QUESMED Flashcards
(256 cards)
1
Q
Recurrent ulcers in the mouth and groin aswell as erythema nodosum on the shins and painful eyes (uveitis) =>
A
Bechets disease
2
Q
A 42 year old woman presents with a 9 week history of pain, swelling and morning stiffness in her hands and feet. She denies any recent diarrhoea or illness. She had a recent sexually transmitted infection (STI) screen which was normal. She is concerned about her nails which she describes as ‘peeling’. On examination, her fingers and toes are swollen. Which condition is this?
A
Psoriatic arthritis
3
Q
Pseudogout joint aspiration features
A
Positively bifringent rhomboid shaped crystals
4
Q
RF for pseudogout
A
Hypothyroidism
Joint damage
Diabetes
5
Q
Management of acute pseudogout
A
Colchicine
6
Q
First line treatment of newly diagnosed rheumatoid arthritis
A
DMARD (methotrexate) and steroids
7
Q
When would you consider hydroxychlorquine in RA?
A
In mild disease
8
Q
First line treatment of polymyositis?
A
Steroids
9
Q
Symptoms of polymyositis
A
Central weakness
No rash
No pain
10
Q
Which part of the spine does RA usually affect?
A
The cervical portion
Usually spares thoracic and lumbar regions
11
Q
Which imaging might an anaesthetist want for a RA patient before surgery?
A
Cervical spine x-ray
This is because of risk of current damage and subluxation
During airway manipulation, the anaesthetist may cause minor neck trauma that can dislocate the cervical vertebrae and cause damage, even death if the vertebrae migrates upwards!
12
Q
Young patient with septic arthritis, most likely cuase
A
STI (gonorrhoea or chlamydia)
13
Q
Triad of disseminated gonorrhoea infection
A
Skin lesions
Polyarthralgias
Tenosynovitis
14
Q
Treatment of gonorrhoea
A
Ceftriaxone
15
Q
Sjogren’s increased your likelihood of contracting which malignancy?
A
MALT
mucosa-associated lymphoid tissue
16
Q
How might MALT present?
A
Bilateral parotid swelling
Cervical lymphadenopathy
17
Q
Young male patient with painful right testicle with intact reflexes, malaise and fever, ulcerating rash on the shins, potential Dx and which Ix to confirm?
A
Polyarteritis nodosa
Need a skin biopsy
18
Q
Which virus is linked with polyarteritis nodosa?
A
Hepatitis B
19
Q
Parietal lobe damage (e.g. from brain metastases) can present with what feature?
A
Visual inattention
20
Q
Damage to which area of the brain can result in Wernickes aphasia?
A
Left posteriori superior temporal gyrus
21
Q
Which area of the brain is damaged in Gerstmann’s syndrome?
A
Inferior parietal lobe
22
Q
Symptoms of Gerstmann’s syndrome
A
agraphia (difficulty in writing)
acalculia (difficulty with math)
aphasia (language disorders)
agnosia (difficulty to perceive objects)
23
Q
Symptoms of hypocalcaemia
A
Parasthesia
Tingling of hands and face
24
Q
Iatrogenic cause of hypocalcaemia
A
Thyroidectomy
25
Symptoms of multiple myeloma
Constipation
Depression
Back pain
Anaemia
26
Symptoms of measles
Development of a fever above 40 degrees
Coryzal symptoms
Conjunctivitis followed by a rash about 2-5 days after onset of symptoms (often starts behind the ears and spreads)
Koplik spots are small grey discolourations of the mucosal membranes in the mouth and appear 1-3 days after symptoms begin during the prodrome phase of infection. They are pathognomonic for measles infection.
27
Complications of measles
Acute otitis media
Bronchopneumonia
Encephalitis
28
What antibody test can you do for measles?
ELISA
29
Management of measles
Supportive
Notifiable disease
Off school as infective for up to 10 days
30
What is the potential pathophysiology of motor neuron disease?
Glutamate signals for calcium to enter motor neurones
| Excessive calcium kills the neurones
31
Symptoms of motor neuron disease
Mix up UMN and LMN signs
| No sensory involvement
32
Fasting growing, most aggressive thyroid cancer and how might it present?
