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year 3 knowledge > Amir Sam > Flashcards

Amir Sam Flashcards

1
Q

Structure to HPC

A

Ask about presenting symptoms- socrates
Associated symptoms to that system
Then questions relating to your differential diagnoses

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2
Q

Associated symptoms with MI

A

Nausea
Sweating
Breathlessness

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3
Q

Chest pain investigations

A

ECG
Troponin
Echo

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4
Q

DDx of chest pain

A 
Cardiac
- IHD
- aortic dissection
- pericarditis
Resp
- PE
-Pneumothorax
-Pneumonia
GI
- oesophagitis
- gastritis
- oesophageal spasm
Musculoskeletal
- costochondritis
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5
Q

Important investigation forgotten about in chest pain

A

BP both arms to check for aortic dissection

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6
Q

Anterior MI ecg

A

LAD

V1-V4

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7
Q

Lateral MI ecg

A

Circumflex
V5-6
aVL

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8
Q

Inferior MI ecg

A

Right coronary artery
II, III
avF

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9
Q

Which enzymes get elevated acutely MI

A

CK isoform

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10
Q

What happens in seizure cause of collapse after event

A

Confused

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11
Q

Important thing to ask to ask about in family history with collapse

A

Sudden death in family

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12
Q

How to check for postural hypotension collapse

A

Change in BP lying vs standing

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13
Q

DDx collpase

A 
Glucose
Cardiac
- valves
- arrythmia
- outflow obstruction
- postural hypotension
Neurological
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14
Q

Forgotten cause of outflow obstruction

A

PE

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15
Q

Investigations for cardiac causes

A

ECG
Pulse, ESM, echo
Lying and standing BP

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16
Q

What is long QT syndrome

A

Abnormal ventricular repolarisation

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17
Q

Acquired causes of long QT

A

Low K+, Mg+, Ca+, hypothermia
MI
Raised ICP
Drugs

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18
Q

Genetic cause of Long QT

A

Change in K+ channel

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19
Q

Family history sign of long QT

A

Sudden death

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20
Q

Causes of cardiac causes of collapse

A

Reduced outflow
Arrythmia either brady or tachy
Postural hypotension
Vasovagal

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21
Q

What does long QT syndrome predispose you to

A

Tachyarrythmias

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22
Q

What does murmur louder on inspiration say about murmur

A

Murmur on right side

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23
Q

What are signs on examination of tricuspid regurg

A

Hepatomegaly

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24
Q

DDx of JVP

A

R heart failure
Tricuspid regurg
Constrictive pericarditis

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25
Q

Causes of JVP

A 
R HF
- pulmonary HTN -PE, COPD
- secondary to left failure
Tricuspid regurg
- R ventricle dilation
- vegetations
- hepatomegaly
Constrictive pericarditis
- infection TB
- autoimmune sarcoid
- maligancy
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26
Q

Questions to ask self about murmur

A

Where loudest

Where radiate

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27
Q

DDx of sinus tachycardia

A 
Caffeine
Alcohol
Sepsis
Hypovolaemia
Endocrine
Anxiety
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28
Q

DDx of SVT

A

Re-entry circuit

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29
Q

Difference between AVNRT and AVRT

A

AVNRT at level of node

AVRT goes into ventricles and back up bundle of kent

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30
Q

Is there an upstroke in AVNRT

A

No

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31
Q

AVRT on ECG

A

SR
Short PR interval
Delta wave

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32
Q

Causes of AF

A

Thyrotoxicosis
Alcohol
Heart- muscle, valve, pericardium
Lung- PE, pneumonia, Cancer

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33
Q

Causes of VT

A

Iscaemia
Electrolyte
Long QT
Drugs

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34
Q

Managment of haemodynamically stable AF

A
  1. Valsalva

2. adenosine

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35
Q

Acute fast AF management

A

Rythm and rate control

Causes and complications

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36
Q

Categories of ECG abnormaliites

A

Iscaemia
Arrythmia or block
Vent strain or hypertrophy

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37
Q

What causes third heart sound

A

Associated with ventricular filling- very common in HF

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38
Q

What causes fourth HS

A

Associated with ventricular hypertrophy

39
Q

Management of HF patient

A

Initially sit them up and give high flow oxygen
Furosemide
GTN infusion

40
Q

What cant you do when a patient is hypothermic

A

Any cardioversion

41
Q

Classify SOB

A 
Seconds
P embolism
Pneumothorax
FB
Mins
airway disease
chest infection
acute HF
Hours
chronic above
Fibrosis
NMJ
Anaemia
Malignancy
Effusions
42
Q

