Questions random Flashcards

1
Q

An 83-year-old woman has collapsed in her room and you are responding to the medical emergency call.

Just before you arrived, she suddenly collapsed and the nurses managed to get her back into bed and attach monitoring equipment.

She was originally admitted with sinus bradycardia and her bisoprolol has been stopped.

She is barely conscious and you note on the monitor a heart rate of 28/min and a BP of 84/51mmHg.

What is the most appropriate immediate management?

A

The correct answer is to give atropine which is the first-line temporising measure. This works as an anti-cholinergic to block the parasympathetic nervous system and thus increases heart rate. It only lasts a short time so there are more definitive measures that can be used to treat bradycardia such as isoprenaline infusions, temporary pacing or a permanent pacemaker.

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2
Q

What features would someone with aortic dissection present with?

A

In aortic dissection, a pulse deficit may be seen:
- weak or absent carotid, brachial, or femoral pulse
- variation in arm BP
In addition, the patient may also have aortic regurgitation (early diastolic murmur), hypertension or hypotension with features of tamponade or neurological signs with associated pain due to spinal/carotid artery involvement.

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3
Q

What anticoagulant drug do you give someone with AF who has dodgy heart valves?

A

Warfarin. DOAC is first line for anyone without valvular pathology. DOAC is great because you dont need regular blood tests to check INR.

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4
Q

What risk score assesses bleeding risk after you have assessed CHAD2vasc score?

A

ORBIT

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5
Q

What electrolyte imbalance can thiazide diuretics cause?

A

Hyponatraemia and hypokalaemia at the same time

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6
Q

What is Welles’s syndrome, how does it present and how is it treated?

A

Describes critical stenosis of left anterior descending coronary artery (LAD). Presents:
- cardiac sounding chest pain which resolves spontaneously
- deep inverted T waves in V2/3
- absent Q waves
- normal or mildly raised cardiac markers (Troponin)

Treated as a high risk NSTEMI -> PCI

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7
Q

Someone has an SVT and 6mg adenosine is given. Does work. What next?

A

Give 12mg. If still doesn’t work give 18mg. If still doesn’t work cardioversion.

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8
Q

Angina is not being controlled by the beta blockers what should you add?

A

Long acting calcium channel blockers. Non dihydropyridines ie amlodipine

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9
Q

Someone’s alanine transaminase (ALT) has gone up after taking statins as they had a Qrisk2 score of 15%. Should they stop taking them

A

Only if it’s increased by three times the recommended limit.

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10
Q

Woman with AF and structural heart disease. Pharmacological cardioversion is agreed on. What med should be given for this?

A

Amiodarone.

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11
Q

What is a common side effects of thiazide diuretics?

A

Gout.

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12
Q

What causes rib notching?

A

Coarction of the aorta. Internal mammary arteries dilate and erode the inferior margins of the ribs.

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13
Q

When should warfarin be stopped before surgery?

A

5 days. Surgery can commence once INR<2. Warfarin can be started again the evening of the surgery.

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14
Q

What HTN drug can cause ED?

A

Thiazide-like diuretics ie indapamide.

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15
Q

Should someone with renal disease be given ACEi for HTN?

A

No, the are CI

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16
Q

What is a poor prognostic factor of ACS?

A

Cardiogenic shock

17
Q

Is IE causing CHD is a indication for surgery of the valve?

A

Yes

18
Q

What is buergers disease?

A

Strongly associated with smoking. Young person with extremity ischaemia and Reynolds. medium vessel vasculitis

19
Q

Definition of orthostatic HTN?

A

Drop in SBP of SVT least 20 mmhg or DBP of 10 mmhg after 3 mins of standing

20
Q

Is ramipril CI in aortic stenosis?

A

Yes

21
Q

What condition are howell-jolly bodies and target cells seen in?

A

Hypospenism - 1/3 patients with coeliac have hyposplenism

22
Q

What is neutropenic sepsis and what is the treatment?

A

Common complication of chemo. Occurs 7-14 days after treatment. Px with temp and other signs of sepsis. Most common cause = staph epidermis (probably die to all the lines cancer patients have).
treatment = tazocin

23
Q

What is the most common inherited thrombophilia?

A

Factor V Leiden

24
Q

What does direct coombs test test for?

A

Autoimmune Heamolytic anaemia

25
Q

What is the most common type of hodgekins lymphoma?

A

Nodular sclerosing

26
Q

How should you manage a man with low Hb, presenting to GP with tiredness and no other symx?

A

Urgent endoscopy and colonoscopy under 2 week wait.

27
Q

How long is a blood tans fusion given over in a non urgent scenario?

A

90-120 mins

28
Q

If a patient is on atenolol for angina, and cannot tolerate a dihydropyridine CCB, what can be added?

A

Long acting nitrate - ie Ivabradine

29
Q

How often should patients with sickle cell recieve the pneumococcal polysaccharide vaccine?

A

Every 5 years

30
Q

What valve is most affected in IVDU?

A

Tricuspid

31
Q

When can a patient with AF get a cardioversion?

A

If its new onset <48 hours then anticoagulate and give DC cardioversion. Do cardioversion especially if patient has structural heart problems. If onset >48 hours then risk of thromboembolism having formed inside atria is too high. Must obtain a transoesophageal USS before cardio version to exclude a thrombus or anticoagulate for 3 weeks before attempted cardioversion.

32
Q

What heart drug is contraindicated in ventricular fibrillation?

A

Verapamil
Can precipitate severe hypotension, ventricular fibrillation and cardiac arrest