mmore bits

Question 1

notching of the inferior border of ribs sign of

Answer 1

coarctation of the aorta - this is due to dilatation of intercostal arteries, superior vena caval obstruction, arteriovenous fistula, or following a Blalock Taussig shunt.

The itnerocstals are dilated as it allows sufficient blood flow to reach the descending aorta. The pressure of these vessels erodes the inferior margin of the ribs.

Coarctation explains this patients refractory hypertension too.

Question 2

what congential condition can cause refractory hypertension and why

Answer 2

coaractation - this cause increased afterload for the left ventricle resulting in an increased systolic pressure in the lV and upper part of the body

Question 3

in what other condition can you see rib notching - but mainly in the upper proportion of the ribs.

Answer 3

marfans syndrome

Question 4

iNR high - minor bleed tx

Answer 4

stop warfarin adn IV vit k

Question 5

INH high and over 8 but a major bleed

Answer 5

stop warfarin , IV vit k and prothrombin complex

Question 6

after atropine what can you give in bradycardiac event

Answer 6

external pacing via transcutaneous pacing then transvenous

Question 7

first thing you do when someone reports someone unresponsive and not witnessed

Answer 7

1 shock 2 min cpr

Question 8

first thing you do if you witness someone go into cardiac arrest

Answer 8

3 shocks intially given then cpr

Question 9

angina pt already tried verampamil and asthmatic what is next on the list that can be given if still having exacerbations

Answer 9

isosobide mononitrate- long acting nitrate

Question 10

what is the problem with combining ivabradine with a rate limiting CCB like verapamil

Answer 10

could lead to severe bradycardia

Question 11

tx of type a aortic dissection - ascending aorta

Answer 11

Intravenous labetalol and immediately refer for aortic root replacement

Question 12

tx of type b - descending

Answer 12

type B - descending aorta - control BP(IV labetalol)

Question 13

aortic regurgitation sign of which aortic dissecton

Answer 13

type a - aortic dissection

Question 14

side effect of ramipril

Answer 14

angioedema - marked toungue and facial swelling

Question 15

what is secondary hypertension

Answer 15

high blood pressure caused by another medical condition

Question 16

what is the most common cause of secondary hypertension

Answer 16

primary hyperaldonsteronism

Question 17

This patient has hypokalaemia and hypernatraemia, which combined with hypertension suggests either

Answer 17

primary hyperaldosteronism, Cushing’s syndrome or renal artery stenosis.

To distinguish between these causes, you can perform a plasma renin: aldosterone ratio and a low-dose dexamethasone suppression test. It is important to note that although primary hyperaldosteronism often presents with hypokalaemia, this may not always be the case. It is most commonly caused by idiopathic bilateral adrenal hyperplasia, followed by an aldosterone-secreting adenoma of the adrenal gland (Conn’s syndrome).

Renal artery stenosis is incorrect. This is more likely to occur in older male smokers with atherosclerotic risk factors such as hypercholesterolaemia or, more rarely, younger women due to fibromuscular dysplasia. In renal artery stenosis, renal bruits may be heard on examination and there may be hypokalaemia and hypernatraemia due to hyperreninaemic hyperaldosteronism (high renin activating the renin-angiotensin-aldosterone system). Although this patient had hypertension with hypokalaemia and hypernatraemia, primary hyperaldosteronism is a much more common cause of this.

Question 18

HF need annual what vaccination

Answer 18

influenza vaccination

Question 19

when in HF do people ned vaccination

Answer 19

normally one off
every 5 years if asplenia, CKD - booster every 5 years

Question 20

mitral valve most affected in IE but hwat about in IE in IVDU

Answer 20

tricuspid valve

Question 21

what medication commonly used in blood pressure and af causes cold perpipheries and night terrors

Answer 21

beta blockers

Question 22

A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds -

Answer 22

left ventricular free wall rupture

Question 23

The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.

Answer 23

left ventricular aneurysm

Question 24

dose of statin given when Qrisk over 10% for hyperlipideamia

Answer 24

20mg

Question 25

what are the HOCM murmur findings

Answer 25

HOCM may present with ejection systolic murmur, louder on performing Valsalva and quieter on squatting

Question 26

u waves and QT prolonging seen in what

Answer 26

hypokalamia

Question 27

what ppi should you prescribe with clopidogrel

Answer 27

lansoprazole

Question 28

ix of choice for aortic dissection

Answer 28

CTA -CAP

Question 29

antiplatelet choice in Nstemi

Answer 29

aspirin, plus either: ticagrelor, if not high bleeding risk clopidogrel, if high bleeding risk

Question 30

positive Kussmaul's sign (the raised JVP that doesn't fall with inspiration

Answer 30

Kussmaul's sign can be used to differentiate cardiac tamponade and constrictive pericarditis s. Another factor that indicates constrictive pericarditis is his recent history of cardiac catheterisation for his coronary angiogram. Recent cardiac surgery (including cardiac catheterisation) is a common cause for constrictive pericarditis. dyspnoea and peripheral oedema

Question 31

Orthostatic hypotension may be exacerbated by venous pooling during exercise (exercise-induced), after meals (postprandial hypotension) and after prolonged bed rest (deconditioning)

Question 32

most important risk factor for aortic dissection

Answer 32

hypertension

Question 33

rhythm control for af 3 conditions

Answer 33

managing atrial fibrillation can be divided into rate control and rhythm control. Patient factors favouring rhythm control include: Age <65 years First presentation of AF Symptomatic.

Question 34

long qt due to hwat

Answer 34

usually due to loss-of-function/blockage of K+ channels

Question 35

In cardiac tamponade, there will be an abnormally large drop in BP during inspiration, known as

Answer 35

pulsus paraodoxus

Question 36

Tricuspid regurgitation becomes louder during inspiration, unlike mitral regurgitation

Answer 36

Systolic murmur. 2- Loudest in the 4th intercostal left parasternal region. 3- Louder on inspiration. 4- The patient has chronic obstructive pulmonary disease and is developing signs of core pulmonale.

Question 37

statin LFTs checked when

Answer 37

LFTs at baseline, 3 months and 12 months

Question 38

what drug that could interact with clopidogrel makes it less effective

Answer 38

Concurrent use of clopidogrel and omeprazole/esomeprazole can make clopidogrel less effective

Question 39

Thiazide diuretics can cause hypercalcaemia and what levels of calcium in the urine whihc may be useful in reducing the incidence of renal stones

Answer 39

hypocalcuria

Question 40

Nitrates are contraindicated in patients with

Answer 40

hypotension

Question 41

A 78-year-old woman is admitted to hospital with nausea, abdominal pain, constipation and low mood with generalised musculoskeletal pain and weakness. On examination she appears dehydrated. what problem and what ecg

Answer 41

hypocalcaemia shortened QT

Question 42

causes of torsades electroltes

Answer 42

hypothermai low k ca and mg

Question 43

ventricular tachycardia (VT hypos as above in torsades what is the main important cause of VT

Answer 43

hypokalamia

Question 44

bisoprolo or verampil in angina mx with heart failure

Answer 44

BB as verapamil avoided - as has a negative iontrophic affect