3rd Yr Med Flashcards
(222 cards)
Stable Angina Features:
No pain at rest
No raised Trop
No ECG changes
Unstable Angina Features:
Pain at rest
No raised Trop
Transient ECG changes (ST Depress, T wave Invers)
nSTEMI Features:
Pain at rest
Raised Trop
ECG changes (ST Depress, T wave Invers)
STEMI Features:
Pain at rest
Raised Trop
ECG changes (ST Elev, LBBB)
Stable Angina Mx
Aspirin 75mg ACEi/ARB SL GTN Statin (Rate control: Beta-blocker, CCB, Ivabradine)
Unstable Angina/nSTEMI Mx
Morphine + Antiemetic O2 Fondaparinux SL GTN Aspirin 300mg Stat (75mg OD) Repeat ECG + Angiography
STEMI Mx + Tx
Morphine + Antiemetic O2 LMWHep SL GTN Aspirin 300mg Stat (75mg) Repeat ECG + Angiography
Tx:
(w/ in 90mis): PPCI (w/ Prasugrel)
Thrombolysis (IV Alteplase)
(Aspirin continued indefinitely, Prasugrel/Clopidogrel continued for 12 months)
HF Class
NYHA:
1: No limitations
2: Mild limitations
3: Severe limitations
4: Sx at rest
HF Ix
BNP/ANP
Echo (Trans-oesophageal)
CXR
(ECG, Trop)
HF Meds
Cardiac meds:
Beta-blockers, CCB (Diltazem, Verapamil), Ivabradine (Slows HR w/out drop in BP)
Diuretics:
Furosemide, Thiazides, ACEi/ARB (If HT), Spironolactone (If Hypokalaemic)
Venodilators:
CCB (Amlodipine), GTN/Nitrates, Hydralazine
ECG Analysis
Rate Rhythm Axis (LAD, RAD) P waves QRS PRi (0.12-0.2s) QRS (0.12s) QT (0.2s) R -> S Progress (L/RBBB) ST Elev/Depress T wave (Tall/Flat/Invers)
AF Mx
Rate control:
Beta-blocker, CCB, Digoxin
Rhythm control:
Beta-blocker, Amiodarone
(If < 48hrs: DC Cardioversion)
Anti-coag:
Rivaroxaban 15mg BD (21 days), 20mg OD
Bradyarrhythmia Mx
SAN ( + Sx): Pacemaker
AVN:
1/2T1 + Syncopal: Cardiac Monitor
2T2/3 + Sx: Permanent Cardiac Pacemaker
Tachyarrhythmia Mx:
SVT
VT
SVT:
Vasovagal manoeuvres
IV Adenosine 6mg (If NSR: Re-entry - Anti-arrhythmic, If no NSR: AF)
Cardioversion (DC, Amiodarone)
VT:
Amiodarone
DC Cardioversion
HT Mx
< 55yo, Diabetic:
ACEi/ARB (+/- CCB +/- Thiazide-like D)
> 55yo, Black:
CCB (+/- ARB/ACEi +/- Thiazide-like D)
Features: AS AR MR MS
AS: (D, Carotids, Holding breath)
Eject-Syst, Cres-decres, Rad to Carotids
AR: (D, Leant forward, Exp)
Early Diast, Decres
MR: (D, L, Exp)
Pan-Syst, Blowing, Rad to Axillae
MS: (Bell, L, Exp)
Opening snap, Mid-Diast, Rumbling
Non-funct Pit Adenoma Mx
Prolactinoma Mx
Non-funct Pit Adenoma Mx:
Surg/RadioTx w/ HRT (GH, HC, Oestrog/Prog/Test, Thyroxine)
Prolactinoma Mx:
D2 (Dopamine) Agonists: Cabergoline, Bromocriptine
Acromegaly Ix
Raised IGF-1, PRL (Co-secreted w/ GH) Failed OGTT (Fails to Supp GH)
Acromegaly Mx
Surg
GHIH (Somatostatin)
GH Antag
Dopamine Agonists (Prevent Release of GH)
DI Features
Polydipsia
Polyuria (Large Vol, Diluted Urine: > 3L/day), Nocturia
Low Urine Osmolality (< 300)
High Serum Osmolality (> 295)
DI Mx
Cranial:
Vasopressin (Exogenous ADH)
Nephrogenic:
Reduced NaCl/Protein Intake +/- Diuretic
(Carbamazepine: Sensitises Renal Tubules)
SIADH Sx + Mx
Fluid Retention (Small Vol, Concentrated Urine)
Mx:
Fluid restrict (+/- Diuretic)
Demeclocycline/Tolvaptan (ADH Antag)
Cushings D Patho + Complications
Pit Adenoma secreting ACTH
+/- DM, HT, Osteoporosis
Cushings D Ix
Raised ACTH/Cortisol, Low CRH, (Raised Glu, BP)
Raised 24hr Urinary Cortisol
Failed Dexamethasone Supp Test (Low-dose does not Supp ACTH)