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Med School Finals > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Anteroseptal, inferior, lateral leads and which coronary artery they cover?

A

Anteroseptal = V1-V4 (LAD)
Inferior = II, III and aVF (RCA)
Lateral = I, aVL, V5, V6 (LCx)

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2
Q

Normal P, PR and QRS duration?

A

P = 0.08-0.1 secs
PR = 0.12-0.2 secs
QRS = < 0.1 secs

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3
Q

What does a small vs large box on a standard ECG represent?

A

Small = 0.04 seconds
Large = 0.2 seconds

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4
Q

Calculating heart rate using the rhythm strip?

A

Regular = 300 ÷ large squares between QRS complexes
Irregular = QRS complexes in 6 seconds (30 large squares) x 10

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5
Q

ECG feature of right vs left axis deviation and causes?

A

Right = lead I + III point to each other
→ RVH, RBB, cor pulmonale, anterolateral MI, left posterior hemiblock
Left axis = lead I + II point away from each other
→ LVH, LBBB, inferior MI, left anterior hemiblock

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6
Q

ECG features of RBBB vs LBBB?

A

WiLLiaM MaRRoW:
→ RBBB = M in V1, W in V6
→ LBBB = W in V1, M in V6

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7
Q

Bifascicular vs trifascicular block?

A

Bifascicular = RBBB + left hemiblock
Trifascicular = above + 1st degree heart block

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8
Q

Outline the sinoatrial (SA) node action potential.

A
  • Slow Na influx (HCN “pacemaker” channel)
  • Rapid Ca influx
  • K efflux
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9
Q

Outline the atrial/ventricular myocyte action potential.

A
  • Rapid Na influx
  • K efflux vs Ca influx (plateau phase)
  • K efflux exceeds Ca influx
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10
Q

Virchow’s triad?

A

Stasis of blood
Endothelial damage
Hyper-coagulability

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11
Q

Heart attack vs cardiac arrest?

A

Heart attack = vascular occlusion or ischaemia leads to tissue death
Cardiac arrest = electrical disturbance stops heart beat

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12
Q

Acute coronary syndromes and ECG/troponin findings?

A

Unstable angina = abnormal/normal ECG + normal troponin
NSTEMI = abnormal/normal ECG + raised troponin
STEMI = ST-elevation/new LBBB + raised troponin (not required)

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13
Q

Patient groups more likely to have an atypical ACS presentation?

A

Elderly
Diabetics
Women

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14
Q

ECG features of ischaemia?

A

ST elevation or depression
T wave elevation or inversion or flattening
New LBBB
Pathological Q waves

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15
Q

ECG criteria for STEMI diagnosis?

A

≥ 1mm ST elevation in any 2 contiguous leads except V2 and V3 where these criteria apply:
→ ≥ 2.5mm in men < 40
→ ≥ 2mm in men > 40
→ ≥ 1.5mm in women

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16
Q

ECG feature of posterior MI?

A

Reciprocal changes in leads V1-V3 (e.g. ST depression)

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17
Q

Which coronary artery supplies the atrioventricular (AV) node and significance?

A

Right coronary artery
RCA infarcts (e.g. inferior MI) can cause arrhythmias

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18
Q

Management of a STEMI?

A

Morphine (severe pain)
Oxygen (SaO2 < 94%)
GTN (not if hypotensive)
Aspirin 300mg
Ticagrelor or prasugrel or clopidogrel
PCI < 120 mins = PCI + UFH and GPI (radial access) or bivalirudin and GPI (femoral access)
PCI > 120 mins = thrombolysis + fondaparinux

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19
Q

Preferred antiplatelet for patient getting PCI vs high bleeding risk?

A

PCI = prasugrel
High bleeding risk = clopidogrel

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20
Q

ECG monitoring post-thrombolysis?

A

ECG after 60-90 mins
Consider PCI if ongoing ischaemia

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21
Q

List some contrindications to thrombolysis?

A

Bleeding/coagulation disorder
Active internal bleeding
Recent bleed, trauma or surgery
Stroke < 3 months ago
Severe hypertension
Intracranial neoplasm

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22
Q

First enzyme to be released in MI and enzyme used to assess re-infarction?

