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Year 3 - CR > Before Exam > Flashcards

Before Exam Flashcards

1
Q

How does complete heart block lead to heart failure

A

By decreasing contractility

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2
Q

Name the severity of asthma attacks and there symptoms

A

Moderate
- 75-50%

Actue severe

  • 50-33%
  • tachycardia
  • greater than 25 breaths per minute

Life threatening

  • Normal PaCO2
  • less than 92% SpO2
  • Silent chest
  • bradycardia
  • hypotension

Near fatal
- rise in PaCO2

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3
Q

Levels of COPD according to the gold post bronchodilator grade

A
  • Mild = greater than 80
  • moderate = 79-50
  • severe = 49-30
  • Very severe = under 30
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4
Q

What glucose level do you give IV

A

20% 50ml IV

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5
Q

What are Roth’s spots

A
  • seen in acute bacterial endocarditis is a red spot caused by haemorrhage with a pale white centre
  • present in the eye
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6
Q

What is antiphopsholipid syndrome and how do you screen for it

A
  • autoimmune hypercoagulabe state caused by Antiphospholipid antibodies, causes arterial or venous blood clots, and leads to recurrent miscarriages, IUGR and preterm births

Antibodies also present

  • lupus anticoagulant
  • Anti apolipoprotein antibodies
  • Anti cardiolipin antibodies
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7
Q

What is factor V Leiden disease

A
  • MOST COMMON THROMBOPHILLIA
  • mutation of one of the abnormal clotting factors int he blood that increases your chance of developing abnormal blood clots
  • also known as resistance to activated protein C
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8
Q

What is protein C deficiency

A
  • disorder that increases the risk of developing an abnormal blood clot
  • results in a hyper coagulable state
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9
Q

What is the 3rd heart sound due to

A
  • Rapid filling of the ventricles in diastole
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10
Q

List the classes of anti-arrthymic drugs

A 
Class 1
- nitrate channel blockers 
class 2
- beta blockers
class 3 
- potassium channel blockers 
class 4 
- Calcium channel blockers
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11
Q

What are the ECG changes in digoxin toxicity

A
  • T wave inversion

- sloping ST segment depression int he lateral chest leads (delta waves)

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12
Q

What conditions cause clubbing

A 
Clubbing causes 
Lung 
- asbestosis 
- lung cancer 
- idiopathic pulmonary fibrosis 
- mesothelioma
= sarcoidosis 
- AV fistulae

Cardiovascular

  • bacterial endocarditis
  • congenial heart disease

GI

  • IBD
  • cirrhosis
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13
Q

How does a Beta blocker help in heart failure

A

Decreases diastolic filling

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14
Q

How does a Beta blocker help in heart failure

A

Increases diastolic filling

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15
Q

What electrolyte abrnomalitiy causes acute muscle weakness

A

hypokalaemia

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16
Q

What is a side effect of adenosine

A
  • Flushing
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17
Q

What medications should be used in secondary prevention of an MI

A
  • Dual antiplatelet therapy (aspirin plus a second anti platelet agent)
  • ACE inhibitor
  • beta blocker
  • statin
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18
Q

What does thiazide diuretics act

A
  • Proximal part of distal convoluted tubules
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19
Q

Name a side effect of beta blockers

A
  • They may cause cold peripheries (hands and feet)
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20
Q

Name an antibiotic can cause a prolonged QT interval

A
  • erythromycin
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21
Q

Difference between synchronised and unsynchronised DC cardio version

A 
Unsycnrhonised 
- VT 
- VF 
- SVT 
dying basically

Synchronised
- everything else

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22
Q

How does a posterior STEMI present on an ECG

A
  • Tall R waves in V1 and V2

- ST depression

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23
Q

What does a pericardial knock mean

A

constrictive pericarditis

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24
Q

Nirates are….

