MI mx

Question 1

STEMI mx - drugs

Answer 1

1. asprin
   2 clopidogrel
2. unfractionated heparin if going for PCI

Question 2

which valve is affected in bacterial endocarditis in IVDU

Answer 2

Tricspid valve

Question 3

Main causes of prolonged QT syndrome

Answer 3

1. amiodorone and sotalol
2. TCA and citalopram
3. erythromycin
4. hypokalaemia/hypomagnesia/hypocalcaemia

Question 4

anterior MI

Answer 4

1. V1 - V4

2. left anterior descending

Question 5

Inferior MI

Answer 5

1. II, III and AvF

2. right coronary artery

Question 6

Anterolateral

Answer 6

1. V4 - V6, I , aVL

2. LAD or left circumflex

Question 7

ejection systolic

Answer 7

1. aortic stenosis

2. pulmonary stenosis

Question 8

pansystolic murmur

Answer 8

1. tricuspid and mitral regurgitation

2. mitral regurg - may be caused by hf

Question 9

late systolic murmur

Answer 9

1. coarctation of aorta

Question 10

early diastolic murmur

Answer 10

1. aortic regurgitation - high pitched and blowing in character
2. caused by infective endocarditis

Question 11

mid diastolic murmur

Answer 11

1. mitral stenosis

Question 12

NSTEMI mx

Answer 12

1. asprin (300mg) + clopidogrel for 12 months
2. GTN
3. morphine

Question 13

NSTEMI mx pt 2

Answer 13

1. Coronary angiography within 96 hours - give tirofiban

2. if no coronary angiography - antithrombin tx - give fondaparinux

Question 14

Mx of PE

Answer 14

1. Well’s score > 4 - likely
2. CTPA to confirm ( if delay start apixaban)
3. first line is DOAC - apixaban/rivoraxaban
4. unprovoked - 6 months
5. provoked - 3 months

Question 15

imaging changes in PE

Answer 15

1. ECG - sinus tachycardia / SIQ3 T3

2. Chest x ray - should be given in all patients and shows no changes

Question 16

Mx of pulseless electrical activity

Answer 16

1. start chest compressions (30:2)
2. 1 mg of adrenaline IV every 3-5 mins between compressions
3. non shockable rhythm

Question 17

Cardiac tamponade

Answer 17

1. caused by trauma to the chest
2. triad of features
   - hypotension
   - raised JVP
   - muffled heart sounds

mx - pericardiocentesis

Question 18

Mx of witnessed cardiovascular arrest

Answer 18

1. 3 consecutive shocks

2. administer amiodorone

Question 19

aortic stenosis - clinical features

Answer 19

1. chest pain / dyspnea
2. narrow pulse pressure and slow rising pulse
3. Mx indicated if symptomatic or valvular gradient of > 40 mmHg

Question 20

RBBB

Answer 20

1. M in V1
2. W in V6
3. broad QRS

Question 21

Mx of PE with haemodynamic instability

Answer 21

1. if hypotension etc

2. thrombolysis !!!

Question 22

SE of loop diuretcis

Answer 22

1. ototoxicity
2. hypokalaemia
3. gout

Question 23

CI to thrombolysis

Answer 23

1. aortic dissection
2. bleeding
3. coagulation disorder
4. stroke < 3 months
5. hyertension severe
6. intracranial neoplasm/injury
7. pregnancy

Question 24

when should statins be stopped?

Answer 24

serum transaminanses conc x 3

Question 25

what are statins CI with?

Answer 25

1. erythromycin/ macrolides - must stop statins during this course as it increases the risk of rhabdomyalisis
2. pregnancy

Question 26

reflex syncope

Answer 26

1. prodrome sx - sweating, pallor and nausea and vomiting before transient loss of consciousness

Question 27

WPW -

Answer 27

1. accessort patheay causing VT
2. short PR interval and delat wave
3. Mx - ablation of the accessory pathway as can degenerate to VF

Question 28

SE of thaizide diuretics

Answer 28

1. idampamie
2. hyponatremia and hypokalaemia
3. hypercalcaemia
4. gout
5. impaired glucose tolerance

Question 29

Aortic coarctation

Answer 29

1. assoc with turner’s
2. radio-femoral delay
3. hypertension
4. mid systolic murmur

Question 30

when should ramipril be stopped?

Answer 30

if potassium > 5.5 or 100% rise in creatiine

Question 31

how is hypertension diagnosed?

Answer 31

1. 2 seperate readings

2. ambulatory blood pressure monitoring

Question 32

Hf prognosis

Answer 32

1. spirnoclactone
2. ace inhibitors
3. diuretics