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Exams - Cardio (Megan) > Passmedicine Questions > Flashcards

Passmedicine Questions Flashcards

1
Q

What is the most common valvular disease after infective endocarditis?

A

Aortic regurgitation

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2
Q

What sort of murmur is aortic regurgitation?

A

High pitched, early diastolic murmur

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3
Q

What signs are seen in aortic regurgitation?

A

Murmur increased by hand gripping manoeuvre
Collapsing pulse
wide pulse pressure
quinckes sign (nailed pulsation)

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4
Q

What is the management of aortic regurgitation?

A

medical management of associated heart failure

Aortic valve surgery if:
Symptomatic patients with severe AR
Asymptomatic patients with severe AR and LV systolic dysfunction

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5
Q

What are examples of ACE inhibitors?

A

Rampril

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6
Q

What are examples of calcium channel blockers?

A

Amlodipine
Verapamil
Diltiazem
Nifedipine

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7
Q

What are examples of thiazide-like diuretics?

A

Indapamine

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8
Q

What is step 4 of treating hypertension?

A

Potassium <4.5 - add low dose spironolactone
Potassium >4.5 - add alpha or beta blocker

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9
Q

what does an atrial septal defect sound like?

A

Ejection systolic murmur louder on inspiration

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10
Q

What does aorta stenosis sound like?

A

High pitched ejection systolic murmur (louder on expiration)

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11
Q

What does pulmonary stenosis sound like?

A

Ejection systolic murmur (louder on inspiration)

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12
Q

What does mitral regurgitation sound like?

A

High pitched pansystolic murmur (louder on expiration)

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13
Q

What does mitral stenosis sound like?

A

Low pitched rumbling mid diastolic murmur

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14
Q

What does tricuspid regurgitation should like?

A

High pitched pan systolic murmur (louder on inspiration)

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15
Q

What is the medical management of stable angina?

A
  1. CCB or Beta-blocker
  2. Use in combination ^
  3. If patient is on mono therapy and can’t tolerate the addition of the other: Long acting nitrate, ivabradine, nicorandil or ranolazine

CCB:
- mono therapy: Use rate limiting eg verapamil or diltiazem
- if used in combination with beta-blocker: Use amlodipine or modified released nifedipine
- DONT USE BETA BLOCKER WITH VERAPAMIL (complete heart block)

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16
Q

What should be done for standard release isosorbide mononitrate?

A

Asymmetric dosing to maintain nitrate free time of 10-14 hours

(not needed for once daily modified release isosorbide mononitrate)

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17
Q

What is the STEMI Criteria?

A
  1. Clinical symptoms of ACS (>20 mins duration and >20 mins persistent ECG leads).
  2. ECG changes must be in > or equal to 2 continuous leads
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18
Q

What should the elevation be of V2 and V3 in women?

A

1.5 mm

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19
Q

What should the elevation be of V2 and V3 in men under 40 years?

A

2.5mm

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20
Q

What should the elevation be of V2 and V3 in men over 40?

A

2mm

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21
Q

What should the ST elevation be in any other leads?

A

1mm

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22
Q

What else is classed as a STEMI?

A

A new LBBB

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23
Q

What are the components of the CHA2DS2-VASc score?

A

Congestive heart failure - 1
Hypertension - 1
Age >75 - 2
Diabetes - 1
Stroke TIA or thromboembolism - 2
Vascular disease (IHD, PAD) - 1
Age 65-74 - 1
Sex (female) - 1

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24
Q

How is the CHADVASc scores interpreted?

A

0 - no anticoagulation
1- consider anticoagulation in males, note females
2 or more - offer anticoagulation

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25
Q

What are the components of the ORBIT score?

A

Haemoglobin <130 in males and <120 in females OR Haemaocrit <40% in males and <36% in females - 2

Age >74 years - 1

Bleeding history (GI, intracranial or haemorrhage stroke) - 2

Renal impairment (GFR <60ml) - 1

Treatment with anti platelets - 1

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26
Q

How is the ORBIT score interpreted?

