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ICM/FCM > Cardiology FCM > Flashcards

Cardiology FCM Flashcards

1
Q

After ECG, what is the first line investigation in a patient presenting with stable angina?

A

CT Angiography

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2
Q

What 4 drugs are used for secondary prevention after a patient has had an MI?

A

1 - DAPT (aspirin & ticargrelor/prasugrel)
2- ACEi
3 - Beta-blocker
4 - statin

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3
Q

A patient has SVT but vasovagal manoeuvres have failed, what treatment is given next?

A

12mg Adenosine

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4
Q

What do you need to warn the patient about as a side effect of adenosine?

A

Chest pain

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5
Q

What dose of atorvastatin do you give to a patient for primary prevention of an MI?

A

20mg

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6
Q

What dose of atorvastatin do you give to a patient as secondary prevention after an MI?

A

80mg

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7
Q

What are the three symptoms that make you think a patient has stable angina?

A

1) Constricting chest pain that can also be in the neck/jaw/arms
2) Relieved by rest/GTN within 5 minutes
3) Started by physical exertion

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8
Q

Besides the symptoms brought on from stable angina, what other symptoms would make you think of atypical angina?

A

1) GI discomfort

2) Breathlessness/nausea

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9
Q

What medication do you prescribe to provide rapid relief for angina and how do you instruct a patient to use it?

A

GTN spray

  • one spray, wait 5 minutes
  • another spray if pain still there, wait another 5 minutes
  • Call 999 if pain still has not eased or if its getting worse
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10
Q

What is the first line medication for angina?

A

Beta-blocker / CCB

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11
Q

What medication should you prescribe for angina if Beta blockers/CCB are contraindicated/not tolerated?

A

Long acting nitrate - Isosorbide mononitrate

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12
Q

Which medication would you give a patient for stable angina as secondary prevention?

A

Anti-platelet treatment - low dose aspirin

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13
Q

A patient has stable angina and DM, what medication would you give them as secondary prevention?

A

ACEi

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14
Q

List 3 symptoms of congestive heart failure?

A
  • Exertional dyspnoea
  • Bi-basal crepitations
  • Pitting oedema
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15
Q

What level of ejection fraction would represent HFrEF?

A

<40%

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16
Q

What % of ejection fraction would represent HRmrEF? (mildly reduced)

A

41-49%

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17
Q

What % of ejection fraction would represent HF-PEF? (Preserved)

A

> 50%

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18
Q

A patient with heart failure has a marked limitation of physical activity and is only comfortable at rest

What would be there NYHA classification?

A

Stage 3

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19
Q

A patient with HF has no limitation for physical activity, with it not causing any symptoms such as breathelessness/palpitations.

What would be their NYHA classification?

A

Stage 1

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20
Q

A pt with HF is unable to carry out any physical activity without discomfort with some symptoms also at rest.

What would be their NYHA classification?

A

Stage 4

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21
Q

A pt with HF has some slight limitation in their physical activity with some mild symptoms.

What would be their NYHA classification?

A

Stage 2

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22
Q

A pt presents with statin-induced myopathy. You do a blood test to check the CK. How soon after should you repeat it?

A

7 days

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23
Q

What drugs increase the risk of myopathy by potently stopping the metabolism of statins? (2 marks)

A

Clarithromycin

Ketoconazole (anti-fungal)

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24
Q

A patient presents with hyperlipidaemia and has a FHx of DM and HTN. After bloods, what is the next step in his management?
A - Offer Atorvastatin 20mg
B - 6 months of healthy diet and exercise
C - Q-Risk score
D - Q-risk and offer statin

A

C
<10% = 6 months of lifestyle modifications
>10% & lifestyle modifications ineffective = offer statin

25
Q

What type of patient would you expect to see presenting with buergers disease?

A

Young male smoker with painful blue fingertips

26
Q

Is buergers disease associated with atherosclerosis?

A

No - it is an inflammatory condition causing thrombus formation in the small and medium sized blood vessels affecting the hands and feet

27
Q

What are the 6 Ps?

A 
Pale 
Pallor
Paraesthesia 
Pain
Pulseless 
Poikilothermia
28
Q

What would you see on an angiography if a patient is presenting with buergers disease?

