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Medicine Flashcards

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1
Q

Asthma Rx Step 1

A

Inhaled short acting B2 agonist PRN eg. salbutamol

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2
Q

Asthma Rx Step 2

A

Add inhaled steroid 200-800mcg/day eg. BECLAMETASONE (Fluticasone longer acting) 400mcg is appropriate starting dose

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3
Q

Asthma Rx Step 3

A
  1. Add inhaled LAB2 Agonist (LABA) eg. SALMETEROL 2. Assess control of asthma: -good response to LABA: continue -Benefit from LABA but control still inadequate:continue LABA and increased inhaled steroid to 800 - No response to LABA: stop LABA, increase steroids to 800mcg. If still inadequate trial other therapies eg. leukotriene R ANT eg. MONTELEUKAST or Sustained Release Theophylline
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4
Q

Asthma Rx step 4

A

Consider trials of: 1. Increasing inhaled steroid upto 200mcg/day 2. Add a 4th drug: eg. Leukotriene R ANT (MONTELEUKAST), sustained release theophylline, B2 Agonist tablet.

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5
Q

Asthma Rx step 5

A

Use daily steroid tablet in lowest dose. maintain inhaled steroid at 2000mcg Refer for specialist care.

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6
Q

Leukotriene R ANT

A

MONTELEUKAST or ZAFIRLUKAST -antiinflam and bronchdilatory. used whe pts poorly controlled on high dose inhaled steroids and and a LABA. -useful in ASPIRIN induced asthma -associated with development of churg-strauss- Vasculitis + airway atopy. (vasculitis-eosinophilic granulomatosis with polyangitis)

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7
Q

FLUTICASONE

A

Inhaled steroid for asthma. Longer acting than Beclametasone.

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8
Q

Diseases causing Obstructive Lung Disease

A

Asthma COPD Bronchiectasis Bronchiolitis Obliterans

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9
Q

PFTs in Obstructuve Lung disease FEV1 - FVC - FEV1:FVC -

A

FEV1 - significantly reduced FVC - reduced or normal FEV1:FVC - reduced

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10
Q

Diseases causing restrictive Lung disease

A

Pulmonary Fibrosis Asbestosis Sarcoidosis ARDS Kyphoscoliosis Neuromuscular Disorders

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11
Q

PFTs in Restrictive Lung Disease FEV1 - FVC - FEV1:FVC -

A

FEV1 - reduced FVC - significantly reduced FEV1:FVC - normal and increased

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12
Q

Stage 1 HTN criteria

A

Clinic BP >140/90 AND ABPM average >135/85

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13
Q

Management of stage 1 HTN: with low CV risk

A

BP >140/90 but CV risk is low Offer ABPM Lifestyle changes 1. Cut salt intake. can drop by up to 10mmHg 2. Eat a healthy, low fat diet 3. quit smoking 4. Exercise 5. Cut down on caffeine

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14
Q

Risk associated with increasing BP

A

every 2mmHg –> 7% increase of mortality from IHD 10% increased mortality from stroke

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15
Q

Stage 2 HTN criteria

A

Clinic BP >160/100 AND ABPM average >150/95 (from at least 14 measurements)

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16
Q

Severe HTN criteria

A

>180mmHg systolic OR >110mmHg diastolic

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17
Q

Management of severe HTN

A

BP >180/>110 - immediate Rx considered - signs of papilloedema or retinal heamorrhage –> same day by specialist -

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18
Q

When to treat stage 1 HTN

A

BP >135/85 AND any 1… - 10 years

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19
Q

fasting plasma glucose 6.2mmol/L

A

Impaired fasting glycaemia. 6.1-6.9 mmol/L Prediabetes

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20
Q

diagnosis of diabetes via one of 2 tests. these tests are…

A

HbA1c Plasma glucose

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21
Q

Diagnosis of diabetes in symptomatic patient

A

-Symptomatic -fasting glucose >7 -Random/OGTT glucose >11.1

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22
Q

Diagnosis of diabetes in asymptomatic patient.