A

First to be released = myoglobin
Assessing for re-infarction = CK-MB

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23
Q

Most sensitive enzyme in MI, time of elevation, peak levels and when it return to normal?

A

Troponin
→ elevates in 4-6 hours
→ peaks at 12-24 hours
→ returns to normal at 7-10 days

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24
Q

Post-MI persistent ST-elevation and ventricular failure?

A

Left ventricular aneurysm

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25
Q

Post-MI cardiac tamponade?

A

Left ventricular free wall rupture

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26
Q

Features and management of cardiac tamponade?

A

Beck’s triad:
→ hypotension
→ raised JVP
→ muffled heart sounds
Management = pericardiocentesis

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27
Q

Post-MI pericarditis classification and management?

A

< 48 hours = acute pericarditis
2-6 weeks = Dressler’s syndrome
Management = NSAID + colchicine

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28
Q

Most common cause of death post-MI?

A

Ventricular fibrillation (VF)

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29
Q

Post-MI DVLA guidance?

A

4 weeks off driving
→ 1 week if successful angioplasty

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30
Q

Management of NSTEMI and unstable angina?

A

Morphine (severe pain)
Oxygen (SaO2 < 94%)
GTN (not if hypotensive)
Aspirin 300mg
Fondaparinux (if urgent PCI not planned)
Unstable = angiography +/- PCI (urgent)
GRACE score > 3% = angiography +/- PCI (within 72 hours)
GRACE score ≤ 3% = ticagrelor or clopidogrel

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31
Q

Secondary drug prevention of ACS?

A

Block an ACS:
→ beta-blocker
→ aspirin (lifelong)
→ ACEi
→ ticagrelor or prasugrel or clopidogrel (12 months)
→ statin

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32
Q

Statin examples, mechanism of action and side effects?

A

Examples = atorvastatin, simvastatin
Mechanism of action = inhibits HMG-CoA reductase
Side effects = myalgia, myositis, rhabdomyolysis, deranged LFTs

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33
Q

Statin monitoring requirements?

A

Baseline LFTs
→ LFTs at 3 months
→ LFTs at 12 months

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34
Q

Investigation for stable angina?

A

CT coronary angiogram

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35
Q

Management of stable angina?

A

GTN for all then:
1st line = beta-blocker or non-dihydropyridine CCB
2nd line = beta-blocker + dihydropyridine CCB
3rd line = beta-blocker + isosorbide mononitrate or ivabradine or nicorandil or ranazoline
4th line = PCI or CABG

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36
Q

Technique for preventing tolerance to standard-release isosorbide mononitrate?

A

Asymmetric dosing intervals e.g. 7 hours apart

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37
Q

Examples of antiplatelets vs anticoagulants?

A

Antiplatelets = aspirin, clopidogrel, prasugrel, ticagrelor
Anticoagulants = warfarin, heparin, rivaroxaban, edoxaban, dabigatran, fondaparinux, apixaban, bivalirudin

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38
Q

Mechanism of action of aspirin, clopidogrel, prasugrel and ticagrelor?

A

Aspirin = COX-1 and COX-2 inhibitor
Clopidogrel/prasugrel/ticagrelor = P2Y12 ADP receptor inhibitor

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39
Q

Mechanism of action of warfarin, heparin, rivaroxaban, apixaban, edoxaban, dabigatran, fondaparinux and bivalirudin?

A

Warfarin = vitamin K antagonist
Heparin/fondaparinux = activates antithrombin III
Rivaroxaban/apixaban/edoxaban = direct factor Xa inhibitor
Dabigatran/bivalirudin = direct thrombin inhibitor

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40
Q

Reversal agent for dabigatran vs apixaban vs rivaroxaban?

A

Dabigatran = idarucizamab
Apixaban/rivaroxaban = andexanet alfa

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41
Q

How is INR calculated?

A

INR = (patient PT ÷ normal PT) x ISI

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42
Q

Key factors which may potentiate warfarin?

A

Liver disease
P450 enzyme inhibitors

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43
Q

List some P450 inducers vs inhibitors?