Anaplastic
Invades local structures (may be breathless or difficulty swallowing)
Lump in the neck that raises on swallowing but NOT tongue protrusion
33
The most common type of thyroid cancer
Papillary
34
Periosteal onion skinning suggests
Ewing's sarcoma
35
Only real chest x-ray finding in asthma
Hyperinflation
36
Chest sign of asthma
Widespread wheeze
37
What is the doctrine of double effect?
If someone is on max morphine on end of life care but still has pain, you can prescribe more morphine to treat that pain in the knowledge that it may hasten their death
38
Symptoms of prolactinoma
In women = lack of libido, galactorrhiea and infertility
In men = gynaecomastia, lack of lidido, less body hair
Also mass-producing effects such as headache and bitemporal hemianopia
39
Mx of symptomatic aortic aneurysm (back pain and epigastric tenderness)
Elective surgery
40
What is Mirrizzi's syndrome?
Stone in the cystic duct compresses the bile duct and causes obstructive jaundice
41
Features of Mirrizzi's syndrome
Recurrent abdominal pains
Jaundice
Dark urine
Pale stools
42
Signs of COPD on respiratory examination
Prolonged expiratory phase, reduced chest expansion and widespread wheeze on auscultation.
43
Management of life-threatening asthma
Oxygen
Salbutamol and ipratropium nebulisers
Steroids
Urgent senior support
44
What is a myoclonic seizure?
Sudden jerking of a limb (say the neck)
45
Treatment of myoclonic seizures
Sodium valproate
46
What do you need to screen for before initiating biological therapies in rheumatoid arthritis?
TB (may get reactivated)
47
What does rituximab target?
CD20 on B cells
48
Management of alcohol dependence
CBT
Oral acamprosate or naltrexon
Consider admission if the dependence is severe (young pt, 30 units a day, vulnerable patients)
49
Medication for BPH with a PMH of postural hypotension?
Finasteride
50
First-line treatment of BPH
Tamsulosin
51
Most common ECG abnormality in anorexia nervosa
Prolonged QT interval
| Due to electrolye disturbance
52
Symptoms of Reye's syndrome
Reduced GCS
Mild anaemia
A transaminitis (high liver enzymes because its basically liver failure)
Raised bilirubin
A prolonged international normalised ratio
Raised lactate
Raised C-reactive protein
53
The typical history of Reye's syndrome
Child under 12yo
Had viral illness
Given aspirin
54
Most common causes of HF in the Western world
Coronary artery disease
Hypertension
Valvular disease
55
Symptoms of pulmonary oedema
Shortness of breath on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough (± pink frothy sputum)
56
Which classification system to grade heart failure?
New York Hear Association
57
A good measure to do that can help to rule out heart failure
BNP
58
Blurry vision that gets worse over the course of the day
| Patient appears tired at the end of each day
Myasthenia Gravis
59
Absent p waves
Widened QRS complexes
Peaked t waves
Hyperkalaemia
60
Treatment for pseudogout in one joint in patient with CKD
Intra-articular steroid injection
61
Renal impairment and high HBA1c, symptoms of diabetes, whats the first line treatment?
Basal insulin therapy because of their renal impairment
62
Humeral fracture can damage which nerve, leading to inability to extend wrist and loss of sensation on the back of the hand
Radial
63
Mx of acute angle glaucoma
Topical pilocarpine
IV acetozolamide
Peripheral laser iridotomy = definitive
64
Features of acute closed angle glaucoma
Fixed dilated pupil
Hard orbit when pressed
Red and watery
Blurred vision
65
How quickly does baby blues present?
First 2 weeks after birth
| Resolves spontaneously
66
When does post partum depression typically present?
