Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year Four - Finals > Cardiovascular System - Finals Paper One > Flashcards

Cardiovascular System - Finals Paper One Flashcards

1
Q

What screening is used in abdominal aortic aneurysm?

A

Single abdominal ultrasound scan for 65 year old males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the next step in those with an abdominal aorta width <3cm?

A

No further action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the next step in those with an abdominal aorta width 3cm - 4.4cm?

A

Rescan every 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the next step in those with an abdominal aorta width 4.5cm - 5.4cm?

A

Rescan every 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the next step in those with an abdominal aorta width >5.5cm?

A

2 week referral to vascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the three criteria for 2 week referral for abdominal aorta surgery?

A

Symptomatic

Aortic diameter > 5.5cm

Rapidly enalrging > 1cm/yeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the first line management option of unruputered abdominal aortic aneurysms?

A

Elective endovascular repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the next step in those with ruptured abdominal aortic aneurysms?

A

Immediate vascular review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the first line management option in those who are haemodynamically stable with a ruptured abdominal aortic aneurysm?

A

CT Scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the first line management option in those who are haemodynamically unstable with a ruptured abdominal aortic aneurysm?

A

Emergency Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In which three patient groups does acute coronary syndrome present atypically?

A

Elderly

Diabetic

Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the left anterior descending artery/anteroseptal region?

A

V1 - V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the right coronary artery/inferior region?

A

II

III

aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the left anterior descending artery/anterolateral region?

A

V1 - V6

aVL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the left circumflex artery/lateral region?

A

I

aVL

V5 - V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the posterior region?

A

V1 - V3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which ECG leads demonstrate changes when acute coronary syndrome develops in the posterior region?

A

V1 - V3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the four ECG criteria for a diagnosis of STEMI?

A

Acute coronary syndrome features > 20 mins with persistent ECG features in > 2 contiguous leads of…

  • 2.5mm ST elevation in leads V2-V3 in men < 40 years old
  • > 2mm ST elevation in leads V2-V3 in men > 40 years old
  • 1.5mm ST elevation in V2-V3 in women

AND

1mm ST elevation in other leads

AND

New left bundle branch block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the five ECG features of posterior myocardial infarctions?

A

ST Depression

Tall, Broad R Waves

R Waves in V2

Upright T Waves

Q Waves In V7 - V9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the initial management of acute coronary syndrome?

A

Morphine

Oxygen < 92%

Nitrates

Aspirin 300mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should we be cautious about administering nitrates in acute coronary syndrome?

A

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is percutanous coronary intervention used to manage STEMIs?

A

When individuals present within12 hours of clinical feature of onset AND within 120 minutes of the time when fibronlysis could have been given

When individuals present after 12 hours of clinical features with evidence of ongoing ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which antiplatelet should be administered, in addition to aspirin, prior to STEMI percutaneous coronary intervention - in those not taking an oral anticoagulant?

A

Prasugrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which antiplatelet should be administered, in addition to aspirin, prior to STEMI percutaneous coronary intervention - in those taking an oral anticoagulant?

A

Clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which access artery is preferred in percutaneous coronary intervention?

A

Radial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which drug therapy should be administered during STEMI percutaneous coronary intervention - with radial access?

A

Unfractioned heparin with bailout glycoprotein IIb/IIIa inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which drug therapy should be administered during STEMI percutaneous coronary intervention - with femoral access?

A

Bivalirudin with bailout glycoprotein IIb/IIIa inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which stent types are used in percutaneous coronary intervention?

A

Drug eluting stents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What should be conducted when individuals are haemodynamically unstable or experience pain post percutaneous coronary intervention?

A

Urgent CABG Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is fibronlysis used to manage STEMIs?

A

When individuals present within 12 hours of clinical feature onset, however percutaenous coronary intervention cannot be delivered within 120 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What investigation is conducted following fibrinolysis? When? Why?

A

ECG Scan

60 - 90 minutes

In order to determine whether percutaneous coronary intervention is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which antithrombin is used to manage NSTEMIs? What is the contraindication?

A

Fondapurinax

High Bleeding Risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What risk assessment system is used to determine management of NSTEMIs?

A

GRACE score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the management option of NSTEMIs in those who are clinically unstable?

A

Immediate coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the management option of NSTEMIs in those who with a GRACE score > 3%?

