Background Flashcards
1
Q
ACS definitions
A
STEMI
- Acute
- > persistent ST segment elevation (1 small square) in 2 contiguous leads (except V2/3)
- > new LBBB with symptoms
- does not require elevated troponins
- Consider posterior STEMI
- > ST depression in V1-3
- Old findings
- > ST segment at isoelectric
- > small R
- > pathologic Q (1/3 corresponding R)
- > inverted T wave
Non-STEMI
- ST segment depression in two contiguous leads (half small square)
- > usually diffuse
- > focal area likely STEMI with reciprocal changes
- T wave inversion in two contiguous leads (one small square)
- > with R:S >1
- elevated troponins without ST elevation
UA
- > unstable/new/severe/frequent angina
- > no trops
- > only transient ECG changes
2
Q
thunderclap headache ddx
A
Always Remembering Several Critical Differentials is A Painful Thorn In My Side
- Aneurysm rupture
- > thunderclap headache after trigger/maybe sentinel bleed
- > vomiting/nuchal rigidity/LOC/seizures
- Reversible cerebral vasoconstriction syndrome
- > recurrent TCH over days to weeks
- > similar triggers to aneurysmal rupture
- > may develop neurological deficits due to stroke
- Spontaneous intracranial hypotension
- > postural headache after trauma/CSF drain
- > nuchal rigidity/nausea/vomiting sometimes
- Cluster headache
- > eye/temple pain lasting up to 3 hours
- > red eyes/ipsilateral lacrimation/rhinorrhea/horners
- Dissection (cervical artery)
- > stroke/TIA/neck or head pain
- > partial horners (no anhidrosis)/tinitus/bruit
- > trauma/connective tissue disorder
- Acute angle glaucoma
- > blurred vision/halos/red eye/dilated pupil
- Posterior reversible encephalopathy syndrome
- > HTN/seizure/visual symptoms/insidious headaches
- > white matter oedema
- > sometimes UMN signs and focal deficits
- Thrombus (venous)
- > VTE risk factors/neuro deficits across arterial territories
- Ischaemic stroke
-Meningitis
- Spontaneous intracerebral haemorrhage
- > HTN/anticoagulated/older
- > gradual focal neuro signs (putamen/post int capsule)
- > headache/vomiting/meningism/stupour
3
Q
Upper GI bleed DDx
A
DDx
- peptic ulcer
- malloryweis
- varices
- portal hyptersive gastropathy
- angiodysplasia
- neoplasia
- erosive
- > oesophagitis
- > gastritis
- > duodenitis
4
Q
DKA triggers
A
Triggers (Don’t PANIC)
- Drugs
- > corticosteroids
- > cocaine
- > simpathomimetics
- > SGLT-2
- > atypical anipsychotics
- Pregnancy
- Acute illness
- New diagnosis (common)
- Infarct
- Compliance
5
Q
Chest pain ddx
A
Life threatening (ED TRAPP)
- Embolism
- Dissection
- Tamponade
- Ruptured viscus
- ACS
- Pericarditis
- Pneumothorax
Other/Common (GIMP)
- Gastrointestinal
- > Gastritis/peptic ulcer
- > Pancreatitis
- > Cholecystitis
- Infective respiratory conditions
- > Pneumonia
- > Asthma/COPD exacerbation
- Musculoskeletal
- > Intercostals/ribs
- Psychiatric
- > Panic/anxiety
6
Q
STEMI ECG changes
A
Lateral STEMI
- Cause
- > Isolated (rare) = Diagonal/left marginal
- > Anterorlateral = proximal LAD
- Elevation
- > I, aVL, V5-6
- Reciprocal depression
- > III, aVF
Inferior STEMI
- Cause
- > Majority = RCA
- > Some = circumflex
- > Rarely = wraparound LAD
- Elevation
- > II,III,aVF
- Reciprocal depression
- > aVL
- RCA
- > elevation III>II, depression in I
- circumflex
- > elevation IIIinferior + anterior STEMI features
7
Q
Epistaxis background
A
Epidemiology
- lifetime incidence over 50%
- more common in winter
Aetiology
- Primary = 85%
- > idiopathic
- Secondary
- > trauma
- > coagulopathy
- > anticoagulation
- > HTN
- > neoplasia
Pathophys
- Anterior = 90%
- > arise from Little’s area = anterior inferior septum
- > confluence of vessels = Kiesselbach plexus
- Posterior
- > usually arterial
- > higher risk of airway obstruction/aspiration
Complications
- bacterial sinusitis
- recurrence
8
Q
ddx psychosis
A
SMS BENDGAME
- Schizophrenia spectrum
- Medications
- Substances
- Brain lesion
- > TBI
- > dementia
- > tumour
- > epilepsy
- > MS
- Endocrine
