Pink summary book 2/3 Flashcards
(87 cards)
1
Q
general tips for X-rays
A
- dont be too specific
- opacification not consolidation
- zones not lobes
2
Q
CXR presentation
A
ABCDE
- Confirm pt details
- Quality of image (rotation, inspiration, projection, exposure)
- Airway (central trachea, carina and bronchi)
- Breathing/bones (lung zones, opacification, absence of lung markings, pleura, meniscus sign, fracture/lytic lesions)
- Cardiac/circulation (Hilar structures, heart size, heart borders)
- Diaphragm (L= gas from stomach, R= higher up due to liver, flattened, costophrenic angles)
- Everything else (aortic knuckles, aortic pulmonary window, soft tissue, tubes, valves and pacemaker)
3
Q
what can cause a deviated trachea
A
Pathology
- pulled→ atelectasis
- pushed → pneumo and pleural effusion
Rotation of pt
4
Q
opacification sign of
A
infection/ cancer / fluid
5
Q
calcification of hilar vessels due to
A
calcification
6
Q
bilateral enlargement of hilar structures
A
sarcoidosis
7
Q
causes of blunted costophrenic angles
A
fluid
consolidation
COPD
8
Q
causes of blunted costophrenic angles
A
fluid
consolidation
COPD
9
Q
review areas on x-ray
A
- lung apices (TB and batwing sign)
- retrocardiac region
- behind diaphragm
- peripheral region of lungs
- hilar regions
- situs invertus
10
Q
ECG presentation
A
- Confirm patients details
- regular or irregular
- heart rate
- heart rhythm
- sinus? P waves before each QRS
- cardiac axis
7.
11
Q
regular or irregular
A
use paper to see spacing
12
Q
heart rate
A
- tachy or brady?
- regular- 300/ no. of boxes R-R
- irregular- no. of QRS in rhythm strip x6
13
Q
heart rhythm
A
regular
regularly irregular
irregularly irregular
14
Q
heart rhythm
A
regular
regularly irregular
irregularly irregular
15
Q
Sinus
A
- regular rhythm
- always p waves inf ront of QRS
16
Q
P waves
A
- sawtooth- flutter
- chaotic- fib
- flat- no atrial activity
17
Q
which leads to look at for cardiac axis
A
- Look at limb leads only (II, AVL, III)
18
Q
Normal axis
A
- lead II most positive
19
Q
Left axis deviation
A
- AVL most positive
20
Q
Right axis deivation
A
lead III most positive
21
Q
PR intevral
A
120-220ms
-
prolonged if >0.2s
- AV delay e.g. heartblock
-
shortened
- accessory pathway
22
Q
QRS
A
narrow <0.12
wide >0.12
tall= ventricular hypertrophy
23
Q
QRS morphology
A
- delta waves
- Q waves
- R waves
- S waves
- J point segment
24
Q
delta waves
A
slurred upstroke e.g. wolf-P-W
25
Q waves
previous MI
26
ST segment
should be isoelectric
* ST elevation- full thickness ischaemia
* ST depression- ischaemia
27
T waves
* tall= ‘tented’
* hyperkalaemia
* **hyperacute**
* STEMI
* **inverted**
* ischaemia
* BBB
* PE
* **biphasic**
* ischamia
* hypokalamia
* **flattened**
* ischaemia
28
U wave
electrolyte imbalance
It comes after the [T wave](https://en.wikipedia.org/wiki/T_wave) of ventricular repolarization and may not always be observed as a result of its small size. 'U' waves are thought to represent repolarization of the [Purkinje fibers](https://en.wikipedia.org/wiki/Purkinje_fibers).
29
causes of atrial fibrillation
1. ismchaemic heart disease
2. mitral valve disease
3. thyrotoxicosis
30
causes of atrial fibrillation
1. ismchaemic heart disease
2. mitral valve disease
3. thyrotoxicosis
31
thyrotoxicosis
exopthalmos
low BP
increased sympathetic drive i.e. AF
32
treatment of AF when patient is haemodynamically stable
1. **Anticoagulation to prevent stroke -** DOAC
2. **Rate control -** B- blocker or digoxin
**If patient is not haemodynamically stable**
1. **Rhythm control-** Cardioversion
33
**DOACs**
* Inhibits factor Xa (apixaban, rivaroxaban and edoxaban) or direct thrombin inhibition (dabigatran)
* Don’t need regular testing of levels compared to the INR monitoring of warfarin
* No restrictions on food or alcohol
* Excreted by the kidney so renal function is monitored yearly
* Lower rate fo bleeding to warfarin and slightly better reduction in strokes
34
**Triggers of AF**
*
* Binge drinking
* Obesity
* Cocaine ad amphetamines
35
**People with AF are at risk of**
* Cardioembolic stroke- due to stasis of blood in the atria
* Cardiac instability
* And higher risk of death
* Increased healthcare cost
36
**Diagnosis of AF**
* Pulse- irregularly irregular
* Symptoms
* Breathlessness
* Palpitations
* Syncope/dizziness
* Chest discomfort
* Stroke or TIA
* ECG
* Echcardiogram
37
pulmonary embolisms investigations
only do a D-dimer in someone at low risk fo PE -→ otherwise straight to a CTPA (gold standard)
-→ if haemodynamically stable give oral anticoagulant
38
with PE always think
could be cancer
39
massive PE will result in
reduced BP → thrombolyse
40
when to anticoagulate
risk benefit
compare risk of bleeding (HAS-BLED) with risk of clot (**CHA2DS2VaSc)**
