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Finals - Systems Paper > Vascular/Cardiothoracic/Cardiology > Flashcards

Vascular/Cardiothoracic/Cardiology Flashcards

1
Q

Screening aortic aneurysm

A

3-4.4cm 12 months

  1. 5-5.4cm 3 months
  2. 5cm+ 2 week ref
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2
Q

Aortic aneurysm diagnosis

A

US first, then CT angiogram guide surgery

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3
Q

ABPR critical ischaemia

A

<0.3

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4
Q

Critical limb ischaemia features

A

Rest pain >2w
Hanging legs of bed relieves
Gangrene

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5
Q

Diagnose acute limb threatening ischaemia

A

Doppler US then ABPI if positive

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6
Q

Acute limb threatening ischaemia treatment

A

IV heparin and vascular review

Thromolysis or surgery is definitive

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7
Q

Drugs for all patients PAD

A

Atorvastatin 80mg and clopidogrel

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8
Q

DVT diagnosis

A

Well score then proximal leg US, if negative then D dimer

DOAC if delay

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9
Q

Treatment DVT

A

1) DOAC

2) LMWH (dalteparin) followed by warfarin - renal impairment

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10
Q

Venous ulcer treatment

A

Compression bandaging

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11
Q

Aortic dissection diagnosis

A

CT angiography - false lumen

Transoesophageal ECHO if unstable

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12
Q

Aortic dissection treatment

A

A - surgery and control BP

B - control BP

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13
Q

Initial MI treatment

A

MONA:

  • morphine
  • oxygen
  • nitrates
  • aspirin
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14
Q

STEMI - when do PCI and fibrinolysis

A

PCI - within 2 hours or consider after 12h if ongoing ischaemia
Fibrinolysis - within 12h

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15
Q

Antiplatelet therapy before PCI

A

Aspirin and prasugrel, if already taking anticoagulant clopidogrel

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16
Q

Antiplatelet therapy fibrinolysis

A

Fondaparinux during then ticagrelor after procedure

Repeat ECG 60-90m and consider PCI

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17
Q

NSTEMI treatment

A

Fondaparinux if no PCI, unfractionated heparin if PCI

Depends on GRACE risk assessment

  • <3% fondaparinux and dual antiplatelet therapy
  • > 3% PCI, unfractionated heparin and dual antiplatelet therapy
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18
Q

NSTEMI dual antiplatelet therapy

A

GRACE:

  • <3 - ticagrelor and aspirin
  • > 3 - prasugrelor/ticagrelor and aspirin
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19
Q

Antiplatelet therapy in MI if bleeding risk

A

Clopidogrel instead of ticagrelor/prasugrelor

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20
Q

Bradyarrythmia most common after what MI

A

Inferior (II, III, avF)

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21
Q

Identify pericarditis after MI

A

Within 48h

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22
Q

Identify dressler syndrome after MI

A

2-6w after

Basically pericarditis

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23
Q

Dressler syndrome treatment

A

NSAID

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24
Q

Identify ventricuar aneurysm after MI

A

Persistent ST elevation and left ventricle failure

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25
Q

Identify free wall rupture after MI

A

1-2w after

Acute HF secondar to cardiac tamponade - raised JVP, pulses paradoxus (drop in BP when breath in)

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26
Q

Identiify ventrical septal defect after MI

A

1st week

Acute HF and pansystolic murmur

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27
Q

Identify acute mitral regurgitation after MI

A

Due to rupture papillary muscle

Acute hypotension, pulmonary oedema, early to mid systolic murmur

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28
Q

MI secondary prevention

A

All patients:

  • dual antiplatelet therapy, stop second after 12m
  • ACEI
  • beta blocker
  • statin
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29
Q