Typically start 1 month post partum and peak at 3 months
67
Mx of post-partum depression
CBT
Risk assessment
Consider inpatient admission with baby is severe
68
Symptoms of anterior uveitis
Painful red eye
Irregularly shaped pupil
Blurry vision
History of back pain or IBD etc. (HLA related)
69
Conditions that can predispose to anterior uvietis (HLA-B27 conditions)
```
Ankylosing spondylitis
Idiopathic juvenile arthritis
Multiple sclerosis
SLE
Inflammatory bowel disease
Granulomatosis with polyangiitis
Reactive arthritis
Infections: herpes, tuberculosis, syphilis, HIV
```
70
Symptomatic patient, diabetes cut off for diagnosis
Random blood glucose =11.1mmol/l
Fasting plasma glucose =7mmol/l
2 hour glucose tolerance =11.1mmol/l
HbA1C =48mmol/mol (6.5%)
71
Smoking is a risk factor for which oesophageal cancers?
Both adenocarcinoma and squamous cell carcinoma
72
Difference between superficial dermal and superficial epidermal burn
Dermal may see blistering, more seen in scalds from liquids
Epidermal = more from flash burns
Both typically heal in 10-14 days (painful) but with minimal scarring
73
What are ecchymoses?
Areas of bleeding under the skin (bruising)
74
First line management of ?hip fracture?
ABCDE
| Anterior and lateral hip x-rays
75
What is the management of grade 1/2 intracapsular hip fractures?
Garden 1/2 fractures can be treated with ORIF and cancellous screws
76
2.5yo with waddling gait and big thigh muscles, what is the inheritance pattern?
X-linked recessive
| Duchenne's muscular dystrophy
77
Pt with Hickmann line, pyrexial and tachycardic but haemodynamically stable. New onset heart murmur in tricuspid area, which antibiotic would you start?
IV vancomycin
78
Immediate management of Quinsy in the community?
Immediate referral to hospital
| Infection can easily spread or cause airway compromise
79
Signs of Quinsy
Deviated uvula
Swelling
Very painful sore throat
Inability to open the mouth easily
80
Common causes of heart failure
Coronary artery disease
Hypertension
Valvular disease
81
What is high output heart failure?
The insufficiency of the heart to supply the metabolic demands of the body is due to the needs being increased = ANAEMIA
82
What is low output heart failure?
The body is normal but the heart can't give enough = dilated cardiomyopathy, restrictive
83
Causes of high output heart failure?
PAT
Pregnancy
Anaemia
Thyrotoxicosis!
84
Causes of low output heart failure
Pump failure, ARRYTHMIAS, excess after-load or excess pre-load
85
What is diastolic low output heart failure?
Impaired ventricular FILLING during diastole
| Because its all crusty, restricted or big and unable to be filled easily
86
What is systolic low output heart failure?
Impaired ventricular contraction during systole
| When it's weak or really dilated
87
Causes of systolic heart failure?
Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Infiltration (e.g. in haemochromatosis or sarcoidosis)
88
Causes of diastolic heart failure?
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
89
BNP>2000ng/L Mx
2w referral for specialist assessment and an echo
90
Cut off for ejection fraction
40%
91
40%< ejection fraction but heart failure =
Preserved ejection fraction heart failure
92
Which Ix to test ejection fraction?
Echo
93
HIV pt with generalised weakness, head CT shows a single, lobulated lesion, most likely cause and treatment?
HIV related primary CNS lymphoma
| Treatment = commence cART and whole brain irradiation
94
Which part of the nephron do thiazide diuretics work on?
DCT on the sodium, potassium channels
95
What can taking bendroflumethiazide do when also taking metformin?
Can increase glucose levels because it interacts with K+ channels, reducing insulin release
96
What type of drug is baclofen?
Its a muscle relaxant
97
What is baclofen used for in MND?
Reduce spasticity
98
In AKI, what can happen to baclofen levels?
Rise, because excreted by kidneys
| Can result in drowsiness/LOC
99
In renal tubular acidosis, why do you get an acidosis?
Impaired acid excretion leads to hyperchloraemic metabolic acidosis.
This leads to activation of the Renin Angiotensin system leading to potassium wasting and hypokalaemia
100
What is type 1 renal tubular acidosis
DISTAL RTA
| The inability of the kidneys to excrete H+ ions
101
What is type 2 renal tubular acidosis?
Proximal RTA
Issue with the proximal tubule (usually caused by Fanconi syndrome)
Can reabsorb a bit of HCO3-
Urine will be acidic
102
What is type 4 renal tubular acidosis?
