Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MC > Chest pain > Flashcards

Chest pain Flashcards

1
Q

The commonest causes of CP encountered in general

practice are ___ and ____

A

musculoskeletal or chest wall pain

and psychogenic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Other terms for MSK pain

A

fibrositis or neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If angina-like pain lasts longer than

15 minutes _____ must be excluded

A

myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Red flag pointers for acute chest pain

A
  • Dizziness/syncope
  • Pain in arms L>R, jaw
  • Thoracic back pain
  • Sweating
  • Palpitations
  • Dyspnoea
  • Pain or inspiration
  • Pallor
  • Past history: ischaemia, diabetes, hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dx of CP

Pitfalls
referred pain from spinal disorders, especially of
the _______—one of the great pitfalls
in medical practice

A

lower cervical spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dx of CP

Pitfalls

being unaware that up to __________are silent, especially in elderly patients,
and that pulmonary embolism is often painless

A

20% of myocardial

infarctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pathological fractures
secondary to osteoporosis or malignancy in the
vertebrae cause _______

A

posterior wall pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

With _______ causes the pain can occur anywhere
in the chest, and tends to be continuous and sharp
or stabbing rather than constricting

A

psychogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Associated symptoms

_______ Consider myocardial infarction,
pulmonary embolus and dissecting aneurysm

A

• Syncope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Associated symptoms

_________. Consider pleuritis,
pericarditis, pneumothorax and musculoskeletal
(chest wall pain).

A

Pain on inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Associated symptoms

_________. Consider spinal dysfunction,
acute coronary syndromes, angina, aortic
dissection, pericarditis and gastrointestinal
disorders such as a peptic ulcer, biliary colic/
cholecystitis and oesophageal spasm

A

Thoracic back pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

auscultation of chest:

— reduced breath sounds, hyper-resonant
percussion note and vocal fremitus →
\_\_\_\_\_\_\_\_\_\_
— friction rub → \_\_\_\_\_\_\_\_\_\_
— basal crackles →\_\_\_\_\_\_\_\_
A

pneumothorax

pericarditis or pleurisy

cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

auscultation of chest:

— apical systole murmur →_____
— aortic diastolic murmur → _____

A

mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

With an ______ the patient may
also appear cold, clammy and shocked, but may show
absent femoral pulses, hemiparesis and a diastolic
murmur of aortic regurgitation

A

aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The ECG in _______ may be
normal but if massive may show right axis deviation,
right BBB and right ventricular strain

A

pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

________ is
characterised by low voltages and saddle-shaped ST
segment elevation.

A

Pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Physical stress, such as the motor-driven
treadmill or a bicycle ergometer, is used to elicit
changes in the ECG to diagnose myocardial ischaemia

A

Exercise stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

This radionuclide myocardial perfusion scan using

thallium can complement the exercise ECG

A

Exercise thallium scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

This monitor is especially useful for silent ischaemia,

variant angina and arrhythmias

A

Ambulatory Holter monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Isotope scanning

1 _____________
• myocardium—to diagnose posterolateral
myocardial infarction in the presence of bundle
branch block
• pulmonary—to diagnose pulmonary embolism

A

Technetium-99m pyrophosphate studies:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Isotope scanning

__________—this scan tests left
ventricular function at rest and exercise in
patients with myocardial ischaemia

A

Gated blood pool nuclear scan (radionucleide

ventriculography)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

This investigation is for dissecting aneurysm

immediate diagnosis

A

Transoesophageal echocardiography (TOE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

______
or pain situated across the chest anteriorly should be
regarded as cardiac until proved otherwise

A

Retrosternal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pain is referred into the left arm _____

more commonly than into the right arm.

A

20 times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stable angina.