Stable angina diagnose

A

CT coronary angiography

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30
Q

Stable angina treatment

A

Aspirin
Atorvastatin
GTN
Long term relief

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31
Q

Stable angina long term relief

A

1) Beta blocker or CCB
2) Increase dose
3) Both
4) Consider long acting nitrate

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32
Q

CCB choice in stable angina

A

Monotherapy - rate limiting like verapamil or diltiazam

Dualtherapy - long acting like modified release nefedipine

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33
Q

Pericarditis diagnosis

A

ECG and ECHO

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34
Q

Pericarditis treatment

A

NSAID and colchine

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35
Q

Classification hypertension

A

1) Clinic 140/90 home 135/85
2) Clinic 160/100 home 150/95
3) Clinic 180/120

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36
Q

Hypertension treatment if <55 or T2 diabetes

A

1) ACEI or ARB
2) + CCB or thiazide like diuretic
3) + CCB and thiazide like diuretic
4) + spironolactone if K<4.5, otherwise a blocker or b blocker

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37
Q

Hypertension treatment if >55 or black

A

1) CCB
2) + ACEI or ARB or thiazide like diuretic
3) Follow same as <55

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38
Q

Most common valve infective endocarditis

A

Mitral valve

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39
Q

Cause infective endocarditis

A

Staph aureus

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40
Q

Cause infective endocarditis poor dental hygeine

A

Strep viridans

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41
Q

Cause infective endocarditis valve surgery last 2m

A

Staph epiderdimis

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42
Q

Cause infective endocarditis colorectal cancer

A

Strep bovis

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43
Q

Dukes major

A

Blood culture positive

Evidence on ECHO

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44
Q

Infective endocarditis treatment

A

1) Amoxicillin

2) Vancomycin and gentamin if allergic

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45
Q

Diagnose acute HF

A

ECHO and BNP

46
Q

Treatment acute HF

A

All patients - loop diuretic
Vasodilators if ischaemia
CPAP if resp failure
Inotropes if hypotension - dobutamine or norephinephrine

47
Q

Diagnose chronic HF

A

B type peptide

48
Q

Treatment chronic HF

A

Loop diuretics everyone

1) ACEI and beta blocker
2) Spironolactone and monitor K
3) Varies depending

49
Q

Chronic HF 3rd line in reduced LVEV

A

Ivabradine or sacabitril-valsartan

50
Q

Chronic HF 3rd line in AF

51
Q

Chronic HF 3rd line if black

A

Hydrolazine and nitrate

52
Q

Supraventricular tachy ECG

A

Narrow complex QRS

53
Q

Supraventricular tachy acute treatment

A

1) Vagal maneuvres
2) IV adenosine - 6, 12, 18 or verapamil if asthma
3) Electrical cardioversion

54
Q

Supraventricular tachy prevention

A

Beta blocker

Radio-frequency ablation

55
Q

Types of AF

A

First episode
Paroxysmal - 2 episodes
Persistent - 2 episodes and lasts >7d
Permanent

56
Q

AF rate control

A

1) B blocker
2) CCB
3) Digoxin

57
Q

AF rhythm control

A

1) Betablocker
2) Amiodarone
3) Catheter ablation -4w anticoagulation before and still needs after

58
Q

When is cardioversion done in AF

A

Unstable or failure of treatment

59
Q

When can cardioversion be done in AF

A

If <48h from presentation, if not needs 3w anticoagulation prior

60
Q

Pharmacological cardioversion

A

Amiodarone or flecanaide

61
Q

CHA2DS2VS score

A 
Congestion HF
Hypertension
Age >75 2, age >65 1
Diabetes
Prior stroke or TIA or VTE 2
Vascular disease
Sex female
62
Q

Assess bleeding risk in AF

A

ORBIT score

63
Q

Anticoagulant choice AF

A

1) Doac

2) Warfarin

64
Q

Ventricular tachy ECG

A

Broad complex QRS

65
Q

Ventricular tachy treatment

A

Unstable - cardioversion

Stable - amiodarone

66
Q

Treatment peri arrest brady

A

1) Atropine 500 micrograms
2) Repeat up to 3mg
3) Transcutaneous pacing
4) Transvenous pacing