Mineralocorticoid deficiency
Normal urine pH
Hyperkalaemia (because switch less K+ for Na+)
Low blood pressure
103
What might the heart rate be in inferior MI?
Bradycardia
| Because AV block (can't message between them so just go at basal ventricular rate)
104
Cut off INR for absolute contraindication for surgery?
INR 1.5
105
Absolute contraindications for laparoscopic surgery
Obvious indication for open therapeutic intervention – Perforation, peritonitis, known intra-abdominal injury, complications of previous surgery, shock, evisceration or abdominal wall dehiscence
Acute intestinal obstruction associated with a massive (>4 cm) bowel dilatation – Can obscure the view making intervention harder.
Uncorrected coagulopathy – INR should be corrected to at least < 1.5, although some surgeons prefer INR to be even lower than this.
Tense or distended abdomen – Suspected intra-abdominal compartment syndrome
Trauma with hemodynamic instability
Clear indication of bowel injuries (e.g. presence of bile or evisceration)
106
Severe chest pain when swallowing, especially cold drinks, what does this suggest?
Oesophageal spasm
107
Diagnosis of oesophageal spasm
Barium swallow showing corkscrew oesophagus
108
Birth defects associated with folic acid antagonists
Anencephaly, cleft lip/palate, skull defects
109
One attempt at endoscopy with band ligation for variaces, still bleeding the next day, what do you do?
If haemodynamically stable -> repeat endoscopy with therapeutic intention
If unstable, consider balloon tamponade
If refractory, consider transjugular intrahepatic portosystemic shunt (TIPS)
110
Scoring system for upper GI bleed?
Glasgow-Blatchford score
111
Viral cause of roseola
HHV6
112
High fever for 5 days, single seizure, as the fever subsides a maculopapular rash appears, Dx?
Febrile convulsion (most likely caused by roseola)
113
Redman syndrome is also known as...
Erythoderma
114
Definition of erythroderma
>90% body surface red and potentially scaling
115
Most common site of occlusion in acute mesenteric ischaemia
Superior mesenteric artery
116
Triad of acute mesenteric ischaemia
Shock
Diffuse abdominal pain
Insignificant abdominal examination
117
Management of transient synovitis
Supportive
118
Features of transient synovitis
Recent infection
Both septic arthritis and transient synovitis cause acute onset limp where the child avoids bearing weight and presents with fever.
Generally, the features of transient synovitis are milder than septic arthritis (mild/absent fever versus high fever, mild vs severe pain).
119
How long do symptoms have to last to consider juvenile idiopathic arthritis?
6w<
| Morning stiffness, starting at the hands and feet and progressing to the spine
120
Features of Klinefelter's syndrome
Small, firm testis
Gynaecomastia
Delayed puberty
Tall (because delayed puberty, keep growing at child rate)
121
Causes of delayed puberty
Androgen insensitivity
Klinefelter's syndrome
Chronic illness (e.g. CF or coeliac)
122
Most common cause of delayed puberty
Late bloomers
| Parent's probably had later puberty
123
Microcytic anaemia in a patient taking isoniazid but with normal iron levels, cause =?
Sideroblastic anaemia
Caused by isoniazid treatment
Hypochromic, microcytic but with normal iron!
124
What is sideroblastic anaemia?
Inability to produce RBC very well
| Get a hypochromic, microcytic anaemia
125
What is herpes labialis?
Cold sores
126
Which type of pneumonia is linked to cold sores?
Streptococcus pneumoniae
127
Most common causative organism for lobar pneumonia?
Streptococcus pneumoniae
128
What might you find on examination for pneumonia?
```
Bronchial breathing over one lobe
Increased vocal resonance
Reduced chest expansion
Increased RR
Pleuritic chest pain
```
129
Risk factors for anorexia nervosa
```
Dieting
Maternal encouragement of weight loss
Family history of eating disorders
Adolescent period
Personal history of anxiety disorders
Depressive disorders or obsessive-compulsive disorders
Perfectionist traits
At-risk professions such as sportspeople, dancers or models
```
130
Chronic ketamine use is associated with which bladder condition?
