Quesmed Csfdiology 2

Question 1

What is a contraindication for adenosine in management of adult tachycardia

Answer 1

Asthma due to adenosine stimulating respiratory fibres and causing bronchospasm that results in shortness of breath. Instead, verapamil shold be offered.

Question 2

What is the alternative to adenosine?

Answer 2

Verapamil, a CCB

Question 3

How does cardiac myxoma present?

Answer 3

Arises from the cardiac mesenchyme:
Fatigue
Clubbing
Haemoptysis
Atrial fibrillation
Dyspnoea

Question 4

What is a typical cardiac tumour?

Answer 4

Cardiac myxoma, composed of unspecialised mesenchymal cells, which typically originate in the left atrium. It causes clubbing, fever, weight loss and variable murmur position due to atrial obstruction.

There is a high risk of tumours embolising so surgery is important.

There may be valvular insufficiency of mitral valve, so annuloplasty is required.

Question 5

How is a cardiac myxoma diagnosed?

Answer 5

Echocardiography and cardiac MRI.

Definitive treatment is with surgical removal with a trio Tommy

Question 6

What is cardiac tamponade?

Answer 6

Fluid build up in the pericardial space, which reduces cardiac output and results in hypotension and tachycardia.

Immediate treatment is required through pericardiocentesis

Question 7

What is a key feature of cardiac tamponade e?

Answer 7

Pulsus paradoxus:
During inspiration, the blood pressure , stroke volume and systolic BP will drop more significantly than normal as the negative pressure from inspiration is exacerbated by the fluid build up and causes the interventricular septum to shift to the left.

Question 8

What are the causes of cardiac tamponade?

Answer 8

Chest trauma
Malignancy
Infection

Question 9

What are the clinical features of cardiac tamponade?

Answer 9

Beck’s triad: raised JVP, hypotension and quiet heart sounds.

Coughing, dyspnoea, weakness, chest pain, and abdominal pain

Absent Y descent on JVP.

Tachycardia
Electrical alteran on ECG

Question 10

What is Beck’s triad?

Answer 10

Raised JVP, quiet heart sounds and hypotension

Question 11

What is electric alteran?

Answer 11

QRS complex of different height in cardiac tamponade

Question 12

What is the first line treatment for haemodynamically unstable patient with cardiac tamponade?

Answer 12

Pericardiocentesis
-> there is a risk of pneumothorax

Question 13

When is intervention indicated in aortic stenosis?

Answer 13

Symptomatic patients all require surgical intervention.

Question 14

What causes absent a awaves?

Answer 14

Atrial fibrillation

Question 15

What causes cannon a waves?

Answer 15

Complete heart block, where atria contracts against closed tricuspid valve

Question 16

How does JVP change during breathing?

Answer 16

It drops on inspiration and rises on expiration

Question 17

What causes JVP to rise on inspiration?

Answer 17

Constriction of right heart expansion, known as Kussmaul’s sign. It occurs due to pericardial effusion, tamponade or pericardial constriction

Question 18

What causes absent Y descent on JVP?

Answer 18

Cardiac tamponade due to impaired right ventiruclar filling

Question 19

What are cardiac resyncrhnoisation devices used for?

Answer 19

Heart failure to stop ventiruclar dyssynchrony

Question 20

What is Pulsus parvus et tarsus?

Answer 20

Slow rising weak pulse in aortic stenosis

Question 21

What is Pulsus paradoxus?

Answer 21

Drop in blood and pulse pressure in inspiration due to cardiac tamponade.

Question 22

What is Pulsus bigeminus?

Answer 22

Two pulses occur simultaneously followed by a long gap, associated with digoxin toxicity

Question 23

What is Pulsus bisferiens?

Answer 23

Seen in hypertrophic cardiomyopathy due to systolic anterior valve motion

Question 24

What are the indications for permanent pacing?

Answer 24

Complete heart block
Sick sinus syndrome

Question 25

What is a feature of atrail pacing?

