Medicine

Question 1

What measurements on a VBG are accurate?

Answer 1

K+, HCO3-, tells us if they are retaining CO2, Hb, Lactate

Question 2

What causes cardiogenic pulmonary oedema?

Answer 2

This is where there is an increase in LV end diastolic pressure causing an increase in pulmonary capillary hydrostatic pressure, fluid collects extravascular pulmonary tissues faster than lymphatics clear it.
Causes=
MI, IHD, HTN, aortic/mitral valve disease, arrythmias, cardiomyopathy, failure of prosthetic heart valve, bera blockers etc etc

Question 3

What are the investigations for heart failure?

Answer 3

ECG- ?LBBB, LAD, LVH, recent or evolving MI
Bloodd inc trop, glucose, BNP
XR chest- look for upper lobe diversion, cardiomegaly, kerley A, B, C lines, pleural effusion, bats wings

Question 4

How do you calculate the ECG rate?

Answer 4

300 divided by the number of large squares between R complexes

Question 5

What is the normal intervals for
A) p waves
B) PR intervals
C) QRS

Answer 5

A- p waves should be <0.12s (<3 little squares)
B- PR intervals should be 0.12-0.2 (3-5 squares)
C- <3 squares

Question 6

Why might the QRS complex be prolonged?

Answer 6

RBBB (M in v1)
LBBB (W in v1)
Ectopics
Tricyclic antidepressant poisoning

Question 7

What does a short and long PR interval indicate?

Answer 7

Short- an accessory pathway like WPW
Long- heart block

Question 8

When is it abnormal for T waves to be inverted?

Answer 8

If T waves are inverted in leades V4 to v6
Peaked T waves are seen in early acute MI and hyperkalaemia
Flattened at waves are seen in hypokalaemia

Question 9

What are the causes of bradycardia?

Answer 9

AV block
Physiological
Beta blockers
Hypothyroidism, hypothermia, hypoxia, MI, increased intracranial pressure
Also occurs in up to 1/3rd of patients with hypovalaemia- GI bleed, ectopic prefnancy

Question 10

What are the symptoms/signs of a hypertensive emergency?

Answer 10

bp >230/130
retinopathy, vomiting, nausea, confusion, neurological deficits, reduced consciousness

Question 11

how do you treat a hypertensive emergency?

Answer 11

nitroprusside, labetalol, gtn with continuous bp monitoring

Question 12

how do you diagnose pre eclampsia?

Answer 12

htn, prtoeinuria and oedema

Question 13

when would you suspect aortic dissection?

Answer 13

htn with sudden severe chest +/- back pain

Question 14

what are the signs of heart failure on an xr chest?

Answer 14

• upper lobe diversion
• pleural effusions
• batwing sign
• kerley a,b,c septal lines
• fluid in interlobar fissures
• cardiomegaly

Question 15

how do you treat cardiogenic pulmonary oedema?

Answer 15

• raise bed
• give oxygen
• IV furosemide 40mg
• catheter

Question 16

what is the difference between a transudate and exudate?

Answer 16

both pleural effusions

transudate- pleural fluid:serum protein >0.5

exudate- pleural fluid:serum protein <0.5

Question 17

what are the causes of transudates and exudates?

Answer 17

exudates;
- pneumonia
- malignancy
- tb
- pe with pulmonary infarction
- collagen vascular disease
- abscess
- pancreatitis
- chylothorax

transudates;
- hepatic failure
- cardiac failure
- nephrotic syndrome

Question 18

what are the causes of jaundice?

Answer 18

jaundice can be classified as pre hepatic/hepatic/post hepatic causes.

Pre hepatic- haemolytic anaemia
malaria
hepatic- viral infection, alcohol, gilberts, paracetamol poisoning, nafld, biliary malignancy
post hepatic- malignancy, pacreatitis, gallstones