A

Percutaneous coronary intervention within 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which antiplatelet should be administered, in addition to aspirin, prior to NSTEMI percutaneous coronary intervention - in those not taking an oral anticoagulant?

A

Prasugrel

OR

Tricagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which drug therapy should be administered during NSTEMI percutaneous coronary intervention?

A

Unfractioned Heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which antiplatelet should be administered, in addition to aspirin, prior to NSTEMI percutaneous coronary intervention - in those taking an oral anticoagulant?

A

Clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which antiplatelet should be administered, in addition to aspirin, when NSTEMIs are managed conservatively - in those with a low bleeding risk?

A

Ticagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which antiplatelet should be administered, in addition to aspirin, when NSTEMIs are managed conservatively - in those with a high bleeding risk?

A

Clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the red blood transfusion threshold in those with acute coronary syndrome?

A

< 80g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a poor prognostic factor in acute coronary syndrome?

A

Cardiogenic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the four secondary prevention pharmacological management options of acute coronary syndrome?

A

Dual Antiplatelet Therapy

ACE Inhibitor

Beta-Blocker

Statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What atorvastatin dose is recommended in secondary prevention?

A

80mg once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What advice is given in regards to driving following myocardial infarction?

A

They cannot drive for a period of four weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the most common cause of death folllowing myocardial infarctions?

A

Ventricular Fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What arythmia can occur in inferior myocardial infarctions?

A

Arterioventricular Block (Bradyarrythmias)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When does Dressler’s syndrome tend to occur > myocardial infarction?

A

2 - 6 weeks > myocardial infarctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the three clincical features of Dressler’s syndrome?

A

Fever

Pleuritic Chest Pain

Pericardial Effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What blood test result indicates Dressler’s syndrome?

A

Increased ESR Levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the management option of Dressler’s syndrome?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When does left ventricular aneurysm tend to occur > myocardial infarction?

A

4 weeks > myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When does left ventricular aneurysm tend to occur > myocardial infarction?

A

4 weeks > myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the three clinical features of left ventricular aneurysm?

A

Bibasal Crackles

3rd Heart Sound

4th Heart Sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the two ECG features of left ventricular aneurysm?

A

ST Elevation

Q Waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When does left ventricular free wall rupture tend to occur?

A

1 - 2 weeks > myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the clinical feature of left ventricular free wall rupture > myocardial infarction?

A

Acute heart failure secondary to cardiac tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the three clinical features of cardiac tamponade?

A

Increased JVP

Pulsus Paradoxus

Diminshed Heart Sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When does ventricular septal defect tend to occur > myocardial infarction?

A

1 week > myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the clinical feature of ventricular septal defect > myocardial infarction?

A

Acute heart failure with pansystolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the invesigation used to diagnose ventricular septal defect?

A

ECHO Scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How is acute mitral regurgitation associated with myocardial infarctions?

A

This is due to ischaemia or rupture of the papillary muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the three clinical features of acute mitral regurgitation?

A

Pulmonary Oedema

Hypotension

Pansystolic Murmur Radiates To Axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What investigation is used to in new-onset acute heart failure?

A

ECHO Scans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the gold standard management option of acute heart failure?

A

IV Loop Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Name two loop diuretics used to manage acute heart failure

A

Furosemide

Bumetanide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the management option of acute heart failure, with respiratory failure?

A

Continous positive airway pressure (CPAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

When should beta-blockers stopped during acute heart failure?

A

They should only be stopped when the patient has a heart rate < 50bpm, second/third degree atrioventriculae block or shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What heart failure classification is associated with hypertrophic obstructive cardiomyopathy?

A

Diastolic Heart Failure (HF-pEF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the three clinical feature of right sided heart failure (cor pulmonale)?

A

Increased JVP

Ankle Oedema

Hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the first line investigation used to diagnose chronic heart failure?

A

N-Terminal Pro-B-Type Natriuretic Peptide (NT‑proBNP) Blood Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What BNP level is deemed as high?

A

> 400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What NTproBNP level is deemed as high?

A

> 2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the next step when BNP/NTproBNP levels are high?

A

2 week ECHO scan referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What BNP level is deemed as raised?

A

100 - 400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What NTproBNP level is deemed as raised?

A

400 - 2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the next step when BNP/NTproBNP levels are raised?

A

6 week ECHO scan referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the NYHA class I of chronic heart failure?

