Questions random Flashcards
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?
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.
What features would someone with aortic dissection present with?
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.
What anticoagulant drug do you give someone with AF who has dodgy heart valves?
Warfarin. DOAC is first line for anyone without valvular pathology. DOAC is great because you dont need regular blood tests to check INR.
What risk score assesses bleeding risk after you have assessed CHAD2vasc score?
ORBIT
What electrolyte imbalance can thiazide diuretics cause?
Hyponatraemia and hypokalaemia at the same time
What is Welles’s syndrome, how does it present and how is it treated?
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
Someone has an SVT and 6mg adenosine is given. Does work. What next?
Give 12mg. If still doesn’t work give 18mg. If still doesn’t work cardioversion.
Angina is not being controlled by the beta blockers what should you add?
Long acting calcium channel blockers. Non dihydropyridines ie amlodipine
Someone’s alanine transaminase (ALT) has gone up after taking statins as they had a Qrisk2 score of 15%. Should they stop taking them
Only if it’s increased by three times the recommended limit.
Woman with AF and structural heart disease. Pharmacological cardioversion is agreed on. What med should be given for this?
Amiodarone.
What is a common side effects of thiazide diuretics?
Gout.
What causes rib notching?
Coarction of the aorta. Internal mammary arteries dilate and erode the inferior margins of the ribs.
When should warfarin be stopped before surgery?
5 days. Surgery can commence once INR<2. Warfarin can be started again the evening of the surgery.
What HTN drug can cause ED?
Thiazide-like diuretics ie indapamide.
Should someone with renal disease be given ACEi for HTN?
No, the are CI