GET AHEAD! MEDICINE SBAs PAPER 1 Flashcards

1
Q

What are the guidelines for treating someone with ACS without ST elevation?

A
  1. Admit to CCU
  2. Low flow oxygen if O2 sats <40%
  3. Fondaparinux 2.5 mg OD SC / LMWH 1 mg/kg/12hrs
  4. If pain continues IV nitrates (50 mg/50 ml of 0.9% saline)
  5. High risk patients give GPIIb/IIIa antagonist and refer for angiography as in patient.
  6. Low risk patients discharge and treat medically. Consider stress test and echo.
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2
Q

Why might you not give someone with ACS without ST elevation a beta-blocker?

A
COPD
Asthma
LVF
Bradycardia
Coronary spasm
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3
Q

What would you give someone with ACS without ST elevation if a beta blocker was contraindicated but you needed to control their blood pressure?

A
Ca antagonist (rate limiting)
Verapamil 80-100 mg every 8 hours
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4
Q

What is the mechanism of fondaparinux?

A

Factor Xa inhibitor

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5
Q

When deciding whether to refer a patient with ACS without ST elevation for angiography or discharge with medical treatment, what factors would constitute a high risk patient?

A
Rise in troponin
Dynamic ST/T wave changes
Diabetes
Chronic kidney disease
Ejection fraction <40%
Early angina post MI
Recent PCI
Prior CABG
Intermediate to high GRACE score
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6
Q

When deciding whether to refer a patient with ACS without ST elevation for angiography or discharge with medical treatment, what factors would constitute a low risk patient?

A

No new chest pain
No signs of heart failure
Normal ECG
-ve troponin 6-9 hours after symptom onset

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7
Q

What are the guidelines for treating someone with ACS with ST elevation?

A
  1. Gain IV access
  2. Take bloods (FBC, U+Es, lipids, glucose, cardiac enzymes)
  3. Brief assessment including history, examination and contraindications to PCI
  4. Aspirin 300 mg
  5. Morphine 5-10 mg (plus metoclopramide 10 mg IV)
  6. PCI if available within 120 mins of medical assessment / Fibrinolysis within 30 mins of admission
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8
Q

Why would you do U+Es in someone with ACS?

A

Check renal function for AKI and future drug treatment

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9
Q

What are some of the risk factors you would want to ask about when taking a history from someone with suspected ACS?

A
Hypertension
Hyperlipidaemia
Diabetes
Previous angina
Previous MI
Previous stroke
Family Hx
Smoking
Diet
Exercise
Occupation
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10
Q

What are the contraindications for fibrinolysis?

A
Known bleeding disorder
GI bleed in the last month
Previous intracerebral heamorrhage
Ischeamic stroke within last 6 months
Cerebral malignancy
Major trauma or head injury in the last 3 weeks
Aortic dissection
Non-compressible puncture such as liver biopsy
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11
Q

What are the fibrinolytic agents used in fibrinolysis in someone with a STEMI?

A

Tissue plasminogen activators:
Alteplase
Retaplase
Tenecteplase

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12
Q

What changes might be seen on an ECG of someone having a posterior MI?

A

Reciprocal changes in the anterior leads (V1-V4):
ST depression
Tall R waves

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13
Q

Which of the following is not a potential cause of obstructive renal impairment? For each one say why it does or does not cause obstructive renal impairment.

Benign prostatic hypertrophy
Recurrent kidney stones
Retroperitoneal fibrosis
Schistosomiasis
Systemic sclerosis
A

Benign prostatic hypertrophy causes obstructive urinary retention which if left untreated will cause renal impairment.

Kidney stones for the same reason are an obstructive cause.

Retroperitoneal fibrosis is widespread fibrosis with the retroperitoneum. This includes the ureter, which as a result of fibrosis, cease to be able to peristalse and an obstruction is created.

Schistosomiasis is a disease caused by parasitic worms. S. haematobium produce eggs that can become lodged retrogradely in the ureter and initiate inflammatory response and granulomas can form. This leads to obstruction.

Systemic sclerosis can cause renal impairment however it is not obstructive. The disease causes fibrinoid thickening of the afferent arterioles which leads to reduced perfusion of the kidney and hence damage.

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14
Q

What is polycythemia rubra vera?

A

A myelo proliferative disorder where the bone marrow makes too many red blood cells, caused by mutation in single pluripotent stem cell.

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15
Q

What are some of the symptoms of polycythemia rubra vera?

A
Headache
Visual disturbances
Lethargy
Pleuritis which is worse after bathing
Increased risk of artero and veno thrombosis
Increased risk of paradoxical bleeding
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16
Q

What would blood tests show in someone with polycythemia rubra vera?

A

Raised Hb
Raised RCC
Raised haematocrit
To lesser extent raised platelets and neutriphils

17
Q

What is the treatment for someone with polycythemia rubra vera?

A

Phlebotomy
Venesection
Low dose aspirin

18
Q

In multiple sclerosis, what are the findings most frequently seen on an MRI scan?

A

Periventricular white matter lesions not necessarily matching the clinical picture

19
Q

What disease is transverse myelitis associated with?

A

Neuromyelitis optica (NMO or Devic disease)

20
Q

What is neuromyelitis optica?

A

A rare autoimmune central nervous system dymyelinating disease affecting the spinal cord and optic nerves. Associated with anti-aquaporin 4 antibodies.

21
Q

Are there focal grey matter lesions in patients with MS?

A

Not usually. Only focal white matter lesions.