STEMI - Acute - >persistent ST segment elevation (1 small square) in 2 contiguous leads (except V2/3) - >new LBBB with symptoms - does not require elevated troponins - Consider posterior STEMI - >ST depression in V1-3 - Old findings - >ST segment at isoelectric - >small R - >pathologic Q (1/3 corresponding R) - >inverted T wave Non-STEMI - ST segment depression in two contiguous leads (half small square) - >usually diffuse - >focal area likely STEMI with reciprocal changes - T wave inversion in two contiguous leads (one small square) - >with R:S >1 - elevated troponins without ST elevation UA - >unstable/new/severe/frequent angina - >no trops - >only transient ECG changes

DDx - peptic ulcer - malloryweis - varices - portal hyptersive gastropathy - angiodysplasia - neoplasia - erosive - >oesophagitis - >gastritis - >duodenitis

Triggers (Don't PANIC) - Drugs - >corticosteroids - >cocaine - >simpathomimetics - >SGLT-2 - >atypical anipsychotics - Pregnancy - Acute illness - New diagnosis (common) - Infarct - Compliance

Life threatening (ED TRAPP) - Embolism - Dissection - Tamponade - Ruptured viscus - ACS - Pericarditis - Pneumothorax Other/Common (GIMP) - Gastrointestinal - >Gastritis/peptic ulcer - >Pancreatitis - >Cholecystitis - Infective respiratory conditions - >Pneumonia - >Asthma/COPD exacerbation - Musculoskeletal - >Intercostals/ribs - Psychiatric - >Panic/anxiety

Lateral STEMI - Cause - >Isolated (rare) = Diagonal/left marginal - >Anterorlateral = proximal LAD - Elevation - >I, aVL, V5-6 - Reciprocal depression - >III, aVF Inferior STEMI - Cause - >Majority = RCA - >Some = circumflex - >Rarely = wraparound LAD - Elevation - >II,III,aVF - Reciprocal depression - >aVL - RCA - >elevation III>II, depression in I - circumflex - >elevation IIIinferior + anterior STEMI features

Epidemiology - lifetime incidence over 50% - more common in winter Aetiology - Primary = 85% - >idiopathic - Secondary - >trauma - >coagulopathy - >anticoagulation - >HTN - >neoplasia Pathophys - Anterior = 90% - >arise from Little's area = anterior inferior septum - >confluence of vessels = Kiesselbach plexus - Posterior - >usually arterial - >higher risk of airway obstruction/aspiration Complications - bacterial sinusitis - recurrence

SMS BENDGAME - Schizophrenia spectrum - Medications - Substances - Brain lesion - >TBI - >dementia - >tumour - >epilepsy - >MS - Endocrine - >thyroid dysfunction - >hypercortisolaemia - Nutritional deficiencies - >folate/B12 - >thiamine - Delirium - Genetic - >klinefelter - >di George - Autoimmune - >general association - >SLE - Metabolic (rare) - >wilsons - Encephalitis - >STI's - >measles/mumps - >EBV

HAD bloody CRAP - Haemorrhoids - Anal fissure - Diverticulosis - Colitis (ischaemic, inflammatory, infectious) - Rapid transport (upper GI) - Angiodysplasia - Polyps/neoplasia - Solitary rectal ulcer syndrome

Epidemiology -usually over 80 years old Aetiology - osteoporosis - age - falls - low BMI - female Pathophys - Intracapsular - >reticular vessels passing up capsule damaged - >risk for avascular necrosis - Extracapsular - >trochanteric - >subtrochanteric - Further classification (Garden) - >displacement - >comminution

GI - bowel obstruction - diverticular - gastroenteritis - mesenteric ischaemia - constipation - appendicitis - unlikely - >biliary colic - >pancreatitis GU - ovarian torsion - ovarian cyst/rupture - tubo-ovarian abscess - ectopic - pyelonephritis Musculoskeletal pain

Background Flashcards by Michael Joubert

ACS definitions

STEMI

Acute
> persistent ST segment elevation (1 small square) in 2 contiguous leads (except V2/3)
> new LBBB with symptoms
does not require elevated troponins
Consider posterior STEMI
> ST depression in V1-3
Old findings
> ST segment at isoelectric
> small R
> pathologic Q (1/3 corresponding R)
> inverted T wave

Non-STEMI

ST segment depression in two contiguous leads (half small square)
> usually diffuse
> focal area likely STEMI with reciprocal changes
T wave inversion in two contiguous leads (one small square)
> with R:S >1
elevated troponins without ST elevation

> unstable/new/severe/frequent angina
> no trops
> only transient ECG changes

How well did you know this?

