Cardiology passtest Flashcards
1
Q
What are the symptoms of rheumatic fever in a child
A
Inflamed joints
+ Sore throat
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
3
Q
What are the signs of signs of bacterial endocarditis?
A
- Lethargy
Low grade fever
4
Q
What’s a normal ABPI?
A
0.9-1.2
5
Q
What is mild ischaemic ABPI?
A
0.5 - 0.9
6
Q
What is severe ischaemia ABPI?
A
0.3-0.5
7
Q
What is critical ischaemia ABPI?
A
Less than 0.3
8
Q
What ABPI is calcified vessels?
A
> 1.2
9
Q
What investigations should be done if ABPI is low?
A
Duplex then an angiography
10
Q
How is ABPI calculated?
A
Ankle pressure/ arm pressure in a supine position
11
Q
What ECG changes are seen in wolf-parkinson white syndrome?
A
Wide QRS with a slurred upstroke of the QRS
12
Q
What features are seen with Atrioventricular septal defect?
A
Prominent right ventricular cardiac impulse
Ejection systolic murmur
Dilation of right sided chambers
13
Q
Where is aortic stenosis best heard?
A
Right sternal border - 2nd intercoastal space
14
Q
What is the bifurcation point of the trachea called?
A
Carina
15
Q
What level is the Carina?
A
T4/T5
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
17
Q
Where is pulmonary valve best heard?
A
2nd ICS left sternal border
18
Q
Where is Tricuspid valve heard best
A
4th ICS right sternal border
19
Q
Where is mitral valve heard best?
A
5th ICS mid clavicular
20
Q
What are the characteristic findings of AF on ECG?
A
Absent P waves and irregular QRS
21
Q
Is hypo or hyper thyroid associated with AF?
A
Hyperthyroid
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
23
Q
What is a genetic risk factor for aortic dissection?
A
Connective tissue disorder - ehlers danlos syndrome
24
Q
What is Beck’s triad?
A
Muffled heart sounds, hypotension, distended neck veins - e.g. JVP
25
What can cause beck's triad?
Cardiac tamponade
Pericardial effusion
26
What is a cardiac tamponade?
Pressure on heart that occurs when blood or fluid build up in space between the muscles
27
What is the usual investigation for an aortic aneurysm?
Abdominal US
28
What is a common demographic of coarctation of aorta in adults younger than 40?
Uncontrolled hypertension
29
What are the symptoms of a coarctation of aorta?
Weak or absent femoral pulse, LV hypertrophy
30
What is a paradoxical stroke?
Blood clot or embolus passes from right side to left side entering arterial circulation, due to patent foramen ovale
31
What worsens pericarditis?
Coughing or laying flat
32
What sound is heard with pericarditis?
Pericardial friction rub - scratchy + high pitched
33
What ECG changes may be seen with pericarditis?
Concave up ST segment for a few days
34
How can low dose dopamine improve renal blood flow?
The dopamine will act on dopamine 1 receptors which cause vasodilation
35
How can high dose dopamine be detrimental to renal blood flow?
Causes vasoconstriction via a-adrenergic receptors which decreases renal blood flow
36
Which artery supplies the left atrium?
Circumflex artery
37
Which artery supplies the intraventricular septum and both ventricles?
Left anterior descending
38
Which artery supplies the left ventricle?
Left marginal artery
39
Which artery supplies the right ventricle and intraventricular + inferior wall of CV septum?
Right coronary
40
What is the saphena varix?
It's a bluish soft mass that is inferolateral to pubic tubercle
41
Where does a pericardial effusion occur?
The space between the visceral and parietal pericardium
42
What is the first line treatment for AF?
Beta blocker - usually bisopolol
43
When would you start a anticoagulation agent like apixaban in AF?
Use the CHA2DS2VASC score
44
What's the use of an anticoagulant in AF?
Stroke prevention
45
How many point in men cha2ds2vasc score gets anticoagulant vs in women
Men is more than 1 in women it's more than 2
46
What are the components of CHA2DS2VASC?
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
47
When is digoxin used for AF?
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.
48
What can cause V waves - giant JVP?
Obstruction of SVC
Tricuspid regurg
49
What are the symptoms of tricuspid regurg?