41
vocal resonance can be measured on
auscultation or on palpation
42
increased vocal resonance
due to increased consolidation (Solid) -→ pneumonia
43
decreased vocal resonance
due to increased fluid = liquid e.g. pleural effusion
44
air bronchogram
air filled bronchi made clear by opacification of surrounding alveoli i.e. in pneumonia
45
AKI blood test results and treatment
increased creatinine and urea
give fluids
46
why ask about birds/ parots
atypical pneumonia e.g. chlamydia psittacosis
47
batwing distribution on X-ray
pulmonary oedema
* apical and basal sparing due to fluid leaving from the hilum (middle zones)
* give furosemide
48
MI basic treatment
MONA
* morphine
* oxygen (only if below 94%)
* nitrate (GTN)
* aspirin (STAT- 300mg)
then PCI-→ consider clopidogrel in prpe
49
prinzmental angina
vasospastic angina that occurs at rest
50
causes of COPD exacerbation
* recent decrease in diuretics
* infection
51
define heart failure
inability of the the heart to meet the demands of the bod
52
heart failure basic treatment
BAD
Beta blockers
ACEi
Diuretics
53
what makes sure the heart pumps effectively
* one way valve -→ blood goes in one direction
* chamber size-→ if too small reduced preload
* functioning muscle
54
causes of HF
* Ischaemic heart disease-→ remodelling due to fibrosis after ischaemia
* HTN→ increased afterload
* Aortic stenosis → increased afterload
* Cardiomyopathies
* Arrhythmias
55
pre-load
stretch of ventricles before contraction
56
after-load
what the heart has to pump againast
57
classifying heart failure
* left or right
* reduced or preserved ejection fraction
58
HfrEF
heart failure with reduced ejection fraction (most common)
* → EF \<40%
* contractility problem
59
HfpEF
preserved ejection fraction
* filling problem-→ stiff and smaller ventricles
60
right sided heart failure causes
* CHRONIC hypoxia causing **cor pulmonale**
* left sided HF
61
left sided heart failure causes
* IHD
* MI
* HTN
* valvular
62
right sided heart failure presentation
* peripheral oedema
* fatigue
* distended jugular vein
63
left sided heart failure presentation
* pulmonary oedema
* fatigue and tiredness
* SoB
64
acute coronary syndrome
*doesnt include stable angina (pain on exercise*
* *unstable angina*
* *NSTEMI*
* *STEMI*
64
acute coronary syndrome
*doesnt include stable angina (pain on exercise*
* *unstable angina*
* *NSTEMI*
* *STEMI*
65
unstable angina
* pain on rest
* normal Troponin
* normal ECG
66
NSTEMI
* pain on rest
* increased troponins
* ECG either normal or ST depression
67
STEMI
* pain on rest
* increased troponins
* ECG- ST elevation
* Q wave
68
fostair
LABA and ICS
keep going even through exacerbation treatment
69
what causes a visible JVP
pulmonary hypertension caused by chronic hypoxia
*due to backlog in the pulmonary system reducing return via the superior vena cave due to increased pressure within the pulmonary system*
70
risperidone
antipsychotic
* decreased dopaminergic and Serotonergic pathway
71
kerley B lines
heart failure
72
trimbow
* antimuscarinic
* steroid
* SABA
73
peak flow in asthma exacerbation
always take peak flow early in asthma exac. to ensure extent of constriction understood
* if they dont have normal peak flow reading then use standardised chart to compare
74
when to admit for COVID
sats \<94%
will have low lymphocytes and eosinophols
75
treatment of COVID-19
* dexamethasone (which will increase BM so consider insulin for T2DM)
* tocilizumab
* covid antibodies-→ REGEN-COV
76
which resp failure in MND
T2RF-→ low O2, high CO2
77
subcutaenous (surgical) emphysema
e. g. when pt is tapped (pleural effusion) causing air from lungs to go into muscle -→ visible on X-ray
- → feels funny
78
chronic pleural effusion
pleurodesis
* talcon powder and saline
* seals the pleura together
79
how to measure extent of pneumothorax
**measure rim of air from the hilum**
If the lung edge measures more than 2 cm from the inner chest wall at the level of the hilum, it is said to be 'large.' If there is tracheal or mediastinal shift away from the pneumothorax, the pneumothorax is said to be under 'tension.' This is a medical emergency!
80
diff between pacemaker and defib on x-ray
pacemaker- higher up
axilla- thicker wire
81
upper lobe diversion
blood vessels same size of bronchioles
* reflects elevation of left atrial pressure
* early signs of pulmonary oedema
82
covid-19 X-ray
patchy consolidation
bilateral
83
primary ciliary dyskineasia (CF)
* youngs
* kartagener
84
youngs
CF- bronchiectasis, sinusitis, reduced fertility
85
kartagener
CF- bronchiectasis, sinusitis, situs inversus
86
TB x-ray
found on upper lobe (more O2 for MTB)
ghon focus and caseating granuloma and complex (lymph)
