Cardiology ICM

Question 1

Besides bloods and initial ECG, what is the first line investigation for palpitations?

Answer 1

Holter Monitor

Question 2

Name 3 components of a blood test that you want to check for palpitations

Answer 2

FBC
TFT - Thyrotoxicosis
U&E - low potassium

Question 3

How does left ventricular hypertrophy present on an ECG and what PMHx would you be interested in as a cause?

Answer 3

R-waves (V5-6)
S waves (V1-V2)
ST elevation

HTN

Question 4

What type of patient is it normal to find a Mobitz type 1 heart block?

A - Athlete
B - Construction worker
C - Obese

Answer 4

Athlete

Due to increased vagal tone

Question 5

How would you manage an athlete with a mobitz type 1 heart block?

Answer 5

Discharge and monitor with ECG in primary care

Question 6

What condition normally causes tall R waves in V1 & V2?
A - RBBB
B - Right ventricular hypertrophy
C - Posterior MI 
D - Anterior MI

Answer 6

Posterior MI

Question 7

What findings on an ECG would make you think of right ventricular hypertrophy?
A - Dominant R waves in V1
B - Dominant waves in V1 & Dominant S waves in V 6
C - Right Axis deviation
D - All of the above

Answer 7

D

Question 8

How does hypokalaemia present on an ECG?

Answer 8

Prolong PR interval 
Small/absent T waves 
Long QT 
ST depression 
U waves

Question 9

What would you see on an ECG for Wolff-Parkinson White syndome?

Answer 9

Delta waves

Question 10

What would you see in RBBB?
A - W in V1 and M in V6
B - M in Vt and W in V 6

Answer 10

B

Question 11

What % of occlusion does widespread ST elevation show?
A - 75%
B - 100%

Answer 11

B

Question 12

What would you see on an ECG that shows hypokalaemia?
A - Delta waves
B - J waves
C - U waves

Answer 12

C - U waves

Question 13

What can increase BNP? (2 marks)

Answer 13

Heart failure

CKD

Question 14

What 3 medications can falsely lower BNP levels?

Answer 14

ACEi
B-blockers
Diuretics

Question 15

What would you do if you suspected HF in a patient who has previously not had an MI?
A - BNP
B - Urgent referral, ECHO and assessment

Answer 15

A

Question 16

Name 4 other causes of increased BNP levels apart from heart failure

Answer 16

LVH
AF
PE
Diabetes

Question 17

In what two groups of people would you see naturally raised BNP?

Answer 17

Women

> 70

Question 18

What does a posterior STEMI cause on an ECG?
A - ST Depression
B - ST Elevation

Answer 18

A

Question 19

If you have an infarct in the RCA, what complication would a patient suffer from?

A - Left ventricular wall thrombus,
B - RBBB
C- Ventricular septal efect
D - 1st degree AV block

Answer 19

D - RCA supplies the AV node

Question 20

What complication can happen from occlusion of the left anterior descending artery that supplies the majority of the left ventricle?

Answer 20

Left ventricular thrombus

Question 21

Where are you more likely to find RBBB?

A LAD
B RCA

Answer 21

A - anterior MI lead to heart block below the level of the AV node

Question 22

A patient has new LBBB on her ECG alongside SOB and fatigue. What next investigation should you do and what condition are you thinking about?

Answer 22

Troponin

ACS

Question 23

What condition are J waves associated with on an ECG if severe?

Answer 23

Hypercalcaemia

Question 24

After examination and ECG, what would be the next best step in investigation of someone presenting with typical/atypical angina and non-cardiac chest pain but positive changes on an ECG?

Answer 24

Contrast CT coronary angiogram