A

Corkscrew collaterals

29
Q

What is the immediate management in a patient presenting with buergers disease?

A

Complete smoking cessation

30
Q

When would you refer a patient with buergers disease to the vascular surgeons?

A

Gangrene or necrosis

31
Q

What is the most appropriate management of buergers disease, apart from complete smoking cessation?

A

Gently warming the leg with a warm towel to promote blood flow

32
Q

What medication can be given to help postural hypotension in an elderly patient with high risk of falls?

A

Fludrocortisone

33
Q

In a child <6 years old presenting with anaphylaxis, what medication should you administer?

A

150micrograms/0.15ml in 1000U IM Adrenaline

34
Q

In a child 6-12 years old presenting with anaphylaxis, what medication and dose should you administer?

A

300micrograms/0.3ml in 1000U IM adrenaline

35
Q

In a child more than 12 years old/adult presenting with anaphylaxis, what medication and dose should you administer?

A

500micrograms/0.5ml in 1000U IM adrenaline

36
Q

Name 3 risk factors for developing infective endocarditis

A

1 - IV drug us
2 - Implants
3 - Hx of infective endocarditis

37
Q

What is the most common causative bacteria of infective endocarditis that is found in the mouth?

A

Viridans Streptococci

38
Q

What is the causative bacteria of infective endocarditis found in the skin and is contracted from IV drug use?

A

Staphy aureus

39
Q

List 3 symptoms of infective endocarditis

A

1 - Fever
2 - New-onset murmur (aortic regurgitation)
3 - Systemic symptoms of infection

40
Q

What signs on a patients hand would represent infective endocarditis? (3 marks)

A

1 - Janeway lesions
2 - Oslers nodes
3 - Splinter haemorrhages

41
Q

What would you expect to see on fundoscopy for infective endocarditis?

A

Roth spots

42
Q

What would you request in the bloods when investigating infective endocarditis? (4)

A

CRP
ESR
WBC
FBC

43
Q

Besides blood, what other sample would you take for infective endocarditis and how many times would you do this?

A

Aseptic blood cultures, 2-3 sets

44
Q

What imaging is requested for infective endocarditis and why?

A

Transthoracic ECHO - assess valves

45
Q

When would you refer a patient with infective endocarditis for emergency valve replacement surgery?

A

When they show signs of congestive heart failure caused by the infective endocarditis

46
Q

Good acronym to remember ventricular fibrillation on ECG

A

Very Funny

47
Q

Good acronym to remember ventricular tachycardia on ECG

48
Q

If a patient is haemodynamically unstable and has wide complex tachycardia (VT) on their ECG, what is the first step in management?

A

DC cardioversion with amiodarone

49
Q

If a patient with VT with haemodynamically stable, what is the first step in management?

A

Amiodarone 300mg IV over 2-60 minutes

50
Q

Pt presents with suspected HF and a BNP level >2000. What is the next step in management?

A

Cardiology referral and TTE within 2 weeks

51
Q

Pt presents with suspected HF and BNP level between 400-2000. What is the next step in management?

A

Cardiology referral and TTE within 6 weeks

52
Q

What is the management for symptomatic third degree AV block?

A

Pacemaker implantation

53
Q

What is the difference between myalagia, myositis and rhabdomyolysis in regards to creatine kinase levels?

A

Myalgia - normal

Myositis - elevated but <10 x upper limit

Rhabdomyolysis - creatine kinase >10x upper limit

54
Q

In a patient with a major bleed who takes warfarin, after stopping warfarin, what is the next most appropriate management?

A

IV vitamin K 5mg and prothrombin complex concentrate

55
Q

<80 year old with stage 1 HTN, only treat if they have DR.COQ

What does this stand for?

A 
DM
Renal disease 
CVD
Organ damage 
Q-risk >10
56
Q

A pt who has had DC cardioversion due to a high risk of stoke following AF now remains in sinus rhythm. What should happen to their anticoagulatio?
A - Stop altogether
B - Continue for 6 months
C - Continue lifelong

A

C - continue lifelong

57
Q

What two ECG findings would show SVT?

A

Narrow complex tachycardia and absent P waves

58
Q

Is it necessary to give antibiotic prophylaxis for infective endocarditis?

A

No - not needed

ICM/FCM (16 decks)

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