Important

Question 1

Medications for secondary ACS prevention?

Answer 1

Statin
ACEi
Beta blocker
Antiplatelet (dual)

+ spironolactone/eplerenone if reduced ejection fraction (started 3-14 days after MI)

Question 2

O2 curve shifts to the right, what effect does this have on O2 delivery at tissues?

Answer 2

increased delivery to tissues

Question 3

Narrow complex tachycardia

Answer 3

SVT

1. vagal maneouvrrw
2. carotid massage
3. Adenosine (6,12,18)
4. verapamil
5. shock

Question 4

Broad complex tachycardia

Answer 4

VT & Fib - Shock –> CPR

1mg adrenaline after 3 shocks then every 3-5 mins
300mg amiodarone after 3 shocks
150mg amiodaron after 5 shocks

Question 5

PEA/asystole

Answer 5

1mg Adrenaline asap

CPR

Question 6

STEMI management

Answer 6

1. PCI <2 hours + 300mg aspirin
2. thrombolysis + 300mg aspirin
3. Medical - aspirin & Ticagrelior

Question 7

Acute NSTEMI

Answer 7

Beta blockers
Aspirin 300mg 
Ticagrelor 180mg 
Morphine 
Anticoagulant (fondiparinux)
Nitrates 

If medium/high risk GRACE score then PCI within 4 days

Question 8

Acute pericarditis management

Answer 8

NSAIDs +/- colchicine

Question 9

Pericarditis on ECG

Answer 9

Reciprocal ST depression & PR elevation in aVR (+V1)
Mild concave elevation across most leads
Sinus tachy

Question 10

Most common ECG feature of PE?

Answer 10

Sinus tachycardia

Question 11

Secondary prevention of stable angina?

Answer 11

Statin
ACEi
beta blocker
Aspirin

Question 12

Unstable angina management

Answer 12

1. Aspirin 300mg lifelong
2. Fondaparinux/LMWH
3. Assess GRACE score
   
   • low risk = Ticagrelor/clopidogrel
   • img risk = angio + (prasugrel/clopridogrel and aspirin).

Question 13

Pharmacological cardioversion

Answer 13

Flecanide
Amiodarone (preferred in structural heart disease)

Question 14

Rate control in AF

Answer 14

Either;
Atenolol
Diltiazen (CCB) - not in HF
Digoxin if sedentary

Question 15

What should be avoided in atrial flutter?

Answer 15

Flecanide

Question 16

What should be initiated if QRisk >10%?

Answer 16

Atorvastatin 20mg

+ SGLT2 If diabetic

Question 17

CHA2DS2 VASC score 1 =

CHA2DS2 VASC score 2 =

Answer 17

CVD, Age >75, Diabetes, Stroke, Vascular disease, Age 65-74, Sex (female)

Score of 1 - consider anticoagulation
Score of 2 = anticoagulant

Question 18

ORBIT

Answer 18

Bleeding risk

Old =>75
Reduced haemoglobin (2 points)
Bleeding risk /history (2 points)
Insufficient eGFR (<60)
Treatment with anticoagulant 

0-2 = low
3 = medium 
4-7 = high

Question 19

PE investigations/management?

Answer 19

Calculate wells
<4 = d-dimer within 4 hours or anticoagulant
>4 = CTPA immediately (interim coag)

Question 20

Medical management of miscarriage?

Answer 20

Misoprostol

Question 21

Medical TOP

Answer 21

Mifepristone 
Plus prostaglandin (misprostol)