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P2a - Cardiology > mock questions > Flashcards

mock questions Flashcards

1
Q

what should be given to an MI patient?

A

aspirin and a PY12 inhibitor (ticagrelor)

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2
Q

what type of drug is aspirin?

A

antiplatelet - COX inhibitor

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3
Q

describe the pharmacology of spironolactone

A

Inhibition of aldosterone receptor in the distal tubules

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4
Q

what are the risk factors for hypertension?

A

High caffeine consumption, sedentary lifestyle, smoking and type A personality

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5
Q

A patient is referred to a cardiology clinic after presenting to their GP with shortness of breath
after walking for 50 metres and general fatigue. on auscultation there is an audible pan-systolic
murmur at the apex. What is the most likely diagnosis?

A

mitral regurgitation

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6
Q

what ECG changes are likely to be seen in an MI?

A

ST elevation, ST depression

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7
Q

John is a 53-year-old Caucasian gentleman who attended GP clinic 2 weeks ago for an annual
check-up. In the GP practice his BP was recorded as 155/100mmHg and he was subsequently given
given an ambulatory blood pressure monitor for 2 weeks. His results show an average blood
pressure of 138/91mmHg. What is the most appropriate management for this result?

A

ramapril

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8
Q

An 89-year-old patient with multiple undiagnosed cardiovascular co-morbidities is brought to
A&E with slurred speech, left arm weakness and a severely ataxic gait. Which underlying condition
is most likely to have contributed to this presentation?

A

atrial fibrillation

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9
Q

Jane is a 68-year-old woman who has presented to her GP following a diagnosis of
hypertension. She is worried that she is at increased risk of having a heart attack and wants to
know how likely this is. Which framework should her GP use to calculate Jane’s risk?

A

QRISK2 score

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10
Q

what is the order of the electrical conduction of the heart?

A

. SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches ->
ventricles

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11
Q

what is the CHADS-VASc score?

A

The CHADS VASc score is used to calculate the stroke risk and subsequently anticoagulation need in
patients with Atrial Fibrillation. CHADS-VASc stands for:
Congestive Heart Failure // Hypertension // Age (75+=2) // Diabetes
Stroke/ TIA/ Thromboembolism
Vascular disease // Age (65-74) // Sex category (female=1)

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12
Q

what would give a collapsing pulse and an early diastolic decrescendo murmur?

A

aortic regurgitation

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13
Q

what would give an irregularly irregular pulse?

A

atrial fibrillation

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14
Q

what is pulsus paradox?

A

BP drops significantly during inspiration, seen in severe Asthma, COPD, blood
loss and cardiac conditions.

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15
Q

what is radio-radial delay?

A

pulse is significantly stronger in one arm than the other and is seen in
coarctation of the aorta.

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16
Q

what would give an ejection systolic crescendo decrescendo murmur, a slow rising pulse and a narrow pulse pressure?

A

aortic stenosis

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17
Q

what would give an apical pansystolic murmur?

A

mitral regurgitation

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18
Q

what would give an apical mid diastolic rumble?

A

mitral stenosis

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19
Q

what would give an ejection systolic murmur heard loudest on inspiration?

A

pulmonary stenosis

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20
Q

what are the cardinal signs of heart failure?

A

Shortness of breath, fatigue, ankle oedema

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21
Q

what is the first line treatment for a patient with hypertension who is over 55 or is of afrocarribean descent?

A

calcium channel blocker

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22
Q

what does a right bundle branch block look like on an ECG?

A

MARROW ‘RR’= Right bundle branch block. The first letter is M so lead 1 has a complex
resembling an M (R wave) and the 6th letter is W so lead 6 has a complex resembling a W (Slurred
S wave).

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23
Q

what does a left bundle branch block look like on an ECG?

A

= Left Bundle Branch Block. The first letter is W so lead 1 has a complex resembling
a W (Slurred S wave) and as the 6th letter is M lead 6 has a complex resembling an M (R wave).
This is the opposite of RBBB.

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24
Q

what are the 4 key features of tetralogy of fallow?