- > thyroid dysfunction
- > hypercortisolaemia
- Nutritional deficiencies
- > folate/B12
- > thiamine
- Delirium
- Genetic
- > klinefelter
- > di George
- Autoimmune
- > general association
- > SLE
- Metabolic (rare)
- > wilsons
- Encephalitis
- > STI’s
- > measles/mumps
- > EBV
9
Q
COPD exacerbation background
A
Epidemiology
- 3-4th leading cause of death
- exacerbations cause most of mortality/morbidity
Aetiology
- Bacterial (majority)
- > haemophilus influenzae
- > strep pneumoniae
- > moroxella catarrhalis
- Viral
- > rhino (most common)
- > influenza
- > parainfluenza
- > adeno
- > corona
- > RSV
- Combined bacterial/viral
- Non infective
- > pollutants
- > smoke
- > dryer/colder weather
Pathophys
- Worsening of underlying inflammation
- > increased airway obstruction
- Likely has residual effects on lung architecture
- > worsening lung function with frequent exacerbations
10
Q
PR bleeding ddx
A
HAD bloody CRAP
- Haemorrhoids
- Anal fissure
- Diverticulosis
- Colitis (ischaemic, inflammatory, infectious)
- Rapid transport (upper GI)
- Angiodysplasia
- Polyps/neoplasia
- Solitary rectal ulcer syndrome
11
Q
Bowel obstruction background
A
Epidemiology
- small more common than large
- small
- > under 5% lifetime risk virgin abdo
- > over 50% post surgery
Aetiology
- small
- > extrinsic = adhesions/hernias/volvulus
- > intrinsic = stricture/neoplasia/haematoma
- > luminal = gall stone/foreign body/intussusception
- large
- > neoplasia
- > volvulus (sigmoid/caecal)
- > stricture
Pathophys
- proximal dilation
- distal hyper-peristalsis and clearance
- venous congestion
- > increased pressure/decreased arterial supply
- > ischaemia and infarction
12
Q
Pyelonephritis background
A
Epidemiology
- incidence = approx 10/10,000
- risk factors
- > much more common in women
- > common after renal transplant
- > frequent sex/new partner
- > recent UTI
- > diabetes
- > stress incontinence
- > foreign body/catheter
- > anatomical abnormality (PCK/reflux/BPH/neuro bladder)
- > immunosuppression
- > more likely to be complicated in pregnancy
Aetiology
- Most common = e coli
- Other
- > klebsiella
- > proteus
- > pseudomonas
- > staph (including MRSA)
- > enterococci (considered contaminant for UTI)
Pathophys
- Source
- > usually ascending infection following cystitis
- > can be due to haematological seeding
- Uncomplicated
- > typical pathogen
- > immunocompetent
- > normal anatomy
- Complicated (more likely to be severe)
- > susceptibility (extremes of age/immunocompromise)
- > abnormal anatomy/physiology (outflow tract/kidney)
- > foreign body/catheterisation/instrumentation/stones
- > pregnancy
- Complications
- > sepsis and septic shock
- > AKI and renal failure
- > renal abscess
- > emphysematous pyelonephritis
- > renal scaring
13
Q
NOF background
A
Epidemiology
-usually over 80 years old
Aetiology
- osteoporosis
- age
- falls
- low BMI
- female
Pathophys
- Intracapsular
- > reticular vessels passing up capsule damaged
- > risk for avascular necrosis
- Extracapsular
- > trochanteric
- > subtrochanteric
- Further classification (Garden)
- > displacement
- > comminution
14
Q
Nephrolithiasis background
A
Epidemiology
- approx 10% lifetime risk
- more common in older age and men
Aetiology
- Supersaturation
- > calcium
- > oxalate
- > uric acid
- > sodium
- Low crystal inhibitors
- > Mg and citrate
- Predisposing factors
- > low urine flow
- > abnormally high/low pH
Pathophys
- Calcium (vast majority of stones)
- > oxalate (most common)
- > phosphate (high pH/parathyroidism)
- Uric acid (low pH)
- Cystine (rare, due to cystinuria inborn error metabolism)
- Struvite (rare, proteus/pseudomonas/klebsiella infection)
15
Q
Nephrolithiasis ddx
A
GI
- bowel obstruction
- diverticular
- gastroenteritis
- mesenteric ischaemia
- constipation
- appendicitis
- unlikely
- > biliary colic
- > pancreatitis
GU
- ovarian torsion
- ovarian cyst/rupture
- tubo-ovarian abscess
- ectopic
- pyelonephritis
Musculoskeletal pain
