Cardio And Resp Flashcards by Jayati A Hine

Treatment for chronic bronchitis exacerbation?

Amoxicillin OR Tetracycline OR
Clarithromycin

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Treatment for community acquired pneumonia?

Amoxicillin
If penicillin allergic: doxy or clarithromycin

Add flucloxacillin if staph ylococci suspected e.g. in influenza

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Treatment for pneumonia with cause suspected to be aytypical?

Clarithromycin

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Treatment for hospital acquired pneumonia?

Within 5 days of admission- co-amoxiclav or cefurotaxime

> 5days- piperacillin c tazobactam
OR
Broad spectrum cephalosporin (e.g. ceftazidime)
OR
Quinolone e.g. ciprofloxacin

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What classes an asthma attack as severe?

One of following
- can’t complete sentences
- peak expiratory flow rate 33-50%
- RR >25
- Pulse >110

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What classes an asthma attack as life threatening?

One of following
- peaks expiratory flow <33%
- O2 sats <92%
- silent chest
- cyanosis or feeble resp effort
- bradycardia
- dysarrythmia
- hypotension
- exhaustion, confusion or coma

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Patient with a fever, dry cough and severe sob has severe Crohn’s. What is it likely to be and how what medication would you treat it with?

Pneumocystitis jiroveci pneumonia

Patient may be in long term steroids so immunosuppressed. Rare fungal cause

Co-trimoxazole
- a combo of trimethoprim and sulfamethoxazole

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Which regions of an ECG are the lateral leads?

I, aVL, V5, V6

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What regions on an ECG represent the anterior aspect of the heart?
What’s artery supplies it?

V1-V4

Supplied by the left anterior descending (LAD) artery

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What regions on an ECG represent the inferior aspect of the heart?
What’s artery supplies it?

II, III, aVF
Right coronary artery

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Changes to ECGs post STEMI?

Immediate
- hyperacute T waves
- then… ST elevation or new LBBB
Over next few days
- pathological Q waves
- T wave inversion

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Complications post MI?

Cardiac arrest
Arrhythmias
Heart failure
DVT/PE
Pericarditis

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Causes of acute pulmonary oedema?

Post MI
Valvular disease
Arrhythmias e.g. complete heart block

Non- cardiac
- fluid overload due to renal failure or overloaded
- post head injury
- ARDS

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What region of an ECG is represented by I, II and aVF?
What artery supplies this area?

Inferior leads

Right coronary artery

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Management of Tousades des pointes

Can spontaneously resolve or develop onto VT
Correct cause e.g electrolyte abnormality or medications
Magnesium infusion, even if Mg normal
Defibrillation if VT occurs

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Symptoms of left ventricular failure

Dyspnoea
Reduced exercise tolerance
Fatigue
Paroxysmal nocturnal dyspnoea
Orthopnoea- worse lying flat
Wheeze
Cough- worse at night
Pink frothy sputum

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CXR signs for heart failure

Cardiomegaly
Pleural effusions
Kerley B lines
Alveolar/interstitial oedema in bat wing distribution
Upper lobe diversion
Fluid in lung fissures

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Furosemide MOA?

Competitively inhibits Na-K-2Cl cotransporter
in the thick ascending loop of Henle
reducing osmotic gradient for water reabsorption

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Hypertensive retinopathy signs?

Silver/copper wiring
A-V nipping
Flame hemorrhages
Cotton wool spots
Papilloedema

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ACEi side effects?

Dry cough
Hypotension- particularly first dose
Renal impairment
Hyperkalaemia
Angioedma/ urticaria

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Hypertension complications?

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Heart failure
Stroke
Aneurysmal disease
IHD
CKD- hypertensive nephropathy
Hypertensive retinopathy
Peripheral vasculopathy

Hypercholesterolaemia signs?

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Xanthelasma- yellowing growths around eyes
Tendon xanthoma
Corneal arcus
Other xanthomatas e.g. palmar, eruptive, tuberous

Gout immediate and long term tx?

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Immediate
- NSAIDS
- Colcichine
Long term (only)
- Allopurinol

Causes of AF?

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Pneumonia
Heart failure
Post MI
PE
Hyperthyroidism
Alcohol excess
Endocarditis

Most common microorganism causing infective endocarditis?

Viridens streptococci

Eye manifestation of infective endocarditis?

Roth spot Which are boat shaped retinal hemorrhages with a pale center

Criteria for diagnosing infective endocarditis?

Duke criteria

What causes an early diastolic murmur? And other signs of this cause?

Aortic regurgitation Collapsing pulse Wide pulse pressure Displaced apex beat

Signs and symptoms of infective endocarditis?

Fever and new murmur- high suspicion Symptoms - fever - rigors - night sweats - dyspnoea - general malaise Signs - Hands: clubbing, splinter haemorages, Oslers nodes, Janeway lesions - Eyes/fundi- Roth spots - Urine dip- microscopic haematuria

IVDU endocarditis most common cause?

Staph aureus, more likely introduced from skin and venous system

ECG regions and their supplying artery?

Anterior aspect LAD V1-V4 Inferior aspect RCA II, III, aVF Lateral aspect Circumflex I, V5, V6

ECG changes in I, V5 and V6. Region and artery supply?

Lateral aspect + aVL Supplied by circumflex artery

ECG changes in II, III and aVF. Region and artery supply?

Inferior aspect RCA

Difference between the second degree heart blocks Mobitz I (Wenkebank) and Mobitz II?

Mobitz I- PR interval progressivly lengthens until P wave dropped Mobitz II- PR interval constant but P wave is often not followed by a QRS complex

What is first degree heart block?

Prolonged PR interval >0.2 seconds Can be normal in athletes

Signs of right sided heart failure?

Raised JVP Ankle oedema Hepatomegaly

What is the CURB-65 score used for?

Stratifying risk for community acquired pneumonia assessing severity and guides whether tx should be as an in or outpatient

What are the scoring factors in the CURB-65

Confusion Urea >7 mmol/l Resp rate >30 BP sys <90 or dias <60 >65 yo

What do the points scored in the CURB-65 indicate for treatment? And there prediction of mortality?

0-1: low risk- less than 3% mortality--> outpatient care 2: intermediate risk- 15% risk --> inpatient care 3-5: high risk- >15% risk --> inpatient/consider ITU 0-1:

Most common causes of CAP?

Haem.influenzae Strep.pneumoniae Mycoplasma.pneumoniae Atypical Staph.aureus Legionella.pneumophila

What resp problem can cause Cushing’s syndrome?

Small cell lung cancers Can release ACTH causing cortisol release, leading to cushings syndrome

COPD medical first line?

SABA OR SAMA SABA e.g. salbutamol SAMA e.g. salmeterol

2nd line COPD drug treatment?

If asthmatic features, likely steroid responsive- add LABA and ICS regularly If no asthmatic features- LABA and LAMA regularly

Example of a LABA

Salmeterol Formoterol

LAMA examples?

Long acting muscarinic antagonists Tiotropium Glycopyrronium

Features of cor pulmonale?

Peripheral oedema Raised jugular venous pressure Systolic parasternal heave Loud o2

Management of cor pulmonale?

Loop diuretic for oedema e.g. furosemide ?long term O2 therapy

How do you differentiate between transudatuve and exudative pleural effusions?

Exudative- protein level >30g/L Transudative- protein level <30g/L

Causes of transudative pleural effusions?

Cardiac failure Cirrhosis Renal failure

Causes of exudative pleural effusions?

Have high protein content Commonly caused by Infection Inflammation Malignancy

Cardio And Resp Flashcards

(50 cards)