Ketamine cystitis
Features of dysuria and blood
Cystoscopy shows thickened bladder walls and inflammation
131
Screening for AAA 3.3cm
Once yearly USS
132
Screening for AAA 4.7cm
Repeat USS every 3mo
133
Mx of AAA size 5.7cm
2w surgery
134
Procedure for malrotation in children
Ladd's procedure, twisting and fixing
| Removing Ladd's bands of adhesion and also removing the appendix while you are in there
135
Symptoms of malrotation
Bilious vomiting
Constipation
Distended abdomen
136
Causes of obstructive shock
Cardiac tamponade
Pulmonary embolism
These STOP the flow from the heart
137
pathophysiology of neurogenic shock
Mass peripheral vasodilation due to loss of neurogenic tone
138
Diagnosis of aplastic anaemia
Anaemia: haemoglobin <10 g/dL
Thrombocytopenia: paltelets <50 x 10^9/L
Neutropenia: absolute neutrophil count <1.5 x 10^8/L
139
Management of twin to twin transfusion syndrome
Specialist centre -> in utero laser of problem vessels
140
What type of drug is acetazolamide?
Carbonic anhydrase inhibitor
| Used in glaucoma to reduce acqeous humour production
141
Recurrent episodes of self-limiting high fever and painful serositis associated with a typical lower limb erysupelas-like rash Dx?
Familial Mediterranean fever
142
Gene in Mediterranean Fever
MEFV on chromosome 16
143
What long-term therapy should patients with familial Meditarranean fever be put on?
Colchicine to reduce long standing inflammation and reduce chance of amyloidosis
144
Electrolyte measurements in tumour lysis syndrome
Hyperkalaemia, hyperuricaemia, hyperphosphataemia -> drives HYPOcalcaemia
145
Normal calcium levels
2.2 - 2.6
146
Causes of HYPOcalcaemia
Vit D deficiency (e.g. ostomalacia or malabsorption => coeliac/chronic pancreatitis)
hypoparathyroidism
Hyperphosphateaemia
147
Causes of malabsorption
Gastrectomy
Short bowel syndrome
Coeliac disease
Chronic pancreatitis
148
Signs of hypocalcaemia =?
```
SPASM
Spasms
Parathesia
Anxiety
Seizures
Muscle tone increase
```
149
Ix for hypocalcaemia
ECG (looking for arrhythmia)
Bone profile (calcium, phosphate, albumin, total protein, ALP)
PTH
Vitamin D
Amylase (if suspected pancreatitis)
X-rays (if suspected osteomalacia)
150
Long standing hearing loss and painless otorrhoea, foul smelling discharge, that is not improving with repeated courses of antibiotics
Cholesteatoma
benign growth of keratinising squamous epithelium trapped in the middle ear cavity
Can be acquired (repeated chronic otitis media) or congenital
151
Features of cor pulmonale
Hx of COPD or other chronic lung disease
| RHF = pitting oedema, ascites, tender smooth hepatomegaly, raised JVP
152
Ulnar deviation, Z thumb deformity, smooth mass in LUQ that moves with ventilation =>
Felty's syndrome!
153
DDx of splenomegaly
Haematological: CML, myelofibrosis, haemolysis
Infective: tropical (malaria, leishmaniasis) and non-tropical (Epstein barr virus)
Other: portal hypertension, infiltration (e.g. sarcoidosis, amyloidosis), Felty's syndrome
154
H.pylori positive with an associated MALT lymphoma found on endoscopy, what is the management?
Amoxicillin, clarithromycin and omeprazole to try to eliminate the H.pylori
155
If H.pylori eradication fails when treating a MALT lymphoma, which drug can you use?
Rituximab
156
Skin change seen in chronic venous insufficency, dark pigmentation caused by chronic haemosiderin deposition.
Dry skin and often have venous ulcers
Dx?
