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1
Q

Specific MoA of Salbutamol

A

Stimulates B2 receptors of respiratory tract, which increases sympathetic activity and relaxes bronchial smooth muscle

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2
Q

Signs on examination of consolidation?

A
  • Reduced chest expansion
  • Dull percussion note
  • Increased tactile fremitus
  • Increased vocal fremitus
  • Bronchial breathing
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3
Q

Percussion note in:

  • consolidation
  • pleural effusion
  • pneumothorax
A

Consolidation = dull
Pleural effusion = Stony dull
Pneumothorax = hyperresonant

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4
Q

Why are TB cases increased?

A
  • HIV/AIDs
  • Use of immunosuppressive drugs
  • Poor socio-economic conditions and overcrowding
  • Increased immigration from areas of high prevalence of TB
  • Multidrug resistance
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5
Q

Why do we use 4 drugs to treat TB?

A

To combat multidrug resistance

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6
Q

Causes of erythema nodosum?

A
  • Idiopathic
  • Crohn’s, UC
  • Sarcoidosis
  • Drugs (oral contraceptive, sulphonamides)
  • Streptococcal infection
  • Chlamydia
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7
Q

Bronchiectasis

Complications

A
  • Pneumonia
  • Septicaemia
  • Recurrent pneumonia/LRTIs
  • Haemoptysis
  • Respiratory failure
  • Cor pulmonale
  • Pneumothorax
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8
Q

Common places for lung cancer to metastasize to?

A
  • Brain
  • Bone
  • Liver
  • Adrenals
  • Other sites on the lungs
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9
Q

What test would you do to look for superior vena cava syndrome?

A

Pemberton’s sign (lift hands above head and keep them there for a minute)

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10
Q

CXR signs in idiopathic pulmonary fibrosis?

A
  • Reduced lung vol
  • Reticulonodular shadowing - often worse in lower zones
  • Honeycomb lung - advanced disease
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11
Q

Causes of clubbing

A
  • bronchial carcinoma
  • mesothelioma
  • bronchiectasis
  • cryptogenic organising pneumonia
  • chronic empyema
  • chronic lung abscess
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12
Q

Causes of bilateral hilar lymphadenopathy

A
  • Lymphoma
  • Bronchial carcinoma
  • TB
  • Mycoplasma
  • Extrinsic allergic alveolitis
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13
Q

Biopsy in sarcoidosis?

A

Non-caseating granulomas

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14
Q

Extraplumonary manifestations of sarcoidosis?

A
  • Erythema nodosum
  • Anterior uveitis
  • Posterior uveitis
  • Arthralgia
  • Bone cysts
  • Neuropathy
  • Cranial nerve palsies
  • Cardiomyopathy
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Hypercalcaemia
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15
Q

Drugs used for pleurodesis

A
  • Talc
  • Bleomycin
  • Tetracycline
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16
Q

Aspiration pneumonia

RFs

A
  • Poor dental hygiene
  • Swallowing difficulties
  • Prolonged hospitalization or surgical procedures
  • Impaired consciousness
  • Impaired mucociliary clearance
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17
Q

Aspiration pneumonia

Which lobes are most commonly affected?

A

Right middle and lower lung lobes are the most common sites affected, due to the larger calibre and more vertical orientation of the right main bronchu

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18
Q

Aspiration pneumonia

Aerobic bacteria examples

A 
Streptococcus pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Klebsiella: often seen in aspiration lobar pneumonia in alcoholics
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19
Q

Aspiration pneumonia

Anaerobic bacteria examples

A

Bacteroides
Prevotella
Fusobacterium
Peptostreptococcus

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20
Q

How does a posterior MI present?

A

Changes in V1-3

Reciprocal changes of STEMI are typically seen:

  • horizontal ST depression
  • tall, broad R waves
  • upright T waves
  • dominant R wave in V2

Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)

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21
Q

3rd heart sound

What does it represent?
When is this normal?
What pathologies could it indicate?

Study These Flashcards
A
  • Caused by diastolic filling of the ventricle
  • Considered normal if < 30 years old (may persist in women up to 50 years old)
  • Heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
22
Q

Side effects of adenosine?