The pain of angina tends to last a few
minutes only (average 3–5 minutes) and is relieved by
_________ The pain
may be precipitated by an_____

A

rest and glyceryl trinitrate (nitroglycerine).

arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

___________

Ischaemic pain lasting
longer than 15 to 20 minutes is usually
infarction. The pain is typically heavy and
crushing, and can vary from mild to intense.
Occasionally the attack is painless, typically in
diabetics. Pallor, sweating and vomiting may
accompany the attack

A

Myocardial infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Unstable angina.

This term includes rest angina,
new onset effort angina, post infarct angina
and post coronary procedure angina. Severe
ischaemic chest pain can last 15–20 minutes
or more. It is classified as low risk or high risk
‘minor myocardial damage

A

Unstable angina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

For management purposes it is best to classify the
clinical presentation of acute ischaemic chest pain as
an ___ or ______

A

ST elevation myocardial infarction (STEMI) or a
non-ST elevation acute coronary syndrome (NSTEACS),
which includes NSTEMI and unstable angina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

The pain, which is usually sudden, severe and
midline, has a tearing sensation and is usually
situated retrosternally and between the scapulae

A

Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

An important diagnostic feature of aortic dissectionis the

A 
inequality in
the pulses (e.g. carotid, radial and femoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

This has a dramatic onset following occlusion of
the pulmonary artery or a major branch, especially
if more than 50% of the cross-sectional area of the
pulmonary trunk is occluded.

A

PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The diagnosis of PE is usually confirmed
by a

  1. ______ (best) and/or
  2. V/Q scan (see later in chapter) and
    ECG (look for _____
A

CT pulmonary angiogram

T wave inversion V1–V4).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Inflammation of the pleura is due to underlying
pneumonia (viral or bacterial), pulmonary infarction,
tumour infiltration or connective tissue disease (e.g.

A

Pleuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Unilateral knife-like chest pain (and upper abdominal
pain) following an URTI. It is caused by a Coxsackie
B viru

A 
Epidemic pleurodynia (Bornholm
disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pericarditis causes three distinct types of pain:

1 __________ aggravated by cough
and deep inspiration, sometimes brought on by
swallowing; worse with lying flat, relieved by
sitting up
2 ___________ that mimics
myocardial infarction
3 pain synchronous with the heartbeat and felt
over the praecordium and left shoulder

A

pleuritic (the commonest),

steady, crushing, retrosternal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The cardinal sign of acute pericarditis is

A

a pericardial friction rub.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

The acute onset of pleuritic pain and dyspnoea in a
patient with a history of asthma or emphysema is the
hallmark of a _______

A

pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Causes of PTX

A

It is due to a rupture of

a subpleural ‘bleb’ or a small air-containing cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

________ can cause oesophagitis
characterised by a burning epigastric or retrosternal
pain that may radiate to the jaw

A

Gastro-oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What worsens GERD

A

after meals, and is more frequent at night. The pain

is worse if oesophageal spasm is present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

The commonest cause of pain of spinal origin is

vertebral dysfunction of the ____

A

lower cervical or upper

dorsal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

This causes mild to moderate anterior chest wall pain
that may radiate to the chest, back or abdomen. It is
usually unilateral, sharp in nature and exaggerated
by breathing, physical activity or a specific position

A

Costochondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

there is a tender, fusiform swelling

at the costochondral junction

A

Tietze

syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

can occur anywhere in the
chest, but often it is located in the left submammary
region, usually without radiation

A

Psychogenic chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

______ is recurrent
attacks of stabbing left-sided submammary pain,
usually associated with anxiety ± depression

A

Da Costa syndrome (effort syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Chest pain in children younger than 12 years

old is more likely to have a ______

A

cardiorespiratory cause,

such as cough, asthma, pneumonia or heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

chest pain in adolescents is more likely to be

associated with a _____

A

psychogenic disturbance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

This complaint, which is common in children and
adolescents, presents as a unilateral low chest pain
that lasts usually 30 seconds to 3 minutes, typically
with exercise, such as long-distance running

A 
Precordial catch (Texidor twinge or
stitch in the side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

The elderly patient presenting with chest pain is

most likely to have_____

A

angina or myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

•an oppressive discomfort rather than a
pain.
• It is mainly retrosternal: radiates to arms, jaw,
throat, back.
• It may be associated with shortness of breath,
nausea, faintness and sweating

A

Angina pectoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Ddx for angina pectoris

A

Mitral valve prolapse, oesophageal spasm and
dissecting aneurysm are important differential
diagnoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

(also referred to as crescendo
angina, pre-infarct angina and acute coronary
insufficiency).