A

Nitrates are contraindicated in aortic stenosis

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25
Q

How do you give

  • adenosine
  • amiodarone
  • atropine
A
  • IV adenosine needs to be inserted via a large 16G cannula into the arm = 6mg/12mg/12mg
  • IV Amiodarone = 300mg IV over 20-60 minutes and then 900mg over 24 hours
  • IV atropine = 500mcg up to 3mg
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26
Q

When are beta blocks contraindicated

A

Beta blockers are contraindicated in patients with asthma when manging AF

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27
Q

Where do you place the ECG leads

A 
Red = right arm 
Yellow = left arm 
Green = left leg 
Black = right leg
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28
Q

What type of murmur does a VSD cause

A

Pansystolic murmur

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29
Q

What are the short term complications of an MI

A
  1. Rupture of papillary muscles
    - pulmonary oedema and hypotension
  2. Left ventricular free wall rupture (1-2 weeks after)
    - Muted heart sounds, low BP, raised JVP, pulsus paradoxes (presents like a tamponade) treat with pericardiocentesis
  3. Arrhythmias
  4. Left ventricular failure
  5. VSD
    - Pan systolic murmur and heart failure symptom
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30
Q

What are the short term complications of an MI

A
  1. Rupture of papillary muscles
    - pulmonary oedema and hypotension
  2. Left ventricular free wall rupture (1-2 weeks after)
    - Muted heart sounds, low BP, raised JVP, pulsus paradoxes (presents like a tamponade) treat with pericardiocentesis
  3. Arrhythmias
  4. Left ventricular failure
  5. VSD
    - Pan systolic murmur and heart failure symptom
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31
Q

What are the long term complications of an MI

A
  1. Intractable left ventricular failure
  2. Dressler’s syndrome
    - Fever, chest pain that is better when leaning forward, pleuritic chest pain, raised ESR = treated with NSAIDS
  3. Ventricular aneurysm
    - Persistent ST elevation and left ventricular failure
  4. Recurrent MI
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32
Q

PE guidelines

A

PE guidelines
If someone has a PE wells score greater than 4
- CTPA
- If you cannot do a CPTA then offer interim anticoagulation
- If allergic to dye or renal issues then offer a V/Q
If CTPA positive
- then continue with anticoagulation
If CTPA negative
- Offer leg ultrasound if suspected DVT
If not suspected DVT stop anticoagulation and continue other diagnosis

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33
Q

PE guidelines

A

PE guidelines
If someone has a PE wells score greater than 4
- CTPA
- If you cannot do a CPTA then offer interim anticoagulation
- If allergic to dye or renal issues then offer a V/Q
If CTPA positive
- then continue with anticoagulation
If CTPA negative
- Offer leg ultrasound if suspected DVT
If not suspected DVT stop anticoagulation and continue other diagnosis

If PE wells score is less than 4 
	- D dimer 
If D dimer positive 
	- CPTA 
If D dimer negative 
Stop anticoagulaiton and consider alternative diagnosis
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34
Q

What makes up the Wells score for PE

A
  • Clinical signs/symptoms of DVT (3)
  • Alternative diagnosis is less likely than PE (3)
  • heart rate more than 100 bpm (1.5)
  • immobilisation for more than 3 days or surgery in the past 4 weeks (1.5)
  • previous DVT/PE (1.5)
  • haemoptysis (1)
  • malignancy (1)

More than 4 is indicative of CPTA

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35
Q

What makes up the wells score for DVT

A
  • Active cancer
  • paralysis, paresis or plaster immobilisation of lower extremities
  • recently bedridden for 3 days or more or major surgery within 12 weeks
  • localised tenderness along distribution of deep venous system
  • entire leg swollen
  • calf swelling at least 3 cm larger than on asymptomatic side
  • pitting oedema confined to the leg
  • collateral superficial veins
  • previously documented DVT
  • alternative diagnosis is at least as likely as DVT

2 or more then DVT is likely

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36
Q

How should you measure blood pressure in the clinic

A

If blood pressure measured in the clinic is 140/90 mmHg or higher:

  • Take a second measurement during the consultation.
  • If the second measurement is substantially different from the first, take a third measurement.
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37
Q

How does home blood pressure monitoring work

A

When using HBPM to confirm a diagnosis of hypertension, ensure that:
for each blood pressure recording, 2 consecutive measurements are taken, at least 1 minute apart and with the person seated and
blood pressure is recorded twice daily, ideally in the morning and evening and
blood pressure recording continues for at least 4 days, ideally for 7 days.