A

ventricular septal defect, pulmonary stenosis,

hypertrophy of the right ventricle and overriding aorta

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25
Q

what are the distinctive signs of infective endocarditis?

A

splinter haemorrhages, Osler’s nodes, Janeway lesions,

Roth spots and fever

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26
Q

what causes a third heart sound?

A

volume overload

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27
Q

what causes a forth heart sound?

A

pressure overload

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28
Q

what should a PR interval be normally?

A

200ms

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29
Q

what are the signs of first degree heart block?

A

prolonged PR interval, asymptomatic

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30
Q

what are the signs of second degree heart block, mobitz 1?

A

PR interval gets progressively longer until a dropped beat, may not require treatment, asymptomatic

31
Q

what are the signs of second degree heart block mobitz 2?

A

normal PR intervals, followed by dropped beat, may cause bradycardia and reduced CO, pacemaker to treat

32
Q

what are the signs of 3rd degree AV block (complete)?

A

no impulses from AV node, ventricular escape rhythm formed, atria and ventricles beat independently from each other (AV dissociation), reduced cardiac output, syncope, sudden cardiac death, P waves appear at 60-100bpm, QRS complexes every 30-45 beats per minute, pace maker to treat

33
Q

what can cause heart blcoks?

A 
right coronary artery occlusion MI, inferior wall, leads 2, 3 and AVf
lyme disease (complete) 
neonatal lupus (anti-ro and anti-la)
34
Q

what are the signs of RBBB?

A

MarroW (V1, V6), wide QRS

35
Q

what are the signs of LBBB?

A

WilliaM (V1, V6), wide QRS, never in healthy heart

36
Q

what is the gold standard investigation for a pulmonary embolism?

A

pulmonary angiogram, echocardiogram if contraindicated - e.g. haemodynamically unstable

37
Q

what is dressler’s syndrome?

A

pericarditis 2-12 weeks after heart attack, PR depression, St elevation, low QRS voltage, raised JVP

38
Q

what are the features of heart failure on an X-ray?

A

ABCDE

A - alveolar oedema
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe vessels
E - pleural effusion
39
Q

what would suggest tricuspid regugitation rather than mitral?

A

pitting oedema, lung NOT affected, right sided heart failure, louder on inspiration

40
Q

what is claudication?

A

pain in feet or toes when exercising

41
Q

what is burger’s test?

A

if positive - shows new onset ischaemia

42
Q

what is the most important first line treatment for septic shock?

A

fluids - to stop heart failure

43
Q

what is the order of conduction through the heart?

A

SA node (in atria, main pacemaker), AV node, bundle of his, purkinje fibres, ventricles

44
Q

what is the most common congenital heart defect?

A

ventricular septal defect, causes a left to right shunt, oxygenated blood enters right ventricle

45
Q

how does atherosclerosis lead to angina?

A

fibrous and lipid rich plaques in coronary arteries leading to blood vessel occlusion

46
Q

what is PCI?

A

This is when the coronary arteries are visualised using a dye to identify areas of obstruction or reduced blood flow which can be stented open. (In triple vessel disease the patient may require a coronary artery bypass graft (CABG))

47
Q

what problems can arise due to atherosclerosis?

A

MI, ischaemic stroke, critical limb ischaemia, sudden CV death

48
Q

what drugs would you give for a ACS?

A

aspirin, morphine, low molecular weight heprin (fondaparinux), stain, ticagrelor, beta blocker, GTN spray

49
Q

what leads to DVT?

A

immobility, long haul flight, surgery, oral contraceptive pill, pregnancy, cancer, HRT

50
Q

what is the best way to investigate heart valves?

A

echocardiogram with doppler and ultrasound to visualise structure

51
Q

what are the most common causes of percarditis?

A

viral infection or autoimmune

52
Q

what are the signs on examination of infective endocarditis?

A

Splinter haemorrhages - fine, thread-like, blood clots appearing vertically in the bed of the fingernail
Osler’s nodes - small, tender, purple subcutaneous lesions on the pulp of the fingertips
Janeway lesions - erythematous, macular, nontender lesions on the fingers, palms and/or soles of the feet
Roth spots - retinal haemorrhages wit white or pale centres seen on fundoscopy
New heart murmur
Petechiae

53
Q

what is the treatment for angina?

