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Cardiology passtest Flashcards

1
Q

What are the symptoms of rheumatic fever in a child

A

Inflamed joints
+ Sore throat

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2
Q

What does Fever JONES stand for in rheumatic fever?

A

J: Joint arthritis, usually migratory and inflammatory
O: Organ inflammation, such as carditis, which looks like a heart shape
N: Nodules under the skin
E: Erythema marginatum rash, which is a ring-like rash that can start in the arms or trunk
S: Sydenham chorea, which is a late feature characterized by jerky, uncontrollable movements

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3
Q

What are the signs of signs of bacterial endocarditis?

A
  • Lethargy
    Low grade fever
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4
Q

What’s a normal ABPI?

A

0.9-1.2

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5
Q

What is mild ischaemic ABPI?

A

0.5 - 0.9

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6
Q

What is severe ischaemia ABPI?

A

0.3-0.5

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7
Q

What is critical ischaemia ABPI?

A

Less than 0.3

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8
Q

What ABPI is calcified vessels?

A

> 1.2

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9
Q

What investigations should be done if ABPI is low?

A

Duplex then an angiography

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10
Q

How is ABPI calculated?

A

Ankle pressure/ arm pressure in a supine position

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11
Q

What ECG changes are seen in wolf-parkinson white syndrome?

A

Wide QRS with a slurred upstroke of the QRS

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12
Q

What features are seen with Atrioventricular septal defect?

A

Prominent right ventricular cardiac impulse
Ejection systolic murmur
Dilation of right sided chambers

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13
Q

Where is aortic stenosis best heard?

A

Right sternal border - 2nd intercoastal space

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14
Q

What is the bifurcation point of the trachea called?

A

Carina

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15
Q

What level is the Carina?

A

T4/T5

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16
Q

What is a pneumonic to help remember where heart sounds are best heard?

A

APE To Man - Aortic, pulmonary , erb’s point, Tricuspid, Mitral

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17
Q

Where is pulmonary valve best heard?

A

2nd ICS left sternal border

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18
Q

Where is Tricuspid valve heard best

A

4th ICS right sternal border

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19
Q

Where is mitral valve heard best?

A

5th ICS mid clavicular

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20
Q

What are the characteristic findings of AF on ECG?

A

Absent P waves and irregular QRS

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21
Q

Is hypo or hyper thyroid associated with AF?

A

Hyperthyroid

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22
Q

What is the pneumonic to help remember triggers for AF?

A

PIRATES:
P- PE
I - Ischaemia
R - respiratory disease
A - atrial enlarged or cardiac tumour
T - thyroid hyper
E- ethanol
S - sepsis , sleep apnea

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23
Q

What is a genetic risk factor for aortic dissection?

A

Connective tissue disorder - ehlers danlos syndrome

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24
Q

What is Beck’s triad?

A

Muffled heart sounds, hypotension, distended neck veins - e.g. JVP

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25
Q

What can cause beck’s triad?

A

Cardiac tamponade
Pericardial effusion

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26
Q

What is a cardiac tamponade?

A

Pressure on heart that occurs when blood or fluid build up in space between the muscles

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27
Q

What is the usual investigation for an aortic aneurysm?

A

Abdominal US

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28
Q

What is a common demographic of coarctation of aorta in adults younger than 40?

A

Uncontrolled hypertension

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29
Q

What are the symptoms of a coarctation of aorta?

A

Weak or absent femoral pulse, LV hypertrophy

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30
Q

What is a paradoxical stroke?

A

Blood clot or embolus passes from right side to left side entering arterial circulation, due to patent foramen ovale

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31
Q

What worsens pericarditis?

A

Coughing or laying flat

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32
Q

What sound is heard with pericarditis?

A

Pericardial friction rub - scratchy + high pitched

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33
Q

What ECG changes may be seen with pericarditis?

A

Concave up ST segment for a few days

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34
Q

How can low dose dopamine improve renal blood flow?

A

The dopamine will act on dopamine 1 receptors which cause vasodilation

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35
Q

How can high dose dopamine be detrimental to renal blood flow?

A

Causes vasoconstriction via a-adrenergic receptors which decreases renal blood flow

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36
Q

Which artery supplies the left atrium?

