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Lectures final revision > Meeran Lectures Notes > Flashcards

Meeran Lectures Notes Flashcards

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1
Q

What is Acute Rheumatic Fever

A

Immune response to strep pyogenes

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2
Q

What is chronic rheumatic heart disease

A

20years after Rheumatic fever

fibrosis of heart valves - MS, AR

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3
Q

infective endocarditis

A

IVDU or people who have a damaged heart valve liklely to get it

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4
Q

Ix in Rheumatic Fever

A

High ASO

positive throat culture

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5
Q

What are the major criteria for rheumatic fever

A

Carditis

Arthritis

Nodules

Erythema Marginatum

Random Movement - Sydenham Chorea

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6
Q

What signs will you see in Mitral stenosis

A

Malar Flush

AF

Tapping Apex

Non displaced apex

Right ventricular heave

Blowing mid diastolic murmur and presystolic accentuation

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7
Q

Mitral Regurg signs

A

Displaced apex

Apical thrill

Quiet S1

Pansystolic murmur radiating to axilla

S3 present - rapid ventricular filling

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8
Q

What is a valvotomy

A

seen in pts with MS - opened up to leave MR

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9
Q

Aortic regurg signs

A

Collapsing pulse

Wide PP

Corrigans Neck

Quinckes fingers

Dynamic apex

EDM heart LSE

Systolic flow murmur

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10
Q

Causes of AR

A

Old syphilis

Marfans

Ank Spond

Reiters

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11
Q

ECG - significnace of Q wave

A

Dead myocardium - full thickness

Takes 4 hours

Deep - won’t recover like T waves will

Consider reperfusion injury through VF

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12
Q

NYHC 1+2

A

give BB

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13
Q

S3

A

rapid ventricular filling

Kentucky

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14
Q

S4

A

Atria contracting against stiff ventricle

HTN or AS

Ten-nes- see

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15
Q

Rx of cardiogenic shock

A

B1 agonist like dobutamine

effect to stimulate heart muscle to work harder

Also balloon pump in aorta to relieve load

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16
Q

Sign of cardiogenic shock

A

Raised JVP

Cold and clammy peripheries

Hypotensive

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17
Q

What is the effect of dopamine in Low, medium and high doses

A

Low - improves renal perfusion

Medium - Beta 1 Cardiac Agonist (cardiogenic shock)

High - not used by Alpha 1 agonist and peripheral vasoconstriction

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18
Q

How to locate the apex beat

A

Most LATERAl and INFERIOR

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19
Q

What DISPLACES the apex beat?