A

Inducers = phenytoin, carbamazepine, rifampicin, St John’s wort, phenobarbitone, chronic alcohol use
Inhibitors = ciprofloxacin, erythromycin, isoniazid, amiodarone, ketoconazole, acute alcohol use

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44
Q

Management of INR 5.0-8.0 (no bleed vs bleed), INR > 8 (no bleed vs bleed) and major haemorrhage?

A

INR 5.0-8.0 (no bleed) = withhold 1 or 2 doses, reduce maintenance dose
INR 5.0-8.0 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
INR > 8 (no bleed) = stop warfarin, oral vitamin K, restart warfarin when INR < 5.0
INR > 8 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
Major haemorrhage = stop warfarin, IV vitamin K, prothrombin complex (1st line) or FFP (2nd line)

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45
Q

Examples of tachycardia?

A

Sinus tachycardia
Atrial fibrillation
Atril flutter
Re-entrant pathways
Ectopic beats

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46
Q

Classification of tachycardias?

A

Narrow, regular
Narrow, irregular
Wide, regular
Wide, irregular

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47
Q

Management of REGULAR narrow complex tachycardia?

A

Unstable = synchronised DC cardioversion!
Stable = vagal manoeuvres e.g. carotid sinus massage or Valsalva manoeuvre (1st line), adenosine 6mg → 12mg → 18mg (2nd line)

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48
Q

Management of REGULAR broad complex tachycardia?

A

Unstable = synchronised DC cardioversion!
Stable = amiodarone or lidocaine

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49
Q

Management of torsades de pointes?

A

Unstable = synchronised DC cardioversion!
Stable = IV magnesium sulphate

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50
Q

Outline the types of AF?

A

Acute (< 48 hours)
Paroxysmal AF (< 7 days, episodic)
Persistent AF (> 7 days, responds to cardioversion)
Permanent AF (> 7 days, no response to cardioversion)

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51
Q

Overview of acute AF management?

A

< 48 hours = rate OR rhythm control
> 48 hours or uncertain = rate control

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52
Q

Rate control management of AF?

A

1st line = beta-blocker or non-dihydropyridine CCB
2nd line = dual therapy of beta-blocker, diltiazem or digoxin

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53
Q

Rhythm control management of AF?

A

DC cardioversion
Pharmacological cardioversion
→ structural heart disease = amiodarone
→ no structural heart disease = flecainide

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54
Q

Advice for cardioversion management of AF?

A

< 48 hours = DC or pharmacological cardioversion
> 48 hours or uncertain = 3 weeks anticoagulation then DC cardioversion or TOE to exclude thrombus in the left atrial appendage then immediate DC cardioversion

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55
Q

Score to assess stroke vs bleeding risk of AF patients?

A

Stroke = CHA2DS2VASC
Bleeding risk = ORBIT

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56
Q

CHA2DS2VASC criteria and recommendation based on score?

A

CHF, HTN, > 75, DM, stroke/TIA/VTE, vascular disease, 65-74, female
0 = no treatment
1 = consider anticoagulation (male), no treatment (female)
≥ 2 = anticoagulation

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57
Q

Drug options for AF anticoagulation?

A

Non-valvular AF = DOAC
Valvular AF/prosthetic valve = warfarin

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58
Q

Management of atrial flutter?

A

Initially the same as AF e.g. rate/rhythm control
Radiofrequency ablation is curative

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59
Q

Examples of bradycardia?

A

Sinus bradycardia
Sick sinus syndrome
Heart block

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60
Q

Outline the types of heart block?

A

1st degree = PR > 0.2, regular
2nd degree (Mobitz I) = PR prolongs until dropped beat
2nd degree (Mobitz II) = PR interval constant but beat sometimes dropped
3rd degree = no association between P wave and QRS

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61
Q

Management of bradycardia?

A

1st line = atropine 500mcg (repeat up to 3mg)
2nd line = transcutaneous pacing
3rd line = transvenous pacing or permanent pacemaker

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62
Q

Which types of heart block require a permanent pacemaker?

A

Mobitz type II
3rd degree (complete) heart block

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63
Q

Shockable vs non-shockable cardiac arrest rhythms?

A

Shockable = VF and pulseless VT
Non-shockable = PEA and asystole

64
Q

4 Hs and 4 Ts of reversible cardiac arrest?

A

Hs = hypoxia, hypothermia, hyper/hypo and hypovolaemia
Ts = thrombosis, toxins, tamponade and tension pneumothorax

65
Q

Defibrillation management of shockable rhythm?