A

No clinical features

No limitation of physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the NYHA class II of chronic heart failure?

A

Mild clinical features

Slight limitation of physical activity, comfortable at rest however activity results in faitgue, palpitations or dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the NYHA class III of chronic heart failure?

A

Moderate clinical features

Marked limitation of physical activity, comfortable at rest however less then ordinary activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the NYHA class IV of chronic heart failure?

A

Severe clinical features

Severe physical limitation, clinical features at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is the first line pharmacological management option of chronic heart failure?

A

ACE Inhibitor

AND

Beta Blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What two beta-blockers improve long term prognosis of chronic heart failure?

A

Bisoprolol

Carvediol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What two beta-blockers improve long term prognosis of chronic heart failure?

A

Bisoprolol

Carvediol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are the two second line pharmacological management option of chronic heart failure?

A

Aldosterone/Mineralocorticoid Antagonists

Angiotension Receptor Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What montioring should be conducted when individuals are administered ACE inhibitors and aldosterone antagonists? Why?

A

Potassium Levels

Hyperkalaemia Risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the four third line pharmacological management options of chronic heart failure?

A

Ivabridine

Sacubitril-Valsartan

Digoxin

Hydralazine & Nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

When is ivabradine used to manage acute heart failure?

A

Heart Rate > 75bpm

AND

Left Ventricular Fraction < 35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

When is sacubitril-valsartan used to manage acute heart failure?

A

Left Ventricular Fraction < 35%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What should be conducted before starting heart failure patients on sacubitril-valsartan?

A

ACEI/ARB Washout Period

This involves stopping these medications 36 hours before administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

When is digoxin used to manage acute heart failure?

A

Coexistent atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

When is hydralazine, with nitrates, used to manage acute heart failure?

A

Afro-Caribbean Patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which drug class does not improve mortality in heart failure?

A

Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the first line management option of acute angina attacks?

A

Sublingual Glyceryl Trinitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the two first line prophylactic management options of stable angina?

A

Beta-Blocker

OR

Calcium Channel Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the first line prophylactic management option of angina - in those with heart failure?

A

Beta-Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the first line prophylactic management option of angina - in those with asthma?

A

Calcium Channel Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Which two calcium channel blockers should be administered as monotherapy when prophylactically managing angina?

A

Verapamil

Dilitiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Which two calcium channel blockers should be administered when administered in compinated with a beta-blocker, when prophylactically managing angina?

A

Amlodpine

Nifedipine

These are known as longer-acting dihydropyridine calcium channel blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Which calcium channel blocker should not be prescribed with beta-blockers? Why?

A

Verapamil

Complete heart block risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What are the two acute management options of angina?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are the four second line prophylactic management options of angina - when individuals cannot toelrate dual therapy with a calcium channel blocker and beta blocker?

A

Long Acting Nitrate

Ivabradine

Nicorandil

Ranolazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Name a long actine nitrate used to manage angina

A

Isosorbide Mononitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

When is a complication of long acting nitrates? How do we prevent this complication?

A

Nitrate Tolerance

Asymmetric dosing interval, daily nitrate free time of 10 - 14 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the most important risk factor of aortic dissection?

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the five clinical features of aortic dissection?

A

Sharp, Tearing Chest/Back Pain

Weak Peripheral Pulses

Asymmetrical Blood Pressure

Hypertension

Aortic Regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is type A aortic dissection?

A

It involves the ascending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What is type B aortic dissection?

A

It involves the descending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is type B aortic dissection?

A

It involves the descending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are the five clinical features of aortic dissection?

A

Sharp, Tearing Chest/Back Pain

Weak Peripheral Pulses

Asymmetrical Blood Pressure

Hypertension

Aortic Regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What pain occurs in type A aortic dissections?

A

Chest Pain

112
Q

In which aortic dissection classification does aortic regurgitation occur?

A

Type A Aortic Dissection

113
Q

In which aortic dissection classification does aortic regurgitation occur?

A

Type A Aortic Dissection

114
Q

In which aortic dissection classification does aortic regurgitation occur?

A

Type A Aortic Dissection

115
Q

What pain occurs in type B aortic dissections?

A

Upper Back Pain

116
Q

What is the chest x-ray feature of aortic dissection?

A

Widened Mediastinum

117
Q

What is the gold standard investigation option used to manage aortic dissection?

