14/06 Flashcards

(214 cards)

1
Q

anterior MI

A

v1-v4
left anterior descening

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2
Q

lateral MI

A

V5-V6, I
left circumflex

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3
Q

inferior MI

A

II,III and AVF
right coronary artery

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4
Q

mx of ACS

A

Morphine - if pt in pain
Oxygen - if pt hypoxic
Nitrates - caution in hyPOtension
Aspirin 300mg

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5
Q

when should be PCI be offered in STEMI

A

presentation within 12 hrs of symptom onset + can be delivered within 120 mins

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6
Q

PCI

A

drug eluting stents through radial access

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7
Q

what to do after fibrinolysis

A

repeat ECG within 60-90 mins and PCI if still changes

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8
Q

what is used to stratify risk post MI

A

kilip class

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9
Q

termination of supraventricular tachys

A

adenosine (avoid in asthma)

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10
Q

epsilon wave

A

Arrhythmogenic right ventricular cardiomyopathy

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11
Q

S2A2DCHAVS

A

S2 - prior stroke, TIA or thromboembolism
A2 - age >=75
D - diabetes
C - congestive HF
H - hypertension or treated hypertension
A - age 65-74
V - vascular disease
S - sex female

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12
Q

MI cardiac enzymes

A

myoglobin is first to rise
CK-MB useful to look for re-infarction

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13
Q

chronic heart failure diagnosis

A

N-terminal pro-B-type natriuretic peptide (NT‑proBNP)
high levels - specialist assessment ECHO 2 weeks
raised levels - specialist assessment ECHO 6 weeks

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14
Q

chronic heart failure first line

A

ACEi and BB

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15
Q

chronic heart failure second line

A

aldosterone antagonist and SGLT2 inhibitor

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16
Q

chronic heart failure third line

A

ivabradine
sacubitril-valsartan
digoxin
hydralazine + nitrate
cardiac resync therapy

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17
Q

coarctation of the aorta features

A

HTN
radio-femoral delay
mid-systolic murmur maximal over the back
apical click from the aortic valve
notching of the inf border of the ribs

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18
Q

acute heart failure mx

A

IV loop diuretics
oxygen
nitrates if heart disease
cpap if resp failure

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19
Q

acute heart failure hypotension

A

ionotropic agents eg dobutamine
vasopressor agents eg norepinephrine
mechanical circulatory assistance

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20
Q

left heart failure

A

pulmonary oedema
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
bibasal fine crackles

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21
Q

right heart failure

A

peripheral oedema
ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia (‘cardiac cachexia’)

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22
Q

when is s3 normal

A

pts less than 30 (sometimes women up to 50)

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23
Q

path s3

A

left ventricular failure (e.g. dilated cardiomyopathy) constrictive pericarditis (called a pericardial knock)
mitral regurgitation