A

Circumflex artery

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37
Q

Which artery supplies the intraventricular septum and both ventricles?

A

Left anterior descending

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38
Q

Which artery supplies the left ventricle?

A

Left marginal artery

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39
Q

Which artery supplies the right ventricle and intraventricular + inferior wall of CV septum?

A

Right coronary

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40
Q

What is the saphena varix?

A

It’s a bluish soft mass that is inferolateral to pubic tubercle

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41
Q

Where does a pericardial effusion occur?

A

The space between the visceral and parietal pericardium

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42
Q

What is the first line treatment for AF?

A

Beta blocker - usually bisopolol

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43
Q

When would you start a anticoagulation agent like apixaban in AF?

A

Use the CHA2DS2VASC score

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44
Q

What’s the use of an anticoagulant in AF?

A

Stroke prevention

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45
Q

How many point in men cha2ds2vasc score gets anticoagulant vs in women

A

Men is more than 1 in women it’s more than 2

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46
Q

What are the components of CHA2DS2VASC?

A

Congestive heart failure
Hypertension
Age - 75 or over = 2 points
Diabetes
Stroke / TIA/ TE - 2 points
Vascular diseases
Age 65 or over
Sex female - 1 point

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47
Q

When is digoxin used for AF?

A

When pt is sedentary and there is non-paroxysnal AF 9the AF doesn’t return to sinus after 7 days) - usually use digoxin in elderly.

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48
Q

What can cause V waves - giant JVP?

A

Obstruction of SVC
Tricuspid regurg

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49
Q

What are the symptoms of tricuspid regurg?

A

Pulsatile hepatomegaly
Left parasternal heave
Pansystolic murmur at left sternal edge

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50
Q

Which type of veins do varicose veins affect?

A

Superficial venous system - long saphenous and main superficial vein

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51
Q

What is the diagnostic investigation for aortic dissection?

A

CT angiography

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52
Q

What is diagnostic test for ruptured AA?

A

CT

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53
Q

How big is syringe for pericardiocentesis?

A

20ml and 18G

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54
Q

What is Buerger’s angle?

A

Raise the patients legs when they’re supine. Legs are then lowered in gradual slow steps downward. The angle at which the colour returns is the burger’s angle

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55
Q

What Buerger angle would warrant a diagnosis of severe limb ischaemia?

A

Less than 20 degrees

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56
Q

Which artery does the inferior epigastric artery branch off from?

A

External iliac artery

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57
Q

Which artery does the deep external pudendal artery originate from?

A

Femoral artery

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58
Q

What ECG changes are shown with Vtach?

A

Fast rhythm and a wide QRS - 120-150 J

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59
Q

What is 1st line treatment for V tach?

A

Electro cardioversion

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60
Q

What is 2nd line treatment for Vtach?

A

300mg amiodarone over 10-20 mins for a loading dose. Then a 900 mg dose over 24 hours

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61
Q

What are the 6P’s of Embolism?

A

Pale
Pulseless
Paraesthesia
Pain
Paralysis
Perishingly cold

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62
Q

If embolism occurs what is the treatment?

A

Urgent embolectomy

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63
Q

What catheter is used in urgent embolectomy?

A

Fogarty catheter

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64
Q

Post urgent embolectomy what medication should patient receive?

A

IV heparin then warfarin for anticoagulation

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65
Q

In an NSTEMI what are ECG changes?

A

None or t wave inversion

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66
Q

What are troponin levels like in NSTEMI?

A

Raised

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67
Q

What differentiates NSTEMI from unstable angina if there is t wave inversion on both ECG?

A

Unstable has no troponin raise

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68
Q

What sound suggests severe mitral stenosis?

A

Early opening snap

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69
Q

What medication should be stopped in a patient with heart failure and why?

A

Calcium channel blockers e.g. diltiazem. Because they have a negative inotropic effect meaning they reduce heart contractility which worsens the heart failure

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70
Q

What is diagnostic test for paradoxical embolus?

A

Transoesophageal echocardiogram

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71
Q

What would be seen on ABG in ischaemic bowel?