Lipodermatosclerosis
157
Most likely cause of atraumatic vertebral collapse in an elderly man
Metastatic malignancy
158
Mx of verebral collapse causing cord compression
Oral steroids
Surgical decrompression
(aim within 48hr)
159
First line treatment of UC
Topical or oral ASA (mesalazine)
160
Extensive UC management
Mesalazine + prednisolone
161
Management of acute severe UC
IV corticosteroids
162
1st line treatment of GBS?
IV immunoglobulin
163
Low sodium to high, your pons will...
DIE
164
High sodium to low, your brain will...
Blow
165
Most common cause of blindness worldwide
Trachoma
166
Cause of trachomas (think Sudan eye disease)
Chlamydia trachomatis
167
Man works with livestock and drinks unpasteurised milk. Now has arthralgia and hepatosplenomegaly -cause?
Brucellosis
168
Treatment of brucellosis
Dual antibiotic therapy
| Doxycyclin and gentamicin
169
Presentation of brucellosis
```
Fever
Weight loss
Night sweats
Lymphadenopathy
Joint pain
Spinal tenderness
PUO!
```
170
Feel unusually prominent foetal parts on abdomen, what does this suggest?
Oligohydramnios
| Potentially due to fetal renal agensis, use of ACEi in pregnancy, malnutrition
171
Causes of polyhydramnios
```
Maternal diabetes
Foetal renal disorders
TTTS
Foetal anaemia
Diaphragmatic hernia of foetus, duodenal atresia (can't swallow amniotic fluid)
```
172
Causes of metabolic alkalosis
```
Loss of chloride =
Vomiting
NG suction
Diuretics (thiazides, loop diuretics)
Diarrhoea (e.g. chloride secreting villous adenoma)
Cystic fibrosis
```
Loss of potassium =
Primary hyperaldosteronism
Cushing’s syndrome
Other causes =
Carbonate overuse
Massive transfusion
173
Genetics of Turner's syndrome
XO
174
Signs and symptoms of ectopic pregnancy
```
Lower abdominal pain
Vaginal bleeding
Cervical motion tenderness
Positive B-HCG test
Shoulder tip pain
Vaginal bleeding
```
175
DDx of painful vaginal bleed
Miscarriage
| Ectopic pregnancy
176
Medical management of ectopic pregnancy
One off methotrexate
177
Treatment of measles
Supportive care
178
Signs and symptoms of measles
Grey spots on mucosa Blanching, maculopapular rash all over
Fever
Cough
Runny nose
179
Causes of high anion gap
```
MUD PILES
Metformin
Uraemia
DKA
Paracetamol
Iron
Lactic acidosis
Ethylene
Salicylates
```
180
Causes of metabolic acidosis with normal anion gap
```
ABCD
Addisons (adrenal insufficiency)
Bicarbonate loss (GI/renal)
Chloride excess
Diuretics
```
181
A TCA overdose can cause what ABG picture?
Metabolic acidosis with raised anion gap
182
Which drug should be co-prescribed with methotrexate?
Folic acid
| Helps reduce toxicity and side effects
183
Management of anaphylaxis
```
Stop offending drug
Administer IM adrenaline 1:1000 0.5ml
IV hydrocortisone 200mg
IV chlorphenamine 10mg
IV NaCl1 500ml
```
184
Tachycardic, hypotensive, decreased consciousness, metabolic acidosis, normal anion gap =>
Severe diarrhoea
185
Herepes zoster on face in one dermatome (shingles), eye involvement if the rash is where?
Nose tip = Hutchinson's sign
186
1st line Mx of lactic acidosis in metformin use
500ml 0.9% saline bolus
187
Causes of lactic acidosis
```
Tissue hypoxia (Type A)
Shock (e.g. cardiogenic, hypovolaemic, haemorrhagic)
Hypoxia
Acute mesenteric ischaemia
Limb ischaemia
Severe anaemia
Seizures
Vigorous exercise
```
```
Abnormalities in metabolism of lactate (Type B)
Diabetic ketoacidosis
Cancer
Liver disease
Inborn errors in metabolism
Drugs:
Metformin - impairs liver metabolism of lactate
Aspirin
```
188
Frontal headache, impotence, bitemporal hemianopia, Ix?
Head MRI for pituitary adenoma
189
Which AF patients get rate control
HR > 90
190
Which AF patients get cardioversion?