A

Arrest witnessed = 3 successive shocks then 2 mins CPR
Arrest unwitnessed = 1 shock then 2 mins CPR

66
Q

Drug management of non-shockable vs shockable cardiac arrest?

A

Non-shockable = adrenaline 1mg STAT
→ adrenaline every 3-5 mins
Shockable = adrenaline 1mg + amiodarone 300mg after 3 shocks
→ adrenaline every 3-5 mins

67
Q

How should drugs be given during cardiac arrest?

A

1st line = intravenous (IV)
2nd line = intraosseous (IO)

68
Q

ECG feature of hypothermia?

A

J waves (upward deflection after QRS)

69
Q

ECG features of hypokalaemia vs hyperkalaemia?

A

Hypo = flat/absent T waves, U waves, ST depression
Hyper = tall T waves, flat P waves, wide QRS

70
Q

Antiarrhythmic drug classes and examples?

A

Class I (Na) = lignocaine, lidocaine, flecainide
Class II (beta) = propanolol, metoprolol, atenolol
Class III (K) = amiodarone, sotalol
Class IV (Ca) = verapamil, diltiazem
Misc = atropine, adenosine, ivabradine, digoxin

71
Q

Atropine mechanism of action and side effects?

A

Mechanism of action = muscarinic antagonist
Side effects = anticholinergic (e.g. dry eyes/mouth, urinary retention)

72
Q

Adenosine mechanism of action and side effects?

A

Mechanism of action = causes transient AVN block
Side effects = bronchospasm, chest pain, flushing

73
Q

Ivabradine mechanism of action and side effects?

A

Mechanism of action = blocks the pacemaker channel
Side effects = heart block, bradycardia, luminous phenomena

74
Q

Digoxin mechanism of action and side effects?

A

Mechanism of action = blocks the Na+/K+ ATPase
Side effects = GI upset, anorexia, yellow-green vision, arrhythmias, gynaecomastia

75
Q

ECG feature of digoxin use?

A

ST “scooped out” or “reverse tick sign”

76
Q

Classic cause of digoxin toxicity and management?

A

Hypokalaemia
→ digoxin binds to K site on the N+/K+ ATPase so less K means more digoxin binding
Management = digibind (digoxin antibody)

77
Q

Monitoring requirements of amiodarone?

A

6 monthly TFTs and LFTs

78
Q

Features, investigation and management of pericarditis?

A

Generally unwell (e.g. fever)
Pleuritic chest pain (worse lying down)
Pericardial rub
Investigation = transthoracic echo
Management = NSAID + colchicine

79
Q

ECG features of pericarditis?

A

PR depression (most specific)
Widespread “saddle” ST elevation

80
Q

JVP feature of constrictive pericarditis?

A

Kussmaul’s sign (JVP rises on inspiration)

81
Q

Features, investigation and management of myocarditis?

A

Generally unwell (e.g. fever)
Chest pain
Typically young patient
Commonly seen with pericarditis
Investigation = endomycocardial biopsy
Management = supportive management

82
Q

Modified Duke’s criteria scores for infective endocarditis diagnosis?

A

2 major criteria OR
1 major + 3 minor criteria OR
5 minor criteria

83
Q

What are the 2 major and 5 minor Duke’s criteria?

A

Major = positive blood cultures, endocardial involvement
Minor = predisposition, fever > 38 °C, negative microbiology, vascular phenomena, immunological phenomena

84
Q

Most common valve affected in infective endocarditis in IVDUs vs non-IVDUs?

A

IVDUs = tricuspid valve
Non-IVDUs = mitral valve

85
Q

Pathogen associated with infective endocarditis in IVDUs, poor dental hygiene, prosthetic valves and GI pathology?

A

IVDUs = staphylococcus aureus
Poor dental hygiene = streptococcus viridans
Prosthetic valves = staphylococcus epidermidis
GI pathology = streptococcus bovis

86
Q

Antibiotic management of infective endocarditis?

A

Native valve = amoxicillin + gentamicin
Prosthetic valve = vancomycin + gentamicin + rifampicin
Staph aureus = flucloxacillin

87
Q

Stanford classification of aortic dissection?