A

Chest Abdomen Pelvis CT Angiograph

118
Q

What is a feature of aortic dissection on CT angiographs?

A

False Lumen

119
Q

What is the investigation of choice when aortic dissection patients are unstable for CT angiographs?

A

Transoesophageal Echocardiography (TOE)

120
Q

What are the two management options of type A aortic dissections?

A

Surgical Management

IV Labetalol

121
Q

What is the surgical management option used to manage proximal type A aortic dissections?

A

Aortic Root Replacement

122
Q

What are the two management options of type B aortic dissections?

A

Conservative Management

IV Labetalol

123
Q

What is the management option of acute atrial fibrillation in those with haemodynamic instability (hypotension, heart failure)?

A

Electrical Cardioversion

124
Q

What is the management option of acute atrial fibrillation in those with haemodynamic stability who present < 48 hours of clinical feature onset?

A

Rate/Rhythm Control

125
Q

What is the management option of acute atrial fibrillation in those with haemodynamic stability who present > 48 hours of clinical feature onset?

A

Rate Control

126
Q

How do we manage atrial fibrillation, rate control or rhythm control?

A

Rate Control

127
Q

What are the two first line rate control management options of atrial fibrillation?

A

Beta-Blockers

Rate-Limiting Calcium Channel Blockers

128
Q

What is the first line rate limiting calcium channel blocker used to manage atrial fibrillation?

A

Dilitiazem

129
Q

What is the second line rate control management options of atrial fibrillation?

A

A combination therapy with two of the following should be administered…

  • Beta-Blocker
  • Dilitiazem
  • Digoxin
130
Q

In which atrial fibrillation patients, in which four circumstances do we use rhythm control management - rather than rate control management?

A

New Onset Atrial Fibrillation (< 48 Hours)

Obvious Reversible Cause

Coexistent Heart Failure

Coexistent Atrial Flutter

131
Q

In which circumstance is electrical cardioversion is used to manage atrial fibrilaltion?

A

Haemodynamically Unstable

132
Q

What should be administered to atrial fibrillation patients who require electrical rhythm control, and present < 48 hours of clinical feature onset?

A

Heparin

133
Q

What electrical cardioversion is used in atrial fibrillation?

A

Synchronised DC Cardioversion

134
Q

What is electrical cardioversion of atrial fibrillation synchronised to?

A

R Wave

135
Q

What should be administered to atrial fibrillation patients who require electrical rhythm control, however present > 48 hours of clinical feature onset? How long should this be administered for?

A

Anticoagulation

4 Weeks

This should be continued lifelong, even when sinus rhythm is maintained

136
Q

What are the two pharmacological cardioversion management options of atrial fibrillation?

A

Amiadarone

Flecainide

137
Q

When is amiodarone recommended to pharmacologically cardiovert atrial fibrillation?

A

Structural Heart Disease

138
Q

What investigation is conducted prior to flecainide administration in atrial fibrillation? Why?

A

ECHO Scan

Structural Heart Disease

139
Q

How is the CHA2-DS2-VASC2 score used to determine atrial fibrillation management?

A

It is used to determine the most appropriate anticoagulation strategy based upon stroke risk

140
Q

What is the CHA2-DS2-VASC2 score?

A

Congestive Heart Failure = 1 Point

Hypertension = 1 Point

Age > 75 Years Old = 2 Points
Age 65 - 74 Years Old = 1 Point

Diabetes = 1 Point

Stroke, TIA, Thromboembolism History = 2 Points

Vascular Disease = 1 Point

Female Sex = 1 Point

141
Q

What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 0?

A

No Treatment

142
Q

What investigation should be conducted when no anticoagulation is required in atrial fibrillation patients? Why?

A

Transthoracic Echocardiograms

This is to exlcude valvular heart disease

143
Q

What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 1?

A

Males = Consider Treatment

Females = No Treatment

144
Q

What anticoagulation management is used to manage atrial fibrillation patients with a CHA2-DS2-VASC2 score of 2?

A

Offer Anticoagulation

145
Q

Do we withold anticoagulation solely due to increased age or falls risk?

A

No

146
Q

What scoring system is used to assess bleeding risk prior to anticoagulation?

A

ORBIT Scoring System

147
Q

What is the first line anticoagulant management option of atrial fibrillation?