A

0-2 LOW RISK (2.4 bleeds per 100 patient years)

3 MEDIUM RISK (4.7 bleeds per 100 patient years)

4-7 HIGH RISK (8.1 bleeds per 100 patient years)

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27
Q

Which anticoagulant is used in AF?

A

1st line: DOAC
2nd line: Warfarin (Not LMWH)

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28
Q

What are the side effects of ACE inhibitors?

A

Cough (may occur up to 1 year after starting treatment)
Angioedema (may occur up to 1 year after starting treatment)
Hyperkalaemia
First dose hypotension
Renal impairment (if undiagnosed renal artery stenosis)

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29
Q

What are the causes of RBBB?

A

Normal variant (more common with increasing age)
Right ventricular hypertrophy
Cor pulmonale
Pulmonary embolism
MI
Atrial septal defect
cardiomyopathy
myocarditis

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30
Q

What is important to remember about ACE inhibitors?

A

They are BAD in AKI
They are GOOD (renoprotective) in CKD

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31
Q

What are examples or Angiotensin Receptor Blockers?

A

Candersartan
Losartan

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32
Q

What is the management for hypertrophic obstructive cardiomyopathy?

A

ABCDE
Amiodarone
Beta blocker (or verapamil) for symptoms
Cardioverter defibrillator
Dial chamber pacemaker
Endocarditis prophylaxis

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33
Q

What is stage 1 hypertension?

A

Clinic BP >140/90
ABPM >135/85

Treat ONLY if <80 yrs

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34
Q

What is stage 2 hypertension?

A

Clinic >160/100
ABPM >150/95

Treat at any age

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35
Q

Severe hypertension?

A

Clinic systolic BP >180
Clinic diastolic BP >120

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36
Q

What is the cause of mitral stenosis?

A

Rheumatic fever

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37
Q

What are examples of thiazides?

A

Bendroflumethiazide

38
Q

What are the indications for urgent valvular surgery in infective endocarditis?

A

Severe congestive heart failure
Infections resistant to antibiotics
Recurrent emboli after antibiotic therapy
severe valvular incompetence
aortic abscess

39
Q

What is the major criteria for Dukes Criteria?

A

Persistently positive blood cultures
Specific imaging findings (like vegetation seen on ECHO)

40
Q

What is the minor Dukes criteria

A

Predisposition (heart pathology or IVDU)
Fever above 38 degrees
Vascular phenomena (laneway lesions, splenic infarction or intracranial haemorrhage)
Immunological phenomena (oilers nodes, Roth spots, glomerulonephritis)
Microbiological phenomena (Positive cultures not qualifying as major criteria)

41
Q

What is the Dukes criteria for?

A

To diagnose infective endocarditis

42
Q

How many of the dukes criteria is required for a diagnosis?

A

One major + 3 minor criteria

OR

5 Minor criteria

43
Q

What is the treatment for infective endocarditis?

A

IV broad spectrum antibiotics: amoxicillin or gentamicin

4 weeks for own heart valves
6 weeks for prosthetic heart valves

44
Q

What is the treatment for infective endocarditis?

A

IV broad spectrum antibiotics: amoxicillin or gentamicin

4 weeks for own heart valves
6 weeks for prosthetic heart valves

45
Q

When should you offer anticoagulation in AF?

A

Women CHADSVASc score >2
Males CHADSVASc score >1

46
Q

What is a common cause of hypertension in young adults?

A

Coarctation of the aorta
Renal artery stenosis - no murmur- late systolic murmur

47
Q

What is the WELLS score for PE?

A

Clinical signs of DVT (leg swelling and pain on palpation of deep veins) - 3

An alternative diagnosis is less likely than PE - 3

Heart rate >100BPM - 1.5

Immobilisation >3 days or surgery in the last 4 weeks - 1.5

Previous DVT/PE - 1.5

Haemoptysis - 1

Malignancy (on treatment, treatment in the last 6 months or palliative) - 1

48
Q

What are the investigations for PE?