Answer 25

Spike is before P wave

Question 26

What is a feature of ventiruclar pacing?

Answer 26

Spike is before QRS complex

Question 27

How does right ventiruclar pacing present on ECG?

Answer 27

Right bundle branch block

Question 28

How does left ventiruclar pacing present on ECG?

Answer 28

Similar to right bundle branch block

Question 29

What causes a spike before P wave and QRS complex?

Answer 29

Dual chamber pacemaker rhythm

Question 30

What is the cause of an ejection systolic murmur that is quieter when squatting with normal?

Answer 30

Hypertrophic cardiomyoapthy which is loudest at the apex. There would be pansystolic murmur.

Question 31

What is cholesterol embolism?

Answer 31

Cholesterol crystals embolism spontaneously, disrupting blood supply to abdominal viscera. Symptoms include dermatological manifestations like rash across the legs.

Question 32

What is the management for Stanford Typee A aortic dissection?

Answer 32

Surgical intervention

Question 33

What is the management for Type B Stanford aortic dissection?

Answer 33

Managed conservatively with morphine and beta blockers. Evidence of end organ damage should be managed with open repair.

Question 34

What are the clinical signs with aortic dissection?

Answer 34

Radio-radial delay and radio-femoral delay Blood pressure difference between arms

Question 35

What are the complications with aortic dissection?

Answer 35

->Stroke -> Limb ischaemia ->Death due to internal haemorrhage -> Cardiac tamponade -> Mesenteric ischaemia

Question 36

How does left ventricular free wall rupture present?

Answer 36

Rapid hypotension, tachycardia and cardiogenic shock, which generally occurs after an anterior STEMI

Question 37

What is the cause of early diastolic murmur at the left sternal border?

Answer 37

Aortic regurgitation

Question 38

How is potassium adminsitered for patients with heart failure?

Answer 38

Slow infusion over 12 hours

Question 39

Which type of bundle branch block is normal?

Answer 39

Right bundle branch block

Question 40

What is aortic sclerosis associated with?

Answer 40

Age related degeneration best heard in the aortic area, typical in patients under age 60

Question 41

What is the next step in management of patients with stable angina with complex disease?

Answer 41

CABG

Question 42

What is a common presentation with atrial flutter?

Answer 42

Palpitations and lightheadedness

Question 43

Which patients are unfit to undergo PCI?

Answer 43

Those with septicaemia

Question 45

How does acute mitral rerugtitation present?

Answer 45

Auden onset pulmonary oedema Hypotension Cardiogenic shock Fatigue

Question 46

What is a typical cause of ejection systolic murmur?

Answer 46

Aortic stenosis

Question 47

What i a typical cause of pansystolic murmur?

Answer 47

Mitral regurgitation which radiates to axilla.

Question 48

How is mitral regurgitation managed?

Answer 48

Mitral valve repair/valvuloplasty unless complete valve replacement is necessary

Question 49

What is first one for atrial flutter?

Answer 49

Beta blocker OR CCB

Question 50

What is second line for atrial flutter in rate/rhythm control?

Answer 50

Cardioversion

Question 51

What is third line for atrial flutter in rate/rhythm control?

Answer 51

Cardiac ablation

Question 52

How does pulmonary embolism present?

Answer 52

Tachycardia Right ventiruclar strain T wave inversion in inferior leads and anterior leads

Question 53

What is the time frame for papillary muscle rupture?

Answer 53

2-10 days post MI

Question 54

What is the caution for adenosine?

Answer 54

Angina First degree heart block Severe heart failure

Question 55

Which asthma medications cause hypokalemia?

Answer 55

Beta 2 agonists like SABA and LABA

Question 56

How is mild hypokalemia treated?

Answer 56

Oral potassium

Question 57

How is asymptomatic hypokalemia with no ECG changes treated?

Answer 57

IV potassium over 100-12 hours

Question 58

When is IV potassium over 3-4 hours given in hypokalemia?