A

Direct Oral Anticoagulants

148
Q

What is the second line anticoagulant management option of atrial fibrillation?

A

Warfarin

149
Q

What is the stage one hypertension criteria?

A

Clinic Blood Pressure = > 140/90 mmHg

ABPM/HBPM = > 135/85 mmHg

150
Q

What is the stage two hypertension criteria?

A

Clinic Blood Pressure = > 160/100 mmHg

ABPM/HBPM = > 150/95 mmHg

151
Q

What is the severe hypertension criteria?

A

Clinic Blood Pressure = > 180/120 mmHg

152
Q

What is the most appropriate management step in those with severe hypertension - when individuals present with end-organ damage features or life threatening features?

A

We admit for specialist assessment

153
Q

What is the most appropriate management step in those with severe hypertension - when individuals don’t present with end-organ damage features or life threatening features?

A

Urgent end-organ damage investigations

154
Q

What is the step four management option of hypertension in those with a potassium < 4.5mmol?

A

Spironolactone

155
Q

What is the step four management option of hypertension in those with a potassium > 4.5mmol?

A

Alpha-Blocker

Beta-Blocker

156
Q

What is the blood pressure target in individuals < 80 years old?

A

Clinic BP = < 140/90mmHg

ABPM/HBPM = < 135/85 mmHg

157
Q

What is the blood pressure target in individuals > 80 years old?

A

Clinic Blood Pressure = < 150/90 mmHg

ABPM/HBPM = < 145/85 mmHg

158
Q

What is the first line management option of hypertension, in those with coexistent type two diabetes mellitus?

A

ACE Inhbitors

OR

ARBs

159
Q

What are the hypertension targets in those with type two diabetes mellitus?

A

< 140/90mmHg

160
Q

What is the inheritance of hypertrophic obstructive cardiomyopathy?

A

Autosomal Dominant

161
Q

What dysfunction is associated with hypertrophic obstructive cardiomyopathy?

A

Diastolic Dysfunction

162
Q

What are the seven clinical features of hypertrophic obctructive cardiomyopathy?

A

Syncope

Extertional Dyspnoea

Jerky Pulse

Large A Waves

Double Apex Beat

Ejection Systolic Murmur

Sudden Death

163
Q

Describe the ejection systolic murmur associated with hypertrophic obstructive cardiomyopathy

A

It is increased with Vasalva manouevre

It is decreased with squatting

164
Q

What are the two associations of hypetrophic obstructive cardiomyopathy?

A

Friedreich’s Ataxia

Wolff-Parkinson White

165
Q

What are the three ECHO features of hypetrophic obstructive cardiomyopathy?

A

MR SAM ASH

Mitral Regurgitation

Systolic Anterior Motion

Assymetric Hypertrophy

166
Q

What is the cause of death in hypetrophic obstructive cardiomyopathy?

A

Ventricular Arrythmias

167
Q

What are the five management options of hypetrophic obstructive cardiomyopathy?

A

ABCDE

Amiodarone

Beta-Blockers

Implantable Cardioverter Defibrilator

Dual Chamber Pacemaker

Endocarditis Prophylaxis

168
Q

What is the most effective management option used to reduce the risk of sudden death in hypertrophic obstructive cardiomyopathy?

A

Implantable Cardioverter Defibrilator

169
Q

Which valve is most commonly affected by infective endocarditis?

A

Mitral Valve

170
Q

Which valve is most commonly affected by infective endocarditis - in intravenous drug users?

A

Tricuspid Valve

171
Q

What is the most common infective organism of infective endocarditis?

A

Staphylococcus Aureus

172
Q

What is the most common infective organism of infective endocarditis - in intravenous drug users?

A

Staphylococcus Aureus

173
Q

What is the most common infective organism of infective endocarditis - in those with poor dental hygiene?

A

Streptococcus Viridans

174
Q

What is the most common infective organism of infective endocarditis - within 2 months of prosthetic valve surgery?

A

Staphylococcus Epidermis

175
Q

What is the most common infective organism of infective endocarditis - in those with colorectal cancer?

A

Streptococcus Bovis

176
Q

What criteria is used to diagnose infective endocarditis?

A

Duke Criteria

177
Q

What is the gold standard investigation used to diagnose infective endocarditis?

A

3 x Blood Cultures

178
Q

What is the initial antibiotic used to manage infective endocarditis affecting native valves?