Not at all

Perfectly

thunderclap headache ddx

Always Remembering Several Critical Differentials is A Painful Thorn In My Side

Aneurysm rupture
> thunderclap headache after trigger/maybe sentinel bleed
> vomiting/nuchal rigidity/LOC/seizures
Reversible cerebral vasoconstriction syndrome
> recurrent TCH over days to weeks
> similar triggers to aneurysmal rupture
> may develop neurological deficits due to stroke
Spontaneous intracranial hypotension
> postural headache after trauma/CSF drain
> nuchal rigidity/nausea/vomiting sometimes
Cluster headache
> eye/temple pain lasting up to 3 hours
> red eyes/ipsilateral lacrimation/rhinorrhea/horners
Dissection (cervical artery)
> stroke/TIA/neck or head pain
> partial horners (no anhidrosis)/tinitus/bruit
> trauma/connective tissue disorder
Acute angle glaucoma
> blurred vision/halos/red eye/dilated pupil
Posterior reversible encephalopathy syndrome
> HTN/seizure/visual symptoms/insidious headaches
> white matter oedema
> sometimes UMN signs and focal deficits
Thrombus (venous)
> VTE risk factors/neuro deficits across arterial territories
Ischaemic stroke

-Meningitis

Spontaneous intracerebral haemorrhage
> HTN/anticoagulated/older
> gradual focal neuro signs (putamen/post int capsule)
> headache/vomiting/meningism/stupour

How well did you know this?

Not at all

Perfectly

Upper GI bleed DDx

DDx

peptic ulcer
malloryweis
varices
portal hyptersive gastropathy
angiodysplasia
neoplasia
erosive
> oesophagitis
> gastritis
> duodenitis

How well did you know this?

Not at all

Perfectly

DKA triggers

Triggers (Don’t PANIC)

Drugs
> corticosteroids
> cocaine
> simpathomimetics
> SGLT-2
> atypical anipsychotics
Pregnancy
Acute illness
New diagnosis (common)
Infarct
Compliance

How well did you know this?

Not at all

Perfectly

Chest pain ddx

Life threatening (ED TRAPP)

Embolism
Dissection
Tamponade
Ruptured viscus
ACS
Pericarditis
Pneumothorax

Other/Common (GIMP)

Gastrointestinal
> Gastritis/peptic ulcer
> Pancreatitis
> Cholecystitis
Infective respiratory conditions
> Pneumonia
> Asthma/COPD exacerbation
Musculoskeletal
> Intercostals/ribs
Psychiatric
> Panic/anxiety

How well did you know this?

Not at all

Perfectly

STEMI ECG changes

Lateral STEMI

Cause
> Isolated (rare) = Diagonal/left marginal
> Anterorlateral = proximal LAD
Elevation
> I, aVL, V5-6
Reciprocal depression
> III, aVF

Inferior STEMI

Cause
> Majority = RCA
> Some = circumflex
> Rarely = wraparound LAD
Elevation
> II,III,aVF
Reciprocal depression
> aVL
RCA
> elevation III>II, depression in I
circumflex
> elevation IIIinferior + anterior STEMI features

How well did you know this?

Not at all

Perfectly

Epistaxis background

Epidemiology

lifetime incidence over 50%
more common in winter

Aetiology

Primary = 85%
> idiopathic
Secondary
> trauma
> coagulopathy
> anticoagulation
> HTN
> neoplasia

Pathophys

Anterior = 90%
> arise from Little’s area = anterior inferior septum
> confluence of vessels = Kiesselbach plexus
Posterior
> usually arterial
> higher risk of airway obstruction/aspiration

Complications

bacterial sinusitis
recurrence

How well did you know this?