A

High lactate and metabolic acidosis

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72
Q

What histological finding are present in chagas disease?

A

trypanosomes

73
Q

What does dilated cardiomyopathy specifically refer to?

A

Cardiac myocytes NOT caused by ischaemia or hypertension

74
Q

What are ECG changes in hypokalaemia?

A

Prominent U waves & flattened T waves/ inversion

75
Q

What are the causes of dilated cardiomyopathy?

A

Alcohol, methamphetamines, doxorubicin ( chemo drug), coxackie, parvovirus b19, HIV

76
Q

What’s the most common organism that causes infective endocarditis?

A

Staph aureus

77
Q

Which two populations are esp at risk of endocarditis

A

IV drug users
Pt with prosthetic valves

78
Q

How is infective endocarditis treated?

A

Amoxicillin and gentamicin

79
Q

What’s the most common site of aortic intimal tears?

A

Proximal descending aorta

80
Q

What’s are the 2 approaches for a CABG?

A

On pump or off pump.

On pump: temporarily stop the heart while a heart and lung machine maintains circulation

81
Q

What is kussmaul sign?

A

Increased JVP when a person inhales

82
Q

What is the management for carotid artery dissection ?

A

Anticoagulation or endovascular stenting

83
Q

What’s the inheritance pattern of dilated cardiomyopathy?

A

Dominant inheritance

84
Q

What is the length of the QRS complex in dilated cardiomyopathy

A
  • B-road compels so over 120
85
Q

Which patients cannot take part in cardiac rehab

A

If systolic is above 200 or diastolic above 110 as it can cause a hypertensive crisis

86
Q

In diabetics what is preferred a CABG or PCI?

87
Q

When is BNP released

A

Secreted by ventricles in response to stretch : therefore BNP increases in heart failure

88
Q

Which patients must be referred to vascular due to lower limb ischaemia?

A

Critically low ABPI or : symptomatic varicose veins
Lower limb skin changes
Superficial vein thrombosis
Active/ healed venous ulcers

89
Q

What is are 2 absolute contraindications to thrombolysis?

A

Cerebral neoplasm
BP over 200/120

90
Q

What is dressler’s syndrome?

A

Secondary form of pericarditis that occurs 2-6 weeks post MI

91
Q

What are the symptoms of dressler’s?

A

Fever, chest pain that worsens with inspiration

92
Q

What is the sound for mitral regurg?

A

Pansystolic murmur

93
Q

Where does mitral regurg radiate to?

94
Q

What is the sound for aortic stenosis?

A

Ejection systolic + 4th heart sound, low volume pulse, forceful apex beat

95
Q

Where does aortic stenosis radiate to?

A

Carotid arteries

96
Q

What sound is mitral stenosis?

A

Mid diastolic with an opening snap

97
Q

What sound is aortic regurg?

A

Early diastolic and collapsing pulse

98
Q

What murmur occurs in ventricular septal defect?

A

Pansystolic

99
Q

How is sinus tachycardia treated? 1st line?

A

Vagal manoeuvre

100
Q

What is second line treatment for sinus tachycardia?

A

Adenosine 6mg IV bolus

101
Q

How many times can you give adenosine for sinus tachycardia?

A

Up to 12 mg IV bolus adenosine up to 3x

102
Q

If adenosine bolus helps to fix sinus tachy what is the likely cause? and if not what is it?

A

Paroxysmal re-entry SVT.
If not: atrial flutter

103
Q

What is treatment for torsades de pointe - irregular v tach?

A

IV magnesium

104
Q

What would hyperkalaemia show on an ECG?

A

Wide QRS
Decreased P wave amplitude
Long PR interval - this is also found in hypo
Tall tented t waves

105
Q

What’s the most common cause of secondary hypertension in young ppl?

A

Renal artery stenosis

106
Q

What is diagnostic investigation for a renal artery stenosis?

A

MRI with gadolinium contrast

107
Q

Which vascular disorder has a preference for the renal arteries?

A

Fibromuscular dysplasia - causes narrowing of renal arteries

108
Q

Where does the aortic arch lie?

A

In superior mediastinum

109
Q

Where does the descending aorta lie?