A

Type A (most common) = ascending aorta
Type B = descending aorta

88
Q

Features, investigations and management of aortic dissection?

A

Tearing chest pain (may radiate to back)
Radio-radial or radio-femoral delay
Pulse deficit
BP different between arms
Investigations = CT angiography (stable) or TOE (unstable)
Management = manage BP e.g. IV metoprolol + surgery (type A) OR conservative management (type B)

89
Q

Cause of S1, S2, S3 and S4 heart sounds?

A

S1 = mitral and tricuspid closure
S2 = pulmonary and aortic closure
S3 = diastolic ventricular filling
S4 = atria contracting against stiff ventricle

90
Q

Rule for hearing murmurs best?

A

RILE:
→ right-sided on inspiration
→ left-sided on expiration

91
Q

Ejection systolic murmur causes?

A

Aortic stenosis
Pulmonary stenosis
Atrial septal defect (ASD)
Tetralogy of Fallot
HOCM

92
Q

Pansystolic murmur causes?

A

Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect (VSD)

93
Q

Early diastolic murmur causes?

A

Aortic regurgitation
Pulmonary regurgitation

94
Q

Mid-late diastolic murmur cause?

A

Mitral stenosis

95
Q

Murmur associated with AF, wide PP, narrow PP, collapsing pulse, slow rising pulse, large JVP V wave and malar flush?

A

AF = mitral stenosis
Wide PP = aortic regurgitation
Narrow PP = aortic stenosis
Collapsing pulse = aortic regurgitation
Slow rising pulse = aortic stenosis
Large JVP V wave = tricuspid regurgitation
Malar flush = mitral stenosis

96
Q

Most common cause of aortic vs mitral murmurs?

A

Aortic stenosis = calcification
Aortic regurgitation = infective endocarditis
Mitral stenosis = rheumatic fever
Mitral regurgitation = valve prolapse

97
Q

Management of valve disease?

A

Asymptomatic = monitor
Symptomatic = surgery e.g. replacement, vavuloplasty

98
Q

Indication for aortic valve surgery in an asymptomatic patient?

A

Valvular gradient > 40mmHg + LVD

99
Q

Features of right-sided vs left-sided heart failure?

A

Right-sided = peripheral oedema, raised JVP, hepatomegaly, anorexia
Left-sided = dyspnoea, orthopnoea, PND, pulmonary oedema

100
Q

CXR features of heart failure?

A

Alveolar oedema
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated upper lobe vessels
Effusion
Fluid in the horizontal fissure

101
Q

Investigations for heart failure?

A

NT-proBNP (1st line)
Tranthoracic echocardiogram

102
Q

Management of patients with raised NT-proBNP?

A

> 2000ng/L = 2 week referral for assessment + echo
400-2000ng/L = 6 week referral for assessment + echo

103
Q

NYHA classification of heart failure?

A

Class I = no symptoms
Class II = mild
Class III = moderate
Class IV = severe (e.g. symptoms at rest)

104
Q

What is ejection fraction and value for heart failure diagnosis?

A

Percentage of ventricular diastolic volume ejected during ventricular systole
→ < 40% = HFrEF
→ ≥ 40% = HFpEF

105
Q

High-output heart failure and causes?

A

Normal heart can’t meet metabolic demands
→ anaemia, pregnancy, thyrotoxicosis

106
Q

Management of acute heart failure?

A

Non-hypotensive = IV loop diuretic
Hypotensive = inotropic agents (e.g. dobutamine), vasopressors (e.g. adrenaline)

107
Q

Management of chronic heart failure?

A

1st line = ACEi + beta-blocker
2nd line = add aldosterone antagonist
3rd line = add SGLT2 inhibitor or ivabradine or digoxin or salcubitril-valsartan or hydralazine + nitrate

108
Q

Drugs which reduce mortality in chronic heart failure?

A

ACEi/ARB
Beta-blocker
Aldosterone antagonist

109
Q

Vaccination recommendations for heart failure?

A

One-off pneumococcal + annual influenza

110
Q

Main investigation for hypertension?

A

Ambulatory BP monitoring (ABPM) or
home BP monitoring (HBPM)

111
Q

Additional investigations for hypertension and why?