Not at all

Perfectly

ddx psychosis

SMS BENDGAME

Schizophrenia spectrum
Medications
Substances
Brain lesion
> TBI
> dementia
> tumour
> epilepsy
> MS
Endocrine
> thyroid dysfunction
> hypercortisolaemia
Nutritional deficiencies
> folate/B12
> thiamine
Delirium
Genetic
> klinefelter
> di George
Autoimmune
> general association
> SLE
Metabolic (rare)
> wilsons
Encephalitis
> STI’s
> measles/mumps
> EBV

How well did you know this?

Not at all

Perfectly

COPD exacerbation background

Epidemiology

3-4th leading cause of death
exacerbations cause most of mortality/morbidity

Aetiology

Bacterial (majority)
> haemophilus influenzae
> strep pneumoniae
> moroxella catarrhalis
Viral
> rhino (most common)
> influenza
> parainfluenza
> adeno
> corona
> RSV
Combined bacterial/viral
Non infective
> pollutants
> smoke
> dryer/colder weather

Pathophys

Worsening of underlying inflammation
> increased airway obstruction
Likely has residual effects on lung architecture
> worsening lung function with frequent exacerbations

How well did you know this?

Not at all

Perfectly

PR bleeding ddx

HAD bloody CRAP

Haemorrhoids
Anal fissure
Diverticulosis
Colitis (ischaemic, inflammatory, infectious)
Rapid transport (upper GI)
Angiodysplasia
Polyps/neoplasia
Solitary rectal ulcer syndrome

How well did you know this?

Not at all

Perfectly

Bowel obstruction background

Epidemiology

small more common than large
small
> under 5% lifetime risk virgin abdo
> over 50% post surgery

Aetiology

small
> extrinsic = adhesions/hernias/volvulus
> intrinsic = stricture/neoplasia/haematoma
> luminal = gall stone/foreign body/intussusception
large
> neoplasia
> volvulus (sigmoid/caecal)
> stricture

Pathophys

proximal dilation
distal hyper-peristalsis and clearance
venous congestion
> increased pressure/decreased arterial supply
> ischaemia and infarction

How well did you know this?

Not at all

Perfectly

Pyelonephritis background

Epidemiology

incidence = approx 10/10,000
risk factors
> much more common in women
> common after renal transplant
> frequent sex/new partner
> recent UTI
> diabetes
> stress incontinence
> foreign body/catheter
> anatomical abnormality (PCK/reflux/BPH/neuro bladder)
> immunosuppression
> more likely to be complicated in pregnancy

Aetiology

Most common = e coli
Other
> klebsiella
> proteus
> pseudomonas
> staph (including MRSA)
> enterococci (considered contaminant for UTI)

Pathophys

Source
> usually ascending infection following cystitis
> can be due to haematological seeding
Uncomplicated
> typical pathogen
> immunocompetent
> normal anatomy
Complicated (more likely to be severe)
> susceptibility (extremes of age/immunocompromise)
> abnormal anatomy/physiology (outflow tract/kidney)
> foreign body/catheterisation/instrumentation/stones
> pregnancy
Complications
> sepsis and septic shock
> AKI and renal failure
> renal abscess
> emphysematous pyelonephritis
> renal scaring

How well did you know this?

Not at all

Perfectly

NOF background

Epidemiology
-usually over 80 years old

Aetiology

osteoporosis
age
falls
low BMI
female

Pathophys

Intracapsular
> reticular vessels passing up capsule damaged
> risk for avascular necrosis
Extracapsular
> trochanteric
> subtrochanteric
Further classification (Garden)
> displacement
> comminution

How well did you know this?