Pulsatile hepatomegaly
Left parasternal heave
Pansystolic murmur at left sternal edge
50
Which type of veins do varicose veins affect?
Superficial venous system - long saphenous and main superficial vein
51
What is the diagnostic investigation for aortic dissection?
CT angiography
52
What is diagnostic test for ruptured AA?
CT
53
How big is syringe for pericardiocentesis?
20ml and 18G
54
What is Buerger's angle?
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
55
What Buerger angle would warrant a diagnosis of severe limb ischaemia?
Less than 20 degrees
56
Which artery does the inferior epigastric artery branch off from?
External iliac artery
57
Which artery does the deep external pudendal artery originate from?
Femoral artery
58
What ECG changes are shown with Vtach?
Fast rhythm and a wide QRS - 120-150 J
59
What is 1st line treatment for V tach?
Electro cardioversion
60
What is 2nd line treatment for Vtach?
300mg amiodarone over 10-20 mins for a loading dose. Then a 900 mg dose over 24 hours
61
What are the 6P's of Embolism?
Pale
Pulseless
Paraesthesia
Pain
Paralysis
Perishingly cold
62
If embolism occurs what is the treatment?
Urgent embolectomy
63
What catheter is used in urgent embolectomy?
Fogarty catheter
64
Post urgent embolectomy what medication should patient receive?
IV heparin then warfarin for anticoagulation
65
In an NSTEMI what are ECG changes?
None or t wave inversion
66
What are troponin levels like in NSTEMI?
Raised
67
What differentiates NSTEMI from unstable angina if there is t wave inversion on both ECG?
Unstable has no troponin raise
68
What sound suggests severe mitral stenosis?
Early opening snap
69
What medication should be stopped in a patient with heart failure and why?
Calcium channel blockers e.g. diltiazem. Because they have a negative inotropic effect meaning they reduce heart contractility which worsens the heart failure
70
What is diagnostic test for paradoxical embolus?
Transoesophageal echocardiogram
71
What would be seen on ABG in ischaemic bowel?
High lactate and metabolic acidosis
72
What histological finding are present in chagas disease?
trypanosomes
73
What does dilated cardiomyopathy specifically refer to?
Cardiac myocytes NOT caused by ischaemia or hypertension
74
What are ECG changes in hypokalaemia?
Prominent U waves & flattened T waves/ inversion
75
What are the causes of dilated cardiomyopathy?
Alcohol, methamphetamines, doxorubicin ( chemo drug), coxackie, parvovirus b19, HIV
76
What’s the most common organism that causes infective endocarditis?
Staph aureus
77
Which two populations are esp at risk of endocarditis
IV drug users
Pt with prosthetic valves
78
How is infective endocarditis treated?
Amoxicillin and gentamicin
79
What’s the most common site of aortic intimal tears?
Proximal descending aorta
80
What’s are the 2 approaches for a CABG?
On pump or off pump.
On pump: temporarily stop the heart while a heart and lung machine maintains circulation
81
What is kussmaul sign?
Increased JVP when a person inhales
82
What is the management for carotid artery dissection ?
Anticoagulation or endovascular stenting
83
What’s the inheritance pattern of dilated cardiomyopathy?
Dominant inheritance
84
What is the length of the QRS complex in dilated cardiomyopathy
- B-road compels so over 120
85
Which patients cannot take part in cardiac rehab
If systolic is above 200 or diastolic above 110 as it can cause a hypertensive crisis
86
In diabetics what is preferred a CABG or PCI?
CABG
87
When is BNP released
Secreted by ventricles in response to stretch : therefore BNP increases in heart failure
88
Which patients must be referred to vascular due to lower limb ischaemia?
Critically low ABPI or : symptomatic varicose veins
Lower limb skin changes
Superficial vein thrombosis
Active/ healed venous ulcers
89
What is are 2 absolute contraindications to thrombolysis?
Cerebral neoplasm
BP over 200/120
90
What is dressler's syndrome?
Secondary form of pericarditis that occurs 2-6 weeks post MI
91
What are the symptoms of dressler's?
Fever, chest pain that worsens with inspiration
92
What is the sound for mitral regurg?
