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Buzz Words (Hana + Y1 Goldmine + Anatomy Tips > Quesmed > Flashcards

Quesmed Flashcards

(75 cards)

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1
Q

What murmur is associated with malar flush?

A

Mitral stenosis
(This is discolouration of cheeks reddish-purple)

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2
Q

What murmur is associated with bruit heard on auscultation of femoral pulse? (Traube’s sign)

A

Aortic regurgitation

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3
Q

What murmur is associated with visible and forceful pulsation of carotid arteries? (Corrigan’s sign)

A

Aortic regurgitation
Due to increased stroke volume and regurgitation of blood into left ventricle

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4
Q

What murmur is associated with pulsation of the uvula? (Müller’s sign)

A

Aortic regurgitation

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5
Q

What murmur is associated with being pan-systolic, heard loudest at left parasternal edge?

A

Tricuspid Regurgitation

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6
Q

What murmur is pulsatile hepatomegaly associated with?

A

Tricuspid regurgitation
Due to increased venous pressure to liver

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7
Q

What murmur is associated with nail bed pulsation?

A

Aortic regurgitation

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8
Q

What murmur is early diastolic heard loudest at left sternal edge? (Quincke’s sign)

A

Aortic regurgitation

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9
Q

What murmur is associated with a slow-rising carotid pulse and narrow pulse pressure?

A

Aortic stenosis
Due to delayed and reduced ejection of blood through a narrowed aortic valve

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10
Q

What murmur is associated with a tapping, non displaced apex beat?

A

Mitral stenosis
Due to forceful closure of mitral valve

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11
Q

When is aortic stenosis classed as ‘severe’?

A

Aortic jet velocity >5m/s
Peak Gradient >40mmHg
Valve area <1cm2

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12
Q

When should you NOT give NSAIDs?

A

Peptic Ulcer Disease in history as NSAIDs can exacerbate GI issues

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13
Q

1st line treatment of Acute Pericarditis

A

NSAID + Colchicine

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14
Q

2nd line treatment of Acute pericarditis

A

Colchicine alone

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15
Q

Pericarditis with pericardial effusion or tampon are treatment

A

Pericardiocentesis

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16
Q

Treatment of Type B Aortic Dissection
(Haemodynamically stable + uncomplicated)

A

IV beta blockers + opioid analgesia
E.g. IV Labetalol + IV Morphine

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17
Q

What is Type B aortic dissection?

A

Dissection limited to descending aorta

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18
Q

What is Type A aortic dissection?

A

Involving ascending aortic arch

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19
Q

Treatment of Type A aortic dissection

A

Open surgery immediately upon diagnosis

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20
Q

Treatment of complicated Type B aortic dissection

A

Endovascular repair with fenestration and stenting

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21
Q

What complicates type B aortic dissection?

A

Peripehral ischaemia, persistent pain, or abdominal aorta rupture

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22
Q

Treatment for WPW Syndrome
(Wolff-Parkinson-White) (Long term)

A

Catheter ablation of the accessory conduction pathway
2nd line are anti-arrhythmic agents for patients for refuse ablation or are unsuitable

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23
Q

Arrhythmia responds to adenosine

A

Wolff-Parkinson-White syndrome

This is a test - adenosine blocks electrical signals through AV node.
BUT if you have WPW you will have an accessory pathway so signals can still travel to ventricles and this will show up on ECG

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24
Q

Acute treatment of WPW

If a patient with WPW presents with a tachyarrhythmia (shock, syncope, heat failure, myocardial ischaemia)

