Phase 2 SBA Mock Flashcards
(78 cards)
What medication is used to treat severe hyperkalaemia ?
Calcium gluconate
What ECG changes are seen in hyperkalaemia ?
Go, go long, go wide, go tall Loss of P waves Prolonged PR interval Widened QRS Tall tented T waves
ECG changes seen in hypercalcaemia
Shortening of the QT interval
In severe cases J waves may be seen
Ventricular and VF in extreme cases
ECG changes seen in hypocalcaemia
Lengthening of the QT interval
Causes of hyperkalaemia
AKI
Medications which interfere with renal potassium excretion e.g. spironolactone, trimethoprim NSAIDs
Medications which infer with cellular K+ e.g. digoxin, beta blockers
Hypoaldosteronism
Acidosis
Tumour lysis syndrome
What is 2nd and 3rd line in treating hyperkalaemia ?
2nd = Insulin and glucose 3rd = Salbutamol
What artery plays a role in ED ?
Internal pudendal artery
What is Wilson’s disease ?
A rare disorder characterised by excess copper stored in various body tissues
Characteristic brownish yellow rings at the corneoscleral junction of both eyes
What is the pulse of a patient presenting with aortic stenosis
A small volume and slow rising pulse
What is 3rd degree atrioventricular heart block ?
Complete heart block
There is no observable relationship between P waves and QRS complexes
What is 1st degree heart block ?
Occurs when there is delayed atrioventricular conduction through the AV node
Despite this every atrial impulse leads to a ventricular contraction
On an ECG this can be visualised as an extended PR interval
2nd Degree heart block ?
Where some of the atrial impulses do not make it through the AV node to the ventricles
On an ECG this will mean that some P waves do not lead to QRS complexes
There are several types of 2nd degree block
Mobitz type 1
Mobitz type 2
What is Mobitz type 1 HB
Where the atrial impulse becomes gradually weaker until it does not pass through the AV node
After failing to stimulate a ventricular contraction the atrial impulse returns to being strong and then the cycle repeats agai
How does Mobitz type 1 HB present on an ECG
On an ECG this will show up as an increasing PR interval until the P wave no long conducts the ventricles
Culminating in an absent QRS complex after a P wave
The PR interval then returns to normal but becomes progressively longer again until another QRS complex is missed
Then repates
What is Mobitz type 2 HB
Intermittent failure of interruption of AV conduction
This results in missing QRS complexes
There is usually a set ratio of P waves to QRS complexes e.g. 3 P waves to each QRS complex = a 3:1 block
The PR remains normal
What is a major complication of 3rd degree HB and Mobitz type 2 (2nd degree) HB ?
Asystole (flatline)
Treatment for unstable arrhythmia or risk of asystole (i.e. MT2, T3B or previous asystole)
1st line = atropine
Treatment for unstable arrhythmia or risk of asystole after 500mcg IV atropine
Atropine IV repeated up to 6 doses
Other inotropes e.g. noradrenaline
Transcutaneous cardiac pacing (Defib)
Treatment for patients at high risk of asystole
Temporary transvenous cardiac pacing
Permanent implantable pacemaker
MOA Atropine
Antimuscarinic that works by inhibiting the parasympathetic nervous system
A 70 year old woman presents with an ulcer above the medial malleolus. She also has swelling and pigmentation on the medial aspect of the lower leg. What type of ulcer is this most likely to be?
Venous
Where do arterial ulcers typically present ?
Periphery e.g. toes
Name some dermatological manifestations of IBD
Erythema nodosum Oral aphthous stomatitis Psoriasis Pyoderma gangrenosum Sweet syndrome
A 62 year old man with longstanding peripheral vascular disease notices central chest discomfort whilst moving furniture. He then develops similar but more severe chest pain whilst watching TV the following day. His wife rings 999 and the paramedics arrive to find him now pain free. An ECG shows deep T wave inversion from leads V2 to V6.
What is the diagnosis ?
Non-ST elevation myocardial infarction