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24
Q

s4

A

aortic stenosis
HOCM
hypertension

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25
aortic valve
right second intercostal space upper sternal border
26
pulmonary valve
left second intercostal space upper sternal border
27
mitral valve
Left fifth intercostal space just medial to mid clavicular line
28
tricuspid valve
left fifth intercostal space lower left sternal border
29
most common lymphoma
diffuse large b cell
30
foot drop after hip arthroplasty nerve injury
sciatic
31
crypt abscesses
ulcerative colitis
32
TCA overdose
bicarbonate
33
lateral epicondylitis
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
34
medial epicondtlitis
pain is aggravated by wrist flexion and pronation
35
SVT mx
vagal manouvres adenosine electrical cardioversion
36
contraindications to statins
pregnancy macrolides eg erythromycin, clari
37
HOCM mx
Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis
38
suspected aortic dissection in unstable pt
trans OESOPHAGEAL echo
39
assess severity of liver cirrhosis
Child-Pugh classification
40
head injury lucid interval
extradural haematoma
41
most specific ecg finding in acute pericarditis
PR depression
42
upper GI bleed score
glasgow blatchford scoring after endoscopy - rockall score
43
tx of alchoholic ketoacidosis
IV saline and thiamine infusion
44
alcoholic liver disease LFTS
gamma-GT >>>> AST:ALT is normally > 2
45
alcoholic hepaitis mx
steroids eg pred pentoxyphylline
46
achalasia diagnosis
oesophageal manometry
47
achalasia tx
pneumatic balloon dilatation heller cardiomyotomy or botox injection
48
main side effect of 5ASAs
haem eg agranulcytosis so monitor FBC
49
SAAG <11 causes
hypoalbuminaemia malignancy infections
50
SAAG >11 causes
liver disorders cardiac disorders lack of blood flow eg Budd chairi, veno-occlusive disease
51
what does high saag indicate
portal hypertension
52
mx of ascites
reduce dietary sodium sometimes fluid restrict aldosterone antagonists drainage if tense ascites antibiotic prophylaxis with ciprofloxacin or norfloxacin TIPS
53
AI hep antibodies
ANA/SMA/LKM1 antibodies, raised IgG levels
54
bile acid malabsorption presentation
chronic diarrhoea
55
bile acid malabsorption test
SeHCAT
56
bile acid malabsorption tx
bile acid sequestrants e.g. cholestyramine
57
carcinoid tumours invx
urinary 5-HIAA plasma chromogranin A y
58
carcinoid tumours tx
somatostatin analogues e.g. octreotide
59
coeliac disease gold standard invx
Endoscopic intestinal biopsy
60
inducing remission in crohns
glucocorticoids enteral feeding with elemental diet 2nd line - 5 ASAs azathioprine or mercaptopurine infliximab - fistulating disease
61
crohns isolated peri-anal disease
metronidazole
62
complex fistulae
draining seton
63
diverticulitis mx
mild - oral abx severe - nil by mouth, IV fluids, iv abx
64
gallstones invx
USS and LFTs
65
acute cholecytitis
Right upper quadrant pain Fever Murphys sign on examination
66
gallbladder abscess
Usually prodromal illness and right upper quadrant pain Swinging pyrexia Patient may be systemically unwell
67
cholangitis
Patient severely septic and unwell Jaundice Right upper quadrant pain
68
cholangitis mx
Fluid resuscitation Broad-spectrum intravenous antibiotics Correct any coagulopathy Early ERCP
69
gallstone ileus
known gallstones Small bowel obstruction (may be intermittent)
70
gallstone ileus mx
Laparotomy and removal of the gallstone from small bowel,
71
risks of ERCP
Bleeding Duodenal perforation Cholangitis Pancreatitis
72
screen for haemachromatosis
general pop - transferrin sat fam member - genetic testing for HFE mutation
73
haemachromatosis iron study
>> transferrin and ferriting << TIBC
74
h pylori eradication
PPI + amox + (clarithromycin OR metronidazole) if pen-allergic: PPI + metronidazole + clarithromycin
75
hepatic encephalopathy mx
lactulose and rifaximin
76
wilsons disease invx
slit lamp examination for Kayser-Fleischer rings reduced serum caeruloplasmin reduced total serum copper free serum copper is increased increased 24hr urinary copper excretion ATP7B gene
77
mx wilsons
pencillamine
78
in controlled drugs what needs to be stated in words and figures
quantity
79
AKI poor response to fluid challenge
acute tubular necrosis
80
dpp4 inhibitors
gliptins
81
IBS tx
pain: antispasmodic agents constipation: laxatives but avoid lactulose diarrhoea: loperamide is first-line second line = TCAs
82
mesenteric ischaemia
typically small bowel due to embolism sudden onset, severe urgent surgery high mortality
83
ischaemic colitis
large bowel multifactorial transient less severe symptoms, bloody diarrhoea thumbprinting conservative mx
84
screening for cirrhosis in chronic liver disease