Pansystolic murmur
93
Where does mitral regurg radiate to?
Axilla
94
What is the sound for aortic stenosis?
Ejection systolic + 4th heart sound, low volume pulse, forceful apex beat
95
Where does aortic stenosis radiate to?
Carotid arteries
96
What sound is mitral stenosis?
Mid diastolic with an opening snap
97
What sound is aortic regurg?
Early diastolic and collapsing pulse
98
What murmur occurs in ventricular septal defect?
Pansystolic
99
How is sinus tachycardia treated? 1st line?
Vagal manoeuvre
100
What is second line treatment for sinus tachycardia?
Adenosine 6mg IV bolus
101
How many times can you give adenosine for sinus tachycardia?
Up to 12 mg IV bolus adenosine up to 3x
102
If adenosine bolus helps to fix sinus tachy what is the likely cause? and if not what is it?
Paroxysmal re-entry SVT.
If not: atrial flutter
103
What is treatment for torsades de pointe - irregular v tach?
IV magnesium
104
What would hyperkalaemia show on an ECG?
Wide QRS
Decreased P wave amplitude
Long PR interval - this is also found in hypo
Tall tented t waves
105
What's the most common cause of secondary hypertension in young ppl?
Renal artery stenosis
106
What is diagnostic investigation for a renal artery stenosis?
MRI with gadolinium contrast
107
Which vascular disorder has a preference for the renal arteries?
Fibromuscular dysplasia - causes narrowing of renal arteries
108
Where does the aortic arch lie?
In superior mediastinum
109
Where does the descending aorta lie?
Posterior mediastinum
110
Which medication is given to all pt with ischaemic limb?
Heparin
111
What conservative measure can be used post surgery to help with postural hypotension?
Abdo binder compression
112
What mechanism is midodrine?
Alpha adrenergic agonist
113
What is a use for midodrine?
Postural hypotension with no organic cause
114
What other drug can be used for postural hypotension?
Fludrocortisone
115
What is main pt demographic for mitral valve prolapse?
Young women with narrow chest and low body weight
116
What are the clinical characteristics of a mitral valve prolapse?
Bulging of mitral leaflets
117
What is post-thrombotic syndrome?
Venous hypertension that affects pt with a history of DVT's
118
What is the difference between mobitz type 1 2nd degree and mobitz type 2 , 2nd degree on ECG?
Mobitz 1: progressive PR interval than a dropped beat
Mobitz 2: Fixed PR interval and dropped beat
119
What is the treatment for symptomatic mobitz 2?
Permanent pacemaker
120
What are the 2 surgical treatment for aortic aneurysm?
1. Open AAA repair with a dacron graft
2. Endovascular aneurysm repair - EVAR
121
When is EVAR more suited vs an open AAA repair?
If patient is unfit or multiple co-morbidities do EVAR
122
What is a hallmark feature of untreated hypertension?
Uniform left ventricular hypertrophy
123
How is acute pericarditis treated?
NSAID's: indomethacin
124
If the 1st line treatment for pericarditis doesn't help what is another treatment option?
Tapering course of oral pred
125
What are ECG changes with posterior MI?
ST depression and tall R waves in leads v1 +v2
126
Where is subcoastal plane?
L3
126
If there isn't a reversible cause of AF what can be administered?
IV flecainide
127
How do you differentiate between tricuspid regurg and mitral regurg?
Both are pan systolic murmurs. BUT mitral is at apex and tricuspid is at left sternal edge
128
What finding on chest X-Ray suggest alveolar oedema?
'Batwing distribution' Patchy hilar shadowing across lungs
129
What are the 4 indications for a pacemaker?
1. Type 2 second degree mobitz heart block
2. 3rd degree AV heart block
3. Symptomatic slow AF
4. Symptomatic bradycardia
130
What level does the aorta bifurcate?
L3-L4
131
Which diuretic is used to improve prognosis, and which one is more for symptomatic relief?
Spironolactone for improved prognosis
Furosemide for symptomatic relief
132
What is the pathogenesis of dressler's?
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
What are the other cause of high troponin bar MI?
PE, CKD, AKI, Pericarditis
134
How does carotid cavernous fistula present?
