clinical Flashcards
(99 cards)
1
Q
these symptoms describe Breathlessness haemoptysis chest pain hoarseness
A
mitral stenosis
2
Q
what are these the symptoms of Breathless fatigue heart failure palpitations
A
mitral regurgitation
3
Q
what are these the symptoms of? Chest pain precipitated exertion, cold weather, emotions, or a heavy meal. tight band of pressure radiates to neck, jaw or arms rapidly improves with rest syncope fatigue
A
stable angina
4
Q
what are the these symptoms of? Chest pain angina tight band radiates to neck and jaw aggravating with stress increasing frequency and severity provoked even at rest Look unwell murmur crackles women, elderly and diabetics may show untypical signs
A
acute coronary syndromes/ myocardial infarcture
5
Q
what are these symptoms of? severe breathlessness, autonomic activation, chest pain. Shock, pulmonary oedema, tachycardia, harsh systolic murmur, parasternal heave, palpable thrill, elevated JVP.
A
papillary muscle rupture from a myocardial infarcture
6
Q
what are these the symptoms of? Angina syncope exertional pre-syncope breathlessness Heart failure
A
aortic stenosis
7
Q
what are the signs of aortic regurgitation?
A
Increased LV systolic pressure
large volume and collapsing pulse
hyperdynamic/displaced apex beat
8
Q
what are the signs of atheroma?
A
Smoking, male, hypertension, diabetes, elderly, obese, sedentary, low birth weight and low economic status. family history biochemistry LDL corneal arcus tendon xanthomata Xanthelasmata
9
Q
what are the signs of mitral stenosis
A
Pulmonary odema embolization diastolic thrill right ventricular heave prominent JVP a wave tapping apex beat
10
Q
mitral regurgitation signs?
A
Pulmonary oedema, cardiogenic shock JVP prominent brisk hyperdynamic apex beat RV heave reduced S1 sound
11
Q
signs of stable angina?
A
Atherosclerosis diabetes mellitus smoking hypertension Hyperlipidaemia age family history obesity xanthalasma and corneal arcus abdominal aortic aneurysm, bruits or reduced peripheral pulse retinopathy anaemia tachycardia, aortic stenosis, mitral regurgitation, elevated JVP, peripheral oedema, basal crackles
12
Q
signs of thrombosis and embolsim
A
Hypercholesterolaemia cardiac failure, burns malignancy age Contraception immobilisation obesirty
13
Q
signs of aortic stenosis
A
Increased LV systolic pressure LV failure small volume pulse and slow rising JVP prominent vigorous and sustained apex beat RV heave S2 sound less audible
14
Q
signs of hypertension
A
Stress age renal disease endocrine disease smoking weight race alcohol genetic low birth weight drugs hypercholesterolaemia pregnancy
15
Q
stage 1 hypertension
A
Stage 1 –BP higher than 140/90 mm Hg clinically and daytime average of 135/85
16
Q
stage 2 hypertension
A
stage 2-160/100 mm Hg DA – 150/95 mm Hg
17
Q
severe hypertension
A
severe – 180 mmHg or diastolic higher than 110 mm Hg
18
Q
investigations for aortic regurgitation
A
ECG CXR cardiac catheterisation echocardiography MRI
19
Q
investigations for mitral stenosis
A
ECG catheritersation CXR – LA enlargement echocardiography MRI
20
Q
investigations for mitral regurgitation
A
ECG
CXR
cardiac catheterisation
echocardiography
21
Q
investigations for stable angina
A
Full blood count lipid profile fasting glucose electrolytes liver/thyroid tests CXR electrocardiogram (patho Q waves or later ST depression) exercise tolerance test myocardial perfusion tests (tracer seen no after stress ischaemia, seen neither at rest or stress it’s infarction) CT invasive angiography cardiac catheterisation
22
Q
investigations for acute coronary syndromes or MI
A
Serial ECG – ST elevation or
T wave inversion
cardiac biomarkers of cardiac troponin.
