14/06 Flashcards
anterior MI
v1-v4
left anterior descening
lateral MI
V5-V6, I
left circumflex
inferior MI
II,III and AVF
right coronary artery
mx of ACS
Morphine - if pt in pain
Oxygen - if pt hypoxic
Nitrates - caution in hyPOtension
Aspirin 300mg
when should be PCI be offered in STEMI
presentation within 12 hrs of symptom onset + can be delivered within 120 mins
PCI
drug eluting stents through radial access
what to do after fibrinolysis
repeat ECG within 60-90 mins and PCI if still changes
what is used to stratify risk post MI
kilip class
termination of supraventricular tachys
adenosine (avoid in asthma)
epsilon wave
Arrhythmogenic right ventricular cardiomyopathy
S2A2DCHAVS
S2 - prior stroke, TIA or thromboembolism
A2 - age >=75
D - diabetes
C - congestive HF
H - hypertension or treated hypertension
A - age 65-74
V - vascular disease
S - sex female
MI cardiac enzymes
myoglobin is first to rise
CK-MB useful to look for re-infarction
chronic heart failure diagnosis
N-terminal pro-B-type natriuretic peptide (NT‑proBNP)
high levels - specialist assessment ECHO 2 weeks
raised levels - specialist assessment ECHO 6 weeks
chronic heart failure first line
ACEi and BB
chronic heart failure second line
aldosterone antagonist and SGLT2 inhibitor
chronic heart failure third line
ivabradine
sacubitril-valsartan
digoxin
hydralazine + nitrate
cardiac resync therapy
coarctation of the aorta features
HTN
radio-femoral delay
mid-systolic murmur maximal over the back
apical click from the aortic valve
notching of the inf border of the ribs
acute heart failure mx
IV loop diuretics
oxygen
nitrates if heart disease
cpap if resp failure
acute heart failure hypotension
ionotropic agents eg dobutamine
vasopressor agents eg norepinephrine
mechanical circulatory assistance
left heart failure
pulmonary oedema
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
bibasal fine crackles
right heart failure
peripheral oedema
ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia (‘cardiac cachexia’)
when is s3 normal
pts less than 30 (sometimes women up to 50)
path s3
left ventricular failure (e.g. dilated cardiomyopathy) constrictive pericarditis (called a pericardial knock)
mitral regurgitation
s4
aortic stenosis
HOCM
hypertension
aortic valve
right second intercostal space
upper sternal border
pulmonary valve
left second intercostal space
upper sternal border
mitral valve
Left fifth intercostal space
just medial to mid clavicular line
tricuspid valve
left fifth intercostal space
lower left sternal border
most common lymphoma
diffuse large b cell
foot drop after hip arthroplasty nerve injury
sciatic
crypt abscesses
ulcerative colitis
TCA overdose
bicarbonate
lateral epicondylitis
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
medial epicondtlitis
pain is aggravated by wrist flexion and pronation
SVT mx
vagal manouvres
adenosine
electrical cardioversion
contraindications to statins
pregnancy
macrolides eg erythromycin, clari
HOCM mx
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis
suspected aortic dissection in unstable pt
trans OESOPHAGEAL echo
assess severity of liver cirrhosis
Child-Pugh classification
head injury lucid interval
extradural haematoma
most specific ecg finding in acute pericarditis
PR depression
upper GI bleed score
glasgow blatchford scoring
after endoscopy - rockall score
tx of alchoholic ketoacidosis
IV saline and thiamine infusion
alcoholic liver disease LFTS
gamma-GT»_space;»
AST:ALT is normally > 2
alcoholic hepaitis mx
steroids eg pred
pentoxyphylline
achalasia diagnosis
oesophageal manometry
achalasia tx
pneumatic balloon dilatation
heller cardiomyotomy or botox injection
main side effect of 5ASAs
haem eg agranulcytosis so monitor FBC
SAAG <11 causes
hypoalbuminaemia
malignancy
infections
SAAG >11 causes
liver disorders
cardiac disorders
lack of blood flow eg Budd chairi, veno-occlusive disease
what does high saag indicate
portal hypertension
mx of ascites
reduce dietary sodium
sometimes fluid restrict
aldosterone antagonists
drainage if tense ascites
antibiotic prophylaxis with ciprofloxacin or norfloxacin
TIPS
AI hep antibodies
ANA/SMA/LKM1 antibodies, raised IgG levels
bile acid malabsorption presentation
chronic diarrhoea
bile acid malabsorption test
SeHCAT
bile acid malabsorption tx
bile acid sequestrants e.g. cholestyramine
carcinoid tumours invx
urinary 5-HIAA
plasma chromogranin A y
carcinoid tumours tx
somatostatin analogues e.g. octreotide
coeliac disease gold standard invx
Endoscopic intestinal biopsy
inducing remission in crohns
glucocorticoids
enteral feeding with elemental diet
2nd line - 5 ASAs
azathioprine or mercaptopurine
infliximab - fistulating disease
crohns isolated peri-anal disease
metronidazole
complex fistulae
draining seton
diverticulitis mx
mild - oral abx
severe - nil by mouth, IV fluids, iv abx
gallstones invx
USS and LFTs
acute cholecytitis
Right upper quadrant pain
Fever
Murphys sign on examination
gallbladder abscess
Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
cholangitis
Patient severely septic and unwell
Jaundice
Right upper quadrant pain
cholangitis mx
Fluid resuscitation
Broad-spectrum intravenous antibiotics
Correct any coagulopathy
Early ERCP
gallstone ileus
known gallstones
Small bowel obstruction (may be intermittent)
gallstone ileus mx
Laparotomy and removal of the gallstone from small bowel,
risks of ERCP
Bleeding
Duodenal perforation
Cholangitis
Pancreatitis
screen for haemachromatosis
general pop - transferrin sat
fam member - genetic testing for HFE mutation
haemachromatosis iron study
> > transferrin and ferriting
«_space;TIBC
h pylori eradication
PPI + amox + (clarithromycin OR metronidazole)
if pen-allergic: PPI + metronidazole + clarithromycin
hepatic encephalopathy mx
lactulose and rifaximin
wilsons disease invx
slit lamp examination for Kayser-Fleischer rings
reduced serum caeruloplasmin
reduced total serum copper
free serum copper is increased
increased 24hr urinary copper excretion
ATP7B gene
mx wilsons
pencillamine
in controlled drugs what needs to be stated in words and figures
quantity
AKI poor response to fluid challenge
acute tubular necrosis
dpp4 inhibitors
gliptins
IBS tx
pain: antispasmodic agents
constipation: laxatives but avoid lactulose
diarrhoea: loperamide is first-line
second line = TCAs
mesenteric ischaemia
typically small bowel
due to embolism
sudden onset, severe
urgent surgery
high mortality
ischaemic colitis
large bowel
multifactorial
transient less severe symptoms, bloody diarrhoea
thumbprinting
conservative mx
screening for cirrhosis in chronic liver disease
transient elastography
screening for cirrhosis in NAFLD
enhanced liver fibrosis blood test