Cardiovascular

Question 1

ABPI results

Answer 1

>1.4 = calcified arteries (eg due to DM)
0.9-1.1 = normal 
0.7-0.9 = claudication 
<0.4 = severe limb ischaemia

Question 2

medical management of a pt with PVD

Answer 2

clopidogrel and atorvastatin

Question 3

PVD

Answer 3

due to atherosclerosis causing stenosis of artery
calf (femoral), buttock (iliac)
absent femoral, popliteal or foot pulses, cold and white leg, ulcers, Buerger’s angle <20 degrees and CRT > 15 seconds if severe
modifiable risk factors (smoking, HTN and cholesterol)

Question 4

varicose veins

Answer 4

long, tortuous and dilated veins of the superficial venous system due to incompetent valves
causes - mechanical, obstruction, FH, obesity, pregnancy and prolonged standing
symptoms: pain, cramps, tingling and restless legs
signs: oedema, eczema, ulcers, phlebitis, lipodermatosclerosis

Question 5

aortic aneurysm

Answer 5

aneurysm is 50% increase or 1.5x the normal size

risk factors: atherosclerosis (smoking and HTN). familial, CT diseases, male, chronic aortic dissection

Question 6

presentation of a ruptured AAA

Answer 6

abdominal distension and collapse
central pain that radiates to the back
may show signs of shock
catastrophic or subacute presentation

Question 7

new onset murmur and fever is INFECTIVE ENDOCARDITIS until proven otherwise!!
what signs might you see if it were IE?

Answer 7

hands –> clubbing, splinter haemorrhages, Janeway lesions and Osler’s nodes
fundoscopy –> Roth’s spots

Question 8

risk factors for IE

Answer 8

non-modifiable: extremes of age, structural congenital heart disease, bicuspid aortic valve
modifiable: previous IE, valve replacement, valvular heart disease, immunocompromised, IVDU

Question 9

IE organisms and treatment

native valve {prosthetic valve}

Answer 9

staph aureus (most common) --> flucloxacillin {+rifampicin and gentamicin}
strep viridians (50-60% of subacute cases) --> benzylpenicillin 
staph epidermis (common for prosthetic valves) --> flucloxacillin {+rifampicin and gentamicin}

blood cultures (2 out of 3 must be positive, taken 12 hrs apart)

Question 10

HF signs on CXR

Answer 10

alveolar oedema (bat wing) Kerly B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural effusion