echo for size of wall abnormality, mitral regurgitation, mural thrombus
23
Q
test for MI complications
A
ECHO
Cath left heart and right heart
24
Q
investigation for aortic stenosis
A
ECG CXR Catheterisation echocardiography MRI
25
investigation for hypertension
```
ECG
echocardiogram
renal ultrasound
renal function
screen for causes
risk score
```
26
treatment for atheroma
```
Smoking cessation
weight loss
blood pressure control
diet
aspirin
surgery
```
27
treatment for mitral stenosis
```
Diuretics
Na restriction
anti-coagulation
valvotomy
MVR
```
28
treatment for mitral regurgitation
Preload/after load reduction from sodium nitroprusside, dobutamine
mitral valve repair or replacement
29
treatment for stable angina
Reduce risk factors
satins, ACE inhibitors, aspirin. Beta blockers, Calcium channel blockers, Ik channel blockers
percutaneous coronary intervention (stenting with aspirin and clopidogrel)
coronary artery bypass surgery with use of long saphenous vein
30
treatment for thrombosis and embolism
Prophylaxis for risk patients; heparin, TEDS
31
treatment for ventricular fibrillations and cardiac failure
CPR and defibrillation
32
treatment for left ventricular thrombus
warfarin
33
ST elevated MI
```
prevention
statins
angiotensin
aspirin
clopidogrel
general measures
```
```
treatment
PCI within 120-150 minutes
fibrinolytic therapy within 90 minutes
thrombolysis if <3hrs onset
thrombolytic agents
```
34
treatment for free wall tear
Pigtail catheter drainage, pericardiocentesis
35
treatment for papillary muscle rupture
PMR – balloon Pump nitrates >90mm hG, inotropes <90 mmhg mitral valve replaced or VSD repair
36
NON-STEMI treatment
Immediately – morphine, oxygen, nitro-glycerine, aspirin
treatment
Aspirin + ADP receptor blocker for 1 year. Anti-thrombotic therapy unfractionated herpain or low mol weight heparin
beta blockers
statins
ACE inhibitors
coronary angiography
revascularisation by PCI or CABG within 3-12 days
37
treatment for aortic stenosis
aortic valve replacement or repair
38
hypertension
```
Aggressive treatment
salt restriction
remove source of stress
remove alcohol
lose weight
```
young – ACE inhibitor or ARB
elderly calcium channel blocker and thiazide a diuretic
alpha-adrenoceptor
antagonists
methyldopa
beta blocker
only nifedipine, methyl dopa, atenolol, labetalol, thiazide diuretic or amlodipine for pregnant wome
39
treatment for aortic regurgitation
vasodilator, aortic valve repair or replacement
40
a subendocardial infarct refers to
non ST elevated myocardial infarct in that it is only limited to a partial, mainly the interior/innermost myocardial cells
41
a transmural infarct refers to
A St elevated myocardial infarct, normally when a whole section of myocardium tissue is necrotic
42
```
Loss of power
loss of sensation
loss of vision
loss of coordination
incontinence
headache, vomiting, neck stiffness
photophobia
fit
```
stroke
43
signs of a stroke
```
Speech dysarthria/dysphasia
neglect
loss of vision
ataxia, vertigo, nystagmus (loss of eye control)
vertigo
visual field defects
high blood pressure
atrial fibrillations
age
race
Family history
prior TIA or stroke
```
44
investigations for a stroke are
```
Blood tests (full blood count, platelets, red cells, lipids)
ECG (24hr)
CT (blood)
MRI (ischaemic)
echocardiogram
carotid doppler (ultrasound)
```
45
stroke treatment options are
Stroke unit
thrombolysis
clot retrieval using a catheter
```
secondary prevention;
clopidogrel or
aspirin + dipyridamole
statin
blood pressure drugs
carotid endarterectomy
```
46
Rheumatic fever signs
Relapsing illness
skin and joint manifestations
pancarditis
sydenham’s chorea/ St Vitu’s dance
47
Impending; increasing back pain and tender
rupture; painful pulsatile mass, haemodynamic instability, hypoperfusion
unusually; distal embolization
aortocaval/aortoenteric fistula, ureteric occlusion, duodenal obstruction
aneurysm
48
signs of aneurysm
```
Degenerative disease
connective tissue disease
infection
male
age
Smoking
hypertension
Family history
```
49
tests for aneurysm
Screening – ultrasound <65
```
patient fitness
blood
ECG
ECHO
PFTs
MPs
CPEX
patient preference
USS
CTA/MRA
```
50
treatment for aneurysm
Size, candidate and suitability
has to be larger than >5.5cm
conservative
repair endovascular or open
emergency; transfusion, laparotomy
51
symptoms of chronic heart failure
Dyspnoea, fatigue, oedema, reduced exercise capacity
52
signs of chronic heart failure
Underlying causes; left ventricular dysfunction or severe aortic stenosis
age
hypertension
obesity
diabetes
tachycardia, raised JVP, 3rd heart sound, chest crepitation’s/effusions, displaced or abnormal apex beat
53
investigations for chronic heart failure
```
Responsiveness to diuretics, evidence of cardiac dysfunction required.