A

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

______Pain occurs during the

night. It is related to unstable angina

A

Nocturnal angina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

______ The pain occurs when lying

flat and is relieved by sitting up.

A

Decubitus angina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

The pain occurs at rest and without
apparent cause.

It is
caused by coronary artery spasm.

A

Variant angina or Prinzmetal angina or spasm

angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ECG of Variant angina or Prinzmetal angina or spasm

angina

A

It is associated with typical
transient ECG changes of ST elevation (as
compared with the classic changes of ST
depression during effort angina).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

T or F

A normal stress test does not
rule out coronary artery disease

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

It helps determine the presence
and extent of reversible myocardial ischaemia since
thallium is only taken up by perfused tissue.

A

Exercise thallium-201 scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

This test assesses the ejection fraction, which is a reliable
index of ventricular function and thus aids assessment
of patients for coronary artery bypass surgery

A

Gated blood pool nuclear scan

60
Q

This test accurately outlines the extent and severity of
coronary artery disease. It is usually used to determine
the precise coronary artery anatomy prior to surgery

A

Coronary angiography

61
Q 
Indications for coronary angiography
1
2
3
4
A

Strong positive exercise stress test
Suspected left main coronary artery disease
Angina resistant to medical treatment
Suspected but not otherwise proven angina

62
Q

Indications for coronary angiography
5
6
7

A

Angina after myocardial infarction
Patients over 30 years with aortic and mitral valve
disease being considered for valve surgery

63
Q

General advice for the stable angina

patient

A

• Reassure patient that angina has a reasonably
good prognosis: 30% survive more than
10 years; 8 spontaneous remission can occur

64
Q

What tog give during acute angina

A

ISDN

65
Q

Forms of nitrates

A

glyceryl trinitrate (nitroglycerine) 600 mcg tab
or
300 mcg (½ tab) sublingually (SL)
or
glyceryl trinitrate SL 400 mcg metered dose
spray: 1–2 sprays; repeat after 5 minutes if pain
persists (maximum two doses)
or
isosorbide dinitrate 5 mg sublingually; repeat
every 5 minutes if pain persists (maximum 3
tablets)

66
Q

Can CCB be given during acute angina?

A

nifedipine 5 mg capsule (suck or chew) if

intolerant of nitrates

67
Q

How to give nitrate tabs

A
  • take ½ (initially) or 1 tablet every 5 minutes

* take a maximum of 3 tablets in 15 minutes

68
Q

avoid _______ if patient has taken sildenafil
or vardenafil in the previous 24 hours or tadalafil in
the previous 5 days

A

nitrates

69
Q

Mild stable angina Tx

(Angina that is predictable, precipitated by more
stressful activities and relieved rapidly)

A

• aspirin 150 mg (o) daily
or
(if intolerant of aspirin) clopidogrel 75 mg (o)
daily glyceryl trinitrate (SL or spray) prn
• Consider a beta blocker or long-acting nitrate or
nicorandil

70
Q

Moderate stable angina

(Regular predictable attacks precipitated by moderate
exertion)

What meds to add on top of meds for stable

A

beta blocker e.g. atenolol 25–100 mg (o) once daily
or
metoprolol 25–100 mg (o) twice daily
plus nitrates
glyceryl trinitrate (transdermal: ointment or
patches) daily (use for 12–16 hours only)
or
isosorbide mononitrate 60 mg (o) SR tablet mane