A

Likely >4 points:

  • Immediate CTPA (ONLY give anticoagulation if there will be a delay in the scan)
  • If this is negative do a proximal leg vein ultrasound if DVT is still suspected

PE Unlikely <4 points:
- Arrange a D-Dimer
- If this is positive, arrange an immediate CTPA (only give anticoagulation if theres a delay)
- If negative, PE unlikely, stop anticoagulation and consider alternative diagnosis

49
Q

What is the treatment for Heart failure with reduced LVEF?

A

ABAL

1st line:
- ACE Inhibitor and Beta blocker (start one at a time)

2nd line:
- Aldosterone antagonist (spironolactone or eplerenone)
- Consider SGLT2 Inhibitor (gliflozin)

3rd line:
- Loop diuretic (symptomatic control only)

Other”
Annual flu vaccine
One off pneumococcal vaccine

50
Q

What is normal left ventricular ejection fraction?

A

45-60%

51
Q

What is allowed when starting an ACE inhibitor?

A

Increase in creatinine of 30% from baseline
Increase in potassium up to 5.5

52
Q

What ECG Changes are seen in acute pericarditis?

A

Most commonly - Widespread ST elevation
Most specifically - PR depression

53
Q

What test should all patients with suspected pericarditis have?

A

Transthoracic echocardiography

54
Q

What is the management of acute pericarditis?

A

NSAIDs and Colchicine

55
Q

what is the treatment for tornadoes des pointes?

A

Magnesium sulphate

56
Q

What are common side effects of beta blockers?

A

Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances, insomnia, nightmares
Erectile dysfunction

57
Q

Which medication cannot be prescribed with a beta-blocker?

A

Verapamil - can cause severe bradycardia (complete heart block)

58
Q

Which medication cannot be prescribed with a beta-blocker?

A

Verapamil - can cause severe bradycardia (complete heart block)

59
Q

Where do the loop diuretics target?

A

Ascending loop of Henle

60
Q

What is the most important risk factor for aortic dissection?

A

Hypertension

61
Q

What is the most important risk factor for abdominal aortic aneurysm?

A

Smoking

62
Q

What is the classic triad of symptoms that are seen in a ruptured abdominal aortic aneurysm?

A

Epigastric pain
Hypotension
Pulsatile mass in the abdomen

63
Q

What should be checked when a patient is on a statin

A

LFTs
- At baseline
- 3 months
- 12 months

64
Q

what should be checked when a patient is on an ACE inhibitor

A

U and Es
- Prior to treatment
- after increasing dose
- at least annually

65
Q

what is the adrenaline dose for paediatric anaphylaxis

A

< 6 months - 100 - 150 micrograms (0.1 - 0.15 ml 1 in 1,000)

6 months - 6 years - 150 micrograms (0.15 ml 1 in 1,000)

6-12 years - 300 micrograms (0.3ml 1 in 1,000)

Adult and child > 12 years - 500 micrograms (0.5ml 1 in 1,000)

66
Q

what are examples of things that cause transudate pleural effusions

A

Congestive heart failure
Liver cirrhosis
Severe hypoalbuminaemia
Nephrotic syndrome

67
Q

what are things that cause exudative pleural effusions

A

Malignancy
Infection
Trauma
Pulmonary infarction
Pulmonary embolism

68
Q

How to tell if a fluid is transudate or exudate

A

Transudate:
Protein <30g/L

Exudate:
Protein >30g/L

69
Q

What is Lights criteria for exudative effusions

A

The fluid is considered as exudate if:
1. The ratio of pleural fluid:serum protein is >0.5
2. The ratio of pleural fluid:LDH is >0.6
3. The pleural fluid LDHH value is greater than 2/3rds of the upper limit of the normal serum value

70
Q

what are the two types of ventricular tachycardia

A
  1. Monomorphic VT = caused by a myocardial infarction
  2. Polymorphic VT = A subtype of polymorphic is tornadoes de pointes
71
Q