A

-As per symptomatic but on 2 separate occasions. -fasting glucose >7 -Random/OGTT glucose >11.1

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23
Q

HbA1c in diabetes

A

>6.5% (48mmol/mol)

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24
Q

things that mislead HbA1c results

A
  • Hbopathies - Haemolytic anaemia - untreated IDA - suspected GDM - Children - HIV - CKD
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25
what to do with impaired fasting glucose...
- offer OGTT to rule out DM - results 7.8-11.1 = impaired glucose tolerance
26
CHADSVASC: Anticoagulation Strategy Score 0 Score 1 Score 2
0: no treatment 1: M- consider anti-coag F- No Rx \>2: Offer anti-coagulation
27
CHADSVASC Scoring
C - Congenstive Heart Failure: 1 H - HTN (or treated): 1 As - Age \>75: 2 Age 65-74: 1 D - Diabetes S2 - Prior Stroke or TIA: 2 Va - Vascular Disease (IHD, PAD): 1 Sex - female: 1
28
HASBLED scoring
H - HTN, uncontrolled, \>160mmHg: 1 A - Score 1 for any.... - Abnormal renal function (dialysis/Cr \>200) - Abnormal LFTs (Cirrhosis, bilirubin \>2 ULN, ALT/AST/ALP \> 3ULN) S - Stroke: 1 B - Bleeding, Hx of bleeding, tendency to bleed: 1 L - Labile INR (unstable/high INR, time in therapeautic range 65 years: 1 D - Drugs predisposing to bleeding: score 1 for drugs (antiplatelets/NSAID), 1 for EToH (\>8 drinks/week)
29
Causes of bradycardia DIVISIONS
Drugs- (ABCD)Antiarrhythmics, Amiodarone, Bblockers, CCBs, Digoxin Ischamia/infarction: inferior MI- heart block Vagal hypertonia: athletes, vasovagal syncope, carotid sinus syndrome Infection: myocarditis, rheumatic fever, IE Sick sinus syndrome: Infiltrative diseases: restrictive/dilated cardiomyopathy O: hypOthyroid, kalaemia, thermia Neuro: raised ICP septal defects Surgery or cardiac catheter.
30
Top 3 causes of bradycardia
1. drugs: antiarrhythmics (type 1), amiodarone, b blockers, ccb, digoxin 2. Infarction/ischaemia: heart block 3. Hypothyroidism
31
Heart block types
1st degree: PR\>200ms 2nd degree: mobitz 1-wenkebach Mobitz 2 Complete heart block: - junctional escape rhythm: narrow QRS 50bpm - ventricular escape rhythm: wide QRS 40bpm
32
Treatment for bradycardia: asx and urgent
If asx and \>40bpm- no Rx \<40bpm- URGENT- resus with an ABC approach 1. Manage underlying cause 2. Medical: - atropine IV (0.6-1.2g) ---- alkaloid that increases HR - isoprenaline 3. External pacing
33
Elective treatment for bradycardia in which conditions
Permanent pacing: - mobitz type II heart block - complete AV block -Sick sinus syndrome - AF - drug resistant tachyarrythmias
34
Management of SVT
If pt unstable- sedate and DC cardiovert Pt stable- identify rhythm and treat
35
PRint \>200ms Regular rhythm
First degree heart block Often asx No Rx
36
Progressive lengthening of PRint One non conducted P wave Next conducted beat short PRint Eg. 5 P waves, 4 QRS- ratio of 5:4
2nd degree heart block Wenkebach/mobitz type I Caused by an INFERIOR MI- reversible conduction block at AVN Rx: monitor
37
Constant PRint Occasional non conducted P waves Often wide QRS Constant P wave rate Conduction ratio van be variable
2nd degree heartblock mobitz type II Caused by ANTERIOR MI: septal infarction Wide QRS- block is often in bundle branches of purkinje Rx: pacemaker
38
Variable number of P waves per QRS- but always fixed. PRint constant and 120-200ms P wave rate constant QRS rate constant
2nd degree fixed ratio heart block 2:1 3:1 4:1 As result of Mobitz I or II - type I: narrow QRS, block at AVN - type II: broad QRS, usually pre-existing BBB
39
Complete dissociation of P waves and QRS complexes p waves constant rate QRS at constant rate Often bradycardic (ventricular escape rhythm of 40bpm)
3rd degree heart block End point of Mobitz type I or II AV block Caused by INFERIOR MI High risk of sudden cardiac death Rx: pacemaker
40
Wide QRS rSR in V1-v3 qRs in V6- slurred S wave in lateral leads Tinv in right sided leads (abnormal repolarisation)
Right bundle branch block MaRRoW Aetiology:INCH - Inferior Mi - Congenital: ASD, VSD, Fallot - Hypertrophy: RVH (PE, Cor pulmonale)