Acutely painful visual loss
Conjunctival injection
Firm and tender pulsatile eyeball
135
How is a carotid cavernous fistula treated?
Obliteration of fistula using endovascular surgery
136
Which pacemaker is used for SAN dysfunction?
AAI
137
Which pacemaker is used for AF?
VVI
138
Which pacemaker is used for 2nd degree heart block?
DDD
139
What dose of atorvastatin should of MI patient be started on?
80mg
140
What are bifid waves (p mitrale - little butt chin in the top of p wave) caused by ?
Left atrial hypertrophy
141
What findings would be seen on chest X-ray with an aortic dissection?
Widening of mediastinum
Loss of aortic knob
142
What is another name for 2nd degree heart block, mobitz 1
Wenckebach's phenomenon - impulse conduction (PR interval becomes prolonged)
143
What body position may reduce the ejection systolic murmur heard with pt with hypertrophic cardiomyopathy?
Squatting
144
What is given to haemodynamically stable patients with a VT?
IV amiodarone
145
What medication can be administered for paroxysmal narrow complex tachycardia?
IV adenosine
146
What is the difference in treatment of wide complex and narrow complex VT?
In wide complex DC cardioversion is needed, whereas IV adenosine can be used in narrow
147
For pt with a mitral valve area less than 1.5 and it's symptomatic what is treatment? and what are the conditions?
Balloon valvuloplasty - valve must be mobile and non-calcified
148
If surgical repair is needed for mitral valve stenosis whatis the preferred method?
Mitral valve repair
149
Where is the transverse sinus of pericardium found?
Behind major vessel emerging from ventricles but in front of SVC
150
What passes through the femoral triangle?
VAN: Femoral vein, artery and vein
151
What can be seen on radiographs is an adult has a coarctation of aorta? and what is this sign called?
Notching of inferior rib margins - Roesler's sign
152
What causes Roesler's sign?
Notching is due to enlarged intercoastal arteries
153
What are the signs of coarctation of adult aorta?
Hypotension in lower limbs and hypertension in upper limbs
154
In babies what defect is coarctation of aorta associated with?
Patent ductus arteriosus
155
What can be added to medication list of a pt taking GTN but it's not working super well
Long acting nitrate - isosorbide
156
When would an AAA need surgery?
1. ruptured
2. greater than 5.5 cm - if symptomatic
3. growing more than 1cm a year and symptomatic
157
What murmur is heard with aortic dissection?
Aortic regurg - early diastolic murmur with a collapsing pulse
158
What are the 2 types of aortic dissection? and what are the differences?
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
What are NYHA classifications?
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
What is prinzemetal angina?
Angina du e to coronary artery spasms
161
What are the 2 different types of infarctions?n the differences of both
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
What is situs inversus?
Organs are on mirrored side of body
163
Which condition is linked to presenting with situs inversus?
Primary cilia dyskinesia
164
What is characteristic ECG finding with 3rd degree heart block?
No associated between p waves and QRS complexes
165
What murmur is seen in pulmonary stenosis?
Crescendo-decrescendo (choppy whooshing sound)
166
What murmur is heard with tricuspid regurg?
Holosystolic at left sternal edge
Present through whole cardiac cycle
Louder on inspiration
High pitched blowing sound
167
In a healthy person how much should HDL ratio be?
Same or less than 5
168
In a pt with risk factors what is acceptable HDL ratio?
Same or less than 4
169
What dose of atorvastatin should be used in patients with high HDL ratio?
20mg atorvastatin
170
In what situation can an EVAR not be done? and why?
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
What is Corrigan's sign?
Indicates aortic incompetence - early diastolic murmur in aortic regurg. Bounding carotid pulse
172
What is done in PE investigation in pregnancy instead of CT pulmonary angiogram?
Ventilation/ perfusion
173
What is assumed in pregnant lady with unilateral red painful leg? and what must be done
DVT - start them on LMWH
174
What is 1st line investigation for lymphedemas?
Lymphoscintigram
175
What device can be used to bridge between transplant?
Left ventricular assist devices
176
What is seen on ECG with atrial flutter?
Saw tooth pattern
177
What happens to our VO2 max as we age?
It decreases