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38
Q

Name the NICE guidelines for hypertension

A
  • If blood pressure in clinic is between 140/90 and 180/110 then offer ABPM to confirm diagnosis (if cannot do ABPM then use HBPM)
    Whilst waiting for the confirmation of diagnosis of hypertension carry out
    • Investigations for target organ damage
    • Formal assessment of cardiovascular risk using cardiovascular risk assessment tool
      Confirm diagnosis of hypertension with people with a
    • Clinic blood pressure greater than 140/90 and
    • ABPM greater than 135/85
      Assess cardiovascular risk and end organ damage
    • Greater than 10% consider medication
    • Test for presence of protein in urine by sending urine sample for estimation of the albumin: creatinine ratio
    • Take blood sample to measure HbA1C, electrolytes, creatinine, eGFR, total cholesterol and HDL
    • Examine the fundi for presence of hypertensive retinopathy
    • Arrange ECG lead
      If a person has severe hypertension greater than 180/120 but no sign and symptoms indicating same day referral then carry out investigations for target organ damage as soon as possible
    • If target organ damage then start anti hypertensive without waitng for ABPM results
    • If no target organ damage identified then repeat clinic blood pressure measurement within 7 days

Medication
- Offer antihypertensive medication to those with Stage 1 hypertension (140/90 or 130/85) if they have target organ damage, established cardiovascular disease, renal disease, diabetes, 10 year cardiovascular risk greater than 10%
- Offer antihypertensive medication to those with stage 2 hypertension (160/100 or 150/95)
Consider antihypertensive drug treatment in addition to lifestyle advice for people aged over 80 with stage 1 hypertension if their clinic blood pressure is over150/90 mmHg

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39
Q

When do you refer for specialist same day treatment in hypertension

A

Refer people for specialist assessment, carried out on the same day, if they have a clinic blood pressure of180/120 mmHgand higher with:
• signs of retinal haemorrhage or papilloedema (accelerated hypertension) or
• life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury

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40
Q

Hypertensive target for people over aged 80

A

Consider antihypertensive drug treatment in addition to lifestyle advice for people aged over 80 with stage 1 hypertension if their clinic blood pressure is over150/90 mmHg

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41
Q

Hypertensive target for people over aged 80

A

Consider antihypertensive drug treatment in addition to lifestyle advice for people aged over 80 with stage 1 hypertension if their clinic blood pressure is over150/90 mmHg )(or 145/85 in ABPM)

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42
Q

when do you give alpha and beta blockers for hypertension versus spironolactone

A

Consider an alpha-blocker or beta-blocker for adults with resistant hypertension starting step 4 treatment who have a blood potassium level of more than 4.5 mmol/l.

  • Spironolactone if under 4.5mmol/l
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43
Q

Name some alpha and beta blockers used in hypertension

A

Alpha = doxazosin

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44
Q

Name drugs used in heart failure

A
  • beta blockers
  • ACE inhibitors
  • Spironolactone

Loop diuretics are purely symptomatic and do not improve survival

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45
Q

Name some thiazide like diuretics

A

indapamide

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46
Q

Angina medication

A
  • 1st line = beta and calcium channel blocker
  • then add a nitrate
    if taking all three should be on pathway for CABG
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47
Q

Is a 3rd or 4th heart sound heard in heart failure

A

3rd heart sound is heard in heart failure

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48
Q

What does digoxin do

A
  • Digoxin is a cardiac glycoside that increases the force of Myocardial contraction and reduces conductively within the AV node
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49
Q

What is pulses paradoxus

A

there will be an abnormally large drop in BP during inspiration,
- can happen in cardiac tamponade

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50
Q

what bronchus are inhaled foreign objects likely to be found in

A
  • right inferior lobe bronchus
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51
Q

What genetics is hypertrophic obstructive cardiomyopathy

A
  • Autosomal dominant
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52
Q

Thiazides can worsen…

A

glucose tolerance

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53
Q

What two beta blockers have been shown to reduce mortality in stable heart failure

