4.1 E) Congestive Cardiac Failure

Front 1

NYHA Classification has 4 categories T/F

Back 1

True

Front 2

NYHA II = angina /dyspnoea on mild activity T/F

Back 2

False {angina on moderate activity }
NYHA III = angina / dyspnoea on mild activity

Front 3

Which of the following , in regards to Echocardiography in Heart failure is False:
1. Segmental hypokinesia suggests that ischaemia is the cause of cardiac failure
2. Mitral annular calcification is a common finding in elderly patients.
3. the presence of left atrial enlargement suggests that the mitral regurgitation is not acute
4. TR is common in patients with heart failure
5. the normal LVEF is > 60%

Back 3

5. LVEF > 50-55%

Front 4

Which is the most common cause of dilated cardiomyopathy?
1. drugs
2. alcohol
3. idiopathic
4. Familial
5. myocarditis

Back 4

3. Idiopathic

Front 5

In regards to Digoxin in Heart Failure, which is incorrect?
1. It's use is no longer controversial when used with ACEI and diuretic
2. Most likely to benefit those with EF < 20%
3. Most likely to benefit those with S3 Gallop.
4. It increases myocardial contractility
5. It improves mortality.

Back 5

5. Improves symptoms-does not benefit mortality

Front 6

In regards to heart failure and implanted defibrillators, which is incorrect?
1. 50% of patients with cardiac failure die suddenly of a ventricular arrhythmia
2. Detecting a ventricular arrhythmia IS an indication for an implantable defibrillator
3. Survival in heart failure is proven with defibrillators
4. Routine use of implanted defibrillators in CCF and low EF but no documented arrhythmias, does not improve survival.
5. Cardiac failure has a poor prognosis

Back 6

4. Routine use in these patients has been shown to improve survival.

Front 7

which is incorrect in regards to heart failure?
1. Most breathless patients with heart failure have an abnormal Left ventricular systolic function.
2. Abnormal LVSF is characterised by DILATATION and HYPOKINESIS
3. Diastolic Dysfunction = stiff, hypertrophies myocardium that DOES NOT RELAX properly
4. Diastolic heart failure is caused by HTN
5. The Clinical and Echocardiographic diagnosis of diastolic heart failure is usually very clear.

Back 7

5. The diagnosis is usually difficult

Front 8

Which is not a precipitant for Cardiac Failure:
1. high salt intake
2. Arrhythmia
3. hypothyroidism
4. drugs that cause salt and water retention {NSAIDS}
5. pregnancy

Back 8

3. thyrotoxicosis not hypothyroidism

Front 9

The ECG in Heart Failure-which is the least likely?
1. is rarely entirely normal
2. RBBB is a common finding
3. LBBB is a common finding
4. LVH can be seen
5. Arrhythmias are common

Back 9

2. LBBB is common- RBBB less so.

Front 10

Blood tests in heart failure-which is incorrect?
1. hypokalaemia can cause arrhythmais
2. hypernatraemia may indicate severe longstanding cardiac failure
3. hyponatraemia can be a poor prognostic sign in severe heat failure
4. renal impairment can be found on Biochemistry
5. Haematology is a useful test for excluding precipitating causes {eg. anaemia}

Back 10

2. HYPOnatraemia may indicate severe longstanding cardiac failure.

Front 11

CCF and CXR- which is incorrect:
1. Pulmonary venous hypertension is usually due to LVF, mitral stenosis or mitral regurgitation.
2. peribronchial cuffing is a sign of increased interstitial thickening from oedema.
3. Kerley B lines are peripherally placed thickened interlobar septa.
4. Kerley C lines are superiposed Kerley B lines
5. Kerley A lines radiate from the hilar region

Back 11

3. Kerley B lines are thickened INTERLOBULAR septa.

Front 12

CCF and CXR-which is incorrect:
1. Cephalisation is upper zone blood vessel distension
2. Only 2 diseases cause acutely increased interstitial lung markings-interstitial pulmonary oedema and interstitial pneumonitis
3. The perihilar haze on CXR represents airspace pulmonary oedema
4. The 3 stages of CCF on CXR are "cephalisation", "interstitial pulmonary oedema" and "airspace pulmonary oedema."
5. Pulmonary venous hypertension = cephalisation

Back 12

3. NO: Pulmonary venous hypertension causes enlargement of the superior pulmonary veins in the upper portions of the hilum.
Cephalisation is upper sone pulmonary vascular distension.

Front 13

Patient characteristics associated with Noninvasive ventilation Failure : which is incorrect?
1. pH <7.25
2. RR > 30
3. APACHE II <=29
4. Pneumonia / ARDS
5. GCS <=13

Back 13

3. APACHE II > 29

Front 14

Complications of BIPAP/CPAP include all except:
1. aerophagia and vomiting
2. barotrauma
3. pressure necrosis of skin
4. increased nosocomial infections compared with intubated patients
5. Aspiration

Back 14

4. DECREASED nosocomial infections compared with intubated patients

Front 15

In regards to BIPAP and CPAP, which is incorrect:
1. CPAP delivers a variable gas flow to achieve a constant airway pressure {Paw}
2. Increases in IPAP generally increase FRC
3. Increases in EPAP generally increase O2
4. Increases in IPAP will increase Vt
5. Increases in IPAP generally will decrease PCO2.

Back 15

2. Increases in CPAP generally increase FRC