New onset AF
| Triggered AF
191
What Ix might you consider after a diagnosis of myasthenia gravis?
CT chest
| Because myasthenia gravis is strongly associated with abnormalities of the thymus
192
Who performs the booking appointment for pregnancy?
Midwife who will support throughout the pregnancy
193
What blood tests are offered for expectant mothers?
HIV
Hepatitis B
Syphilis
194
What dose of ICS may you add first line in chronic asthma management in adults?
400 MICROGRAMS
195
Mx of mild Parkinsons disease
Ropinerole
196
Mx of Parkinson's disease
Levodopa and carbidopa
197
Treatment of severe aortic stenosis
Surgical (if young)
Transcatheter aortic valve implantation (TAVI) if older
198
What Ix must you do to determine severity of a heart murmur, e.g. aortic stenosis?
Echocardiogram
199
What is TAVI?
Transcather aortic valve implantation
200
Triad of symptoms of aortic stenosis
Syncope
Heart failure
Angina
201
Symptoms of aortic stenosis
```
Syncope
Angina
Heart failure
Exertional dyspnoea
Decreased exercise tolerance
```
202
Buttocks and back pain, vascular cause
Ilioaortic disease (claudication)
203
Mx of claudication
```
Doppler
ABPI
RF modification
Statins
Aspirin
Clopidogrel
```
Potential further options = bypass
204
Standard treatment for chronic HF
```
ACEi (improve heart remodelling)
Beta blockers (improve heart efficiency)
Diuretics (symptomatic)
```
205
QRISK 15% means...
15% chance of heart attack in the next 10 years
206
What should you consider prescribing for a patient with QRISK 11%?
A statin
| Atorvastatin 20mg once nightly (because the cholesterol enzyme is more active at night!)
207
Mx of patient with high QRISK score
Life modifications
Regular testing of lipids
Statin (e.g. atorvastatin)
208
Secondary causes of hyperlipidaemia
Diabetes mellitus
Hypothyroidism (poor clearance of LDL)
Nephrotic syndrome (hypoalbuminaemia leads to hyperlipidaemia)
209
Blood pressure cut offs in ascending order of severity
1. Single reading >140/90 mmHg and average ambulatory readings >135/85 mmHg
2. Single reading >160/100 mmHg and average ambulatory readings >150/95 mmHg
3. Single reading with systolic >180 mmHg or diastolic >110 mmHg.
210
Single reading high blood pressure cut off
140/90
211
Average ambulatory cut off for high blood pressure
135/85
212
What type of drug is carvedilol?
Beta blocker
213
Medical management of heart failure
Lisinopril (ACEi)
Carvedilol (B blocker)
Furosemide (diuretic)
214
Sx of heart failure, what do you need to do first to screen?
Measure BNP
| If elevated, refer for trans-thoracic echocardiogram
215
When is BNP released?
When the ventricles stretch
| It has a high negative predictive
216
When is BNP released?
When the ventricles stretch
| It has a high negative predictive value, if it isn't raised, it probably isn't heart failure
217
Features of HOCM
Ejection systolic murmur louder when squatting
| Palpitations and feeling faint when exercising
218
What is HOCM?
Genetic mutations in sarcomere lead to cardiac hypertrophy
219
What is holiday heart syndrome?
Big night out, triggers AF
220
Causes of AF
Ischaemic heart disease (most common)
Rheumatic heart disease
Hypertension
```
Non-cardiac
Dehydration
Infective
Alcohol
Electrolyte disturbance
```
221
Classification of AF
Acute (lasts <48 hours)
Paroxysmal (lasts <7 days and is intermittent)
Persistent (lasts >7 days but is amenable to cardioversion)
Permanent (lasts >7 days and is not amenable to cardioversion)
222
Cause of mid-systolic click
Mitral valve prolapse
223
Complications of HTN
```
Coronary artery disease
Heart failure
Renal failure
Stroke
Peripheral vascular disease
```
224
Gene for haemochromatosis
HFE
225
What is the pathophysiology of haemochromatosis?
