mock questions Flashcards
what should be given to an MI patient?
aspirin and a PY12 inhibitor (ticagrelor)
what type of drug is aspirin?
antiplatelet - COX inhibitor
describe the pharmacology of spironolactone
Inhibition of aldosterone receptor in the distal tubules
what are the risk factors for hypertension?
High caffeine consumption, sedentary lifestyle, smoking and type A personality
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?
mitral regurgitation
what ECG changes are likely to be seen in an MI?
ST elevation, ST depression
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?
ramapril
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?
atrial fibrillation
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?
QRISK2 score
what is the order of the electrical conduction of the heart?
. SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches ->
ventricles
what is the CHADS-VASc score?
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)
what would give a collapsing pulse and an early diastolic decrescendo murmur?
aortic regurgitation
what would give an irregularly irregular pulse?
atrial fibrillation
what is pulsus paradox?
BP drops significantly during inspiration, seen in severe Asthma, COPD, blood
loss and cardiac conditions.
what is radio-radial delay?
pulse is significantly stronger in one arm than the other and is seen in
coarctation of the aorta.
what would give an ejection systolic crescendo decrescendo murmur, a slow rising pulse and a narrow pulse pressure?
aortic stenosis
what would give an apical pansystolic murmur?
mitral regurgitation
what would give an apical mid diastolic rumble?
mitral stenosis
what would give an ejection systolic murmur heard loudest on inspiration?
pulmonary stenosis
what are the cardinal signs of heart failure?
Shortness of breath, fatigue, ankle oedema
what is the first line treatment for a patient with hypertension who is over 55 or is of afrocarribean descent?
calcium channel blocker
what does a right bundle branch block look like on an ECG?
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).
what does a left bundle branch block look like on an ECG?
= 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.
what are the 4 key features of tetralogy of fallow?
ventricular septal defect, pulmonary stenosis,
hypertrophy of the right ventricle and overriding aorta
what are the distinctive signs of infective endocarditis?
splinter haemorrhages, Osler’s nodes, Janeway lesions,
Roth spots and fever
what causes a third heart sound?
volume overload
what causes a forth heart sound?
pressure overload
what should a PR interval be normally?
200ms
what are the signs of first degree heart block?
prolonged PR interval, asymptomatic
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
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
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
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)
what are the signs of RBBB?
MarroW (V1, V6), wide QRS
what are the signs of LBBB?
WilliaM (V1, V6), wide QRS, never in healthy heart
what is the gold standard investigation for a pulmonary embolism?
pulmonary angiogram, echocardiogram if contraindicated - e.g. haemodynamically unstable
what is dressler’s syndrome?
pericarditis 2-12 weeks after heart attack, PR depression, St elevation, low QRS voltage, raised JVP
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
what would suggest tricuspid regugitation rather than mitral?
pitting oedema, lung NOT affected, right sided heart failure, louder on inspiration
what is claudication?
pain in feet or toes when exercising
what is burger’s test?
if positive - shows new onset ischaemia
what is the most important first line treatment for septic shock?
fluids - to stop heart failure
what is the order of conduction through the heart?
SA node (in atria, main pacemaker), AV node, bundle of his, purkinje fibres, ventricles
what is the most common congenital heart defect?
ventricular septal defect, causes a left to right shunt, oxygenated blood enters right ventricle
how does atherosclerosis lead to angina?
fibrous and lipid rich plaques in coronary arteries leading to blood vessel occlusion
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))
what problems can arise due to atherosclerosis?
MI, ischaemic stroke, critical limb ischaemia, sudden CV death
what drugs would you give for a ACS?
aspirin, morphine, low molecular weight heprin (fondaparinux), stain, ticagrelor, beta blocker, GTN spray
what leads to DVT?
immobility, long haul flight, surgery, oral contraceptive pill, pregnancy, cancer, HRT
what is the best way to investigate heart valves?
echocardiogram with doppler and ultrasound to visualise structure
what are the most common causes of percarditis?
viral infection or autoimmune
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
what is the treatment for angina?
GTN spray and a beta blocker or CCB
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
what is a side effect of a calcium channel blocker?
ankle swelling
what drug may worsen heart failure?
verapamil, calcium channel blocker
what are the signs of right-sided heart failure?
peripheral oedema, anorexia, nausea, big face and nosebleeds and ascites
what are the signs of left-sided heart failure?
Poor exercise tolerance, nocturia, cold fingers and shortness of breath
which valve will most likely be affected in infective endocarditis in an IV drug user?
tricuspid valve - venous blood reaches here first
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)
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.
what are the complications of infective endocarditis?
pulmonary embolism, kidney damage,
spleen damage, abscess formation, sepsis, heart failure, valvular regurgitation, aortitis, stroke, death
what would be seen on the chest x-ray of someone with aortic stenosis?
Cardiomegaly, dilated ascending aorta, pulmonary oedema, calcification of aortic valve
what are the symptoms of sepsis?
Fevers, rigors, night sweats, weight loss, anaemia, splenomegaly, clubbing
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
what can be done to investigate chronic limb ischaemia?
Contrast angiography / Ankle Brachial Pressure Index. 1 mark for just ‘ABPI’. /Doppler ultrasound.
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
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
what are the ECG changed in atrial fibrilation?
Absent p waves, variable ventricular rate, absence of [isoelectric] baseline, QRS complex <120ms, fibrilaltory waves
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
what is becks triad?
hypotension, distended jugular veins, muffled heart sounds
what does the presence of beck’s triad indicate?
cardiac tamponade
what are investigations that could be done to diagnose cardiac tamponade?
ECG (low voltage QRS), echocardiogram (enlarged cardiac silhouette),
CXR, cardiac enzymes
The patient is hemodynamically unstable and is sent to A&E for an urgent
procedure to relieve the pressure. what is this called?
pericardiocentesis
