infection cause

A

CF
Kartagener’s syndrome
Hypogammaglobulinaemia
IgA deficiency
Measles
= haemophilus influenzae

85
Q

Indications for steroids in sarcoidosis (5)

A

Symptomatic + CXR findings
Hypercalcaemia
Eye involvement
Neurological involvement
Cardiac involvement

86
Q

What asbestos fibres are the most dangerous?

A

Blue fibres

87
Q

XR signs in bronchiectasis

A
  • Tramlines
  • Signet sign
88
Q

Drug used in CF

A

Orkambi (lumacaftor/ivacaftor)

89
Q

Association with mycoplasma

A

Cold AIHA
Bilateral consolidation

90
Q

What is the most common cause of pneumonia?

A

Streptococcus

91
Q

Management of low severity CURB score pneumonia

A

Amoxicillin or macrolide antibiotic

92
Q

Management of severe PCP

A
  • initial is co-trimoxazole (+ steroids if hypoxia)
    Can use IV pentamidine in severe disease
93
Q

Transudate effusion =
Causes (5)

A

= <30 grams of protein
= causes of low protein
Heart failure
Liver failure
Nephrotic Syndrome
Hypothyroidism
Meig’s Syndrome

94
Q

Exudate Effusion =
Causes (5)
Indications for chest drain (2)

A

= >30g/protein
Infection
Malignancy
Autoimmune
Pancreatitis
Pulmonary emboli
Indications = pH <7.2, turbid fluid

95
Q

Squamous cell lung cancer paraneoplastic syndromes (3)

A

Hyperthyroidism
Hypercalcaemia
HPOA

96
Q

Large cell lung cancer association

A

Can be bHCG positive

97
Q

Contra-indications to surgical management of lung cancer (3)

A

FEV <1.5
Hilar malignancy - SVCO, vocal cord paralysis
Malignant effusion

98
Q

Derivation of lung carcinoid
- finding on bronchoscopy

A

= APUD cells
- Cherry red balloon appearance on bronchoscopy

99
Q

Investigation in ARDS

A

Pulmonary capillary wedge pressures
- help to rule out cardiac causes

100
Q

Management of aspergilloma

A

Surgical resection

101
Q

Most common site for atrial myxoma

A

Left atria

102
Q

Valve abnormality associated with HOCM

A

MR with anterior systolic leaflet movement

103
Q

Mechanism of clopidogrel and ticagrelor

A

P2Y12 inhibition
Clopidogrel = IRREVERSIBLE
Ticagrelor = REVERSIBLE

104
Q

Marker positive in small cell lung cancer

A

Banbesin

105
Q

Reduced LV gradient
- good or bad?

A

= little pressure difference
Minimal LV obstruction
Good

106
Q

What to avoid in HOCM (medication)?

A

ACE-I

107
Q

Histology finding in rheumatic fever

A

Aschoff bodies
= granulomatous nodules

108
Q

Indication for LTOT in COPD

A

Polycythaemia

109
Q

ECG findings in Brugada Syndrome

A

ST elevation in V1-V3 and RBBB

110
Q

What can right axis deviation indicate?

A

Left posterior hemiblock

111
Q

ST depression specific for ischaemia

A

Downsloping

112
Q

Why aren’t b-blockers used as frequently in hypertension?

A

Less likely to prevent stroke
Impairment of glucose tolerance

113
Q

What is alpha-1 antitrypsin?

A

A protease inhibitor

114
Q

Genotype of familial hypercholesterolaemia

A

Heterozygous

115
Q

Pulmonary HTN heart sound finding

A

Loud S2

116
Q

What should you avoid in accessory pathways in AF?

A

Avoid AV blocking drugs
= encourages atrial fibrillation to travel down the accessory pathway - can become v. fibrillation
Use fleccanide instead

117
Q

Poor prognosis in HOCM

A

Septal thickness >3cm

118
Q

Management of multifocal atrial tachycardia

A

Verapamil
- DCCV and digoxin not useful

119
Q

Pulse feature in PDA

A

Collapsing pulse (left to right shunt, rapidly dropping/changing volumes in aorta)

120
Q

What is found in EAA?

A

Circulating IgG preceptins

121
Q

Give a cause of DCM

A

Selenium

122
Q

What is the mechanism of bosentan?

A

Endothelin A and B antagonist

123
Q

What is the most common cause of congenital long QT syndrome?

A

Defects in K+ channel

124
Q

What is the mechanism of cardiomyopathy with trastuzumab?

A

erb-b2 blockade (HER2 receptor)
= herceptin

1MRCP Part 1 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions