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Flashcards in Rapid medicine Deck (40):
1

Aortic dissection: Definition

Tear in the aortic intima allows blood to surge into aortic wall, causing split between the inner and outer tunica media, creating a false lumen

2

Aortic dissection: Predisposing factors

HTN
Atherosclerosis
Connective tissue disease
Congenital cardiac abnormality
Aortitis
Iatrogenic
Trauma
Crack

3

Aortic dissection: Px

Hx
Sudden tearing central chest pain, may radiate to back. May lead to occlusion of the aorta and its branches.
Ex
Murmur on back below scapula.
BP discrepancy between arms
Wide pulse pressure
Collapsing pulse

4

Aortic Dissection Ix

FBC crossmatch 10 units of blood
CXR Bulge
CT thorax
Echo

5

Aortic Dissesction Mx

CT thorax urgent
Type A - Ascending
surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B* - Descending
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

6

Aortic Regurg: Def

Reflux of blood from aorta into LV during diastole

7

Aortic Regurg: Ax

Causes (due to valve disease)
rheumatic fever
infective endocarditis
connective tissue diseases e.g. RA/SLE
bicuspid aortic valve

Causes (due to aortic root disease)
aortic dissection
spondylarthropathies (e.g. ankylosing spondylitis)
hypertension
syphilis
Marfan's, Ehler-Danlos syndrome

8

Aortic Regurg: Px

early diastolic murmur
collapsing pulse Water hammere
wide pulse pressure
mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams

9

Rare signs associated with dynamic pulse

Quincke's sign - pulsating nail bed
de Musset's - head nodding w/ pulse
Becker's - pulsating of pupillary vessels
Traube's - pistol shot sound on auscultation of femoral arteries

10

Aortic Regurg: Ix

CXR - cardiomegaly, pulmonary oedema
ECG - LV hypertrophy (Left axis deviation, inverted T waves in I,aVL & V5-6)
Echo

11

Aortic Regurg: Mx

Vasodilators
ACei or Nifedipine in pts w/ LV systolic dysfunction
Aortic valve replacement
pts w/ ventricular decompensation: EF , 50%, LV enlargement

12

Aortic stenosis: Def

Narrowing of the LV outflow tract at the level of the aortic valve

13

Aortic stenosis: Ax

degenerative calcification (most common cause in older patients > 65 years)
bicuspid aortic valve (most common cause in younger patients < 65 years)
William's syndrome (supravalvular aortic stenosis)
post-rheumatic disease
subvalvular: HOCM

14

Aortic stenosis: Px

Hx
Triad - Dyspnoea, angina, syncope
Ex
narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
Ejection systolic radiating to carotid
left ventricular hypertrophy or failure

15

Aortic stenosis: Ix

ECG - LV hypertrophy, LBBB
CXR - calcification
Echo - visualizes calcification and level of stenosis
Angiography

16

Aortic stenosis: Mx

Optimise RF's
Statins, antihypertensives, DM
Angina - BB
HF - ACEi & diuretics.
Avoid nitrates

Asymptomatic then observe the patient is general rule
Asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
Symptomatic
valve replacement
balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement

17

Valve types

Metal - last longer but need anticoag
Bioprosthesis - no anticoag but fail sooner (10-15 yrs)

18

AF: Def

Characterized by rapid, chaotic and ineffective electrical conduction
Subdivided into permanent, persistant and paroxysmal

19

AF: Ax

Idiopathic
Thyrotoxicosis
HTN
Pneumonia
IHD
Pericarditis
Bronchial Ca
PE

20

AF: Px

Hx
Asymptomatic
Palpitations
Chest pain
Dyspnoea
Ex
Irregularly irregular HR

21

AF: Ix

ECG - uneven baseline, absent p waves, irregular QRS
Blds - Cardiac enzymes, TFT's
Echocardiogram - Valve disease, atrial dilation

22

AF: Mx

1) Rate vs rhythm
2) Stroke control

23

AF: Mx rate control

Older than 65 years
History of ischaemic heart disease

Beta blocker or Rate limiting CCB e.g. diltiazem
2nd line any 2 of:
BB
Diltiazem
Digoxin

24

AF: Mx Rhythm
Younger than 65 years
Symptomatic
First presentation
Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)
Congestive heart failure

<48hrs duration of onset
Amiodarone
DC synchronized shock
Maintenance of sinus rhythm
Amiodarone
Sotalol
Flecainide

25

CHA2DS2VASC

Congestive heart failure
Hypertension
Age >65 >75
Diabetes
Stroke previous
Vascular disease
Female

26

Abx: CAP uncomplicated

Amoxicillin or macrolide = mild - moderate
clarithromycin + Co-amox/cefuroxime = moderate - severe

27

Abx: CAP atypical

Clarithromycin
(macrolide/tetracycline)

28

Abx: Hospital acquired pneumonia

1st line Ciprofloxacin +/- Vancomycin
2nd line Piptazobactam + Vancomycin
Aspiration Cefuroxime + metronidazole

29

Abx: Lower UTI

Nitrofurantoin, trimethoprim, amoxicillin or cephalosporin

30

Abx: Pyelonephritis

Broad spectrum cephalosporin or quinolone

31

Abx: Impetigo

Fusidic acid

32

Abx: Cellulitis

Flucloxacillin

33

Abx: Otitis media

Amoxicillin

34

Abx: Otitis externa

Fluclox

35

Abx: Gonorrhoea

IM Ceftriaxone + Azithromycin

36

Abx: Chlamydia

Doxycycline

37

Abx: PID

Oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole

38

Abx: Syphilis

Benpen, Doxy

39

Abx: C diff

Metronidazole or Vanc

40

Abx: Campylobacter

Clarithromycin