A

Posterior mediastinum

110
Q

Which medication is given to all pt with ischaemic limb?

111
Q

What conservative measure can be used post surgery to help with postural hypotension?

A

Abdo binder compression

112
Q

What mechanism is midodrine?

A

Alpha adrenergic agonist

113
Q

What is a use for midodrine?

A

Postural hypotension with no organic cause

114
Q

What other drug can be used for postural hypotension?

A

Fludrocortisone

115
Q

What is main pt demographic for mitral valve prolapse?

A

Young women with narrow chest and low body weight

116
Q

What are the clinical characteristics of a mitral valve prolapse?

A

Bulging of mitral leaflets

117
Q

What is post-thrombotic syndrome?

A

Venous hypertension that affects pt with a history of DVT’s

118
Q

What is the difference between mobitz type 1 2nd degree and mobitz type 2 , 2nd degree on ECG?

A

Mobitz 1: progressive PR interval than a dropped beat
Mobitz 2: Fixed PR interval and dropped beat

119
Q

What is the treatment for symptomatic mobitz 2?

A

Permanent pacemaker

120
Q

What are the 2 surgical treatment for aortic aneurysm?

A
  1. Open AAA repair with a dacron graft
  2. Endovascular aneurysm repair - EVAR
121
Q

When is EVAR more suited vs an open AAA repair?

A

If patient is unfit or multiple co-morbidities do EVAR

122
Q

What is a hallmark feature of untreated hypertension?

A

Uniform left ventricular hypertrophy

123
Q

How is acute pericarditis treated?

A

NSAID’s: indomethacin

124
Q

If the 1st line treatment for pericarditis doesn’t help what is another treatment option?

A

Tapering course of oral pred

125
Q

What are ECG changes with posterior MI?

A

ST depression and tall R waves in leads v1 +v2

126
Q

Where is subcoastal plane?

126
Q

If there isn’t a reversible cause of AF what can be administered?

A

IV flecainide

127
Q

How do you differentiate between tricuspid regurg and mitral regurg?

A

Both are pan systolic murmurs. BUT mitral is at apex and tricuspid is at left sternal edge

128
Q

What finding on chest X-Ray suggest alveolar oedema?

A

‘Batwing distribution’ Patchy hilar shadowing across lungs

129
Q

What are the 4 indications for a pacemaker?

A
  1. Type 2 second degree mobitz heart block
  2. 3rd degree AV heart block
  3. Symptomatic slow AF
  4. Symptomatic bradycardia
130
Q

What level does the aorta bifurcate?

131
Q

Which diuretic is used to improve prognosis, and which one is more for symptomatic relief?

A

Spironolactone for improved prognosis
Furosemide for symptomatic relief

132
Q

What is the pathogenesis of dressler’s?

A

Formation of autoantibodies against cardiac antigens which are released during an infarction and subsequent deposition of antibody-antigen complexes in pericardium and pleural space

133
Q

What are the other cause of high troponin bar MI?

A

PE, CKD, AKI, Pericarditis

134
Q

How does carotid cavernous fistula present?

A

Acutely painful visual loss
Conjunctival injection
Firm and tender pulsatile eyeball

135
Q

How is a carotid cavernous fistula treated?

A

Obliteration of fistula using endovascular surgery

136
Q

Which pacemaker is used for SAN dysfunction?

137
Q

Which pacemaker is used for AF?

138
Q

Which pacemaker is used for 2nd degree heart block?

139
Q

What dose of atorvastatin should of MI patient be started on?

140
Q

What are bifid waves (p mitrale - little butt chin in the top of p wave) caused by ?

A

Left atrial hypertrophy

141
Q

What findings would be seen on chest X-ray with an aortic dissection?

A

Widening of mediastinum
Loss of aortic knob

142
Q

What is another name for 2nd degree heart block, mobitz 1

A

Wenckebach’s phenomenon - impulse conduction (PR interval becomes prolonged)

143
Q

What body position may reduce the ejection systolic murmur heard with pt with hypertrophic cardiomyopathy?

144
Q

What is given to haemodynamically stable patients with a VT?

A

IV amiodarone

145
Q

What medication can be administered for paroxysmal narrow complex tachycardia?