71
Q

Aim for Moderate stable angina

A

Moderate stable angina

72
Q

Define persistent angina

A

Not prevented by beta blocker

73
Q

Mx of Persistent angina

A

add a dihydropyridine calcium-channel blocker (CCB)
(must have beta blocker cover)

nifedipine CR 30–60 mg (o) once daily
or

amlodipine 2.5–10 mg (o) once daily
plus nitrates

74
Q

Mx of Persistent angina

If beta blocker contraindicated

A

(use a nondihydropyridine
calcium-channel blocker):

diltiazem 30–90 mg (o) tds or CR 180–360 mg (o)
daily
or
verapamil (according to directions)
and/or
nicorandil 5 mg (o) bd, increasing after a week to
10–20 mg bd
plus nitrates
75
Q

Refractory stable angina MX

A

Replace CCB with perhexiline

76
Q

Includes onset of angina at rest, abrupt worsening
of angina and angina following acute myocardial
infarction

A

Unstable angina

77
Q 
For variant angina (spasm) use nitrates and
calcium antagonist (avoid\_\_\_\_\_\_
A

beta blockers).

78
Q 
As a rule, avoid the combination of verapamil and a
beta blocker (risk of \_\_\_\_\_\_
A

tachycardia and heart block).

79
Q

T or F

A

Tolerance to nitrate use is a problem, so 24-hour
coverage with long-acting preparations is not
recommended.

80
Q

______can be used prophylactically prior to

any exertion that is likely to provoke angina

A

Nitrates

81
Q

One current technique for CAD is dilating coronary
atheromatous obstructions by inflating a balloon
against the obstruction—___________

A 
percutaneous transluminal
coronary angioplasty (PTCA)
82
Q

Two complications of the balloon inflation

angioplasty are _____ and ______which occurs in 30% in the first 6 months after angioplasty

A

acute coronary occlusion (2–4%) and

restenosis,

83
Q

_______is now the most favoured
procedure to maintain patency of the obstructed
coronary vessel

A

PTCA followed by stenting

84
Q

_______, which include drugs such as primolimus,
sirolimus or paclitaxel, can be used as well as the
bare metal stent.

A

Modern drug eluting

stents

85
Q

Veins used in CABG

A

saphenous

internal mammary

86
Q

Symptomatic patients with significant __________ should undergo bypass surgery,
and those with two or three vessel obstruction and
good ventricular function are often considered for
angioplasty or surgery

A

left main

coronary obstruction

87
Q

Silent infarcts may occur in?

A

‘Silent infarcts’ in diabetics, hypertensives,

females and elderly;

88
Q

Dx of MI

A

Diagnosis is based on 2 out of 3 criteria: history
of prolonged ischaemic pain, typical ECG appearance,
and rise and fall of cardiac enzymes

89
Q 
Etiology of MI
1
2
3
4
A
  • Thrombosis with occlusion
  • Haemorrhage under a plaque
  • Rupture of a plaque
  • Coronary artery spasm
90
Q

Impt signs in MI

• variable pulse: watch for _______
• mild ______: third or fourth heart sound,
basal crackles

A

bradyarrhythmias

cardiac failure

91
Q

ECG of MI is suggestive of?

A

full thickness infarction

92
Q

Characteristics of Q wave

A

broad (>1 mm) and deep >25% length R wave

— occurs normally in leads AVR and V1; III
sometimes
— abnormal if in other leads

93
Q

Q wave can also occur in

A 
LBBB, WPW and
ventricular tachycardia (VT)
94
Q

Q waves do not develop in ____

A

subendocardial

infarction.

95
Q

The strategies for management of AMI are based

on the _____

A

distinction between Q wave (transmural)

or non-Q wave (subendocardial) infarction

96
Q

Q wave infarction has been proved to benefit
from ______ but non-Q wave
infarction has not

A

thrombolytic therapy

97
Q

T or F

A normal ECG, especially early, does not exclude
AMI.

A

T

Q waves may take days to develop

98
Q

What enzyme?