A
  • Carvedilol and bisoprolol
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54
Q

at what QRISK score do you offer a statin

A
  • greater than 20%
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55
Q

In IV drug use the …

A

Tricuspid valve is the most commonly affected

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56
Q

How does renal function affect BNP

A

Renal dysfunction (eGFR <60) can cause a raised serum natriuretic peptides

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57
Q

in bradycardia if hypotensive do you DC cardio version

A

no

- atropine

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58
Q

What drugs are used for primary prevention in MI

A
  • Antihypertensive therapy

- Lipid lowering therapy - statins

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59
Q

What do you do if you have a major bleed on warfarin

A

stop warfarin, give intravenous vitamin K 5mg, prothrombin complex concentrate

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60
Q

When do you do aortic valve surgery

A

if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

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61
Q

When do you do aortic valve surgery

A

if symptomatic then valve replacement

if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery

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62
Q

When do you a balloon valvuloplasty in aortic valve surgery instead

A

balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement

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63
Q

When do you refer due to chest pain

A
  • current chest pain or chest pain in the last 12 hours with an abnormal ECG: emergency admission
  • chest pain 12-72 hours ago: refer to hospital the same-day for assessment
  • chest pain > 72 hours ago: perform full assessment with ECG and troponin measurement before deciding upon further action
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64
Q

What are the common causes of bacterial endocarditis

A

Streptococcus viridans

Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)

Staphylococcus epidermidis (in prosthetic valves)

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65
Q

What is the order of investigations for aortic dissection

A
  • go CT angiogram 1st line

- if patient is too unstable for this then transoesophageal echocardiography

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66
Q

How long post MI can you not drive for

A

DVLA advice post MI - cannot drive for 4 weeks

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67
Q

what is another name for polymorphic ventricular tachycardia

A

Torsade de pointes

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68
Q

What type of antibiotics can cause tornado de pointes

A
  • Macrolides
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69
Q

if you are unstable in an NSTEMI what is the treatment plan

A

NSTEMI management: unstable patients should have immediate coronary angiography

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70
Q

Write down the CHADVASC score

A
  • CCF
  • Hypertension
  • Age 65-74 or over 75 (2)
  • Diabetes
  • Vascular disease
  • Previous stroke or TIA (2)
  • Female Sex
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71
Q

Causes of torsade de pointes

A
  • hypothermia

- hypokalaemia

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72
Q

all patients with type 2 diabetes get (in hypertension)

A

ACE

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73
Q

What is bifasciular block

A
  • right bundle branch block and left axis deviation
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74
Q

what does digoxin toxicity look like on an ECG

A
  • downscoping ST depression
  • inverted T waves
  • short QT interval
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75
Q

What condition is hypertrophic cardiomyopathy associated with

A
  • Wolff Parkinson white
76
Q

When taking warfarin what are the results of PT and APPT

A
  • Prolonged PT

- normal APTT

77
Q

When is digoxin used in AF

A

used if you have AF and heart failure

78
Q

What is boerhaave syndrome

A

The Mackler triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema. It commonly presents in middle aged men with a background of alcohol abuse

79
Q

What medication do you give to an NSTEMI management conservatively

A

aspirin, plus either:

  • ticagrelor, if not high bleeding risk
  • clopidogrel, if high bleeding risk
80
Q

One day following a thrombolysed inferior myocardial infarction a 72-year-old man develops signs of left ventricular failure. His blood pressure drops to 100/70mmHg. On examination he has a new early-to-mid systolic murmur.

A

Papillary muscle rupture

81
Q

ECG changes of hypothermia

A
  • Long QT interval
  • bradycardia
  • J wave
  • first degree heart block
  • atrial and ventricular arrhythmias
82
Q

What is orthostatic hypotension

A

Orthostatic hypotension can be diagnosed when there is a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg after 3 minutes of standing