A

Dilatation

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20
Q

What causes cardiac dilatation

A

VOLUME OVERLOAD

AR

HF

MR

ASD/VSD

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21
Q

What causes HYPERTROPHY

A

PRESSURE OVERLOAD

AS

HTN

CoArc Aorta

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22
Q

Non Q waves in MI ECG

A

Subendocardial MI

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23
Q

When is MI reversible

A

If ST elevation seen in 4 -12 hours

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24
Q

When are Q waves irreversible after

A

6 hours

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25
Ix in Penumonia
Sputum Sample/culture Lateral vie Chest Xray Bloods Xray in 6 weeks to ensure its cleared and no underlying pathology
26
Mx of simple pneumothorax
Can leave it
27
Why should you drain a tension penumothorax
Pinches on OVC and SVC so reduced CO
28
What is asthma
Reversible airway obstruction
29
What is emphysema
Irreversible airways obstruction
30
What is a normal FEV1
75% of FVC
31
Acute severe asthma RX
Oxygen 5mg Salbutamol and oxygen Steroids 100mg IV Hydrocortisone 40mg Pred )D
32
If asthma is severe
Transfer to ITU Aminophylline 100-200mg slow IV Ventilate MgSo4 - risk of arrhythmias
33
asthma what is paradox breathing
greater than 20mmHg difference in pressure on breathing. Measure with a cuff and see the dial moving
34
IN COPD what oxygen should be given
If O2 and Co2 both 7 give venturi 24% If Co2 climbs give NIV to get rid of Co2. Turn off NIV when the infection clears and things return to normal
35
Chronic Liver Disease signs
Spider Navi \>5 Clubbing Palmer Erythema Duypytrens Gynaecomastia Testicular atrophy
36
Liver Cell Failure
Jaundice Leuconychia Bruising Ascites Encephalopathy
37
Signs of Portal hypertension
Splenomegaly Ascites Dilated veins on abdomen Haematemesis and melaena
38
With dilated abdo veins how to tell of portal hypertension or IVC obstruciton
Direction of the vein inferior to umbilicus Portal Hypertension - blood flow away from umbilicus IVC obstruction - towards the umbilicus
39
Signs in Cholestasis
Excoriations Pale stools Dark urine - negative for urobilinogen jaundice Xanthelasma
40
How to copare kidney and spleen in RIF
Kidney moves to RIF and down Spleen (CML) - from left down to right Kidney is resonant Spleen is dull Rise above the kidney and not the spleen
41
Types of Erythema
Migratory Necrolytic Erythema Chronicum Migrans Marginatum Ab igne Multiforme Nodosum
42
Necrolytic migratory erythema associated with
Glucagonoma
43
Chronic Migrans seen in
Lyme Disease
44
Marginatum seen in
Acute Rheumatic fever
45
Erythema Ab Igne seen in
Hotwater bottle
46
Erythema multiforme
Target lesions SJS
47
Nodosum seen in
variety IBD Sarcoid Cnacer dRUGS Infections
48
Action of Insulin
movement of Glut 4 to cell surface and movement of K+ and phosphate into cells Stimulates fat generation
49
In DKA what is treatment
Fluid Insulin Potassium If pH is less than 7 have to give small amoun of bicarb as insulin doesnt work in that low pH
50
Third nerve palsy with large pupil
COMPLETE third nerve palsy
51
Surgical Third nerve palsy
Pupil is not spared seen in Posterior communicating aneurysm Pressure on nerve
52
Why is it important to treat a squint in young
At birth the brain hasn't developed the macula - if an image doesnt fall on the eye get AMBLIOPIA from lack of developement
53
Squint causes
Muscle weakness or strabismus (squint)
54
Why do a cover test in a patient with a squint?
It proves that the 6th nerve (Abducting the eye) is working so no 6th nerve palsy present
55
If patient states see double vision what should you do?
Work out which is the weak eye Weak eye is responsible for the outer most image
56
Causes of Unilateral Exopthalmos
Graves Peri-orbital Cellulitis trauma
57
Causes of Complex othalmoplegia
Graves Myathenic Gravis Retro-orbital tumour Miller-Fischer Syndrome
58
Stages of diabetic retinopathy
Background Pre-proliferative Proliferative Diabetic maculopathy
59
Signs of Background retinopathy
hard exudates Microaneurysm Blot Haemorrhages
60
Rx of background retinopathy
Improved control of DM - metformin
61
What do cotton wool spots indicate?
retinal ischaemia
62
Pre-proliferative stage
Cotton wool (ischamia) Silver wiring and flame haemorrhages as thin walled vessels
63
rx of cotton wool
Require laser tx to stop new vessel formation Old - dark new - bright
64
Laser rx can be mistaken for what?
Retinitus Pigmentosa which is spicular Dominant condition which can also occur by itself
65
What is Horners
Damage to the sympathetic chain
66
Ix in Horners
X-ray for possible lung tumour
67
Signs of hypertensive retinopathy
1. Silver wiring 2. AV nipping 3. Cotton wool spots and flame haemorrhages 4. Papilloedema
68
What is homonomous hemianopia
Can't see one side of vision even with both eyes open
69
Who gets homonomous hemianopia?
Storke patients
70
IVDU Cardio complications and Signs
Staph A infection on tricuspid valve Endocarditis Signs Hands - roth spots, janeway lesions, splinter haemorrhages, clubbing, petechiae Murmur - diastolic murmur Abdo - Splenomegaly from active immune with septic emboli Microscopic haematuria
71
Malar Flush
Mitral Stenosis
72
How can MS be heard better
After exercise
73
Other conditions in MS
Af (50%)
74
Chest x ray in Mitral stenosis 2 signs to look for
Left atrial enlargement Pulmonary Haemosiderosis from pHTN
75
Causes of AF
MS Thyrotoxicosis Caffeine/Alcohol Ischameic Heart Disease Rheumatic heart disease Rheumatic Heart disease (common) PE Ca bronchus
76
Rx AF
Rate and Rhythm rate - BB or digoxin Rhythm - Amioderone but bad SE
77
What are the implications of using Digoxin in AF
It locks people into a lower rate Suitable in people who don't need their ventricular reserve (old)
78
After MI if AV node stops working and they have a pulse rate of 30 what needs to happen?
Need PACING
79
An LV aneurysm will show what on ECG?
ST elevation
80
What are the signs of heart failure?

Lectures final revision (10 decks)

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