Answer 58

Patient is symptomatic OR ECG changes and potassium is less than 3.0

Question 59

Whic investigation is ideal for patients with unexplained arrythmias?

Answer 59

7-day ECG Implantable looop recorder

Question 60

What are the causes of pericardial effusion unrelated to pericarditis?

Answer 60

Chest wound Bacterial infection It presents with muffled heart sounds and Beck’s triad

Question 61

What is the character of the pain in pericardial effusion?

Answer 61

Diffuse

Question 62

When is transcutaneous pacing used?

Answer 62

Bradycardia and unresponsive to atropine Post-inferior mI

Question 63

When is permanent pacing used?

Answer 63

Complete heart block Mobitz type 2 heart block Symptomatic type 1 heart block Cardiac resynchrnsiation therapy

Question 64

What are the complications of pacing?

Answer 64

Haemothorax Pneumothorax Heart perforation Thromboembolism Infection

Question 65

What is colchicine?

Answer 65

Anti-gout medication01

Question 66

How should pulseless electrical activity be managed?

Answer 66

CPR with adrenaline IV -> it is a non shockable rhythm

Question 67

When can shock be performed for pulseless electrical a ctivity?

Answer 67

Rhythm on ECG shows ventiruclar tachycardia or ventiruclar fibrillation, then unsynchronised shock can be delivered.

Question 68

Which ECG finding is very specific to acute pericarditis?

Answer 68

PR depression

Question 69

How does phaechromocytoma present?

Answer 69

Headaches, diaphoresis, tremor, palpitations and hypertension

Question 70

How does pericardial effusion present?

Answer 70

Very similarly to cardiac tamponade, however there is electrical alterans on ECG and no change in blood pressure with inspiration.

Question 71

How long can a patient not drive after receiving an implanted cardiac defibrillator as secondary prevention?

Answer 71

6 months

Question 72

What is the definitive treatment for severe symptomatic aortic stenosis?

Answer 72

Aortic valve replacement.

Question 73

What s Spodick’s sign?

Answer 73

Downward sloping T-P lane due to pericarditis

Question 74

What is the definitive treatment for sick sinus syndrome?

Answer 74

Permanent pacemaker

Question 75

What causes a mid-systolic click and systolic murmur?ff

Answer 75

Cardiac arrythmia

Question 76

What is a key risk of cardiac catheterisation?

Answer 76

Emboli travelling to the cerebral circulation resulting in stroke causing neurological deficits

Question 77

What is the normal range for QT interval?

Answer 77

350-450ms

Question 78

What is the cause of syncope on Exertional?

Answer 78

Cardiac arrythmias

Question 79

What is the most common cause of aortic stenosis in a young patient?

Answer 79

Bicuspid aortic valve

Question 80

What is the acute treatment for bradycardia?

Answer 80

500 micrograms of atropine every 3-5 minutes

Question 81

What is the stepwise approach from atropine?

Answer 81

Adrenaline 2-10 micrograms per minute or isoprenaline 5 micrograms per minute If these fail, transcutaneous pacing.

Question 82

What is infective endocarditis linked to?

Answer 82

Regurgitation fo aortic, mitral and tricuspid valve

Question 83

What is the cause of a mid-diastolic murmur loudest when patient lying on their left?

Answer 83

Mitral stenosis,causing irregularly irregular pulse use to atrial fibrillation

Question 84

What is used for the management of narrow tachycardia in patients where adenosine is contraindicated?

Answer 84

Verapamil

Question 85

How should narrow complex tachycardia be managed?

Answer 85

6mg bolus of adenosine Followed by a further 12mg bolus of adenosine 18mg bolus of adenosine -> if unsuccessful, expert help should be sought

Question 86

What findings on the jVP

Question 87

Which medication should be avoided in wolf-Parkinson white syndrome?

Answer 87

Diltiazem because it enhances conduction through accessory pathways