Not at all

Perfectly

Nephrolithiasis background

Epidemiology

approx 10% lifetime risk
more common in older age and men

Aetiology

Supersaturation
> calcium
> oxalate
> uric acid
> sodium
Low crystal inhibitors
> Mg and citrate
Predisposing factors
> low urine flow
> abnormally high/low pH

Pathophys

Calcium (vast majority of stones)
> oxalate (most common)
> phosphate (high pH/parathyroidism)
Uric acid (low pH)
Cystine (rare, due to cystinuria inborn error metabolism)
Struvite (rare, proteus/pseudomonas/klebsiella infection)

How well did you know this?

Not at all

Perfectly

Nephrolithiasis ddx

bowel obstruction
diverticular
gastroenteritis
mesenteric ischaemia
constipation
appendicitis
unlikely
> biliary colic
> pancreatitis

ovarian torsion
ovarian cyst/rupture
tubo-ovarian abscess
ectopic
pyelonephritis

Musculoskeletal pain

How well did you know this?

Not at all

Perfectly

Urinary obstruction background

Study These Flashcards

Epidemiology
-most commonly BPH

Aetiology

Unilateral
> stones
> iatrogenic
> malignancy
Bilateral
> BPH
> urethral/meatal strictures
> clot post haematuria
Extrinsic
> anticholinergic drugs
> spinal cord injury
> MS/Parkinsons
> masses/tumours

Pathophys

Obstructed flow and back pressure
> decreased renal blood flow
> decreased eGFR
> up regulation RAS
Apoptosis/fibrosis
> decreased resorption of Na/water
> inability to concentrate urine
> impaired electrolyte handling

Cellulitis background

Study These Flashcards

Epidemiology

risk factors
> prior episodes
> ulcer/wound
> dermatosis
> tinea
> lymphoedema/venous insufficiency

Aeiology

Common
> GAS
> s aureus
Immunocompromise
> pseudomonas
> cryptococcus

Pathophys

Micro-organisms gain access to dermal/sub cut tissue
> disruption of cutaneous barrier
Complications
> sepsis
> chronic limb oedema (damage to lymphatics)

Smoke inhalation

Study These Flashcards

Epidemiology

quarter of burns victims
over half with burns to face

Aetiology

Heat
Particulates/irritants
Systemic toxins

Pathophys

Direct thermal injury
> usually restricted to upper airway (air dissipates heat)
> causes angio-oedema
> lower airway if steam/explosive gases (holds heat)
Asphyxiation
> low FiO2 during fire
> CO causes tissue hypoxia
> CN causes lactic acidosis
> Met Hb from Hb denaturation/oxides from fire
Lung irritation
> bronchospasm and mucus plugging
> pulmonary oedema and A-a gradient hypoxia

Biliary colic background

Study These Flashcards

Epidemiology

F’s for risk factors
> fair
> female
> fat
> forty
Gall stones
> 80% asymptomatic
Biliary colic
> 1-2% risk each year
> 50% have recurrent attacks
> 3% develop complications

Aetiology

Cholesterol stones (90%)
> mixed is most common
Pigment
Acaculous

Pathophys

Concussion Background

Study These Flashcards

Epidemiology
-male predominancy

Aetiology

MVA
Sports
Falls
Assault

Pathophys

Lesions
> contusions (most common)
> epidural haematoma
> subdural haematoma
> axonal injury
Axonal compression and stretching
> reactive axonal swelling
> hyper/hypometabolism with decreased perfusion
> axonal seperation and phagocytosis

Complications SAH

Study These Flashcards

Bloody Hot CHIPS

> Bleeding (mortality increased to approx 70%)
> Hydrocephalus
> Cardiac (arrythmia/trops/takasubo)
> Hyponatraemia
> Ischaemia (delayed due to vasospasm)
> Pressure (increased ICP)
> Seizures

DDx altered level of consciousness

Study These Flashcards

A
-arrhythmia 
E
-electrolytes
I
-infection/sepsis
O
-oxygen
U
-ureamia

G
-glucose
A
-acidosis
T
-trauma
E
-ethanol
S
-shock

Rhabdomyolysis background

Study These Flashcards

Epidemiology

Risk factors
> deconditioning
> polypharmacy
> hypothyroid
> hypokalaemia/hypophosphataemia