What is the management of ventricular tachycardia

A

if adverse signs present (systolic BP <90, chest pain, heart failure):
- Immediate cardioversion (antiarrhythmatics)
- if these fail - use electrical cardioversion

Drug therapy:
- amiodarone (through a central line)
- Lidocaine

DO NOT USE VERAPAMIL

72
Q

what are the common tumour markers to be aware of

A

Ovarian cancer - CA125
Pancreatic cancer - CA19-9
Breast Cancer - CA 15-3

73
Q

what are other common tumour markers to be aware of

A

Prostate carcinoma - PSA
Hepatocellular carcinoma, teratoma - AFP
Colorectal cancer - CEA
SCLC, gastric cancer, neuroblastoma - Bombesin
Melanoma, schwannoma - S-100

74
Q

What are examples of immune checkpoint inhibitors and what do they do

A

They are used to treat solid tumours. They are a type of immunotherapy.

Ipilimumab
Nivolumab
Atezollizumab

75
Q

what is trastuzumab

A

A monoclonal antibody directed against the HER2/neu receptor.

Cardiotoxic
flu like symptoms and diarrhoea are common

76
Q

what imaging is used to diagnose idiopathic pulmonary fibrosis

A

High-resolution CT scanning

77
Q

what is the treatment for meningitis

A

IV antibiotics:
- <3 months >50 years = Cefotaxime (or cefrtiaxone) + Amoxicillin (or ampicillin)
- 3 months - 50 years = Cefotaxime (or ceftriaxone)

IV Dexamethasone - AVOID in meningococcal septicaemia

78
Q

What is the prophylactic treatment for bacterial meningitis

A

Given if close contact within 7 days before onset

Oral ciprofloxacin or rifampicin.

79
Q

When should acetylcysteine be given for paracetamol overdoses

A
  • Staggered overdose (>1 hour)
  • patients who present 8-24 hours after taking more than 150mg/kg
  • present >24 hours after if they are jaundiced, hepatic tenderness, ALT is upper limit of normal
  • The plasma paracetamol concentration is on or above a single treatment line
80
Q

How is acetylcysteine given

A

IV infusion >1 hour - to reduce the number of adverse effects.

Can cause anaphylactoid reaction - stop infusion and restart at a slower rate.

81
Q

What is the treatment for an aspirin (salicylate) overdose?

A

Charcoal

82
Q

What is the treatment for opioid overdose

A

PINPOINT PUPILS

Acute emergency:
IV or IM naloxone

Opioid detoxification:
Methadone or buprenorphine

83
Q

What is the treatment for trigeminal neuralgia

A

First-Line:
Carbamazepine

Failure to respond to treatment or <50:
Refer to neurology

84
Q

What is an empyema

A

When a pleural effusion contains pus

pH <7.2
Low glucose <3.4
High LDH >200

85
Q

When can activated charcoal be used in a paracetamol overdose

A

If the paracetamol was ingested <1 hour ago

86
Q

What is the management of carbon monoxide poisoning

A

100% high flow oxygen via a non-rebreathe mask, continued for at least 6 hours

Should be continued until all symptoms have resolved (rather than monitoring CO levels)

87
Q

which antibiotic is contraindicated in G6PD

A

ciprofloxacin

88
Q

what is the mechanism of action of warfarin

A

inhibits epoxide reductase preventing the reduction of vitamin K to its active hydroquinone form

this in turn acts as a cofactor in the carboxylation of clotting factor II, VII, IX and X (mnemonic = 1972) and protein C.

89
Q

what is the mechanism of action of low molecular weight hepatin

A

Activates antithrombin III. Forms a complex that inhibits factor Xa

90
Q

what can cause serotonin syndrome

A

MAOI
SSRI
St Johns wort
Tramadol
Ecstasy
Amphetamines

91
Q

what can be used for migraine prophylaxis

A

Propanolol

Second line - Topiramate

Exams - Cardio (Megan) (11 decks)

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