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P2a - Cardiology > mock questions > Flashcards

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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
what are the distinctive signs of infective endocarditis?
splinter haemorrhages, Osler’s nodes, Janeway lesions, | Roth spots and fever
26
what causes a third heart sound?
volume overload
27
what causes a forth heart sound?
pressure overload
28
what should a PR interval be normally?
200ms
29
what are the signs of first degree heart block?
prolonged PR interval, asymptomatic
30
what are the signs of second degree heart block, mobitz 1?
PR interval gets progressively longer until a dropped beat, may not require treatment, asymptomatic
31
what are the signs of second degree heart block mobitz 2?
normal PR intervals, followed by dropped beat, may cause bradycardia and reduced CO, pacemaker to treat
32
what are the signs of 3rd degree AV block (complete)?
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
what can cause heart blcoks?
``` right coronary artery occlusion MI, inferior wall, leads 2, 3 and AVf lyme disease (complete) neonatal lupus (anti-ro and anti-la) ```
34
what are the signs of RBBB?
MarroW (V1, V6), wide QRS
35
what are the signs of LBBB?
WilliaM (V1, V6), wide QRS, never in healthy heart
36
what is the gold standard investigation for a pulmonary embolism?
pulmonary angiogram, echocardiogram if contraindicated - e.g. haemodynamically unstable
37
what is dressler's syndrome?
pericarditis 2-12 weeks after heart attack, PR depression, St elevation, low QRS voltage, raised JVP
38
what are the features of heart failure on an X-ray?
ABCDE ``` A - alveolar oedema B - Kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural effusion ```
39
what would suggest tricuspid regugitation rather than mitral?
pitting oedema, lung NOT affected, right sided heart failure, louder on inspiration
40
what is claudication?
pain in feet or toes when exercising
41
what is burger's test?
if positive - shows new onset ischaemia
42
what is the most important first line treatment for septic shock?
fluids - to stop heart failure
43
what is the order of conduction through the heart?
SA node (in atria, main pacemaker), AV node, bundle of his, purkinje fibres, ventricles
44
what is the most common congenital heart defect?
ventricular septal defect, causes a left to right shunt, oxygenated blood enters right ventricle
45
how does atherosclerosis lead to angina?
fibrous and lipid rich plaques in coronary arteries leading to blood vessel occlusion
46
what is PCI?
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
what problems can arise due to atherosclerosis?
MI, ischaemic stroke, critical limb ischaemia, sudden CV death
48
what drugs would you give for a ACS?
aspirin, morphine, low molecular weight heprin (fondaparinux), stain, ticagrelor, beta blocker, GTN spray
49
what leads to DVT?
immobility, long haul flight, surgery, oral contraceptive pill, pregnancy, cancer, HRT
50
what is the best way to investigate heart valves?
echocardiogram with doppler and ultrasound to visualise structure
51
what are the most common causes of percarditis?
viral infection or autoimmune
52
what are the signs on examination of infective endocarditis?
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
what is the treatment for angina?
GTN spray and a beta blocker or CCB
54
what are the modifiable and non-modifiable risk factors for angina?
modifiable - obease, smoking, high blood pressure, T2DM, high cholestrol non- male, age, family history, hyperlipdeamia
55
what is a side effect of a calcium channel blocker?
ankle swelling
56
what drug may worsen heart failure?
verapamil, calcium channel blocker
57
what are the signs of right-sided heart failure?
peripheral oedema, anorexia, nausea, big face and nosebleeds and ascites
58
what are the signs of left-sided heart failure?
Poor exercise tolerance, nocturia, cold fingers and shortness of breath
59
which valve will most likely be affected in infective endocarditis in an IV drug user?
tricuspid valve - venous blood reaches here first
60
what are the major criteria for infective endocarditis?
Evidence of endocardial involvement (i.e, vegetation visible on transthoracic echocardiogram / transesophageal echocardiogram - presence of C. burnettii is a major criterion)
61
what are the minor criteria for infective endocarditis?
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
what are the complications of infective endocarditis?
pulmonary embolism, kidney damage, | spleen damage, abscess formation, sepsis, heart failure, valvular regurgitation, aortitis, stroke, death
63
what would be seen on the chest x-ray of someone with aortic stenosis?
Cardiomegaly, dilated ascending aorta, pulmonary oedema, calcification of aortic valve
64
what are the symptoms of sepsis?
Fevers, rigors, night sweats, weight loss, anaemia, splenomegaly, clubbing
65
what are the symptoms of chronic limb ischameia?
Hair loss, atrophic skin, brittle / slow-growing nails, ulcers, numbness in feet, absent distal pulses, intermittent claudication
66
what can be done to investigate chronic limb ischaemia?
Contrast angiography / Ankle Brachial Pressure Index. 1 mark for just ‘ABPI’. /Doppler ultrasound.
67
describe arterial ulcers
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
describe venous ulcers?
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
what are the ECG changed in atrial fibrilation?
Absent p waves, variable ventricular rate, absence of [isoelectric] baseline, QRS complex <120ms, fibrilaltory waves
70
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.
cardiac tamponade
71
what is becks triad?
hypotension, distended jugular veins, muffled heart sounds
72
what does the presence of beck's triad indicate?
cardiac tamponade
73
what are investigations that could be done to diagnose cardiac tamponade?
ECG (low voltage QRS), echocardiogram (enlarged cardiac silhouette), CXR, cardiac enzymes
74
The patient is hemodynamically unstable and is sent to A&E for an urgent procedure to relieve the pressure. what is this called?
pericardiocentesis

P2a - Cardiology (17 decks)

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