```
Gene mutation (HFE), increased iron absorption, leading to high iron levels
This iron accumulates in organs such as the heart and skin and pancreas. Causing dilated cardiomyopathy, heart failure, tanned skin and diabetes
```
226
Most common cause of mitral stenosis
Rheumatic fever
227
Management of late stage heart failure after max medical treatment
Cardiac resynchronisation therapy (CRT)
228
What drug can be used as a pill in the pocket for AF in young people?
Flecainide
229
Rate control drugs for AF
Beta blockers
Verapamil or diltiazem (CCB)
Digoxin = second line
230
Chest pain and new onset bundle branch block on ECG, what are you concerned about?
ACS
| Treat urgently with primary percutaneous coronary intervention if possible
231
First line investigation of angina
CT coronary angiography
232
Sinus bradycardia with no adverse signs, what do you need to do?
Observe and try to identify a cauase (e.g. hypothyroidism)
233
Cut off for bradycardia
HR < 60bpm
234
Drug that can induce bradycardia
Verapamil + B blocker!
235
Syncope, dizziness, tiredness, what Ix should you do?
ECG
236
HR 48 with symptoms of syncope, what should you give?
Atropine
| Block parasympathetic activity, increasing heart rate
237
Most common heart murmur post MI
```
Mitral regurgitation (secondary to rupture of papillary muscle)
Ventricular septal defect
```
These both give a PAN-SYSTOLIC murmur
238
Slow rising pulse is associated with which heart valve murmur?
Aortic stenosis
239
Collapsing pulse is associated with which murmur?
Aortic regurgitation
240
Causes of aortic regurgitation
Rheumatic heart disease
Infective endocarditis
Aortic dissection
IHD
241
Chronic causes of regurgitation murmurs (mitral and aortic)
Calcific aortic valve disease (age related)
Congenital disease e.g. bicuspid aortic valve
Rheumatic heart disease - most common cause in the developing world
Infective endocarditis
Rheumatic causes e.g. rheumatoid arthritis, antiphospholipid syndrome
Marfan's syndrome
242
Electrolyte imbalance that causes prolonged QT interval
Hypocalcaemia
| Hypokalaemia
243
What electrolyte imbalance is common after thyroidectomy?
Hypocalcaemia because loss of parathyroid glands
244
Clinical features of pericarditis
```
Chest pain (usually pleuritic and worse on lying flat)
Fever
Pericardial friction rub
ECG changes
Widespread saddle-shaped ST elevation
PR depression
Raised troponin
```
245
Management of stable angina
The management of stable angina includes optimising risk factors for cardiovascular disease:
```
Smoking cessation
Glycaemic control
Hypertension
Hyperlipidaemia
Weight loss
Alcohol intake
```
First line medical
Aspirin
Statin
Sublingual GTN
Beta blocker or rate limiting calcium channel blocker
Can add a long acting nitrate
246
Medical treatment of chronic heart failure
ACEi
Beta blocker
Furosemide
Spironolactone
247
Causes of heart failure
```
Causes of systolic heart failure
Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Infiltration (e.g. in haemochromatosis or sarcoidosis)
```
```
Causes of diastolic heart failure
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
```
248
What is high output heart failure?
Increased metabolic demands so the heart can't cope
| E.g. anaemia or infection or thyrotoxicosis
249
Clinical features of Brugada syndrome
Coved ST elevation followed by inverted T waves = Brugada sign
Episodes of palpitations and dizziness
Syncope
250
Management of Brugada syndrome
Implantable cardiodefibrillator
251
ECG changes in posterior STEMI
ST elevation in leads 2, 3, aVF
252
ECG changes in NSTEMI
ST depression in whichever leads
| T wave inversion!
253
The inheritance pattern of HOCM
Autosomal dominant
| 50% chance of son having it!
254
Features of insulinoma
Aggression
Raised C-peptide
Low glucose
Signs of hypoglycemia
255
What is a Whipple's procedure?
Pancreaticoduodenectomy
256
COPD management
Conservative:
COPD nurse
Chest physio
Medical =
SABA
LABA + ICS if asthma Sx
LABA + LAMA if not
Then all of them