A

IV adenosine

146
Q

What is the difference in treatment of wide complex and narrow complex VT?

A

In wide complex DC cardioversion is needed, whereas IV adenosine can be used in narrow

147
Q

For pt with a mitral valve area less than 1.5 and it’s symptomatic what is treatment? and what are the conditions?

A

Balloon valvuloplasty - valve must be mobile and non-calcified

148
Q

If surgical repair is needed for mitral valve stenosis whatis the preferred method?

A

Mitral valve repair

149
Q

Where is the transverse sinus of pericardium found?

A

Behind major vessel emerging from ventricles but in front of SVC

150
Q

What passes through the femoral triangle?

A

VAN: Femoral vein, artery and vein

151
Q

What can be seen on radiographs is an adult has a coarctation of aorta? and what is this sign called?

A

Notching of inferior rib margins - Roesler’s sign

152
Q

What causes Roesler’s sign?

A

Notching is due to enlarged intercoastal arteries

153
Q

What are the signs of coarctation of adult aorta?

A

Hypotension in lower limbs and hypertension in upper limbs

154
Q

In babies what defect is coarctation of aorta associated with?

A

Patent ductus arteriosus

155
Q

What can be added to medication list of a pt taking GTN but it’s not working super well

A

Long acting nitrate - isosorbide

156
Q

When would an AAA need surgery?

A
  1. ruptured
  2. greater than 5.5 cm - if symptomatic
  3. growing more than 1cm a year and symptomatic
157
Q

What murmur is heard with aortic dissection?

A

Aortic regurg - early diastolic murmur with a collapsing pulse

158
Q

What are the 2 types of aortic dissection? and what are the differences?

A

A and B
A: occurs proximal to subclavian artery origin and needs urgent surgery
B: occurs distal to subclavian artery origin and is treated medically

159
Q

What are NYHA classifications?

A

Class 1: no limit to physical activity
Class 2: slight limitation but fine at rest
Class 3: marked limitation of activity
Class 4: Discomfort at both rest and activity

160
Q

What is prinzemetal angina?

A

Angina du e to coronary artery spasms

161
Q

What are the 2 different types of infarctions?n the differences of both

A
  1. Transmural: causes ST elevation in a few leads , usually happens in community setting
  2. Subendocardial: Occurs during shock and ST elevation in most leads
162
Q

What is situs inversus?

A

Organs are on mirrored side of body

163
Q

Which condition is linked to presenting with situs inversus?

A

Primary cilia dyskinesia

164
Q

What is characteristic ECG finding with 3rd degree heart block?

A

No associated between p waves and QRS complexes

165
Q

What murmur is seen in pulmonary stenosis?

A

Crescendo-decrescendo (choppy whooshing sound)

166
Q

What murmur is heard with tricuspid regurg?

A

Holosystolic at left sternal edge
Present through whole cardiac cycle
Louder on inspiration
High pitched blowing sound

167
Q

In a healthy person how much should HDL ratio be?

A

Same or less than 5

168
Q

In a pt with risk factors what is acceptable HDL ratio?

A

Same or less than 4

169
Q

What dose of atorvastatin should be used in patients with high HDL ratio?

A

20mg atorvastatin

170
Q

In what situation can an EVAR not be done? and why?

A

If the aneurysm is above the renal arteries: bcos there isn’t adequate length of aorta to attach the graft onto so there’s an increased risk of blood leaking around the graft.

171
Q

What is Corrigan’s sign?

A

Indicates aortic incompetence - early diastolic murmur in aortic regurg. Bounding carotid pulse

172
Q

What is done in PE investigation in pregnancy instead of CT pulmonary angiogram?

A

Ventilation/ perfusion

173
Q

What is assumed in pregnant lady with unilateral red painful leg? and what must be done

A

DVT - start them on LMWH

174
Q

What is 1st line investigation for lymphedemas?

A

Lymphoscintigram

175
Q

What device can be used to bridge between transplant?

A

Left ventricular assist devices

176
Q

What is seen on ECG with atrial flutter?

A

Saw tooth pattern

177
Q

What happens to our VO2 max as we age?

A

It decreases

UKMLA (14 decks)

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