Corrections 3

Question 1

What murmur is heard in coarctation of the aorta?

Answer 1

Systolic murmur heard under the L clavicle and over the back.

Question 2

What valvular disorder is associated with polycystic kidney disease?

Answer 2

mitral valve prolapse & mitral regurgitation

Question 3

Define unstable angina

Answer 3

Patients with ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia.

i.e. can have ECG changes but no rise in troponin

Question 4

What monitoring is required in statins?

Answer 4

LFTs at baseline, 3 months and 12 months

Question 5

What 3 electrolytes imbalances can cause long QT?

Answer 5

1) hypokalaemia
2) hypocalcaemia
3) hypomagnesaemia

Question 6

What is the most common form of cardiomyopathy?

Answer 6

Dilated cardiomyopathy (90%)

Question 7

Causes of dilated cardiomyopathy?

Answer 7

1) idiopathic (most common)

myocarditis: e.g. Coxsackie B, 2) HIV, diphtheria, Chagas disease

3) IHD

4) peripartum

5) HTN

6) iatrogenic: e.g. doxorubicin

7) substance abuse: e.g. alcohol, cocaine

8) inherited: either a familial genetic predisposition to DCM or a specific syndrome e.g. Duchenne muscular dystrophy

9) infiltrative e.g. haemochromatosis, sarcoidosis

Question 8

Echo findings in dilated cardiomyopathy?

Answer 8

1) Reduced LV EF

2) Dilated LV

3) No regional wall motion abnormalities

Question 9

What is used to treat cardiac tamponade when the patient has a neoplastic disease, which is melanoma in this case?

Answer 9

Percutaneous balloon pericardiotomy

Question 10

Most common causes of infective endocarditis:

1) <2m post valve surgery
2) >2m post valve surgery

Answer 10

1) staph. epidermis

2) staph. aureus

Question 11

What is action of fibrinolytic drugs (e.g. atelplase, streptokinase) used in thrombolysis?

Answer 11

Plasminogen activators (into plasmin).

Plasmin breaks down fibrin in clots.

Question 12

A previous stroke in what time period is a contraindication to thrombolysis?

Answer 12

<3m

Question 13

What are 3 indications for thrombolysis?

Answer 13

1) STEMI

2) Massive PE + hypotension

3) Ischaemic stroke

Question 14

What does the GRACE score predict?

Answer 14

6m mortality post NSTEMI

Question 15

What does LV aneurysm post-MI increase the risks of?

Answer 15

Thrombus may form within the aneurysm increasing the risk of stroke.

Patients are anticoagulated.

Question 16

What is the diagnostic test for Lyme disease?

Answer 16

Antibody titres for Borrelia burgdorferi

Question 17

How can lyme disease affect the heart?

Answer 17

Can cause myocarditis –> ST elevation on an ECG

Question 18

For STEMI patients receiving thrombolysis, what should they be given alongside this?

Answer 18

Antithrombin e.g. fondaparinux

Question 19

What does severe hyperkalaemia in the context of an AKI require?

Answer 19

Immediate discussion with critical care/nephrology to consider haemofiltration/haemodialysis

Question 20

What diameter defines an AAA?

Answer 20

> 3cm

Question 21

Who is an elective repair for AAA considered in? (3)

Answer 21

1) diameter growing >1cm per year

2) ≥5.5cm

3) symptomatic

Question 22

What is the gold standard imaging for diagnosing a ruptured AAA?

Answer 22

CT angiogram (only in stable patients)

Question 23

Describe Stanford system classification of aortic dissection

Answer 23

Type A (ascending) –> affects aorta before the brachiocephalic artery

Type B (descending) –> affects descending aorta AFTER left subclavian artery

Question 24

What is the single most common cause of 2ary hypertension?

Answer 24

1ary hyperaldosteronism (including Conn’s syndrome)

Question 25

What clinic BP readings define:

1) Stage 1 HTN
2) Stage 2 HTN
3) Stage 3 HTN

Answer 25

1) 140/90
2) 160/100
3) 180/120

Question 26

What 2 eye signs may be seen in malignant HTN?

Answer 26

1) papilloedema

2) retinal haemorrhages

Question 27

Management of malignant HTN?

Answer 27

1) SAME DAY referral
2) Fundoscopy exam –> to look for key findings

Question 28

How can statins affect the liver?

Answer 28

Can cause a transient and mild rise in ALT and AST in first few weeks.

Stop statins if rise is >3x baseline.

Question 29

What 2hr OGTT result implies impaired glucose tolerance?

Answer 29

7.8-11.1 mmol/L

Question 30

If new BP >= 180/120 mmHg + no worrying signs but no signs of papilloedema/retinal haemorrhages, what is next step?

Answer 30

Urgent investigations for end-organ damage (e.g. bloods, urine ACR, ECG)

Question 31

What do questions regarding Takayasu’s arteritis commonly refer to?

Answer 31

An absent limb pulse.

It is more common in younger females (e.g. 10-40 years) and Asian people.

Question 32

What 2 medications can be used for pharmacological conversion in AF?

Answer 32

1) flecainide
2) amiodarone