8/12/15 Interactive Cases in General Medicine 3 Flashcards
A person presents with chest pain. How should they be investigated?
- ECG (STEMI/NSTEMI)
- Troponin; if + PCI coronary angiography, if - exercise tolerance test
- Echo
What are the cardiac differentials for CP?
IHD especially associated with nausea and sweating, aortic dissection can lead to AR EDM, pericarditis associated with post-viral illness
What are the respiratory differentials for CP?
Pneumonia (cough, sputum), pneumothorax (SOB sudden), PE (haemoptysis, CP, SOB)
Causes of sudden breathlessness within seconds?
Foreign body obstruction, pneumothorax, PE
Gastro causes of CP?
Oesophageal spasm, gastritis/oesophagitis. Retrosternal pain, excess EtOH
Musculoskeletal causes of CP?
Costochondritis, Tietze’s syndrome
STEMI: V1-4
Anterior MI, LAD
STEMI: V5-6, I, aVL
Lateral MI, LCX
STEMI: II, III, aVF
Inferior MI, RCA
Collapse ?cause
Before; was there any warning?
During; tongue biting, incontinence, jerky movements
After; confusion
Low volume, slow rising pulse, ESM
AS
Investigation of arrhythmia
ECG for tachy/brady and long QT syndrome, this will predispose to VT
Postural hypotension investigation
BP lying and standing
Classification of long-QT syndrome?
Abnormal ventricular depolarisation
- Congenital, FH sudden death, abnormal K+ channel mutation
- Acquired, low K+/Mg2+, drugs
How are the symptoms of hypoglycaemia classified?
Neuroglycopaenic: confusion, drowsy, aggressive, coma
Adrenergic: tachycardia, sweating
May be due to insulinoma if hypo early in the morning, but more commonly due to a DM having taken insulin but not eaten food
