Amir Sam Flashcards
1
Q
Structure to HPC
A
Ask about presenting symptoms- socrates
Associated symptoms to that system
Then questions relating to your differential diagnoses
2
Q
Associated symptoms with MI
A
Nausea
Sweating
Breathlessness
3
Q
Chest pain investigations
A
ECG
Troponin
Echo
4
Q
DDx of chest pain
A
Cardiac - IHD - aortic dissection - pericarditis Resp - PE -Pneumothorax -Pneumonia GI - oesophagitis - gastritis - oesophageal spasm Musculoskeletal - costochondritis
5
Q
Important investigation forgotten about in chest pain
A
BP both arms to check for aortic dissection
6
Q
Anterior MI ecg
A
LAD
V1-V4
7
Q
Lateral MI ecg
A
Circumflex
V5-6
aVL
8
Q
Inferior MI ecg
A
Right coronary artery
II, III
avF
9
Q
Which enzymes get elevated acutely MI
A
CK isoform
10
Q
What happens in seizure cause of collapse after event
A
Confused
11
Q
Important thing to ask to ask about in family history with collapse
A
Sudden death in family
12
Q
How to check for postural hypotension collapse
A
Change in BP lying vs standing
13
Q
DDx collpase
A
Glucose Cardiac - valves - arrythmia - outflow obstruction - postural hypotension Neurological
14
Q
Forgotten cause of outflow obstruction
A
PE
15
Q
Investigations for cardiac causes
A
ECG
Pulse, ESM, echo
Lying and standing BP
16
Q
What is long QT syndrome
A
Abnormal ventricular repolarisation
17
Q
Acquired causes of long QT
A
Low K+, Mg+, Ca+, hypothermia
MI
Raised ICP
Drugs
18
Q
Genetic cause of Long QT
A
Change in K+ channel
19
Q
Family history sign of long QT
A
Sudden death
20
Q
Cardiac causes of collapse
A
Reduced outflow
Arrythmia either brady or tachy
Postural hypotension
Vasovagal
21
Q
What does long QT syndrome predispose you to
A
Tachyarrythmias
22
Q
What does murmur louder on inspiration say about murmur
A
Murmur on right side
23
Q
What are signs on examination of tricuspid regurg
A
Hepatomegaly
24
Q
DDx of JVP
A
R heart failure
Tricuspid regurg
Constrictive pericarditis
25
Causes of JVP
```
R HF
- pulmonary HTN -PE, COPD
- secondary to left failure
Tricuspid regurg
- R ventricle dilation
- vegetations
- hepatomegaly
Constrictive pericarditis
- infection TB
- autoimmune sarcoid
- maligancy
```
26
Questions to ask self about murmur
Where loudest
| Where radiate
27
DDx of sinus tachycardia
```
Caffeine
Alcohol
Sepsis
Hypovolaemia
Endocrine
Anxiety
```
28
DDx of SVT
Re-entry circuit
29
Difference between AVNRT and AVRT
AVNRT at level of node
| AVRT goes into ventricles and back up bundle of kent
30
Is there an upstroke in AVNRT
No
31
AVRT on ECG
SR
Short PR interval
Delta wave
32
Causes of AF
Thyrotoxicosis
Alcohol
Heart- muscle, valve, pericardium
Lung- PE, pneumonia, Cancer
33
Causes of VT
Iscaemia
Electrolyte
Long QT
Drugs
34
Managment of haemodynamically stable SVT
1. Valsalva
| 2. adenosine
35
Acute fast AF management
Rythm and rate control
| Causes and complications
36
Categories of ECG abnormaliites
Iscaemia
Arrythmia or block
Vent strain or hypertrophy
37
What causes third heart sound
Associated with ventricular filling- very common in HF
38
What causes fourth HS
Associated with ventricular hypertrophy
39
Management of HF patient
Initially sit them up and give high flow oxygen
Furosemide
GTN infusion
40
What cant you do when a patient is hypothermic
Any cardioversion
41
Classify SOB
```
Seconds
P embolism
Pneumothorax
FB
Mins
airway disease
chest infection
acute HF
Hours
chronic above
Fibrosis
NMJ
Anaemia
Malignancy
Effusions
```
42
Iatrogenic
Caused by treatment
43
What would cause SOB after chest drain
Pulnomary odema
44
When is pain worse pericarditis
Lying down
| Breathing in
45
Recent history for pericarditis
RTI
46
When is aortic regurg murmur heard best
Leaning forward
47
Murmur for aortic dissection
Aortic regurg
48
What done if patient comes in with stemi
PCI
49
Difference in echo between MI and myocarditis
MI regional wall abnormality where event occurred whereas myocarditis globally
50
Treatment for NSTEMI
MONOBASH and angiogram
51
Outflow obstruction causes of collapse
Aortic stenosis
PE
Hypertrophic obstructive cardiomyopathy
52
What to ask about when querying neuro cause of collpase
Aura
Confusion afterwards
Tongue biting
Shaking
53
Which drugs can lead to long QT syndrome
