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Finals Conceptual Overview Flashcards

1
Q

Doses of antiplatelet drugs?

A
  1. Clopidogrel = 600mg if cath lab (300mg if not) then 75mg OD
  2. Ticagrelor = 180mg then 90 mg BD
  3. Prasugrel = 60mg then 10mg OD
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2
Q

Features which make VT likely diagnosis?

A

Previous IHD (re-entry circuit around scar tissue)

  • A:V dissociation (p waves not linked to QRS)
  • Abnormal RBBB pattern (first QRS peak in V1 is highest)
  • Presence of capture (normal QRS randomly) or fusion beats (normal sinus beat + ventricular beat)
  • QRS concordance in V1-V6 (all pointing up)
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3
Q

Definitions of AF?

A
  1. Paroxysmal = <7 days
  2. Persistent = 7 days to 12 months
  3. Permanent = >12 months or failed cardioversion
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4
Q

Causes of AF?

A

Ischaemic HD

Alcohol excess

Mitral valve disease

HTN

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5
Q

Rate and rhythm control in AF?

A

Rate

  • Beta blockers
  • Non-dihydropiridine CCB
  • Digoxin - only in old people (doesn’t drop BP, needs to be sedentary)

Rhythm

  • Amiodarone - lots of SEs (thyroid)
  • Flecanide - CI in structural abnormal heart (young patients)
  • Sotalol
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6
Q

Pressure changes in AS and MR?

A

AS = LV pressure higher at start of systole –> ejection systolic

MR = LV pressure always higher than LA –> pan systolic

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7
Q

What is ivibradine?

A

SA node inhibitor

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8
Q

How to accentuate left and right sided murmurs?

A

Left = expiration + hold

Right = inspiration + hold

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9
Q

Midline sternotomy scar?

A
  1. CABG
  2. VSD repair
  3. Valve replacement
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10
Q
  1. Williams Syndrome
  2. Noonan’s Syndrome
  3. Marfan’s Syndrome
  4. Down’s Syndrome
  5. Turner Syndrome

Chromosomes and what they are associated with?

A
  1. Williams Syndrome - chr 7 = AS
  2. Noonan’s Syndrome - chr 12 = PS
  3. Marfan’s Syndrome - chr 15 = AR/MR
  4. Down’s Syndrome - trisomy 21 = AVSD
  5. Turner Syndrome - 45XO = coarctation/bicuspid AV
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11
Q

Clues from legs in CV exam?

A

If midline sternotomy and scar on legs, CABG. If not, valve replacement.

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12
Q

What Ig is most common in myeloma?

A

IgG

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13
Q

What comes from myeloid cells?

A

Megakaryocytes, erythrocytes (–> reticulocytes –> RBCs), mast cells, MYELOBLASTS

Myelocytes produce…

  • Basophils, neutrophils, eosinophils (granulocytes) and monocytes
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14
Q

Diagnostic criteria for myeloma?

A
  1. Monoclonal protein (serum or urine)
  2. Plasma cells in bone marrow (>20%)
  3. Osteolytic lesions on skeletal survey

2/3 required for diagnosis

(Normal serum Ig is reduced)

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15
Q

Features of myeloma?

A
  • Pancytopenia
  • Hypercalcaemia
  • Normal ALP
  • Raised urea/creatinine (deposition of Ig in kidney)
  • Pseudohyponatraemia
  • B2-microglobulins
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16
Q

Management options in myeloma?

A

Radio/chemo

Interferons

Stem cell transplant

Thalidomide

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17
Q

Types of myeloid leukaemia?

A

Acute

AML

Chronic

  • CML
  • Polycythaemia Rubra Vera
  • Myelofibrosis
  • Myelodysplasia
    • Can all transform to AML
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18
Q

Types of lymphoid leukaemia?

A

Acute

ALL

Chronic

  • CLL - can transform to the others
  • Hodgkin’s Lymphoma
  • Non-Hodgkin’s Lymphoma
  • Multiple Myeloma
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19
Q

Causes of anaemia?

A
  1. Microcytic
    • Iron deficiency (intake, malabsorption, bleeding)
    • Thalassaemia
  2. Normocytic
    • Acute blood loss
    • Haemolytic anaemia
    • Bone marrow failure (no response to EPO)
    • Renal failure (no production of EPO)
  3. Macrocytic
    • Megaloblastic (B12/folate)
    • Non-megaloblastic
      • Smoking, alcohol, liver disease, hypothyroid, cytotoxics
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20
Q

Causes of haemolytic anaemia?

A
  1. Hereditary (abnormal architecture)
    • Spherocytosis (too spherical)
    • Eliptocytosis (too eliptical)
    • Sickle cell anaemia (Glutamic acid –> valine)
      • Rare = G6PD and PKD
  2. Acquired
    • Autoimmune (SLE, CLL)
    • Alloimmune (ABO, Rh)
    • Drugs
  3. Paroxysmal Nocturnal Haemoglobinuria
    • Immune system targets red cells for lysis
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21
Q

Blood results in haemolytic anaemia?