A

1st line - synchronised DC (direct current) cardioversion

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25
Acute treatment of WPW If the patient is stable they are managed according to the rhythm: Narrow complex tachycardia with short PR
Same as SVT management 1st line = vagal manouevres: Valsalva manouevre or carotid sinus massage. 2nd line = adenosine
26
Acute treatment of WPW If the patient is stable they are managed according to the rhythm: Broad complex tachycardia, AF or atrial flutter
1st line = IV anti-arrhythmics: procainamide or fleicanide as they help prevent rapid conduction through the accessory pathway. 2nd line = DC cardioversion
27
1st line stable angina (long term) treatment
1st line = beta-blocker (bisoprolol) OR calcium channel blocker (verapamil or diltiazem). Do not combine due to risk of heart block. DO NOT GIVE beta blocker to asthmatics as they bronchoconstrict
28
2nd line stable angina treatment
2nd line = beta-blocker (bisoprolol) AND long-acting dihydropyridine calcium channel blocker (amlodipine or nifedipine)
29
3rd line stable angina treatment
3rd line = beta-blocker (bisoprolol) AND long-acting dihydropyridine calcium channel blocker AND long-acting nitrate. A 3rd medication should only be added if the patient is symptomatic despite 2 anti-anginal drugs. At this stage, revascularisation with PCI or CABG must be considered
30
Acute angina treatment / secondary prevention
Secondary prevention: aspirin 75mg OD and statin 80mg ON. (To reduce MI/ stroke risk) GTN spray for symptom relief: inform patient of side-effects (headache, flushing, dizziness) and to repeat dose if pain not stopped after 5 minutes. Emergency help should be sought if pain not subsided after 2 doses of GTN as this may indicate acute coronary syndrome.
31
Acute STEMI treatment
For emergencies, always follow A-E structure. Targeted oxygen therapy (aiming for sats >90%) Loading dose of PO aspirin 300mg Note that some hospital protocols will also call for a loading dose of a second anti-platelet agent such as clopidogrel (300mg) or ticagrelor (180mg) For those going on to have PCI, NICE guidance suggests adding prasugrel (if not on anticoagulation) or clopidogrel (if on anticoagulation) Sublingual GTN spray - for symptom relief IV morphine/diamorphine - in addition this causes vasodilation reducing preload on the heart Primary percutaneous coronary intervention (PPCI) for those who: Present within 12 hours of onset of pain AND Are <2 hours since first medical contact
32
Treatment of NSTEMI/Unstable Angina
For emergencies, always follow A-E structure. Targeted oxygen therapy (aiming for sats >90%) Loading dose of PO aspirin 300mg and fondaparinux Patients should have their 6 month mortality score (often the GRACE score) calculated as early as possible - all those who are anything other than lowest risk should also be given prasugrel or ticagrelor unless they have a high risk of bleeding where PO clopidogrel 300mg is more appropriate. Sublingual GTN spray - for symptom relief IV morphine/diamorphine - in addition this causes vasodilation reducing preload on the heart Start antithrombin therapy such as treatment dose low molecular weight heparin or fondaparinux if they are for an immediate angiogram Patients with should be offered an angiogram within 96 hours of symptom onset
33
Post-MI Management
ALL patients post-MI patients should be started on the following 5 drugs: Aspirin 75mg OM + second anti-platelet (clopidogrel 75mg OD or ticagrelor 90mg OD) Beta blocker (normally bisoprolol) ACE-inhibitor (normally ramipril) High dose statin (e.g. Atorvastatin 80mg ON) All patients should have an ECHO performed to assess systolic function and any evidence of heart failure should be treated. All patients should be referred to cardiac rehabilitation. Patients who have been treated without angiography should be considered for ischaemia testing to assess for inducible ischaemia.
34
Most common cause of aortic stenosis in young patient
Cogenitally bicuspid aortic valve Less common cause = rheumatic fever - but more seen in mitral stenosis
35
Most common cause of mitral stenosis
Rheumatic fever (95%) AF is a common finding in Mitral stenosis due to increases in left atrial pressure and associated left atrial dilation
36
Most common cause of aortic stenosis in older patient
Valvular calcification
37
What is a cardiac tumour and how do you manage this?
Atrial myxomas are the most common type of cardiac tumour. They present with a triad of embolism, systemic symptoms and intra-cardiac obstruction. Other features include an audible ‘plop’ in diastole (tumour plop), clubbing, Raynaud’s phenomenon (due to microemboli) and pulmonary hypertension. This patient has a history of TIA, fever and weight loss and signs consistent with atrial myxoma. Investigations may show raised ESR, thrombocytopaenia, raised white cell count and haemolytic anaemia. Diagnosis is with trans-oesophageal echocardiography (TOE). Myxomas grow rapidly and can lead to systemic embolism and sudden death so should be urgently removed surgically.
38
A triad of embolism, systemic symptoms and intra-cardiac obstruction. Other features include an audible ‘plop’ in diastole (tumour plop), clubbing, Raynaud’s phenomenon (due to microemboli) and pulmonary hypertension.
Atrial myxoma
39