A

Amoxicillin

179
Q

What are the five indications for urgent surgical management of infective endocarditis?

A

Severe Valvular Incompetence

Aortic Abscess

Resistant Infections

Heart Failure

Emboli > Antibiotic Therapy

180
Q

Are prophylactic antibiotics required before procedures in those with infective endocarditis?

A

No

181
Q

What is a risk factor of acute pericarditis?

A

Systemic Lupus Erythematosus

182
Q

Describe the chest pain associated with pericarditis

A

It is pleuritic, often relieved by sitting forward

183
Q

What are the two ECG features of pericarditis?

A

Saddle Shaped ST Elevation

PR Depression

184
Q

What is the most specific ECG feature of pericarditis?

A

PR Depression

185
Q

What is a gold standard investigation used to investigate all cases of pericarditis?

A

Transthoracic ECHO Scan (TTE)

186
Q

What is the first line management option of pericarditis?

A

NSAIDs & Colchicine

187
Q

Name two NSAIDs used to manage pericarditis

A

Naproxen

Ibuprofen

188
Q

What are the eight clinical features of constrictive pericarditis?

A

Dyspnoea

Peripheral Oedema

Kussmaul’s Sign

Increased JVP

JVP X + Y Descent

Pericardial Knock

Hepatomegaly

Ascites

189
Q

What is the chest x-ray feature of constrictive pericarditis?

A

Pericardial Calcification

190
Q

What are the three differences between cardiac tamponade and constrictive pericarditis?

A

Cardiac Tamponade = Absent JVP Y Descent, Pulsus Paradoxus Present, Kussmaul’s Sign Rare

Constrictive Pericarditis = Present JVP X+Y Descent, Pulsus Paradoxus Absent, Kussmaul’s Sign Present

191
Q

What is pulsus paradoxus?

A

It is when there is an abnormally large drop in blood pressure during inspiration

Therefore the peripheral pulses will disappear during inspiration

192
Q

What are the five clinical features of rheumatic fever?

A

Erythema Marginatum

Sore Throat

Polyarthritis

Sydenham’s Chorea

Ejection Systolic Murmur

193
Q

Describe the rash associated with rheumatic fever

A

There are pink, ring shaped lesions, with a pale-pink centre, surrounded by a slightly raised red outline

194
Q

What is Sydenham’s chorea?

A

It is defined as involuntary jerking

195
Q

What is the first line pharmacological management option of rheumatic fever?

A

IM Benzylpenicillin/Oral Penicillin V

196
Q

What is the first line management option of supraventricular tachycardia?

A

Vagal Manouevres

197
Q

What are the two vagal manouvres used to manage supraventricular tachycardia?

A

Valsalva Manouevre

Carotid Sinus Massage

198
Q

What is the first line pharmcaological management option of supraventricular tachycardia? Describe the dosing

A

IV Adenosine

6mg, then 12mg, then 18mg

199
Q

How do we administer IV adenosine?

A

Insert 16G cannula in right antecubital vein

200
Q

What are the three side effects of adenosine?

A

Chest Pain

Bronchospasm

Transient Flushing

201
Q

What are the three side effects of adenosine?

A

Chest Pain

Bronchospasm

Transient Flushing

202
Q

What is the second line pharmcaological management option of supraventricular tachycardia?

A

Verapamil

203
Q

What are the two features of Torsades de Pointes on ECG scans?

A

Prolonged QT Interval

Rapid Polymorphic QRS Complexes

204
Q

What is the feature of Torsades de Pointes on ECG scans?

A

Prolonged QT Interval

205
Q

What are the four causes of Torsades de Pointes?

A

Hypothermia

Subarachnoid Haemorrhage

Erythromycin

Citalopram

206
Q

What is the management option of Torsades de Pointes?

A

IV magnesium sulphate

207
Q

What is the management option of Torsades de Pointes?

A

IV magnesium sulphate

208
Q

What is the most common cause of mitral stenosis?

A

Rheumatic Fever

209
Q

What are the four clinical features of mitral stenosis?

A

Dyspnoea

Haemoptysis

Malar Flush

Atrial Fibrillation

210
Q

What are the four clinical features of mitral stenosis?

A

Dyspnoea

Haemoptysis

Malar Flush

Atrial Fibrillation

211
Q

What are the five murmur features of mitral stenosis?