A

GTN spray and a beta blocker or CCB

54
Q

what are the modifiable and non-modifiable risk factors for angina?

A

modifiable - obease, smoking, high blood pressure, T2DM, high cholestrol
non- male, age, family history, hyperlipdeamia

55
Q

what is a side effect of a calcium channel blocker?

A

ankle swelling

56
Q

what drug may worsen heart failure?

A

verapamil, calcium channel blocker

57
Q

what are the signs of right-sided heart failure?

A

peripheral oedema, anorexia, nausea, big face and nosebleeds and ascites

58
Q

what are the signs of left-sided heart failure?

A

Poor exercise tolerance, nocturia, cold fingers and shortness of breath

59
Q

which valve will most likely be affected in infective endocarditis in an IV drug user?

A

tricuspid valve - venous blood reaches here first

60
Q

what are the major criteria for infective endocarditis?

A

Evidence of endocardial involvement (i.e, vegetation
visible on transthoracic echocardiogram / transesophageal echocardiogram -
presence of C. burnettii is a major criterion)

61
Q

what are the minor criteria for infective endocarditis?

A

predisposing factor (i.e.,
IVDU, predisposing heart condition), temperature >38C, vascular phenomena
(arterial emboli, pulmonary infarcts, conjunctival haemorrhages, roth spots,
janeway lesions, osler nodes), immunologic phenomena (glomerulonephritis,
painful nodes, positive rheumatoid factors), microbiologic evidence.

62
Q

what are the complications of infective endocarditis?

A

pulmonary embolism, kidney damage,

spleen damage, abscess formation, sepsis, heart failure, valvular regurgitation, aortitis, stroke, death

63
Q

what would be seen on the chest x-ray of someone with aortic stenosis?

A

Cardiomegaly, dilated ascending aorta, pulmonary oedema, calcification of aortic valve

64
Q

what are the symptoms of sepsis?

A

Fevers, rigors, night sweats, weight loss, anaemia, splenomegaly, clubbing

65
Q

what are the symptoms of chronic limb ischameia?

A

Hair loss, atrophic skin, brittle / slow-growing nails, ulcers, numbness in feet, absent distal pulses, intermittent claudication

66
Q

what can be done to investigate chronic limb ischaemia?

A

Contrast angiography / Ankle Brachial Pressure Index. 1 mark for just ‘ABPI’. /Doppler ultrasound.

67
Q

describe arterial ulcers

A

Location - tips of toes / distal extremities, lateral malleolus), phalangeal heads;
Characteristics - punched-out appearance , pale / necrotic wound tissue,minimally exudative, skin pail / shiny / taut / thin , absence of hair

68
Q

describe venous ulcers?

A

Location - gaiter area, lower calf to medial malleolus Characteristics - irregular shape, granular appearance, moderately - highly exudative, haemosiderin staining, lipodermatosclerosis / subcutaneous fibrosis and hardening of skin, firm oedema

69
Q

what are the ECG changed in atrial fibrilation?

A

Absent p waves, variable ventricular rate, absence of [isoelectric] baseline, QRS complex <120ms, fibrilaltory waves

70
Q

A 48 year old woman with no significant medical history presents with decreased exercise
tolerance and progressive dyspnoea at rest. This has been happening for 3 days and she
does not recall any recent illness or travel. She has also noticed that her ankles have
swollen and the GP identifies a raised JVP and pulsus paradoxus.

A

cardiac tamponade

71
Q

what is becks triad?

A

hypotension, distended jugular veins, muffled heart sounds

72
Q

what does the presence of beck’s triad indicate?

A

cardiac tamponade

73
Q

what are investigations that could be done to diagnose cardiac tamponade?

A

ECG (low voltage QRS), echocardiogram (enlarged cardiac silhouette),
CXR, cardiac enzymes

74
Q

The patient is hemodynamically unstable and is sent to A&E for an urgent
procedure to relieve the pressure. what is this called?

A

pericardiocentesis

P2a - Cardiology (17 decks)

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