transient elastography
85
screening for cirrhosis in NAFLD
enhanced liver fibrosis blood test
86
pancreatic cancer imaging
CT scan double duct sign
87
peptic ulcer bleeding vessel
gastroduodenal artery
88
primary biliary cholangitis bloods
anti-mitochondrial antibodies raised IgM
89
small bowel bacterial overgrowth syndrome tx
rifaximin
90
SBP tx
intravenous cefotaxime
91
benzo overdose
flumazenil
92
mesothelioma
histology, following a thoracoscopy
93
what is ARDS
non-cardiogenic pulmonary oedema
94
subacute combined degeneration of the spinal cord
Distal sensory loss, tingling absent ankle jerks/extensor plantars gait abnormalities/Romberg's positive
95
hiv, ct brain ring enhancement
toxoplasmosis
96
achalasia cancer
squamous cell
97
ileostomy
right iliac fossa spouted liquid output
98
colostomy
more likely L side abdo flushed solid output
99
loop ileostomy
defunction colon
100
loop colostomy
defunction distal segment of colon
101
anal cancer risk factor
HPV
102
when should anal fissure be further invx for IBD
if anterior midline (90% occur in post midline)
103
acute anal fissue tx
soften stool - dietary advice and bulk forming laxatives lubricants analgesics regional anaesthetics
104
chronic anal fissue mx
continue acute tx topical GTN 8 wks -> sphincterectomy
105
haemorrhoids tx
conservative rubber band ligation haemorrhoidectomy
106
anal neoplasm
squamous cell carcinoma
107
rectal neoplasm
adenocarcinoma
108
Caecal, ascending or proximal transverse colon
right hemocolectomy
109
Distal transverse, descending colon
left hemicolectomy
110
sigmoid colon
high anterior resection
111
upper or lower rectum
anterior resection
112
anal verge
Abdomino-perineal excision of rectum
113
FIT screening
every 2 years aged 50-74 can also be used if pts dont meet 2 week wait criteria
114
usual site of diverticular disease
teniae coli
115
large bowel obstruction invx
xray first line CT gold standard
116
large bowel obstruction mx
NBM IV fluids nasogastric tube with free drainage
117
large bowel obstruction, cause does not require surgery
conservative mx for 72 hours
118
when abx in large bowel obstruction
if surgery planned or perf suspected
119
emergency surgery large bowel obstruction
overt peritonitis or evidence of bowel perforation
120
perianal abscess
incision and drainage
121
pt presents with rectal bleeding invx
PR exam and procto-sigmoidoscopy
122
volvulus diagnostic invx
abdo xray
123
tx sigmoid volvulus
rigid sigmoidoscopy with rectal tube insertion
124
tx caecal volvulus
operative with R hemocolectomy
125
thrombosed haemorrhoids mx
if present within 72 hours, excision otherwise stool softeners, ice packs and analgesia
126
anaesthetic with anti-emetic properties
propofol
127
kallman syndrome
LH FSH low-normal and testosterone low
128
order of structures divided in the abdo midline incision
linea alba transversalis fascia extraperitoneal fat peritoneum
129
order of strutures divided in the abdo paramedian incision
anterior rectus sheath rectus (retracted) posterior rectus sheath transversalis fascia extraperitoneal fat peritoneum
130
most common cause of bowel obstructions
small bowel = adhesions large bowel = tumours
131
Posterior triangle lymph node biopsy
accessory nerve
132
lloyd davies stirrups
common peroneal nerve
133
thyroidectomy
laryngeal nerve
134
anterior resection of rectum
hypogastric autonomic nerves
135
axillary node clearance
long thoracic nerve thoracodorsal nerve intercostobrachial nerve
136
inguinal hernia surgery
ilioinguinal nerve
137
varicose vein surgery
sural and saphenous nerves
138
post. approach to hip
sciatic nerve
139
carotid endaterectomy
hypoglossal nerve
140
thyroid peroxidase antibodies
hashimotos and graves
141
antibodies to TSH receptor
graves
142
tx of cryptochordism
Orchidopexy at 6- 18 months of age
143
hiatus hernia gold standard
barium swallow
144
imaging in acute pancreatitis
uss
145
GET SMASHED
Gallstones Ethanol Trauma Steroids Mumps (other viruses include Coxsackie B) Autoimmune (e.g. polyarteritis nodosa), Ascaris infection Scorpion venom Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia ERCP Drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
146
what is ascending chlangitis
bacterial infection (usually e coli) of the biliary tree
147
features of ascending cholangitis
charcots triad fever RUQ pain jaundice hypotension + confusion (+ these 2 = reynolds pentad)
148
ascending cholangitis tx
iv abx ERCP after 24-48 hrs to relieve any obstruction
149
boerrhaves syndrome diagnosis
CT contrast swallow
150
chronic pancreatitis imaging
CT scan
151
absolute CIs to laparoscopic surgery
haemodynamic instability/shock raised intracranial pressure acute intestinal obstruction with dilated bowel loops uncorrected coagulopathy