67
Q

Treatment peri arrest tachy

A

Unstable - up to 3 DC shocks then treat depending on wide or narrow QRS

68
Q

Torsades de pointes ECG

A

Form of ventricular tachy - broad QRS

69
Q

Torsades de pointes treatment

A

IV magneisum sulphate

70
Q

What is WPW

A

Congenital accessory pathway

71
Q

WPW ECG

A

Short PR

Wide QRS with delta wave

72
Q

WPW treatment

A

Radiofrequency ablation accesory pathway

73
Q

Cardiac tamponade triad

A

Becks triad:

  • hypotension
  • raised JVP
  • muffled heart sounds
74
Q

What is cardiac tamponade

A

Accumulation pericardial fluid under pressure

75
Q

Differentiate cardiac tamponade from constrictive pericarditis

A

Tamponade - pulsus paraxous present, kausmaull sign rare (increase in JVP during inspiration)

76
Q

Cardiac tamponade treatment

A

Urgent pericardiocentesis

77
Q

Identify myocarditis

A

Young and acute
Chest pain
SOB

Increased inflammatory, increased cardiac enzymes, increased BNP

78
Q

Myocarditis cause

A

Viral most common - coxsackie, HIV

79
Q

Most common cardiomyopathy

A

Dilated (90%)

80
Q

Identify dilated cardiomyopathy

A

Systolic murmur
S3
Balloon appearance on xray

81
Q

Identify HOCM

A

Exertion SOB
Systolic murmur
Jerky pulse, double apex beat

82
Q

Aortic regurgitation murmur

A

Early diastolic

83
Q

Aortic regurgitation pulse

A

Collapsing pulse

Wide pulse pressure

84
Q

Aortic stenosis murmur

A

Ejection systolic

85
Q

Aortic stenosis pulse

A

Slow rising pulse

Narrow pulse pressure

86
Q

When consider surgery in valve disease

A

Symptomatic or valvular gradient >40

87
Q

Mitral regurgitation murmur

A

Pansystolic

88
Q

Rheumatic fever most common valve problem

A

Mitral stenosis

89
Q

Mitral stenosis murmur

A

Mid/late diastolic murmur

90
Q

Mitral stenosis pulse

A

Low volume pulse

91
Q

Tricuspid regurgitation murmur

A

Pansystolic

92
Q

Tricuspid regurgitation cause

A

Pulmonary hypertension (eg COPD)

93
Q

Drugs in life support

A

Adrenaline 1mg every 3-5m

Amiodarone 300mg after 3 shocks, then 150mg after 5

94
Q

Atrial septal defect murmur and heart sounds

A

Ejection systolic

Splitting S2

95
Q

Driving after ACS

A

4 weeks later

96
Q

Driving aortic aneurysm

A

Cant >6.5cm

97
Q

What is rheumatic fever

A

Immunological reaction 2-6w after strep pyogene infection

98
Q

Statins primary and secondary prevention

A

Primary - atorvastatin 20mg

Secondary - atorvastatin 80mg

99
Q

Warfarin and major bleeding

A

Stop warfarin

IV vit K 5mg and prothrombin complex

100
Q

INR >8 and minor bleeding

A

Stop warfarin
IV vit K 1-3mg
Restart when INR < 5

101
Q

INR >8 and no bleeding

A

Stop warfarin
IV vit K BY MOUTH
Restart when INR < 5

102
Q

INR 5-8 and no bleeding

A

Withhold 1 or 2 doses warfarin

Restart after

103
Q

Digoxin ECG

A

Downslopping ST depression
Flattened/inverted T waves
Decrased QT interval
Brady

104
Q

Hypokalaemia ECG

A

U waves
Small T waves
Increased PR

105
Q

Hyperkalaemia ECG

A

Peaked T waves
Broad QRS
Sinusoidal if severe

106
Q

Hypothermia ECG

107
Q

Always pathological on ECG

108
Q

Infective endocarditis normally affects

A

Mitral valve

Tricuspid valve in IVDU

109
Q

ECG in cor pulmonale

A

Electrical alterans (alterating height QRS)

110
Q

Pulse with headbobbing

A

Aortic regurgitation

111
Q

Valve disease in marfans

A

Aortic regurgitation

Finals - Systems Paper (20 decks)

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