A

High reticulocytes

Low haptoglobin

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22
Q

Definition of a haemolytic anaemia?

A

RBC lifespan < 15 days

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23
Q

Causes of pancytopenia?

A

Ls

  • Leukaemia
  • Lymphoma

Ms

  • Metastases (to bone)
  • Multiple myeloma
  • Myelofibrosis
  • Myelodysplasia
  • Megaloblastic anaemia

Others

  • Splenomegaly
  • Aplastic anaemia
  • Drugs (chemo, methotrexate, sulphasalazine, azathioprine, gold, penicillamine)
24
Q

What can you reverse heparin with?

A

Protamine sulfate

25
Q

Haemophilia?

A

A = haemarthrosis

B = milder –> epistaxis, no haemarthrosis

Treat with factor replacement or desmopressin

26
Q

Causes of prolonged PT and APTT?

A

DIC or liver disease

27
Q

PT?

A

10-15s

Factors V, VII, X, Fibrinogen, Prothrombin (Extrinsic pathway)

DIC, liver disease (synthetic function), warfarin

28
Q

APTT?

A

18-45s

Factors V, VIII, IX, X, XI, XII, Fibrinogen, Prothrombin (Intrinsic pathway)

  • DIC, liver disease
  • Heparin
  • Haemophilia A or B
  • vWD
  • Antiphospholipid Syndrome
29
Q

What is FDPs?

A

Fibrin degradation products

Accelerated destruction of fibrinogen

Differentiates DIC from liver disease

30
Q

What is microangiopathic haemolytic anaemia?

A

Clotting causes mechanical destruction of red cells –> haemolytic anaemia

  • TTP
  • HUS
  • DIC
31
Q

What does conjugated mean?

A

Water soluble

32
Q

Causes of jaundice?

A
  1. Pre-Hepatic (unconjugated)
    • Haemolytic anaemia
    • Failure in conjugation (Gilbert’s, Crigler Najjar)
    • Physiological (newborn)
  2. Hepatic
    • Viruses
    • Alcohol
    • Drugs (amiodarone, steroids)
    • Metabolic disorders
    • RHF (back pressure to liver)
    • Mets
  3. Post-Hepatic
    • Gallstones
    • Pancreatic carcinoma
    • Drugs (co-amox –> cholestasis)
    • LNs
    • Primary/Secondary biliary cirrhosis
    • Primary sclerosing cholangitis (UC)
33
Q

Definition of jaundice?

A

Bilirubin >35

34
Q

Causes of ascites?

A

Transudate (SAAG <1.1)

  • Portal hypertension
  • Hypoalbuminaemia
  • Hypothyroidism

Exudate (SAAG >1.1)

  • Pancreatitis
  • Malignancy (liver, peritoneum)

SAAG = serum-ascites albumin gradient

35
Q

Causes of liver cirrhosis?

A
  1. Alcohol
  2. Viruses
    • Hep B, Hep C, HIV, EBV, CMV, HSV
  3. Metabolic
    • Wilson’s disease, Haemochromatosis (high transferrin sats), Alpha-1-antitrypsin deficiency (+emphysema)
  4. Immune
    • Primary biliary sclerosis, Primary sclerosing cholangitis, autoimmune hepatitis (needs immune screen)
36
Q

Complications of liver cirrhosis?

A
  1. Portal Hypertension
    • Varices, haemorrhoids, splenomegaly, ascites
  2. Hepatorenal Syndrome
    • Splanchnic dilation –> RAAS –> RA constriction and hypoperfusion
    • Terlipressin causes splanchnic constriction
  3. Spontaneous Bacterial Peritonitis
    • Neuts >250/mm3, WCC >500m3
    • Fast treatment with broad spec abx
  4. Hepatic Encephalopathy
    • Low GCS/confusion, constructional apraxia, hepatic flap
    • Lactulose - empties bowel and gets rid of waste (ammonia)
  5. Hepatocellular Carcinoma
    • Regular screening
37
Q

Child Pugh Score?

A
  1. Bilirubin
  2. Albumin
  3. INR
  4. Ascites/Encephalopathy (decompensation)
38
Q

4 most common causes of pancreatitis?

A
  • Gallstones
  • Ethanol
  • ERCP
  • Drugs
    • Azathioprine, thiazides, sodium valproate, tetracycline
39
Q

Complications of acute pancreatitis?

A

Early

  • Shock
  • Sepsis –> ARF, DIC
  • ARDS
  • Hypocalcaemia
  • Hyperglycaemia

Late (>1 week)

  • Necrosis
  • Pseduocyst
    • CT –> drainage
  • Bleeding
  • Pleural effusion/Ascites
40
Q

Causes of GI bleeds?

A

Common

  • GORD
  • Peptic ulcer
  • Gastric cancer
  • Mallory Weiss Tear
  • Oesophageal varices

Rare

  • Aorto-Enteric fistula (AAA repair –> fatal)
  • Angiodysplasia
  • Haemobilia
  • Dieulafoy lesion (arteriole erosion)
  • Meckel’s diverticulum (age 2, 2 inches, 2% population, 2:1 M:F, 2cm from ileocaecal valve)
  • Peutz-Jegher’s syndrome
  • HHT
41
Q

Management of IBD?