41
Wide QRS Loss of Q waves laterally (Q waves are normal septal depol) Tall R waves in lateral leads Deep S waves v1 (v1-3) M shaped R wave in lateral leads ST segment and T waves opposite direction to QRS vector
Left bundle branch block Usually always in presence of organic disease Causes: FLIC -Fibrosis -LVH: AS, htn -Inferior infarction -Coronary heart disease
42
RBBB plus LAD
Bifascicular block Extensive conducting system disease-
43
RBBB + L?anterior fascicle block + first degree AV block
Trifascicular block
44
Type of Escape rhythm SAN fails to depolarise.... Abnormal P wave Normal QRs 60-80bpm
Atrial escape
45
Type of escape rhythm Usually no P waves (occasionally after QRS) Normal QRS 40-60bpm
Junctional escape rhythm
46
Type of escape rhythm Usually as a result of complete AV block- See regular p waves If SAN failure- no P waves Wide QRS 20bpm
Ventricular escape rhythm
47
These are all types of what?... AVNRT AVRT Atrial Tachycardia Atrial Flutter Atrial fibrillation
Narrow complex tachycardia
48
Tachycardia P wave absent or immediately before/after QRS QRS normal (\<120ms)
AV nodal Re-entrant Tachycardia - re-entry of depolarisation into the SAN via long and short pathways
49
S1Q3T3 Deep s wave in 1 Pathological Q wave in III Tinv in III
PE
50
Delta wave
Wpw
51
Down sloping ST segment (reverse tick) Tinv
Digoxin
52
Wide QRS No P waves Sine wave appearance bradycardia
Hyperkalaemia
53
Small T waves ST depression Prolonged QTint U waves
Hypokalaemia
54
Lichen Planus: Ps
Planus: ?AI Purple Pruritic Papular Polygonal Flexor surfaces (palms, soles, genitals) Wickhams striae on surface Oral involvement common Koebner Phenomenon (new lesions at trauma site)
55
1. Name the rash 2. describe the rash 3. causes of the rash 4. treatment
1. Lichen planus 2. purple, pruritic, papular, polygonal rash on flexor surfaces. Commonly oral. 3. ?Autoimmune, quinine, thiazides 4. topical steroids (severe- immunosuppression)
56
Joint most commonly affected by gout
first metatarsal-phalangeal joint
57
Microcystal synovitis: monosodium urate monohydrate crystals in the synovium 1. what is it? 2. which joint likely affected? 3. risk factors? 4. management- acute and chronic
1. Gout 2. first metatarsal-phalangeal joint 3. RF:alcohol, obesity, foods high in purine (liver, kidney, oily fish, red wine, cheese 4. Acute: NSAIDS, ateroid injection, colchicine slow onset of action. If above CI use low dose pred (15mg/day), allopurinol if pt already on it 4. Chronic: Lifestyle modification, Allopurinol Prophylaxis (2 weeks after acute attack)
58
Indications and instructions for starting Allopurinol in Gout
Indications: 1. Recurrent attacks (\>2 in 1 year) 2. Tophi 3. renal disease 4. uric acid renal stones 5. prophylaxis if on cytotoxics or diuretics Instructions: 2 weeks post acute attack. Before then may precipitate another acute attack. - Titrate dose to serum uric acid - cover with NSAID or cochicine whilst starting
59
Cystic Fibrosis 1. Mode of inhertitence 2. chromsome number 3. Mutation in... 4. clinical manifestations 5. complications 6. treatment
1. AR 2. 7 3. CFTR (cystic fibrosis transmembrane receptor 4. Lungs- chronic infections esp Pseudomonas Aeroginosa, bronchiectasis. Digestive- meconium ileus, pancreatic insufficiency, FTT, repro- male infertility 5. life expectancy 35yrs, death by end stage lung disease 6. supportive via MDT, chest physio, mucolytics, Abx for Cx infx, pancreatic enzyme replacement (creon), heart-lung transplant.
60
7 diagnostic criteria of rheumatoid arthritis
Only need 4 for a diagnosis: 1. morning stiffness for \>1h for \>6/52 2. Arthritis in \>3 joints 3. Arthritis of hand joints 4. Symmetrical 5. Rheumatoid Nodules 6. +ve Rheuamtoid factor 7. Radiographic changes
61
radiological changes in rheumatoid arthritis
1. juxtaarticular osteopenia 2. soft tissue swelling 3. loss of joint space 4. advanced: 1. bony erosions 2. subluxation
62
Neurtropenia + Rheumatoid Arthritis + Splenomegaly
FELTYS SYNDROME
63

Medicine and Surgery (6 decks)

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