83
Q

what is the mechanism of action of alteplase

A

Thrombolytic drugs activate plasminogen to form plasmin

84
Q

name an example of a glycoprotein IIb/IIIa receptor antagonist

A

Tirofiban

85
Q

What part of the QRS complex is used for synchronisation in DC cardioversion

A

R wave

86
Q

Name some SABA

A
  • salbutamol

- tetrabutaine

87
Q

Name some LABA

A
  • salmeterol

- formeterol

88
Q

name some SAMA

A
  • ipratropium
  • glycopyrronium
  • aclidinium
  • umeclidinium
89
Q

Name some LAMA

A
  • tiotropium
90
Q

Non haemolytic febrile reaction

  • causes
  • features
  • treatment
A

Causes
- thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage

Features

  • fever
  • chills

Management

  • slow or stop transfusion
  • paracetamol
  • monitor
91
Q

Minor allergic reaction

  • cause
  • features
  • management
A

Cause
- through to be caused by foreign plasma proteins

Features

  • Pruritus
  • urticaria

Management

  • temporarily stop the transfusion
  • antihistamine
  • monitor
92
Q

Anaphylaxis in blood transfusion reaction

  • cause
  • features
  • management
A

cause
- can be caused by patients with IgA deficiency

Features

  • hypotension
  • dyspnoea
  • wheezing
  • angioedema

management

  • stop the transfusion
  • IM adrenaline
  • ABC support = oxygen, fluids
93
Q

Acute haemolytic reaction

  • cause
  • features
  • management
A

Cause
- ABO-incompatible blood e.g. secondary to human error

Features

  • fever
  • abdominal pain
  • hypotension
Management 
- stop transfusion 
Confirm diagnosis 
 - check the identity of patient on blood product 
- send blood for direct Coombs test 
Supportive care 
- fluid resuscitation
94
Q

Transfusion-associated circulatory overload

  • cause
  • features
  • management
A

Cause
- Excessive rate of transfusion, pre-exisiting heart failure

Features

  • Pulmonary oedema
  • hypertension

Management

  • slow or stop transfusion
  • consider IV loop diuretic and oxygen
95
Q

Transfusion related acute lung injury

  • cause
  • features
  • management
A

Cause
- Non-cardiogenic pulmonary oedema thought to be secondary to increase vascular permeability caused by host neutrophils that become activated by substance sin donated blood

Features

  • hypoxia
  • pulmonary infiltration on CXR
  • fever
  • hypotension

Management

  • stop the transfusion
  • oxygen and supportive care
96
Q

which oral contraceptive pill increases the risk of breast cancer

A

progesterone pill increases the risk of breast cancer (thus the combined pill does as well)

97
Q

What is the management of atelectasis

A
  • Positioning the patient upright

- Chest physiotherapy with mobilisation and breathing exercise

98
Q

What is altelctasis

A

Atelectasis is a common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty. It is caused when airways become obstructed by bronchial secretions.

99
Q

Name a contraindication for chest drain insertion

A

INR greater than 1.3

100
Q

Diagnostic tests for asthma

A
  • Peak flow - variability of 20% - twice daily readings
  • Reversibility bronchodilator FEV1 = improvement of 12% /200ml post bronchodilator FEV1
  • Eosinophil = raised eosinophil count
  • FENO = greater than 40ppb
  • Spirometry = obstructive picture, less than 0.7

Direct challenge with histamine = should show a 20% fall in FEV1 of 8mg/ml or less

101
Q

What tests do you need to do before starting azithromycin

A
  • Do an ECG to rule out prolonged QT interval and baseline liver function tests
102
Q

What is the gold standard investigation to confirm diagnosis of mesothelioma

A

Diagnosis of a mesothelioma is made on histology, following a thoracoscopy

103
Q

What is the mechanism of action of bupropion

A

a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

104
Q

What is the mechanism of action of Varenicline

A

a nicotinic receptor partial agonist

105
Q

When should NIV be considered in patients with COPD

A

NIV should be considered in all patients with an acute exacerbation of COPD in whom a respiratory acidosis (PaCO2>6kPa, pH <7.35 ≥7.26) persists despite immediate maximum standard medical treatment

106
Q

What is the difference between Churg-strauss syndrome and granulomatosis with polyangitis

A

Churg-strauss = pANCA

Granulomatosis with polyangitis = cANCA

107
Q

What is the first step in management of pleural effusion

A

Pleural aspiration = 21G needle and 50ml syringe

  • if the fluid is purulent or turbid/clody then a chest tube should be placed to allow drainage
  • If the fluid is clear but the pH is less than 7.2 in patients with suspected pleural infection then a chest tube should be placed
108
Q

describe how the chest drain rises and falls on inspiration and expiration

A

Chest drain swinging: Rises in inspiration, falls in expiration

109
Q

What is the most common cause of an exudative pleural effusion

A

Pneumonia

110
Q

What is the difference in rash you get in sarcoidosis versus SLE

A

Sarcoidosis

  • affects nose, cheeks, lips, ears, and digits
  • purple plaque raised
111
Q

What do you expect to find a raised TLCO

A

. You would only expect to find a raised TLCO in asthma or a left-to-right cardiac shunt. This is because in these conditions, the problem is not affecting the alveoli directly or gas exchange and so the lungs try to compensate for the problem by improving gas exchange.