A

ECG = LVH
U&Es = renal disease
Urinalysis = renal disease
HbA1c = co-existing diabetes
Lipid profile = co-existing hyperlipidaemia
Fundoscopy = diabetic retinopathy

112
Q

Classification of hypertension?

A

Stage 1 = clinic ≥ 140/90 and ABPM/HBPM ≥135/85
Stage 2 = clinic ≥ 160/100 and ABPM/HBPM ≥ 150/95
Stage 3 = clinic systolic ≥ 180 OR diastolic ≥ 120

113
Q

Drug options for hypertension?

A

1st line = A (< 55 or T2DM) OR C (> 55 or Afro-Caribbean)
2nd line = A+C or A+D (< 55 or T2DM) OR C+A OR C+D (> 55 or Afro-Caribbean)
3rd line = A+C+D
4th line = spironolactone (K < 4.5) OR alpha-blocker e.g. doxasozin or beta-blocker e.g. atenolol (K > 4.5)

114
Q

Blood pressure targets for < 80 years vs > 80 years?

A

< 80 = 140/90
> 80 = 150/90

115
Q

ACEi/ARB examples, side effects and cautions?

A

ACEi = ramipril, lisinopril
ARB = losartan, candesartan
Side effects = hyperkalaemia, cough (ACEi), angioedema (ACEi)
Cautions = pregnancy, renovascular disease

116
Q

ACEi/ARB renal advice?

A

Generally renoprotective
Contraindicated in bilateral renal artery stenosis
Monitor U&Es regularly

117
Q

Beta-blocker examples, side effects and cautions?

A

Cardioselective (β1) = atenolol, bisoprolol, metoprolol
Non-cardioselective (β1/β2) = propanolol, carvedilol, labetalol
Side effects = bronchospasm, hyperkalaemia, cold extremities, erectile dysfunction, sleep issues, fatigue
Cautions = asthma, uncontrolled HF, verapamil use

118
Q

Calcium channel blocker examples and side effects?

A

Dihydropyridines = amlodipine, nifedipine
Non-dihydropyridines = verapamil, diltiazem
Side effects = peripheral oedema, flushing, headache

119
Q

Thiazide diuretic examples, mechanism of action and side effects?

A

Thiazide = bendroflumethiazide
Thiazide-like = indapamide
Mechanism of action = blocks NaCl reabsorption in the DCT
Side effects = hyponatraemia/hypokalaemia, hypercalcaemia, impaired glucose tolerance, gout, erectile dysfunction

120
Q

Loop diuretic examples, mechanism of action and side effects?

A

Examples = furosemide, bumetanide
Mechanism of action = blocks Na reabsorption in the thick ascending LoH
Side effects = hyponatraemia/hypokalaemia/hypocalcaemia, hypercalciuria, ototoxicity

121
Q

Potassium sparing diuretic examples and side effects?

A

Aldosterone antagonists = spironolactone, eplerenone
ENaC inhibitors = amiloride
Side effects = hyperkalaemia, endocrine dysfunction (aldosterone antagonist)

122
Q

Criteria and management of orthostatic hypotension?

A

Drop of ≥ 20mmHg systolic +/- ≥ 10mmHg diastolic within 3 mins of standing
Management = midodrine or fludrocortisone

123
Q

Score used to investigate patients with low suspicion of a PE and interpretation?

A

Pulmonary embolism rule-out criteria (PERC)
All must be absent for negative result

124
Q

Score used to investigate patients with suspected PE and values?

A

Wells score
> 4 points = PE likely
≤ 4 points = PE unlikely

125
Q

Investigations for a likely PE (Wells > 4)?

A

Urgent CTPA
DOAC if CTPA delayed
+ve CTPA = PE confirmed
-ve CTPA = consider doppler scan

126
Q

Investigations for an unlikely PE (Wells ≤ 4)?

A

D-dimer
+ve D-dimer = urgent CTPA
-ve D-Dimer = consider alternative diagnosis

127
Q

Indication for V/Q scan in PE and why?

A

Renal disease or pregnancy
No contrast required (renal), no increased risk of breast cancer (pregnancy)

128
Q

Management of stable PE?