ECHO
radionucleotide
left ventriculogram
cardiac MRI
12 lead ECG
BNP (low excludes heart failure)
CXR
found out LVSD;
coronary angiogram, MRI, test autoantibodies, CT exclude renal failure etc.
NYHA grading
```
54
treatment for chronic heart failure
```
Diuretics
ace inhibitors
betablockers
aldosterone receptor blockers
ARNI’s
```
55
symptoms of dilated myopathy
Dyspnoea, PND, oedema, weight gain, cough,
56
signs of dilated myopathy
```
JVP elevated
displaced Apex
s3/s4 noise
MR murmur
pleural oedema
pleural effusion
hepatomegaly
atrial fibrillations
Acites
crepitations
narrow pulse
sacral oedema
oedema
```
57
investigations for dilated myopathy
```
ECHO
ECG
bloods
angiogam
BNP
CXR
biopsy
```
58
treatment for dilated myopathy
```
Treat anaemia
remove exacerbating factors such as drugs or toxins
diet
ACEI
AT2 blockers
diuretic
betablockers
Spironolactone
anticoagulantants
transplant
```
59
pericarditis symptoms
Chest pain, pleuritic pain, postural leaning back hurt more, fever
60
pericarditis signs
Pericardial rub, elevated JVP, effusion
low b.p.
breathing diminishes pulse
muffled heart sounds
61
pericarditis investigation s
ECHO, ECG, troponin, PR segment depression, St changes
62
pericarditis treatment
Limit use of NSAIDS
drain if necessary
anti-microbials
63
restrictive cardiomyopathy signs
Diabetic, sarcoidosis, amyloid, sarcoid, haemochromatosis
64
restrictive cardiomyopathy investigations
ECG, CXR, BNP, blood tests
auto-antibodies, amyloid biopsy, low plasma alpha galactose (fabry) ECHO
CMRI
65
restrictive cardiomyopathy treatment
No diuretics or anticoagulants,
| most likely have to cardiac transplant, ICD or treat iron deficiency, or underlying amyloid or Fabrys.
66
Hypertrophic cardiomyopathy symptoms
Chest pain, dyspnoea, presyncope, syncope, exertional stress, arrhythmias, angina,
67
Hypertrophic cardiomyopathy signs
Genetic, notched pulse pattern, double apex beat, thrills, murmurs which increase more with Valsalva and squatting, JVP raised, notched pulse pattern
68
Hypertrophic cardiomyopathy investigations
ECG
ECHO, MRI
risk test for whether defibrillator is needed
family testing
69
Hypertrophic cardiomyopathy treatment
Avoid exercise, avoid dehydration
remove negative drugs or stimuli
obstructive form surgical or alcohol septal ablation to restore flow.