112
Q

What is the most common valve effected in infective endocarditis

A

Mitral valve

113
Q

What is the most appropriate way to measure the QT interval on the ECG?

A

Time between the start of the Q wave and the end of the T wave

114
Q

ST segment

A

end of S wave start of T wave

115
Q

PR

A

start of P wave to start of Q wave

116
Q

Platelet transfusions levels

A

Offer platelet transfusions to patients with a platelet count of <30 x 10 9 with clinically significant bleeding (World Health organisation bleeding grade 2- e.g. haematemesis, melaena, prolonged epistaxis)

Platelet thresholds for transfusion are higher (maximum < 100 x 10 9) for patients with severe bleeding (World Health organisation bleeding grades 3&4), or bleeding at critical sites, such as the CNS.

117
Q

What is a high risk with platelet transfusions

A

It should be noted that platelet transfusions have the highest risk of bacterial contamination compared to other types of blood product.

118
Q

Difference in statin dose between primary and secondary prevention of cardiovascular disease

A

Atorvastatin 20mg is a high-intensity statin and should be started as primary prevention against cardiovascular disease. Atorvastatin 80mg is used in secondary prevention.

119
Q

Differnece in causes of aortic stenosis

A

younger patients < 65 years: bicuspid aortic valve

older patients > 65 years: calcification

120
Q

What is De Musset’s sign

A

De Musset’s sign (head bobbing) is a clinical sign of aortic regurgitation in time with heat beat

121
Q

What investigation is used in idiopathic pulmonary fibrosis

A

In idiopathic pulmonary fibrosis, high resolution CT is the investigation of choice

122
Q

Indications for harm-dialysis

A

AEIOU: acidosis, electrolyte imbalances e.g. severe hyperkalemia (above 6.5), intoxication e.g. methanol, overload of volume, and uraemia.

123
Q

Who should you offer LTOT to

A

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension

124
Q

Who should you offer LTOT to

A

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary hypertension
125
Q

when must statins be stopped

A

Statins must be temporarily stopped when a macrolide antibiotic is started

126
Q

what drugs can cause SIADH

A 
sulfonylureas*
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
127
Q

What is transferrin and what happens to it in iron deficiency anaemia

A

Transferrin is the body’s carrier of iron around the blood. In states of iron deficiency, transferrin increases as the body tries to “make the most” of what iron it has left, meaning that transferrin levels go up.

128
Q

What is TIBC and what happens to it in iron deficiency anaemia versus anaemia of chronic disease

A

TIBC measures the number of binding sites on transferrin available for iron. It therefore also increases in ID and decreases in ACD

129
Q

How do you calculate transferrin saturation

A

calculated by serum iron / TIBC

130
Q

How do you treat SIADH

A

SIADH is treated with fluid restriction

131
Q

What antibiotic is given against spontaneous bacterial peritonitis

A

Patients with ascites (and protein concentration <= 15 g/L) should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

132
Q

In an AKI if protein is present what type of AKI is it

A

The urine dip shows proteinuria which would only be present with an intrinsic renal AKI

133
Q

Acute pancreatitis causes..

A

Hypocalaemia

134
Q

What tends to cause hypercholestrolaemia rather than hypertriglyceridaemia

A

Hypercholesterolaemia rather than hypertriglyceridaemia: nephrotic syndrome, cholestasis, hypothyroidism

135
Q

What is the most specific ECG marker for pericarditis

A

PR depression: most specific ECG marker for pericarditis

136
Q

What should all patients with pericarditis have

A

all patients with suspected acute pericarditis should have transthoracic echocardiography

137
Q

What two vessels does a transjugular intrahepatic portosystemic shunt connect

A

A transjugular intrahepatic portosystemic shunt (TIPS) procedure connects the hepatic vein to the portal vein

138
Q

how does hypothyroidism impact sodium

A

Hypothyroidism causes a euvolaemic hyponatraemia

139
Q

What does Membranous glomerulonephritis histology look like

A

basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2

140
Q

What overdose is flumazenil used in

A

Flumazenil is used in benzodiazepine overdose.