A

Mid-Late Diastolic Murmur

Increased Murmur On Expiration

Loud S1 Sound

Opening Snap

Low Volume Pulse

212
Q

What are the five murmur features of mitral stenosis?

A

Mid-Late Diastolic Murmur

Increased Murmur On Expiration

Loud S1 Sound

Opening Snap

Low Volume Pulse

213
Q

What is the management option of asymptomatic mitral stenosis?

A

ECHO Scan Monitoring

214
Q

What are the two management options of symptomatic mitral stenosis?

A

Percutanoeus Mitral Balloon Valvotomy

Mitral Valve Surgery

215
Q

What are the two risk factors of mitral regurgitation?

A

Marfans Syndrome

Ehlers Danlos Syndrome

216
Q

What are the five murmur features of aortic regurgitation?

A

Pansystolic Murmur

Murmur Radiation To Axilla

Murmur Loudest At Apex

Quiet S1 Sound

Widely Split S2 Sound

217
Q

What is the most common valvular heart disease?

A

Aortic Stenosis

218
Q

What is the most common cause of aortic stenosis in individuals > 65 years old?

A

Degenerative Calcification

219
Q

What is the most common cause of aortic stenosis in individuals < 65 years old?

A

Bicuspid Aortic Valve

220
Q

What is the most common cause of supravalvular aortic stenosis?

A

William’s Syndrome

221
Q

What are the seven murmur features of aortic stenosis?

A

Ejection Systolic Murmur

Murmur Radiation To Carotids

Murmur Decreased > Valsalva Manouevre

Soft/Absent S2 Sound

S4 Sound

Narrow Pulse Pressure

Slow Rising Pulse

222
Q

What feature makes aortic stenosis murmurs quieter?

A

Left ventricular systolic dysfunction

223
Q

What is the management option of asymptomatic aortic stenosis?

A

Observation

224
Q

What is the management option of asymptomatic aortic stenosis, with a valvular gradient > 40mmHg?

A

Aortic Valve Replacement

225
Q

What is the management option of symptomatic aortic stenosis?

A

Aortic Valve Replacement

226
Q

What aortic valve replacement method is selected in those with low/medium operative risk?

A

Surgical Aortic Valve Replacement

227
Q

What aortic valve replacement method is selected in those with high operative risk?

A

Transcatheter Aortic Valve Replacement

228
Q

What is the most common cause of aortic regurgitation?

A

Marfan’s Syndrome

229
Q

What are the five murmur features of aortic regurgitation?

A

Early Diastolic Murmur

Quincke’s Sign

De Musset’s Sign

Collapsing Pulse

Wide Pulse Pressure

230
Q

What is Quinke’s sign?

A

It is defined as nailbed pulsation

231
Q

What is De Musset’s sign?

A

It is defined as head bobbing

232
Q

When is aortic valve surgery recommended in aortic regurgitation?

A

Symptomatic & Severe

Asymptomatic & Severe With LV Systolic Dysfunction

233
Q

What investigation is used to diagnose valvular heart disease?

A

ECHO Scans

234
Q

What anticoagulation class is recommended in those with mechanical heart valves?

A

Warfarin

235
Q

What are the four features of Wolff Parkinson White syndrome on ECG scans?

A

Short PR Interval

Wide QRS Complexes

Delta Waves

Axis Deviation

236
Q

What is the best management option of radiofrequency ablation?

A

Radiofrequency Ablation

237
Q

What is the ECG feature of first degree heart block?

A

Increased PR Interval > 0.2s

238
Q

What is the management option of first degree heart block?

A

No treatment

239
Q

What is the ECG feature of second degree heart block type one?

A

Progressive prolongation of the PR interval until a dropped QRS complex occurs

240
Q

What is the ECG feature of second degree heart block type two?

A

Constant PR interval however the P wave is not often followed by a QRS complex

241
Q

What is the ECG feautre of third degree heart block?

A

No association between the P waves and QRS complexes

242
Q

When third degree heart block occurs following a myocardial infarction, which artery tends to be affected?

A

Right Coronary Artery

243
Q

When third degree heart block occurs following a myocardial infarction, which artery tends to be affected?

A

Right Coronary Artery

244
Q

What is the most common risk factor of acute limb ischaemia?