What does a soft or inaudible second heart sound indicate?
Aortic stenosis as the valve has become immobile and correlates with severe stenosis (Could also be an ejection click or a 4th heart sound)
40
Name type of narrow complex tachycardias
SVT, Sinus Tachycardia, AF/Flutter QRS <0.12 (3 squares ish)
41
Name examples of broad complex tachycardia
VT, Polymorphic VT (Torsades de Pointes) , AF/SVT with bundle branch block, WPW Syndrome? HR > 100bpm and QRS wider than 0.12s (3 squares ish)
42
Asthma with arrhythmias
Do not give beta blockers or adenosine due to bronchospasm risk
43
SVT Management unstable patient
Synchronised DC shock (Conscious patients require sedation before)
44
SVT Management in Stable patients
1st - Vagal manoeuvres e.g. carotid sinus massage or Valsalva manoeuvre 2nd - IV adenosine 6mg, 12mg, 18mg 3rd - Verapamil or BB can be tried with DC cardio version
45
Cause of mitral regurgitation
Infective endocarditis
46
Management of Acute Atrial Fibrillation unstable
1st line = synchronised DC cardioversion +/- amiodarone
47
Management of Acute Atrial Fibrillation Stable/ onset of AF < 48 hours
Rate or rhythm control DC cardioversion with sedation or pharmacological anti-arrhythmics - (Fleicanide if no structural heart disease, BUT amiodarone if yes) Delayed cardioversion = give heparin to anti coagulate
48
Management of Acute Atrial Fibrillation Stable/ onset of AF >48 hours / unclear
Rate control only with beta-blockers, diltiazem (CCB) or digoxin
49
Management of Chronic AF
Rate control: 1st line - BB (bisoprolol) or rate limiting CCB (diltiazem) 2nd line - Dual therapy Rhythm control: Flecainide (preferred for young patients) Amiodarone (older) Sotalol (BB + K channel blocker)
50
CHA2DS2VASc Score
C: 1 point for congestive cardiac failure. H: 1 point for hypertension. A2: 2 points if the patient is aged 75 or over. D: 1 point if the patient has diabetes mellitus. S2: 2 points if the patient has previously had a stroke or transient ischaemic attack (TIA). V: 1 point if the patient has known vascular disease. A: 1 point if the patient is aged 65-74. Sc: 1 point if the patient is female. Max - 9 = 15% Stroke risk Males >1 = anticoagulation Females >2 = anticoagulation (If stroke outweighs bleeding risk)
51
ORBIT/ HASBLED Score
H: Hypertension 1 point A: Abnormal renal or liver function 2 points if both are present S: Stroke (previous) 1 point B: Major bleed (previous) 1 point L: Labile INR 1 point E: Elderly (>65) 1 point D: Drugs/alcohol 1 point for drug or alcohol use (2 points if both are present) ORBIT Sex Haemoglobin (<13mg/Dl in males, <12mg
74) 1 point Bleeding history 2 points Renal function (eGFR <60) 1 point Concomitant use of anti-platelets 1 point
52
HASBLED/ ORBIT Score (HASBLED is phasing out?)
H: Hypertension 1 point A: Abnormal renal or liver function 2 points if both are present S: Stroke (previous) 1 point B: Major bleed (previous) 1 point L: Labile INR 1 point E: Elderly (>65) 1 point D: Drugs/alcohol 1 point for drug or alcohol use (2 points if both are present) ORBIT Sex Haemoglobin (<13mg/Dl in males, <12mg
74) 1 point Bleeding history 2 points Renal function (eGFR <60) 1 point Concomitant use of anti-platelets 1 point
53
Dressler's Syndrome Treatment
High dose aspirin
54
What murmur is ejection systolic, heard loudest at pulmonary area, radiating to shoulder?
Pulmonary stenosis
55
What murmur is associated with Noonan Syndrome?
Pulmonary stenosis
56
What murmur is associated with Marfan's Syndrome?
Mitral valve prolapse (Mitral regurgitatio) and aortic regurgitation
57
What murmur is Williams syndrome associated with?
Aortic stenosis
58
What is Turner's syndrome associated with?
Coarctation of the aorta (pan systolic murmur heard in left scapular area)
59
What is Down's syndrome associated with?
ASD (atrial septal defects), VSD (ventricular septal defects or AVSD (atrioventricular septal defects)
60
Cor pulmonale
Right sided heart failure seen in severe COPD Peripheral oedema and raised JVP
61
What medication causes a fall in eGFR and Hyperkalaemia?
ACE inhibitors (ramipril)
62
What murmur is associated with wide pulse pressure?
Aortic regurgitation
63
Side effects of Loop Diuretics
Tinnitus + Deafness Hypomagnesaemia (more likely in alcoholic cirrhosis patients)
64
What is Gynaecomastia?
An increase in amount of breast tissue in boys and men Side effect of Spironolactone
65
Pan-systolic murmurs
Mitral regurgitation, Tricuspid regurgitation
66
Amiodarone MoA
Blocks voltage gated K+ channels Class III anti-arrhythmic
67
Digoxin MoA
Inhibits Na+/K+ ATPase
68
Class IV antiarrhythmic drugs
Calcium channel blockers
69
Class I antiarrhythmic drugs
Sodium channel blockers
70
Class II antiarrhythmic drugs
Beat blockers (sympathetic - adrenergic effect)
71
Class III antiarrhythmic drugs
Potassium K+ channel blockers prolongs action potential duration and refractory period of heart, increase AV node delay?
72
Widespread concave ST-segment elevation and associated PR depression
Acute pericarditis
73
When to add beta blockers in resistant hypertension?
When potassium level is >4.5 If below, you could try spironolactone as it's potassium sparing
74
Rheumatic fever management
IV Benzylpenicilin
75
What causes rheumatic fever?
Group A beta-haemolytic streptococcal infection

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