```
Arrythmics
Psycotics
Depressants
Histamines
Biotics
Methadone
```
54
What does murmur louder on expiration suggest about murmur
Its on the left side
55
What would you consider in patient with pan systolic murmur but no signs of valve defects
Ventricular septal defect
56
How to differentiate between AVNRT and AVRT
In tachycardia they look exactly the same so when slow heart down the abnormality will be seen if its AVRT, if not then will be normal. Heart slowed by vagal manoevers and adenosine
57
What abnormalities will be seen on ECG if AVRT
Short PR
| Delta wave
58
When can delta wave only be seen
Sinus rythm
59
Differences in focus between flutter and fibrillation
Flutter- single ectopic focus which can be ablated
| Fib- no focus
60
Management plan for haemodynamically stable SVT
Vagal maooeuvres
| Adenosine with cardiac monitor
61
What must be treatment for anyone arrythmia haemodynamically unstable
DC cardioversion
62
Management Plan For A Patient With Acute Fast AF & BP: 120/80
```
Need to rate and rythm control
Rythm
- if onset less than 48 hours DC cardioversion
- IV flecainide or amiodarone
Rate control
- digoxin or B blocker
Treat underlying cause
```
63
When wouldn't you give IV flecainide acute fast AF
Structural heart disease
64
What would you give for acute fast AF with structural heart abnormality
IV amiodarone
65
How long would you wait after acute fast AF of over 48hrs to give DC cardioversion
3-4 weeks- in mean time anticoagulate
66
What do you give with CHADVASC score above 1
Warfarin and LMWH
67
What do you give for CHAD VASC score of 1
Aspirin and LMWH
68
What to give for VT with no haemodynamic compromise
IV amiodarone then look for and treat cause
| Implant ICD
69
What do you do for pulseless VT
Defibrillate as in cardiac arrest
70
What to give if patient goes into torsades de pointes
IV magnesium sulphate
71
What do when patient is in haemodynamically unstable VT
Defibrillation
72
Difference between defibrillate and DC cardioversion
Cardioversion has to be synced so can be delivered at any time whereas defibrillation can be at any time
DC cardioversion can be given to any haemodynamically unstable patient wheras defibrillation for people in VF
73
What is Votlage criteria for LVH
S in V1 + R in V5 or V6 whichever is larger > 7 large squares
74
What suggests ischaemia on ECG
ST elevation or depression
T wave inversion
Pathological Q waves
75
What do pathological Q waves look like and what do they suggest
Over 2mm deep or over 1mm wide
| Suggest old infarcts
76
How to look for previous infarcts on ECG
Pathological Q waves
77
What does digoxin toxicity look like on ECG
ST depression + inverted T waves in V5-6 (‘reversed tick’) + any arrhythmia
78
How does hyperkalaemia appear on ECG
Tall, tented T waves, widened QRS, absent P waves, prolonged PR interval, bradycardia
79
How does hypokalaemia appear on ECG
Small T waves, prominent U wave
80
How does hypocalcaemia appear on ECG
Long QT interval
81
How does hypercalcaemia appear on ECG
Short QT interval, small T waves
82
What does fixed wide splitting of S2 suggest
Atrial septal defect
83
What is fixed wide splitting of S2 best heard with
diaphragm
84
What is third heart sound best heard with
Bell as high pitched
85
Management of acute HF
1. Sit up
2. 60-100% oxygen
3. GTN infusion
4. Diamorphine
5. IV furosemide
6. Treat underlying cause
86
Why give diamorphine acute HF
Anxiolytic and improves breathlessness
87
What are shockable causes of cardiac arrest
VF
| Pulseless VT
88
What are unshockable causes of cardiac arrest
PEA
| Asystole
89
What would you be thinking if cardiac arrest patient arrives hypothermic
VT or VF
90
Who you cant give adrenaline to
Hypothermic patients
91
What are 8 reversible causes of cardiac arrest
```
Hypoxia
Hypovolaemia
Hyperkalaemia (or any other metabolic disorder)
Hypothermia
Thrombous
Toxins
Tension pneumothorax
Tamponade
```
92
Way to remember causes of cardiac arrest
4 ts
| 4 hs
93
Management for VF or pulseless VT
```
Shock
CPR 2 mins
Assess rythm
Adrenaline every 3-5 mins(if over 30C)
Amiodarone after 3 shocks
Correct reversible changes
```
94
Investigations for infective endocarditis
Echo
| Three sets of blood cultures