A

Atrial Fibrillation

245
Q

What are the six clinical features of acute limb ischaemia?

A

6 P’s

Pale

Pulseless

Painful

Paralysed

Paraesthetic

Perishing With Cold

246
Q

What vessel is affected by peripheral arterial disease when individuals present with buttock pain rather than calf pain?

A

Iliac Vessels

246
Q

What vessel is affected by peripheral arterial disease when individuals present with buttock pain rather than calf pain?

A

Iliac Vessels

247
Q

How do we differentiate between acute limb ischaemia and critical limb ishaemia?

A

Acute Limb Ischaemia = The clinical features develop within days

Critical Limb Ischaemia = The clinical features develop over weeks

248
Q

How do we differentiate between acute limb ischaemia and critical limb ishaemia?

A

Acute Limb Ischaemia = The clinical features develop within days

Critical Limb Ischaemia = The clinical features develop over weeks

249
Q

How do we differentiate between acute limb ischaemia and critical limb ishaemia?

A

Acute Limb Ischaemia = The clinical features develop within days, pain not present at rest

Critical Limb Ischaemia = The clinical features develop over weeks, pain worse on exertion and persistent at rest

250
Q

How do we differentiate between acute limb ischaemia and critical limb ishaemia?

A

Acute Limb Ischaemia = The clinical features develop within days

Critical Limb Ischaemia = The clinical features develop over weeks

251
Q

What is the intial investigation option of acute limb ischaemia?

A

Handheld arterial doppler scan

252
Q

What is the next appropriate investigation option of acute limb-threatening ischaemia - when doppler scans are positive?

A

Ankle-Brachial Pressure Index

253
Q

What are the four initial management options of acute limb ischaemia?

A

ABC Approach

Paracetamol, Codeine, IV Opioids

IV Unfractioned Heparin

Vascular Review

254
Q

What is the conservative management option of peripheral arterial disease?

A

Exercise Training

255
Q

What are the two pharmacological management options of peripheral arterial disease for secondary prevention of cardiovascualr disease?

A

Atorvastatin 80mg once daily

Clopidogrel 75mg once daily

256
Q

What are the two pharmacological management options of peripheral arterial disease?

A

Statin

Clopidogrel

257
Q

What is the surgical management option of peripheral arterial disease - in high-risk patients with short segment stenosis (<10cm) or aortic iliac disease?

A

Endovascular Angioplasty Revascularisation

258
Q

What is the surgical management option of peripheral arterial disease - in high-risk patients with long segment stenosis (>10cm), multifocal lesions, lesions of the femoral artery or purely infrapopliteal disease?

A

Open Surgical Angioplasty Revascularisation

259
Q

What is a risk factor of venous leg ulcers?

A

Chronic venous insufficiency

260
Q

Where are venous leg ulcers located?

A

It is located above the medial malleolus

261
Q

Are venous leg ulcers painful or painless?

A

Painless

262
Q

What is the investigation used to diagnose venous ulceration?

A

Ankle-Brachial Pressure Index (ABPI)

263
Q

What is the feature of venous ulcers on ankle brachial pressure index measurements?

A

Normal (0.9-1.2)

264
Q

What is the most important management option of venous ulcers?

A

Compression Bandaging

265
Q

What is the most cpommon risk factor of arterial leg ulcers?

A

Chronic Obliterative Arterial Disease

266
Q

Where are arterial ulcers located?

A

Toes & Heels

267
Q

Describe the appearance of arterial leg ulcers

A

Deep, punched out appearance

268
Q

Are arterial leg ulcers painful or painless?

A

Painful

269
Q

What is the feature of arterial ulcers on ankle brachial pressure index measurements?

A

Reduced < 0.9

270
Q

What is the most common risk factor of neuropathic ulcers?

A

Diabetes mellitus

270
Q

What is the most common risk factor of neuropathic ulcers?

A

Diabetes mellitus

271
Q

Where are neuropathic ulcers located?

A

Plantar surface of metatarsal head

Plantar surface of hallux

272
Q

What is the management option of neuropathic ulcers?

A

Cushioned Shoes

273
Q

What is Marjolin’s ulcer?

A

It is a form of squamous cell carcinoma

274
Q

What are the two risk factors of pyoderma gangrenosum?

A

Inflammatory Bowel Disease

Rheumatoid Arthritis

Year Four - Finals (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions