cardiology incorrects Flashcards
50 YO, atrial fibrillation picked up incidentally, pulse rate 80bpm, chadsvasc score is 0
what is the next step in management?
no medication!!
patient has non symptomatic AF. rate is controlled. no other RFs
A 63 year old woman has episodes of irregular palpitations, lasting several days and occurring once a month. She has ischaemic heart disease and type 2 diabetes.Her ECG confirms atrial fibrillation.
The patient wants to discuss the risks before starting anticoagulation (see image).
Which is her lifetime risk of having a stroke related to her atrial fibrillation?
A. 3%
B. 15%
C. 20%
D. 30%
E. 60%
UKMLA ppq!
Correct Answer(s): E
Justification for correct answer(s): 60% as the her CHADsVasc score is 3
From the table her adjusted stroke risk is 3.2
so 3% per year with life expectancy from 63 years to be about 20 years (83) (2020: life expectancy is 82 years). 3 x 20 is 60%. When discussing this with patients it puts it into perspective more if its lifetime rather than annual risk. Patients more likely to choose anticoagulation.
A 88 year old woman has 30 hours of severe abdominal pain. She was discharged from hospital 4 weeks ago following an aortobifemoral bypass graft.She has diffuse tenderness of the abdomen with absent bowel sounds. Plain X-ray of the abdomen is unremarkable.Investigations:Haemoglobin 114 g/L (115-160)
White cell count 18 × 109/L (3.8–10.0)Urea 16.4 mmol/L (2.5–7.8) Creatinine 158 μmol/L (60–120)CRP 110 mg/L (<5)Arterial blood gas breathing air
pH 7.28 (7.35–7.45)
PO2 13 kPa (11–15)
PCO2 4.6 kPa (4.6–6.4)
Bicarbonate 16 mmol/L(22–30)Lactate 4.5 mmol/L (1–2)
UKMLA ppq
Mesenteric ischemia
History of vascular disease and lactic acidosis
side effects of amiodarone?
thyroid dysfunction: both hypothyroidism and hyper-thyroidism
corneal deposits
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
peripheral neuropathy, myopathy
photosensitivity
‘slate-grey’ appearance
thrombophlebitis!! and injection site reactions
bradycardia
lengths QT interval
inhaled foreign objects are most likely found where?
Right inferior lobe bronchus
a diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).
What abnormality is most likely to have been present on the patient’s ECG?
T-wave inversion in V1-3
40%
A 35-year-old male presents with pain in both legs for the last two weeks. He has noted that the pain occurs after he has walked for ten minutes during his morning walk and is relieved when he sits for some time. There is no swelling but has noted that his toes turn white, then blue and red during the cold. There is no history of trauma. He does not drink alcohol but has been smoking three to four packs of cigarettes per day for ten years.
Which of the following is the most likely diagnosis?
Thromboangiitis obliterans/ buergers disease
A 63-year-old man with a history of hypertension and stable angina is currently on 20mg bisoprolol OD, aspirin 75mg OD, atorvastatin 80 mg OD, and glyceryl trinitrate (GTN) spray PRN. He remains compliant with his medication; however, he continues to experience chest pain during moderate physical activity. His heart rate is 80 bpm, and his blood pressure is 120/80 mmHg.
Which medication would be most appropriate to add to this man’s regimen?
amlodipine
If angina is not controlled with a beta-blocker, a longer-acting dihydropyridine calcium channel blocker should be added
colleague asks you to pass her the amiodarone syringe for infusion. You find that the crash trolley has been restocked incorrectly and the syringe is missing.
What drug can be substituted in this situation?
lidocaine
which valve condition is associated with polycystic kidney disease?
mitral valve prolapse
A 47-year-old man presents to the emergency department with sudden onset central chest pain. The patient has a past medical history of hypertension for which he is taking ramipril. His observations are BP 153/90mmHg in his right arm and 130/80 in his left arm, heart rate 89/minute, temperature 37.2ºC, respiration rate 17/minute, and oxygen saturation 98% on room air. On examination, pulses are absent in the right leg and diminished in the left.
diagnosis?
What is the preferred investigation for this patient’s presentation?
aortic dissection
CT angiography chest/abdomen/pelvis
Renal dysfunction (eGFR < 60) can cause a raised serum natriuretic peptides/ BNP
A 35-year-old woman presents to the ED with acute shortness of breath following a motor vehicle accident 30 minutes ago. On examination, her blood pressure is 82/45 mmHg, the pulse is 120 bpm, capillary refill time is 3 seconds, and JVP is 6 cm above the sternal angle. A 500 mL bolus of IV crystalloid was given, but she remains hypotensive and tachycardic.
Given the most likely cause of this presentation, what is the most appropriate management?
pericardiocentesis
cardiac tamponade
when should simvastatin be taken?
last in the evening
Mobitz type 1 (Wenckebach phenomenon) is a normal variant in an athlete - discharge with safety netting advice
major bleeding on warfarin management?
Give intravenous vitamin K 5mg and prothrombin complex concentrate
statins + what drug is a common interaction?
erythromycin/clarithromycin
You are working in a GP practice. Your next patient is a 27-year-old female who has just found out she is 6 weeks pregnant. She has a past medical history of familial hypercholesterolaemia, type 1 diabetes and asthma. What should your next step in management be?
stop statin -> contraindicated in pregnancy
Ivabradine use may be associated with visual disturbances including phosphenes and green luminescence
what are the warfarin inr targets in valve replacement?
Mechanical valves - target INR:
aortic: 3.0
mitral: 3.5
learn hypokalemia presentation on ecg, can be caused by furosemide
A 64-year-old man presents to the respiratory clinic for a scheduled review of his pulmonary hypertension. He was diagnosed with pulmonary hypertension ten years previously. His comorbidities include type 2 diabetes mellitus and heart failure. His medications include bosentan, metformin, sitagliptin, ramipril and bisoprolol.
On examination, he is slightly overweight; he has mild peripheral oedema; his lungs are clear; and there is a high-pitched, pansystolic murmur, heard loudest at the lower left sternal edge, which is loudest on inspiration.
Which underlying pathology is most likely to explain his murmur?
ttricuspid regurg
RILE
and then systolic murmur so tricuspid regurbg not stenosis
Lung crackles heard on auscultation/ cardiogenic shock is a poor prognostic indicator in acute coronary syndrome
common adverse effect of indapamide?/ thiazide like diuretics
erectile dysfunction
stable angina first line treatment?
A beta-blocker or a calcium channel blocker eg dilitiazem
beta blocker side effects?
bronchospasm
cold peripheries
fatigue
insomnia, including nightmares!!!
erectile dysfunction
A 46-year-old woman presents to the medical assessment unit with a four-month history of shortness of breath and lightheadedness on exertion. On examination, she has a systolic murmur. When palpating her radial artery, a double pulse is felt during systole.
What condition is most likely to produce this pulse?
mixed aortic valve disease
New LBBB is always pathological and never normal even in an athlete
antiplatelet regime following a stroke?
Aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg daily lifelong
A 14-year-old boy presents to the Emergency Department as he is unable to control his facial muscles and arm movements. For the last 5 weeks, following a throat infection, he has been experiencing ongoing fever, worsening shortness of breath and joint pains, mainly in his legs which have not been effectively managed. What is the most likely cause of the patient’s recent symptoms?
Sydenham’s chorea - complication of rhuematic fever
warfarin interacts with fluconazole!!