— starts rising at 3–6 hours, peaks at 10 hours
and persists for about 5–14 days
— now the preferred test
— positive in unstable angina

A

Troponin I or T:

99
Q

T or F,

Trop I or Trop T is useful in repeat MI

A

F

100
Q

What enzyme?

— after delay of 6–8 hours from the onset of
pain it peaks at 20–24 hours and usually
returns to normal by 48 hours

A

creatinine kinase (CK):

101
Q

______: myocardial necrosis is present
if >15% of total CK; unlike CK, it is not
affected by intramuscular injections

A

CK–MB

102
Q

• It is performed from 24 hours to 14 days after
onset.
• It scans for ‘hot spots’, especially when a
posterolateral AMI is suspected and ECG is
unhelpful because of pre-existing LBBB.

A

Technetium pyrophosphate scanning

103
Q

Management of acute coronary syndromes

Prevent and treat cardiac arrest; have a ____
available to treat ventricular fibrillation

A

defibrillator

104
Q

Management of acute coronary syndromes

• Give _____ as early as possible (if no
contraindications).
• Prescribe a_______
early (if no contraindications

A

aspirin

beta blocker and an ACE inhibitor

105
Q

For a STEMI it is important to re-establish

flow as soon as possible, usually by either____ or _____

A

thrombolytic
therapy or primary angioplasty (preferably with
stenting).

106
Q

The optimal first-line treatment for the patient with a
STEMI is ______
ideally within 60 minutes (the golden hour) of the onset
of pain

A

urgent referral to a coronary catheter laboratory (PTCA)

107
Q

Adjunct therapy for STEMI will include:

A

aspirin/clopidogrel
and heparin and possibly a glycoprotein IIb/IIIa platelet
inhibitor such as prasugrel, ticagrelor or abciximab

108
Q

Management of NSTEACS

If angioplasty is unachievable either through timing
or the unavailability of the service (such as in rural
locations) ______is an indication for STEMI

A

thrombolysis

109
Q

Golden period for thrombolysis in STEACS

A

within

12 hours of the commencement of chest pain.

110
Q

What is the ideal fibrinolytic

A

Second-generation fibrin-specific agents (reteplase,

alteplase or tenecteplase) are the agents of choice

111
Q

Fibrinolytic for NSTEACs

____ can be used but it is inappropriate for
use in Indigenous people and those who have received
it on a previous occasion

A

Streptokinase

112
Q

Further management for NSTEACs

Full heparinisation for 24–36 hours (after
rt-PA—not after streptokinase), especially for
__________, supplemented by warfarin

A

large anterior transmural infarction with risk of

embolisation

113
Q

Further management for NSTEACs

\_\_\_\_\_\_\_\_(if no thrombolytic therapy or
contraindications) as soon as possible:
atenolol 25–100 mg (o) daily
or
metoprolol 25–100 mg (o) twice daily
A

Beta blocker

114
Q

Further management for NSTEACs

Start early introduction of ACE inhibitors
(within 24–48 hours) in those with significant
_________ (and other
indications).

A

left ventricular (LV) dysfunction

115
Q

Further management for NSTEACs

• Statin therapy to lower cholesterol.
• Treat \_\_\_\_\_\_\_\_.
• Consider \_\_\_\_\_\_\_\_\_ (after
thrombolysis).
• Consider frusemide.
A

hypokalaemia

magnesium sulphate

116
Q

Special management issues

Indications for coronary angiography

  • Development of angina
  • Strongly positive _______test
  • Consider after use of_____
A

exercise

streptokinase

117
Q

basal crackles, extra (third or fourth) heart

sounds, X-ray changes

A

Acute left ventricular failure

118
Q

Cardiogenic shock (a major hospital management procedure)

Requires early specialist intervention which may
include
1
2
3
A
  • treat hypotension with inotropes
  • intra-aortic balloon pump
  • urgent angiography ± angioplasty/surgery
119
Q

This occurs in first few days after AMI (usually
anterior AMI), with onset of sharp pain.

