Acute medicine Flashcards
Difference between stable and unstable angina
Relieved by rest OR GTN spray
Gold standard investigation for stable angina
CT coronary angiogram
3 parts of medical management of stable angina
Immediate symptomatic relief - GTN spray
Long term symptomatic relief - BB or CCB
Secondary prevention - Aspirin, statin, ACEI, (BB or CCB)
4 drugs patient with stable angina should be on
ACEI
BB or CCB
Statin
GTN
What is the GRACE score after a NSTEMI
The 6 month risk of death or a repeat MI
- Medium or high risk (>5%) PCI within 4 days
When does Dresslers syndrome occur
2-3 weeks after MI
Management of Dresslers syndrome
NSAIDS ?steroids and occasionally pericardiocentesis
Secondary prevention of an MI
6 A’s
Aspirin Another anti-platelet for up to 12 months Atorvastatin (75mg) Ace inhibitor Atenolol or other BB
Aldosterone antagonist if heart failure
Artery affected in anterolateral MI
Left coronary
Artery affected in anterior MI
LAD
Artery affected in lateral MI
Circumflex
Artery affected in inferior MI
RCA
Other causes of raised troponin
Renal failure Sepsis Myocarditis Aortic dissection PE
3 features of pneumonia on examination of chest
Bronchial breath sounds
Fine course crackles
Dull ness to percussion (thicker due to collapse or consolidation)
Score for CAP
CURB-65
Confusion Urea >7 RR >30 BP<90 s >65
Most common cause of pneumonia in UK healthy (ish) people
Streptococcus pneumoniae
What is the definition of atypical pneumonia
Organism that cannot be cultured in a normal way or detected by gram stain
30s male presents unwell after a cheap holiday and is hyponatraemic
Legionella
SIADH
How does mycoplasma pneumoniae present
Young patient with neurological symptoms
Erythema multiform - target lesions
Mild pneumonia
MCQ about a farmer with a flu like illness
Coxiella burnetill (Q fever)
Linked to animal exposure
Pneumonia associated with birds and parrots
Chlamydia psitacia
Two most common classes of ABX for pneumonia
Amoxicillins or macrolides
When can a DVT present as a stroke
Patients with an ASD
Main contraindication for anti-embolic compression stockings
PAD
What is a significant difference in calf sizes in the context of DVT
Greater than 3 cm
When should a DVT USS be repeated
If positive d dimer and wells score: likely
7 days after negative USS
How may management change for a illofemoral DVT
Catheter thrombolysis directly to clot
When may IVC filters be used
IN recurrent PEs
Patients unsuitable for anticoagulation
What should patients with an unprovoked DVT have after they finished treatment
Physical exam and bloods
Antiphospholipid antibodies
Thrombophilias if have a first line relative with a DVT or PE
What is Budd Chari syndrome
Thrombosis in hepatic vein
Abdominal pain, hepatomegaly and ascites
Acute hepatitis
3 most common causes of cellulitis
Staph A
Group A and group C strep
Classification of cellulitis and range
ERON
1-4
4= sepsis
DKA criteria
Glucose >11
Ketosis >3
Acidosis <7.3
Treating DKA
FIG PICK
Fluids
Insulin
Glucose
Potassium
Infection
Chart
Ketones
T1DM patient presents with little hard lumps on their abdomen
lipodystrophy
Alcohol dependance effect on FBC MCV
Raised MCV
Treatment for acute alcoholic hepatitis
Steroids
4 stages of alcohol withdrawal by time
6-12: tremor, sweating, headache and craving
12-24: hallucinations
24-48: seizures
24+: DT
Symptoms of DT
Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia, HTN, hyperthermia Ataxia
Assesment scale for alcohol withdrawal
CIWA-Ar
Which vitamin does alcohol excess lead to deficiency in
B1
What comes first Wernickes or korsakoffs
W then K
3 features of Wernickes
2 features of Korsakoff’s
Confusion, oculomotor disturbances, ataxia
Memory impairment and behavioural changes
What causes vasodilation in sepsis
Nitrous oxide
What causes oedema and capillary leaking in sepsis
Cytokines: interlukins and TNF
What may thrombocytopenia concerning in a septic patient
Possible DIC
What should be measured during a anaphylactic attack
Serum mast cell tryptase within 6 hours
COPD dyspnoea scale
MRC 1-5
5 cannot leave house
What is PESI score
PE severity index
1-2 get sent home same day
PE treatment
DOAC
Can pregnancy or breast feeding women have DOACs
Not good data so LMWH used instead
When can a PERC be used and what score rules out a PE
When clinically unlikely
0 = very low risk
Other than TTTW what else can be seen in hyperkalemia
Flat p waves
Sloping ST
Broad QRS
Management and doses of hyperkalemia
Calcium glutinate 30ml 10% bolus
Then
5mh salbutamol or 10 units in 50ml 50% insulin dextrose
Best initial delirium test
SQID
” is this patient more confused”
What is AMT4
Test for delirium in patients with acute confusion
High level of epithelial cells on urine culture dx:
Contamination, do not treat
