passmed

Question 1

what treatment should patients receive if they have an acute stroke (non-hemorrhagic) and have AF ?

Answer 1

> aspirin 300mg d for the first two weeks
will then be switched to clopidogrel 75mg d
after two weeks following his stroke, anticoagulation therapy (ie apixaban)

Question 2

what treatment for haemorrhagic stroke and AF ?

Answer 2

> Warfarin / direct thrombin or factor Xa inhibitor

>anti platelets only if needed for other comorbids.

Question 3

what signs are associated with aortic regurgitation ?

Answer 3

De Musset’s (head bobbing)

early diastolic murmur

collapsing pulse

wide pulse pressure

Quincke’s sign

*symptoms = light headedness, irregular palpitations

Question 4

what is IV adenosine used to treat ?

Answer 4

supreventricular tachycardia (SVT)

a narrow regular complexed tachycardia

*if adenosine is ineffective then try beta blockers

Question 5

how to treat bradycardia ?

Answer 5

IV atropine

Question 6

what is IV amiodarone used to treat ?

Answer 6

broad complex tachycardias - without adverse effects

Question 7

when is synchronised cardioversion required ?

Answer 7

to manage ventricular tachycardias when adverse effects are present and also if IV amiodarone is ineffective

Question 8

how to manage an MI ?

Answer 8

1st = aspirin + clopidogrel / ticagrelor + unfractioned heparin / warfarin in patients about to have PCI

2nd = oxygen therapy

3rd = PCI or thrombolysis if PCI not available

*tPA > streptokinase for thrombolysis

4th = ECG should be performed 90mins after thrombolysis - if resolution then PCI is suggested

Question 9

asthma in any context ?

Answer 9

AVOID BETA BLOCKERS

Question 10

what are the first lines for rate control for AF ?

Answer 10

beta blockers and calcium channel blockers and perhaps digoxin

Question 11

first lines for rhythm control for AF ?

Answer 11

beta blockers

dronedarone

amiodarone

Question 12

how to treat AF if medical therapies are ineffective ?

Answer 12

catheter ablation

*need anticoagulation two weeks prior to procedure

Question 13

what valve is most affected for patient with infective endocarditis ?

Answer 13

tricuspid

Question 14

what should beta blockers not be prescribed concurrently with ?

Answer 14

verapamil

Question 15

angina drug management ?

Answer 15

1st = aspirin , GTN spray

2nd = bBlockers, CCBs

*if CCB used as monotherapy then use a rate limiting one ie verapamil/diltiazem
if used with bBs then use a long acting CCB (nifedipine)
*if patient is symptomatic still with a bB THEN add CBB

3rd = if there is tolerance then up the dosage to maximum (eg atenolol 100mg d)

4th =  if patient is on monotherapy and cannot tolerate either bB or CBB then consider: 
long acting nitrate 
ivabradine 
nicorandil 
ranolazine

Question 16

what anti-hypertensive should you avoid prescribing in patients with diabetes ?

Answer 16

thiazides - worsen glucose tolerance

Question 17

what is pulsus paradoxus ?

Answer 17

an abnormally large drop in BP during inspiration

Question 18

what to do if patient has minor bleeding, their INR is 8.3 and they are on warfarin ?

Answer 18

stop warfarin and prescribe IV vitamin K

repeat dose of vit K if INR is still high after 24 hours

restart warfarin when INR <5.0

Question 19

does infective endocarditis require prophylaxis ?

Answer 19

nopeeeeeee

Question 20

what is used for symptomatic bradycardia if atropine fails ?

Answer 20

external pacing