Cardiovascular

Question 1

Best urgent investigation for suspected AAA?

Answer 1

Bedside abdo USS

Question 2

Beck’s triad

Answer 2

Hypotension, distended neck veins, muffled heart sounds = pericardial effusion

Question 3

Mitral stenosis

Answer 3

Mid-diastolic murmur with opening snap

Question 4

Mitral regurgitation

Answer 4

Pan-systolic murmur radiating to the axilla

Question 5

Aortic regurgitation

Answer 5

Early diastolic murmur with collapsing pulse

Question 6

After an MI, when is VF most likely to start?

Answer 6

First few hours after MI

Question 7

ECG changes for acute pericarditis

Answer 7

Widespread concave ST segment elevation and PR interval depression

Question 8

First line treatment of hypertension in pregnancy

Answer 8

Labetolol. If asthmatic then nifedipine

Question 9

Management of SVT

Answer 9

Vagal manouvre, Adenosine, Beta blocker, Calcium channel blocker, digoxin

Question 10

Cardiac features of Turner’s syndrome

Answer 10

Coarctation of the aorta

Question 11

Cardiac features of Downs Syndrome

Answer 11

AVSD

Question 12

Hypertension treatment

Answer 12

Under 55: ACEi or ARB
Over 55 or Afro-carribean: CCB (step 2 is ACEi or ARB)

Question 13

HCM

Answer 13

Mid systolic murmur and jerky pulse. Symptoms worsen after exercise. Worsen with valsalva but improving with squatting

Question 14

First line anti-anginal

Answer 14

Beta blocker or CCB (e.g. nifedipine)

Question 15

Short QT interval, which medication?

Answer 15

Digoxin

Question 16

Screening for AAA

Answer 16

Men over the age of 65.
If <3cm = discharged
If 3-4.4cm = yearly USS
If 4.5-5.5cm = 3 monthly USS
If >5.5cm = vascular surgery

Question 17

How does clopidogrel work

Answer 17

Blocks platelet ADP receptors

Question 18

When can you drive following a coronary angioplasty (successful)

Answer 18

1 week

Question 19

Unexplained collapse, when you can you drive?

Answer 19

Cannot drive for 6 months

Question 20

Hypocalcaemia ECG changes?

Answer 20

Prolonged QT interval

Question 21

Wolff Parkinson White ECG changes?

Answer 21

Shortened PR and delta waves

Question 22

Ejection systolic murmur with narrow pulse pressure

Answer 22

Aortic sclerosis

Question 23

Murmur associated with AS

Answer 23

AR

Question 24

Murmur associated with Marfans syndrome

Answer 24

AR (more commonly aortic root dilatation)

Question 25

Diagnosis criteria for IE?

Answer 25

Modified Dukes criteria:
MAJOR criteria: 1. Blood cultures; 2. Echo showing vegetations
MINOR criteria: IVDU, temp >38, embolic phenomena, predisposing heart lesion, immunologic phenomena, BC not meeting major criteria
(NEED 2 majors or 1 major and 3 minor)

Question 26

Target BP for over 80s

Answer 26

Clinic reading of 150/90 or home reading of 145/85

Question 27

60 year old man post coronary angio develops severe right foot pain. Pulse present. Tissue loss of lateral 2 toes and levido reticularis.

Answer 27

Cholesterol embolisation

Question 28

Treatment of pericarditis

Answer 28

NSAIDs until asymptomatic alongside colchicine for 3 months

Question 29

Drug that works by inhibiting thromboxane A2 production?

Answer 29

Aspirin

Question 30

Drug that works activating antithrombin 3

Answer 30

Enoxaparin

Question 31

Harsh systolic murmur over the precordium, doesn’t change with inspiration. Biventricular hypertrophy.

Answer 31

VSD (pansystolic murmur)

Question 32

Bisferiens - associated with?

Answer 32

Mixed AS and aortic incompetence

Question 33

Collapsing pulse

Answer 33

AR

Question 34

Pulsus paradoxus

Answer 34

Left ventricular failure

Question 35

Plateau

Answer 35

AS

Question 36

What type of pulse:
A) noted when taking BP, doubling in rate as Mercury level falls
B) Severe COPD
C) Pulse volume decreases markedly with inspiration
D) Slow upstroke and prominent in the brachial and carotid pulses

Answer 36

A) Pulsus alternans
B) Pulsus paradoxus
C) Pulsus Paradoxus
D) Plateau