A

Provoked = 3 months of DOAC
Unprovoked or cancer = 6 months of DOAC

129
Q

Management of unstable vs recurrent PE?

A

Unstable = thromboylsis e.g. alteplase
Recurrent = IVC filter

130
Q

Score used to investigate patients with suspected DVT and values?

A

Wells score
≥ 2 = DVT likely
< 2 = DVT unlikely

131
Q

Investigations for a likely DVT (Wells ≥ 2)?

A

Urgent leg USS
DOAC if USS delayed
USS +ve = DVT confirmed
USS -ve = consider D-dimer

132
Q

Investigations for an unlikely DVT (Wells < 2)?

A

D-dimer
D-dimer +ve = urgent leg USS
D-dimer -ve = consider alternative diagnosis

133
Q

Management of DVT?

A

Provoked = 3 months of DOAC
Unprovoked or cancer = 6 months of DOAC

134
Q

Preferred anticoagulant in pregnancy and why?

A

LMWH e.g. dalteparin
→ does not cross the placenta

135
Q

Advice for patients regarding flights and thrombosis?

A

Low risk = no measures needed
Moderate-high risk = compression stockings

136
Q

Most common cardiomyopathy?

A

Dilated cardiomyopathy

137
Q

Most common cause of death in young athletes?

A

Hypertrophic obstructive cardiomyopathy (HOCM)

138
Q

Medical name for “broken heart” syndrome?

A

Takotsubo cardiomyopathy

139
Q

ECG feature of Wolff-Parkinson White (WPW) syndrome and management?

A

Slurred QRS upstroke (delta wave)
Management = radiofrequency ablation

140
Q

ECG feature of Brugada syndrome and management?

A

ST elevation in V1-V3 followed by inverted T wave
Management = ICD

141
Q

Heart condition associated with DiGeorge vs Turner’s syndrome?

A

DiGeorge = Tetralogy of Fallot
Turner’s = coarctation of the aorta

142
Q

Large cell vasculitis associated with occlusion of the aorta and absent limb pulses?

A

Takayasu’s arteritis

143
Q

Small and medium vessel vasculitis with strong link to smoking?

A

Buerger’s disease (thromboangiitis obliterans)

144
Q

Outline the screening programme for AAA?

A

One-off abdominal USS for men age 65
→ < 3cm = no action
→ 3-4.4cm = re-scan every 12 months
→ 4.5-5.4cm = re-scan every 3 months
→ ≥ 5.5cm = refer for intervention

145
Q

High rupture risk features of AAA?

A

Symptomatic
≥ 5.5cm
Grown > 1cm/year

146
Q

Management of AAA?

A

Endovascular repiar (EVAR)
Open aneurysm repair

147
Q

Abnormal ABP values?

A

< 0.9 or > 1.2

148
Q

Location of venous vs arterial ulcers and management?

A

Venous = above medial/lateral malleoli
→ compression bandaging
Arterial = toes, shins, pressure points
→ modify risk factors e.g. hypertension

149
Q

Features of lower limb venous insufficiency?

A

Varicose veins
Venous ulcer
Stasis eczema
Lipodermatosclerosis
Haemosiderin deposition
Superficial thrombophlebitis

150
Q

Management of superficial thrombophlebitis?

A

Compression stockings + NSAID

151
Q

What does peripheral arterial disease (PAD) cover?

A

Intermittent claudication
Critical limb ischaemia
Acute limb-threatening ischaemia

152
Q

Features and management of intermittent claudication?

A

Pain in leg muscles during exercise then resolves at rest
Management = exercise regime + statin + clopidogrel

153
Q

Features and management of critical limb ischaemia?

A

Rest pain (hang legs out of bed)
Ulceration
Gangrene
Management = endovascular revascularisation (< 10cm) or open surgical revascularisation (> 10cm)

154
Q

Features and management of acute limb-threatening ischaemia?

A

Pale, pulseless, painful, paralysed, paraesthesis, perishingly cold
Management = analgesia + urgent vascular review

155
Q

Wet vs dry gangrene and management?

A

Wet = infectious e.g. necrotising fasciitis
→ IV antibiotics + debridement or amputation
Dry = non-infectious e.g. ischaemic
→ amputation

Med School Finals (18 decks)

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