152
herceptin
trastuzumab
153
mx of uncomplicated descending aorta dissection
beta blockade and analgesia
154
when is asthma cough often worse
at night
155
results of FeNO in asthma
increased due to inflammation >40 in adults and 35 in kids is diagnostic
156
MART inhaler
ICS + LABA
157
pts on a saba + ICS whos asthma is not well controlled
LTRA
158
asthma diagnostic spriometry
<70%
159
asthma diagnostic reversibility testing
>12% improvement in FEV1
160
most common cause of occupational asthma
isocyanates
161
mod asthma attack
PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm
162
severe asthma attack
PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm
163
life threatening asthma attack
PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma normal PCO2
164
near fatal asthma
a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.
165
myeloma without mets bloods
hypercalcaemia normal/high phosphate normal ALP
166
infant with bilous vomiting and obstruction
intestinal malrotation
167
what guides antibiotics in acute bronchitis
CRP >100, 20-100 give delayed script
168
abx in acute bronchitis
doxycycline
169
invx copd
post bronchodilator spirometry CXR FBC
170
FBC COPD
to exclude 2ndary polycythaemia
171
COPD no asthmatic features
add (LABA) + (LAMA) if already taking a SAMA, discontinue and switch to a SABA
172
copd asthmatic features
LABA + ICS if patients remain breathless or have exacerbations offer triple therapy i.e. LAMA + LABA + ICS if already taking a SAMA, discontinue and switch to a SABA
173
abx prophylaxis copd
azithromycin
174
LTOT COPD requirements
pO2 of < 7.3 kPa or a pO2 of 7.3 - 8 kPa and one of the following: secondary polycythaemia peripheral oedema pulmonary hypertension
175
when to give abx in COPD exacerbation
purulent sputum or clinical signs of pneumonia
176
abx copd exacerbation
amox, doxy or clari
177
COPD exacerbation hosp
O2 nebs iv hydrocortisone or oral prednisolone iv theophylline
178
when to use NIV in COPD exacerbation
respiratory acidosis pH 7.25-7.35 (pts who are more acidotic need HDU/more monitoring)
179
NIV in COPD
BPAP
180
duchenne muscular dystrophy diagnosis
genetic analysis
181
juvenile myoclonic epilepsy
seizures in the morn/following sleep deprivation
182
hearing loss menieres disease
unilateral sensorineural hearing loss
183
2ndary mx of MI - CRABS
clopidogrel ramipril aspirin BB statin
184
lemon tinge to skin
pernicious anaemia
185
sleep apnoea diagnosis
polysomnography
186
allergic bronchopulmonary aspergillosus features
bronchiectasis and eosinophilia (asthma like features)
187
allergic bronchopulmonary aspergillosus mx
steroids itraconazole
188
alpha 1 antitrypsin def features
COPD in young non-smokers
189
atelectasis
post-op complication where alveolar collapse -> resp difficulty airways become blocked with secretions
190
atelectasis tx
positioning the patient upright chest physiotherapy: breathing exercises
191
bilateral hilar lymphadenopathy
TB or sarcoidosis
192
tramlines and signet ring signs
bronchiectasis
193
chest drain position
5th intercostal space midaxillary line
194
SAMA
ipratropium
195
EGPA
asthma blood eosinophilia (e.g. > 10%) paranasal sinusitis mononeuritis multiplex pANCA positive in 60%
196
extrinsic allergic alveolitis
type 3 hypersensitivity
197
GPA
upper respiratory tract: epistaxis, sinusitis, nasal crusting lower respiratory tract: dyspnoea, haemoptysis rapidly progressive glomerulonephritis ('pauci-immune', 80% of patients) saddle-shape nose deformity also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
198
red jelly sputum
klebsiella
199
red currant jelly sputum
klebsiella
200
klebsiella
alcoholics and diabetics
201
auscultation in lung cancer
fixed, monophonic wheeze
202
when in hoarseness seen in lung cancer
Pancoast tumours pressing on the recurrent laryngeal nerve
203
paraneoplastic small cell
ADH -> hyponatraemia ACTH -> cushings LEMS
204
paraneoplastic squamous cell
PTH-rp -> hypercalcaemia clubbing hypertrophic pulmonary osteoarthopathy ectopic TSH -> hyperthyroidism
205
paraneoplastic adenocarcinoma
gynaecomastic HPOA
206
bloods lung cancer
raised platelets thrombocytosis
207
invx lung cancer
CT
208
most common lung cancer
adenocarcinoma
209
lower zone fibrosis
IPF SLE drug induced asbestosis
210
sleep apnoea mx
wt loss CPAP
211
o2 curve -> left
Lower oxygen delivery, caused by Low [H+] (alkali) Low pCO2 Low 2,3-DPG Low temperature
212
o2 curve -> right
Raised [H+] (acidic) Raised pCO2 Raised 2,3-DPG* Raised temperature
213
transudate (<30 protein)
heart failure hypoalbuminaemia meigs syndrome hypothyroidism
214
exudate (>30 protein)
infection CTD neoplasia pancreatitis PE yellow nail syndrome dressers