A

Medical

  1. Steroids
  2. 5-ASA (mesalazine, sulfasalazine)
  3. Azathioprine (if TPMT low –> CI due to risk of myelosuppression)
  4. Methorexate (only Crohn’s)
  5. Biologics (anti-TNFs)
  6. Antibiotics (metronidazole, cipro)

Surgical

  • Limited resection
  • Colectomy
42
Q

What are carcinoid tumourS?

A

Appendix/Rectum

  • Secrete serotonin (5-HT)
  • Flushing, diarrhoea, bronchoconstriction
  • Associated with R heart disease
  • Chromografin low
43
Q

Causes of gynaecomastia?

A

DISCO

  • Digoxin
  • Illicit drugs
  • Spironolactone
  • Cimetidine
  • Oestrogen containing drugs (finesteride etc)
44
Q

Indications for liver transplant?

A

Cirrhosis

Acute failure (PCM OD)

Carcinoma

45
Q

Abdominal scars and indications (general)?

A

RUQ

  • Gall bladder, bile ducts, liver

Epigastric

  • Stomach, duodenum

Central

  • Small bowel, pancreas

RIF

  • Appendicitis, gynae causes

LIF

  • Large bowel, gynae

Suprapubic

  • GU, gynae
46
Q

Causes of glomerular disease?

A
  1. Primary
    • Nephrotic (glomerulonephritis)
    • Nephritic
    • Chronic
  2. Secondary
    • DM
    • Amyloidosis
    • SLE
    • Goodpastures, ANCA vasculitis
    • Infective endocarditis (septic emboli)
    • Thrombotic microangiopathy (HUS, DIC)
    • Drugs (gold, penicillamines)
  3. Hereditary
    • Fabry’s diseae
    • Alport’s syndrome (collagen mutation)
47
Q

Causes of nephrotic syndrome?

A
  1. Minimal Change Disease
    • Most common cause in kids (Hodgkin’s disease)
  2. Membranous
    • Infective - Hep B/C, syphilis
    • CT disease - RA, SLE
    • Neoplastic - Lung Ca, gastric Ca, lymphoma, leukaemia
    • Drugs - gold, penicllamine, NSAIDs
  3. Focal Segmental Glomerulonephritis (RARE)
    • E.g. HIV
  4. Membranoproliferative (RARE)
    • Cryoglobulinaemia, lipodystrophy
48
Q

Definitions of microalbuminaemia, macroalbuminaemia, nephrotic syndrome?

A

Microalbuminaemia = 30-300 mg/24h

Macroalbuminaemia = 300mg - 3g/24h

Nephrotic syndrome = >3g/24h

49
Q

Complications of nephrotic syndrome?

A
  1. HTN (secondary) - due to RAAS activation
  2. Hypercholesterolaemia
  3. Hypoalbuminaemia –> peripheral oedema
  4. Thrombosis
    • Loss of antithrombin III and protein S
  5. Infection
    • Loss of Ig
50
Q

Biochemical changes in CKD?

A

Decreased

  • Na+, HCO3-, Ca2+

Increased

  • Urea, Creatinine, K+, H+, phosphate, Mg2+, urate
51
Q

Causes of AKI?

A
  1. Pre-Renal
    • Low plasma volume
    • Low cardiac output
    • Occlusion of renal artery
  2. Renal
    • ATN (ischaemic or toxic - contrast, gent)
    • Glomerular disease
    • Tubulo-interstitial disease (penicillin, NSAIDs, diuretics)
    • Pyelonephritis
  3. Post-Renal
    • Renal stones
    • Malignancy (bladder, prostate, cervix)
    • Retroperitoneal fibrosis
52
Q

How to differentiate between pre-renal and renal AKI?

A

Urinary Sodium

  • Pre-renal = low
  • Renal = high
53
Q

Causes of renal mass?

A

Unilateral

  • PCKD
  • Carcinoma
  • Hydronephrosis
  • Abscess
  • Pyelo
  • RA stenosis

Bilateral

  • PCKD –> may have ballotable masses if transplant but originals not removed
  • Carcinoma
  • Hydronephrosis
  • Amyloidosis
  • Tuberous sclerosis
54
Q

Immunosuppression in kidney transplant?

A
  1. Steroids
    • Prednisolone
    • Weight gain, diabetes, osteoporosis, psychosis, myopathy
  2. Calcineurin Inhibitors
    • Ciclosporin –> nephrotoxicity, gum hypertrophy, hirsutism, HTN
    • Tacromilus –> tremor, diabetes
  3. Anti-Metabolites
    • Mycophenolate Mofetil –> mucositis
    • Azathioprine –> rash, hepatitis, pancreatitis
55
Q

What is cutanea tarda?

A

Porphyria in CKD –> photosensitive rash

- FINALS (24 decks)

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