use of beta blockers, Verapamil, or Disopyrimide to treat symptoms and anticoagulants for atrial fibrillations
70
myocarditis signs/symptoms
Heart failure, shortness of breath, acute fever, heart block
71
myocarditis investigations
ECG
| Biomarkers elevated but not consistent with MI, ECHO, MRI, Viral DNA PCR, autoantibodies, Step antibodies, HIV
72
myocarditis treatment
Treat heart failure and arrhythmia, use of immunotherapy or stop toxic exposure
73
pericardial effusion symptoms
Fatigue, shortness of breath, dizzys with low BP, chest pain
74
pericardial effusion signs
Pulsus paradoxus, JVP raised, low BP, pulmonary oedema,
75
pericardial effusion investigations
ECHO
CXR
Sample fluid
76
pericardial effusion treatment
Drainage
| pericardial window if persistent
77
Ventricular tachycardia symptoms
palpitations, dyspnoea, syncope, poor LV function
78
tests for Ventricular Tachycardia
Bloods, ECHO, angiogram
79
treatment for Ventricular tachycardia
Cardiac arrest protocol, DC cardioversion, treat underlying cause
ICD therapy
80
bradycardia symptoms
syncope
81
bradycardia signs
```
Neuromuscular disease
bifascicular/trifascicular block
sinus node disease
cartid sinus hypersensitivity
vasovagal syncope
```
82
bradycardia treatment
pacemaker
83
coarctation signs
Turner’s syndrome
hypertension
cold legs, poor pulse
if before left subclavian right radial femoral delay, if after left subclavian then right and left radio-femoral delay
84
coarctation symptoms
Heart failure, failure to thrive
hypertension
85
chronic limb ischaemia symptoms
```
Fontaine classification;
asymptomatic
stage 2: claudication pain
A – more than 200 m
B – less than 200 m
stage 3 - feet rest pain
stage 4 – necrosis, gangrene
```
86
chronic limb ischaemia signs
Risk factors; male, age, smoking, hypercholesterolaemia, hypertension, diabetes
ulceration, pallor, hair loss, pulses, capillary refill time
87
chronic limb ischaemia investigations
```
Exercise tolerance
effect of incline
Change over time
bilateral
tissue loss and peripheral pulse/sensation
ankle brachial pressure index
0.95-0.5 = claudication
0.5-0.3 = rest pain
<0.2 gangrene/ulceration
buerger’s test
slow to regain colour
hyperaemic sunset
```
88
chronic limb ischaemia treatment
```
Managed similar to coronary heart disease;
antiplatelet therapy
statins
BP control
smoking cessation
Exercise
diabetic control
angioplasty, stent, endovascular reconstruction or bypass if critical
bypass required an autologous conduit
amputation if necessary
```
89
acute limb ischaemia symptoms
Pain, pallor, perishing cold, paraesthesia (pins and needles) paralysis, pulseless
90
Acute limb ischaemia signs
Recent trauma, dissection, aneurysm, thrombosis, embolism
chronic limb ischaemia
rapid onset
compartment syndrome; inflammation, oedema, obstruction, tense tenderness, rise in creatine kinase, risk of renal failure
91
Acute limb ischaemia inv.
ECG
blood
nil by mouth?
92
Acute limb ischaemia treatment
```
Analgesia, anticoagulated
limb salvageable
amputate
embolectomy
Bypass
endovascular
thrombolysis
palliate
```
93
Diabetic foot disease symptoms
Ulceration, recent infection like symptoms, painless
94
Diabetic foot disease inv.
Diabetes, check pressure check pressure points, plantar foot surface, tracking infection, investigate for gas gangrene, necrotising fasciitis, osteomyelitis
95
Diabetic foot disease treatment
PREVENTION
Footcare, glycaemic control, wearing shoes, regular woundcare, systemic antibiotics
revascularisation, distal bypass, amputation
96
Infective Endocarditis
Fever/chills
| night sweats, malaise, fatigue, anorexia, weight loss, weakness, arthralgia, headache, SOB
97
Infective Endocarditis signs
Cardiac murmur, janeway lesions, osler nodes, roth spot, meningeal signs, cutaneous infarcts, vasculitis rash, signs of heart failure , embolic events, history of IE, prosthetics
98
Infective Endocarditis investigation
```
Blood culture 3 sets 30 mins apart +/-
renal function tests
Urinalysis
ECG (PR prolonged)
CXR
MRI, PET/CT, ECHO, SPECT
```
99
Infective Endocarditis treatment
I.V. antibiotics
| or antibiotic prophylaxis for prevention as well as good oral hygiene and aseptic measures
