Rubgy cardio revision

Question 1

In an OSCE what is the most important first question?

Answer 1

Are you in pain just now?

Allows you to identify whether this is ample or a full history

Question 2

In a history what would you want to know about palpitations?

Answer 2

When?
How long for?
Any other symptoms?

Question 3

What is the positioning of the precordial ECG leads?

Answer 3

V1: 4th intercostal space at right border of sternum
V2: 4th intercostal space at left sternal edge
V4: 5th intercostal space midclavicular line
V3: between V2 and V4
V6: 5th intercostal space mid-axillary line
V5: between V4 and V6

Question 4

Occlusion of which arteries affect which surfaces of the heart?

Answer 4

Lateral = circumflex
Anterior = LAD
Septal = LAD
Inferior = RCA

Question 5

Elevation of which leads indicates an MI on the septal, anterior, lateral and inferior surfaces?

Answer 5

Septal: V1 and V2
Anterior: V3 and V4
Lateral: V5, V6, I and aVL (L=lateral)
Inferior: II, III, aVF (F= foot - at the bottom)

Question 6

What do ACE inhibitors do?

Answer 6

Prevent the conversion of angiotensin I to angiotensin II by blocking the angiotensin converting enzyme
Can cause a dry cough (25%)

Question 7

How do ARBs work?

Answer 7

Block the angiotensin II receptor (so no effect on the levels on angiotensin II)

Question 8

Name 2 calcium channel blockers and state which type of muscle they are effective against

Answer 8

Amlodipine + nifedipine

Smooth muscle channel blockers

Question 9

What is the major side effect of Ca channel blockers?

Answer 9

Swollen ankles

Question 10

Name and give an example fo the 2 types of diuretic

Answer 10

Thiazides: bendroflumethiazide
Loop: furosemide (not used for hypertension - good for HF)

Question 11

What are B-blockers used to treat?

Answer 11

Angina (first line),
Hypertension (rarely),
Congestive cardiac failure (caution)
Post MI

Question 12

Name 2 nitrates and explain what they are used to treat?

Answer 12

Glyceryltrinitrate (GTN) - short acting
=> used for angina/IV in MONA+T

Isosorbide mononitrate - long acting
=> acute coronary syndrome/prophylaxis of angina

Question 13

What is the main symptom of digoxin toxicity?

Answer 13

Blurred yellow visioning headache

Question 14

How is a murmur described?

Answer 14

1. Systole or diastole?
2. Type (ejection or pansystolic?)
3. Where is it loudest?
4. Where does it radiate to?
5. What grade?
6. Influenced by respiration?

Question 15

What is the most common murmur?

Answer 15

Aortic stenosis

Question 16

What is the grading of murmurs?

Answer 16

Grade 1: Very quiet - may not be audible
Grade 2: Quiet - audible
Grade 3: Moderately loud
Grade 4: Loud - palpable thrill
Grade 5: Very loud + thrill - audible with stethoscope partially of chest
Grade 6: Very loud + thrill - audible without stethoscope

Question 17

What is the post MI treatment?

Answer 17

Dual antiplatelet therapy
ACEI
B-blocker
Statin

Question 18

What is heart failure and what are it symptoms?

Answer 18

Inadequate cardiac output for the bodies needs

SOB, fatigue, poor exercise tolerance, ankle oedema, nocturnal cough, sleep on pillows (pulmonary oedema)

Question 19

What are the main causes of congestive cardiac failure?

Answer 19

Coronary artery disease,
Hypertension,
Valvular disease,
Post MI

Question 20

How is acute heart failure initially treated?

Answer 20

Sit upright
O2 (high flow)
Investigations
Diamorphine IV
Furosemide IV
GTN (2 puffs)

Question 21

How is the management of acute heart failure increased?

Answer 21

Increase furosemide

CPAP (continuous positive airway pressure)

Question 22

How is chronic heart failure managed?

Answer 22

Furosemide,
ACE inhibitor,
B-blocker,
Spironolactone,
(increase to include digoxin and vasodilators - isosorbine mononitrate)

Question 23

In cardiac arrest which rhythms are shockable and which are not?

Answer 23

SHOCKABLE: pulseless ventricular tachycardia, ventricular fibrillation

NOT SHOCKABLE: asystole, pulseless electrical activity

Question 24

What are the signs of acute limb ischaemia?

Answer 24

6 Ps:
Pain,
Pulseless,
Paraesthesia,
Paralysis,
Pallor,
Perishingly cold

Question 25

What is the difference and the difference in treatment between an arterial and a venous thrombus?

Answer 25

Arterial: white thrombus (PLT rich) - anti platelets (aspirin, clopidogrel, ticegralor)
Venous: red thrombus (RBC rich) - anticoagulants (heparin, warfarin, apixiban)

Question 26

What are the important clotting factors?

Answer 26

2, 7, 9, 10