Aetiology

Drug
> cocaine
> narcotics
> aspirin
> statin
Toxins
> cyanide
> CO
> envenomation
Trauma
> over external states
> seizures

Pathophys

Disruption of sarcolemma
> trauma
> disruption of ATP dependent ion homeostasis
Release of intracellular contents
> myoglobin
> CK
> K/Mg/Ph
> uric acid

Anaphylaxis ddx

Study These Flashcards

ASAP Fluids, Ventilation, Adrenaline

anaphylaxis
shock
asthma attack
panic attack
foreign body aspiration
vasovagal reaction
acute exacerbation COPD

Acute SOB DDx

Respiratory - PE - Anaphylaxis - Pneumothorax - Asthma exacerbation - COPD exacerbation - Foreign body Cardiac - MI - APO - Tamponade

Tachycardia DDx

Narrow QRS - Regular - >sinus tachy - >AVNRT/AVRT - >atrial flutter - >atrial tachy - Irregular - >AF - >multi focal atrial tachycardia - >atrial flutter with variable conduction Wide QRS - Regular - >monomorphic VT - >AVRT - Irregular - >VF - >polymorphic VT

Pneumothorax background

Epidemiology - >twice as common in men - >tall slender body - >young - >family hx - >smoking - >COPD - >sever asthma - >cystic fibrosis Aetiology - Spontaneous - >primary: no apparent cause - >secondary: complication of lung disease - Traumatic - >penetrating or blunt injury - >iatrogenic Pathophys - Pleural pressure less than atmospheric - Communication between pleural and alveoli/external - Tension - >intrapleural pressure > atmospheric during expiration - >ball valve mechanism and inspiratory accumulation

Burn classification

Depth - Superficial - >only epidermis - >painful/erythematous/blanchable - >don't blister - Partial thickness - >epidermis + part of dermis (superficial/deep) - >painful/erythematous - >blisters + weeping - >superficial blanchable/deep unblanching - >superficial heals without scars/deep invariably scars - Full thickness - >full dermis + subcutaneous tissue - >waxy/charred/overlying eschar - >not painful - >no blisters - >doesn't blanch - >limb viability threatened if circumferential - >doesn't heal spontaneously/forms contractures Distribution - Total body surface area - >not including superficial - Lund-browder chart - >best for children (variable growth proportion) - Rule of 9's - >head = 9 - >each limb = 9 - >each leg = 18 - >anterior/posterior trunk = 18 - Palm - >palm only = 0.5% - >palm + fingers = 1%

Anorectal abscess background

Epidemiology - much more common in men - peak 20-40's - 1/3 of patients Aetiology - Anal gland infection - >between internal/external sphincter - >drain into anal crypts at dentate line Pathophys - Blockage of crypt - >faeces - >trauma + oedema (constipation/foreign body) - >inflammation (crohns) - Infection - >inter-sphincteric space - >spread and fistulisation - Abscess - >inter-sphincteric - >supra-levator - >perirectal - >perianal

Spinal cord compression background

Epidemiology - Young - >trauma - Old - >falls Aetiology - Trauma - Fracture - >osteoporosis - >steroids - >osteomyelitis - Degenerative disk disease - Neoplastic - >majority metastatic (MM/lung/breast/renal/prostate) - >primary (meningeal/glial/ependynal) - Infection - >epidural abscess - >discitis - >Potts disease (TB) - Other - >chemo neuropathy - >stroke Pathophys - Vulnerable tracts - >corticospinal - >spinocerebellar - >posterior spinal columns

Post tonsillectomy bleeding

Epidemiology - over 5% - risk - >older - >coagulopathy - >chronic tonsillitis Aetiology - Primary - >within 24hrs - Secondary - >usually 1 week post - >more common Pathophys - Secondary - >separation of eschar - >infection or dehydration - Risk - >rarely require transfusions - >can cause upper airway obstruction

Olecranon bursitis

Epidemiology - risks - >older - >male - >diabetes - >labourer Aetiology - Infective - >trauma to skin overlying bursa - Non infective - >repetitive trauma - >gout - >rheumatoid - >osteoarthritis

Background Flashcards

(32 cards)