What Cx STEMI?

A

Pericarditis

120
Q

SIgns of Pericarditis

A

pericardial friction rub

121
Q

Tx of Pericarditis

A

anti-inflammatory medication (e.g.
aspirin, indomethacin or ibuprofen for pain) with
caution

122
Q

What to avoid in pericarditis?

A

anticoagulant

123
Q

This occurs weeks or months later, usually around
6 weeks.
• Features: pericarditis, fever, pericardial effusion
(an autoimmune response)

A

Post-AMI syndrome (Dressler syndrome

124
Q

What Cx STEMI?

  • Clinical: cardiac failure
  • Features: arrhythmias, embolisation

• Signs: double ventricular impulse, fourth heart
sound, visible bulge on X-ray

A

Left ventricular aneurysm

125
Q 
Left ventricular aneurysm Mx
1
2
3
4
A

— antiarrhythmic drugs
— anticoagulants
— medication for cardiac failure
— possible aneurysmectomy

126
Q

This presents with severe cardiac failure and a loud
pansystolic murmur. Both have a poor prognosis and
early surgical intervention may be appropriate

A

Ventricular septal rupture and mitral valve

papillary rupture

127
Q

Aortic dissection
• Early definitive diagnosis is necessary: best
achieved by ________

A

transoesophageal echocardiography

128
Q

Aortic dissection

Emergency surgery needed for many, especially
for ________

A

type A (ascending aorta involved).

129
Q

Tx of PE

A

heparin IV: 5000 U as immediate bolus,
continuous infusion 30 000 U over 24 hours
or
heparin 12 500 U (sc) bd

130
Q

PE

The dose of heparin should then be adjusted
daily to maintain the APTT between ____

A

1.5 and 2 times

control.

131
Q

Heparinization sched for PE

A

Continue heparin 5–10 days

132
Q

Drainage of the pleural space indicated for a
large pneumothorax _______ pleural area, with
persistent dyspnoea

A

> 25%

133
Q

PTx Tx

— <25% collapse, no symptoms: ___
— <25% collapse + persisting symptoms: _____
— >25% collapse: usually drain

A

observe

drain

134
Q

PTx Tx

For recurrent attacks, excision of____ or ____

A

cysts or

pleurodesis may be necessary

135
Q

Statistics indicate a 30–50% recurrence rate
of spontaneous pneumothorax (most within
12 months), _____ on the same side, _____
on the opposite side

A

35%

10–15%

136
Q

Acute tension pneumothorax Tx

For urgent cases insert a 12–16 gauge needle into
the pleural space through the ______

A

second intercostal

space on the affected side.

137
Q

Mx of Esophageal Spasm

A

Long-acting nitrates (e.g. isosorbide dinitrate
10 mg tds)
or
Calcium-channel blockers (e.g. nifedipine CR
20–30 mg once daily)

138
Q

Costochondritis is a common cause of anterior
pain, which is generally well localised to the
costochondral junction and may also be a component
of an inflammatory disorder, such as one of the
_________

A

spondyloarthropathies

139
Q

______ is often an undiagnosed
cause of chest pain: keep it in mind, especially
if pain is recurrent and intermittent (proved by
echocardiography).

A

Mitral valve prolapse

140
Q

______ can cause peripheral oedema,

so be careful not to attribute this to heart failure

A

Calcium antagonists

141
Q

The pain of______ can be very

severe and mimic myocardial infarction.

A

oesophageal spasm

142
Q

Oesophageal spasm responds to _____

do not confuse with angina

A

glyceryl trinitrate:

143
Q

______ are a very rare

cause of severe sudden thoracic pain (T2–9).

A

Intervertebral disc protrusions

144
Q

Infective endocarditis can cause _____

A

pleuritic posterior

chest pain

145
Q

The sudden onset of dyspnoea without chest pain

can occur frequently with ____ and ____

A

(painless) myocardial

infarction and pulmonary embolism

MC (90 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions