Passmed questions

Question 1

What do you give the person in therms of anticoagulation if they have had an ishcaemic stroke and atrial fibrillation

Answer 1

• Aspirin 300mg OD for 2 weeks then lifelong anti-coagulation

Question 2

what anticoagulation should you give following a stroke

Answer 2

• warfarin or a direct thrombin factor Xa inhibitor should be given
• antiplatelets should only be given if needed for the treatment of other comorbdities
• in acute stroke patients in the absence of haemorrhage anticoagulation therapy should be commenced after 2 weeks

Question 3

A 34-year-old IVDU presented to the Emergency Department due to fever, chills and feeling unwell. Examination revealed vesicular breath sounds, S1 & S2 heart sounds with a murmur.
which following criteria is useful

Answer 3

• fever and a new murmur = so likely bacteria endocarditis thus the duke criteria

Question 4

Name one thing a CPTA is contraindicated in

Answer 4

• renal impairment - thus do a V/Q scan instead

Question 5

What needs to be shown on an ECG in order for a STEMI to take place

Answer 5

• ECG changes for thrombolysis or PCI ST elevation of >2mm in 2 or more consecutive anterior leads (V1-V6)
• ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL)
• or a New left bundle branch block

Question 6

What valve do IV drug users commonly affect in infective endocarditis

Answer 6

• The tricuspid valve

Question 7

After starting an ACE inhibitor…

Answer 7

After starting an ACE inhibitor, significant renal impairment may occur if the patient has undiagnosed bilateral renal artery stenosis

Question 8

What do you give when the patient has bradycardia

Answer 8

• IV atropine - patients with bradycardia and signs of shock require 500 micrograms of atropine repeated up to max of 3mg
• after 3mg of atropine the next step is using transcutaneous pacing

Question 9

In tachyarrhtyhmia when do you do DC cardio version

Answer 9

• do DC cardio version when systolic BP is <90 mmHg
• Shock signs
• syncope
• MI
• heart failure

Question 10

First line treatment for PE

Answer 10

DOAC

Question 11

First line management of acute pericarditis

Answer 11

• NSAID and colchicine

Question 12

How does a posterior MI look like on an ECG

Answer 12

• A posterior MI causes ST depression not elevation on a 12-lead ECG

Question 13

What is Dressler syndrome

Answer 13

Dressler syndrome fits the presentation and the time frame in this instance. It is a condition characterised by an autoimmune response mounted by the body after injury to myocardium or pericardium, in the case of this gentleman - a myocardial infarction. The condition comprises of fever, pericarditis, pleuritic pain +/- pericardial effusion. Dressler syndrome usually occurs between 2 -3 weeks after the initial injury, but can also present a few months later.

Question 14

A 67-year-old male is returned to the ward following a successful cardiac catheterisation procedure. He had presented earlier in the day with an ST-elevation myocardial infarction and was taken straight for primary percutaneous coronary intervention. One hour later, he develops shortness of breath and chest pain. An electrocardiogram (ECG) is performed showing tachycardia with associated narrow QRS complexes which vary in amplitude across all leads.

What is the most likely cause of this patient’s presentation?

Answer 14

Cardiac tamponade

- Electrical alternates is suggestive of cardiac tamponade