Iatrogenic

A

Caused by treatment

43
Q

What would cause SOB after chest drain

A

Pulnomary odema

44
Q

When is pain worse pericarditis

A

Lying down

Breathing in

45
Q

Recent history for pericarditis

A

RTI

46
Q

When is aortic regurg murmur heard best

A

Leaning forward

47
Q

Murmur for aortic dissection

A

Aortic regurg

48
Q

What done if patient comes in with stemi

A

PCI

49
Q

Difference in echo between MI and myocarditis

A

MI regional wall abnormality where event occurred whereas myocarditis globally

50
Q

Treatment for NSTEMI

A

MONOBASH and angiogram

51
Q

Outflow obstruction causes of collapse

A

Aortic stenosis
PE
Hypertrophic obstructive cardiomyopathy

52
Q

What to ask about when querying neuro cause of collpase

A

Aura
Confusion afterwards
Tongue biting
Shaking

53
Q

Which drugs can lead to long QT syndrome

A 
Arrythmics
Psycotics
Depressants
Histamines
Biotics
Methadone
54
Q

What does murmur louder on expiration suggest about murmur

A

Its on the left side

55
Q

What would you consider in patient with PSM but no signs of valve defects

A

Ventricular septal defect

56
Q

How to differentiate between AVNRT and AVRT

A

In tachycardia they look exactly the same so when slow heart down the abnormality will be seen if its AVRT, if not then will be normal. Heart slowed by vagal manoevers and adenosine

57
Q

What abnormalities will be seen on ECG if AVRT

A

Short PR

Delta wave

58
Q

When can delta wave only be seen

A

Sinus rythm

59
Q

Differences in focus between flutter and fibrillation

A

Flutter- single ectopic focus which can be ablated

Fib- no focus

60
Q

Management plan for haemodynamically stable SVT

A

Vagal maooeuvres

Adenosine with cardiac monitor

61
Q

What must be treatment for anyone arrythmia haemodynamically unstable

A

DC cardioversion

62
Q

Management Plan For A Patient With Acute Fast AF & BP: 120/80

A 
Need to rate and rythm control
Rythm
- if onset less than 48 hours DC cardioversion
- IV flecainide or amiodarone
Rate control
- digoxin or B blocker
Treat underlying cause
63
Q

When wouldn’t you give IV flecainide acute fast AF

A

Structural heart disease

64
Q

What would you give for acute fast AF with structural heart abnormality

A

IV amiodarone

65
Q

How long would you wait after acute fast AF of over 48hrs to give DC cardioversion

A

3-4 weeks- in mean time anticoagulate

66
Q

What do you give with CHADVASC score above 1

A

Warfarin and LMWH

67
Q

What do you give for CHAD VASC score of 1

A

Aspirin and LMWH

68
Q

What to give for VT with no haemodynamic compromise

A

IV amiodarone then look for and treat cause

Implant ICD

69
Q

What do you give for pulseless VT

A

Defibrillate as in cardiac arrest

70
Q

What to give if patient goes into torsades de pointes

A

IV magnesium sulphate

71
Q

What do when patient is in haemodynamically unstable VT

A

Defibrillation

72
Q

Difference between defibrillate and DC cardioversion

A

Cardioversion has to be synced so can be delivered at any time whereas defibrillation can be at any time
DC cardioversion can be given to any haemodynamically unstable patient wheras defibrillation for people in VF

73
Q

What is Votlage criteria for LVH

A

S in V1 + R in V5 or V6 whichever is larger > 7 large squares

74
Q

What suggests ischaemia on ECG

A

ST elevation or depression
T wave inversion
Pathological Q waves

75
Q

What do pathological Q waves look like and what do they suggest

A

Over 2mm deep or over 1mm wide

Suggest old infarcts

76
Q

How to look for previous infarcts on ECG

A

Pathological Q waves

77
Q

What does digoxin toxicity look like on ECG

A

ST depression + inverted T waves in V5-6 (‘reversed tick’) + any arrhythmia

78
Q

How does hyperkalaemia appear on ECG

A

Tall, tented T waves, widened QRS, absent P waves, prolonged PR interval, bradycardia

79
Q

How does hypokalaemia appear on ECG

A

Small T waves, prominent U wave

80
Q

How does hypocalcaemia appear on ECG

A

Short QT interval

81
Q

How does hypercalcaemia appear on ECG

A

Long QT interval, small T waves

82
Q

What does fixed wide splitting of S2 suggest

A

Atrial septal defect

83
Q

What is fixed wide splitting of S2 best heard with

A

diaphragm

84
Q

What is third heart sound best heard with

A

Bell as high pitched

85
Q

Management of acute HF

A
  1. Sit up
  2. 60-100% oxygen
  3. GTN infusion
  4. Diamorphine
  5. IV furosemide
  6. Treat underlying cause
86
Q

Why give diamorphine acute HF

A

Anxiolytic and improves breathlessness

87
Q

What are shockable causes of cardiac arrest

A

VF

Pulseless VT

88
Q

What are unshockable causes of cardiac arrest

A

PEA

Asystole

89
Q

What would you be thinking if cardiac arrest patient arrives hypothermic

A

VT or VF

90
Q

Who you cant give adrenaline to

A

Hypothermic patients

91
Q

What are 8 reversible causes of cardiac arrest

A 
Hypoxia
Hypovolaemia
Hyperkalaemia (or any other metabolic disorder)
Hypothermia
Thrombous
Toxins
Tension pneumothorax
Tamponade
92
Q

Way to remember causes of cardiac arrest

A

4 ts

4 hs

93
Q

Management for VF or pulseless VT

A 
Shock
CPR 2 mins
Assess rythm
Adrenaline every 3-5 mins(if over 30C)
Amiodarone after 3 shocks
Correct reversible changes
94
Q

Investigations for infective endocarditis

A

Echo

Three sets of blood cultures

year 3 knowledge (10 decks)

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