Study These Flashcards
A
  • Transient feeling of warmth/flushing
  • Chest pain
  • Bronchospasm
  • Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
23
Q

Adenosine

What enhances it’s effect?
What blocks the effect?

Study These Flashcards
A
  • The effects of adenosine are enhanced by dipyridamole (antiplatelet agent)
  • Blocked by theophyllines
24
Q

Adenosine

When should it be avoided?

Study These Flashcards
A

It should be avoided in asthmatics due to possible bronchospasm.

25
Adenosine MoA
- Causes transient heart block in the AV node - Agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux - Adenosine has a very short half-life of about 8-10 seconds
26
Changes to ECG in few days following STEMI?
- T wave inversion | - Pathological Q waves
27
Complications of coronary angiography?
- Bleeding/hemorrhage - Infection - MI - Stroke - Allergy to contrast - Damage to coronary vessels, requiring intervention ,- Death
28
Angina Other than exertion, what may trigger it?
- Cold/windy weather - Emotion - Lying down - Vivid dreams
29
Angina How does aspirin help prevent coronary events?
- Irreversibly inhibits cyclooxygenase, which prevents further production of TxA2 (thromboxine) from platelets as they do not have a nucleus, shifting the balance of PGI2: TxA2 towards inhibiting platelet aggregation
30
Acute pulmonary oedema management
- Furosemide - GTN/nitrates - Morphine - Oxygen
31
What is a capture beat?
A normal QRS complex between VT complexes
32
What ECG changes can digoxin cause?
ST depression T wave inversion In leads V5-V6
33
Where and how does furosemide work?
Loop of Henle, ascending limb !! Competitively inhibits the Na-K-2Cl cotransporter in the thick ascending limb of Loop of Henle, diminishing the osmotic gradient for water absorption
34
BNP in HF
- **If high (> 2000 NTproBNP or > 400 BNP)**: ECHO and specialist assessment within **2 weeks** - **If raised** (**> 400 NTproBNP** or **>100 BNP**): ECHO and specialist assessment within **6 weeks**
35
How to calculate BMI?
Weight divided by Height squared
36
BMI classifications
Underweight: < 18.5 Normal: 18.5 - 24.9 Overweight: 25 - 30 Obese: > 30
37
Statin MoA
Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis
38
Causes of AF
``` Pneumonia MI PE Hyperthyroidism Alcohol excess Heart failure Endocarditis Mitral stenosis ```
39
Hypercalcaemia ECG changes
- SHORT QT INTERVAL - In severe hypercalcaemia, Osborn waves (J waves) may be seen - Ventricular irritability and VF arrest has been reported with extreme hypercalcaemia
40
Metabolic causes of seizures
``` Hypoglycemia Hyponatraemia Hypernatraemia Anoxia Water intoxification ```
41
Which airway would you consider in a seizure?
Nasopharyngeal
42
3 layers of the meninges
- Dura mater - Arachnoid mater - Pia mater
43
Muscles in hand/wrist supplied by median nerve?
LLOAF - Two lateral lumbricals - Opponens pollicis - Abductor pollicis brevis - Flexor pollicis brevis
44
Rfs for carpal tunnel
``` idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis ```
45
Ix's for carpal tunnels
Electrophysiology | motor + sensory: prolongation of the action potential
46
Tx of carpal tunnel
``` corticosteroid injection wrist splints at night surgical decompression (flexor retinaculum division) ```
47
What anatomical landmark allows categorisation of upper/lower GI bleed during endoscopy?
The ligament of Treitz at the duodenojejunal flexure
48
What is budd chiari syndrome
Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition - polycythaemia rubra vera - thrombophilas - pregnancy - COCP
49
Features of budd chiari
abdominal pain: sudden onset, severe ascites → abdominal distension tender hepatomegaly
50
Budd chiari Ix's
- US with doppler flow studies
51
Criteria for liver transplant in paracetamol overdose
Arterial pH < 7.3, 24 hours after ingestion or all of the following: - prothrombin time > 100 seconds - creatinine > 300 µmol/l - grade III or IV encephalopathy

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