Chest pain

Question 1

Name 3 rare causes of angina

Answer 1

Decubitus angina
Prinzmental angina
Coronary syndrome X

Question 2

What is decubitus angina?

Answer 2

Angina when lying down brings on symptoms

Question 3

What is prinzmental angina?

Answer 3

Symptoms caused by coronary vasospasm

Question 4

What is coronary syndrome X?

Answer 4

Symptoms of angina but with NORMAL exercise tolerance and normal coronary angiograms

Question 5

What is the difference between unstable angina and an MI?

Answer 5

There is NO cardiac injury in angina

Question 6

In which sort of people might the acute coronary syndrome be silent/ asymptomatic?

Answer 6

Diabetics and the elderly

Question 7

Recall 3 ECG features of a STEMI

Answer 7

Hyperacute T waves
ST elevation
New LBBB

Question 8

Recall 2 ECG features of unstable angina/ NSTEMI

Answer 8

Inverted T waves

ST depression

Question 9

Recall which coronary artery supplies each portion of the heart

Answer 9

Inferior: right coronary artery
Anterior: LAD
Lateral: left circumflex
Posterior: posterior descending

Question 10

In which leads is the ECG affected in an inferior infarct?

Answer 10

II, III, aVF

Question 11

In which leads is the ECG affected in an anterior infarct?

Answer 11

V1-V5

Question 12

In which leads is the ECG affected in a lateral infarct?

Answer 12

I, aVL, V5/6

Question 13

In which leads is the ECG affected in a posterior infarct?

Answer 13

V1-3

Question 14

What would be seen on ECG in a posterior infarct specifically?

Answer 14

Tall R waves and ST depression in leads V1-3

Question 15

Recall the mnemonic for and the management plan of the acute coronary syndrome

Answer 15

MONARCH
Morphine
Oxygen
Nitrates (GTN)
Aspirin
Revascularisation (PCI)
Clopidogrel
Heparin (LMWH)

Question 16

Within how many hours of onset of symptoms of the ACS can PCI be performed?

Answer 16

4.5

Question 17

Recall the mnemonic for and the complications of ACS

Answer 17

DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
Heart failure

Valve disease
Aneurysm
Dressler's syndrome
Embolism
Reinfarction

Question 18

Why is warfarin not given in the acute setting for MI?

Answer 18

It has an initial procoagulative effect because it blocks proteins C + S

Question 19

What is Dressler’s syndrome?

Answer 19

Pericarditis that presents 2-10 weeks post-MI

Question 20

What is the first line of treatment for cardiac tamponade?

Answer 20

Pericardiocentesis

Question 21

What is Beck’s triad?

Answer 21

Triad of signs indicating cardiac tamponade

Question 22

Recall the elements of Beck’s triad?

Answer 22

Muffled heart sounds
Raised JVP
Low BP

Question 23

What is heard upon auscultation in pericarditis?

Answer 23

Pericardial friction rub

Question 24

What is the characteristic ECG finding in pericarditis?

Answer 24

Widespread saddle-shaped ST elevation

Question 25

What is Tietze syndrome?

Answer 25

A rare inflammatory disorder characterised by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction), specifically where the ribs attach to the sternum.

Question 26

When should DC cardioversion be performed in atrial fibrillation?

Answer 26

If patient is haemodynamically unstable

Question 27

Differentiate how you would control rhythm in a patient with AF <48 hours and >48 hours since onset of symptoms

Answer 27

<48hrs: DC cardioversion or cheical cardioversion with flecainide/ amiodarone >48 hours: anticoagulate for 3-4 weeks before attempting cardioversion

Question 28

Recall the anti-coagulant drug of choice for patients of low and high CHA2DS2-Vasc scores

Answer 28

Low risk: aspirin/ none | High risk: warfarin

Question 29

What CHA2DS2-Vasc score indicates anti-coagulation therapy should be started?

Answer 29

>1

Question 30

Recall 3 drugs that may be used in rate control for AF

Answer 30

Verapamil Beta blockers Digoxin

Question 31

Recall 2 ECG features of SVT

Answer 31

No p waves | Narrow-complex

Question 32

Recall 3 symptoms of SVT

Answer 32

Palpitations Syncope Dyspnoea

Question 33

What is the name of the accessory pathway present in AVRT?

Answer 33

Bundle of Kent

Question 34

What ECG change is indicative of Wolff-Parkinson-White syndrome?

Answer 34

Delta waves

Question 35

What is the first line of management in a haemodynamically unstable SVT patient?

Answer 35

Synchronised DC cardioversion

Question 36

What is the first line of management in a haemodynamically stable SVT presentation?

Answer 36

Vagal manoevres

Question 37

Recall the incrementally increasing dose of adenosine that can be given to chemically cardiovert

Answer 37

6mg 12mg 12mg

Question 38

Recall 2 vagal manoevres

Answer 38

Carotid body massage | Blowing against a syringe

Question 39

Give one reason why adenosine may be contra-indicated, and an alternative drug that could be used

Answer 39

Asthma | Verapamil

Question 40

Recall 4 key clinical features of hypertrophic obstructive cardiomyopathy

Answer 40

Jerky carotid pulse Double apex beat Ejection systolic murmur FHx of sudden death at <65 y/o

Question 41

How should a true hyperkalaemia be treated?

Answer 41

10mL 10% calcium gluconate

Question 42

Why might a blood test reveal a false hyperkalaemia?

Answer 42

If blood is drawn too quickly --> red cell lysis --> K+ release