141
Q

What electrolyte abnormalities do thiazide diuretics cause

A

hypokalamia

142
Q

What electrolyte abnormalities do thiazide diuretics cause

A

hyponatraemia, hypokalaemia, hypercalcaemia

143
Q

Drugs for secondary prevention in MI

A

All patients should be offered the following drugs:
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

144
Q

what drug is contraindicated in ventricular tachycardia

A

Verapamil

145
Q

What is the only calcium channel blocker licensed for use in heart failure

A

amlodipine is the only calcium channel blocker licensed for use in heart failure.

146
Q

What ECG changes are seen in hypothermia

A 
bradycardia
'J' wave - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias
147
Q

What are the complications of CLL

A

anaemia
hypogammaglobulinaemia leading to recurrent infections
warm autoimmune haemolytic anaemia in 10-15% of patients
transformation to high-grade lymphoma (Richter’s transformation)

148
Q

HYPOKALAMEIA IS NOT A ..

A

COMPLICATION OF BLOOD TRANSFUSION

149
Q

Which heart sound is hypertrophic obstructive cardiomyopathy associated with

A

Hypertrophic obstructive cardiomyopathy - is classically associated with an S4

150
Q

causes of a normal anion gap metabolic acidosis

A 
Causes of a normal anion gap metabolic acidosis are ABCD:
Addison's
Bicarb loss
Chloride
Drugs
151
Q

Management of STEMI

A

STEmi identified

  1. Give aspirin
  2. Assess whether PCI is possible within 120 minutes

if possible = PCI

  1. Give praugrel
  2. Give unfractionated heparin and bailout glycoprotein IIb/IIIa inhibitor

if not = Fibronolysis

  1. Give antithrombin at the same time
  2. following procedure give ticagrelor
  3. For ongoing MI consider PCI

other

  • if patient is a high bleeding risk swap prasugrel for ticagrelor/ Ticagrelor for clopidogrel
  • If patient is taking oral anticogualtions swap pragrel for clopidogrel
152
Q

When should out repeat ECG after firbonolysis

A

An ECG should be repeated after 60-90 minutes to see if the ECG changes have resolved. If patients have persistent myocardial ischaemia following fibrinolysis then PCI should be considered.

153
Q

Management of NSTEMI

A

NSTEMI identified

  1. Aspirin 300mg
  2. Fondaparinux if no immediate PCI planned
  3. Estimate 6 month mortality rate
  4. if low risk under 3% = CONSERVATIVE MANAGEMENT
  5. Give Trcagrelor
  6. if intermediate/high risk >3% = PCI
  7. offer immediately if clinically unstable otherwise offer within 72 hours
  8. Prasugrel or ticagrelor
  9. Give unfractionated heparin
  10. Drug-eluting stents should be used in preference
154
Q

What factors does the GRACE score take into account

A
  • age
  • heart rate, blood pressure
  • cardiac and renal function
  • cardiac arrest on presentation
  • ECG findings
  • troponin levels
155
Q

What is blood pressure target for people aged over 80

A
  • 150/90

ABPM = 145/85

156
Q

Name soem GLP-1 Drugs

A

Exenatide

Liraglutide

157
Q

When can you use GLP-1 Drugs

A

BMI >= 35 kg/m² in people of European descent and there are problems associated with high weight, or

BMI < 35 kg/m² and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities.

158
Q

Name some DPP-4 inhibitors

A

Sitaglipitin

Vildagliptin

159
Q

Name some sulfonylureas

A

Glicazide

160
Q

Name some thiazolidinediones

A

Glitazones

- pioglitazone

161
Q

Name some SGLT2 inhibitors

A
  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
162
Q

What are the side effects of SGLT2 inhibitors

A
  • urinary and genital infection (secondary to glycosuria). Fournier’s gangrene has also been reported
  • normoglycaemic ketoacidosis
  • increased risk of lower-limb amputation: feet should be closely monitored

Patients taking SGLT-2 drugs often lose weight, which can be beneficial in type 2 diabetes mellitus.

163
Q

What result of short synacthen test

A

cortisol should be above 550 = this would exclude Addisons

164
Q

What are the causes of primary hypoparathyroidism

A
  • decrease PTH secretion
  • e.g. secondary to thyroid surgery*
  • low calcium, high phosphate
  • treated with alfacalcidol
165
Q

How do you treat primary hypoparathyroidsm

A

treated with alfacalcidol

166
Q

What are the main symptoms of hypoparathyroidism

A
  • tetany: muscle twitching, cramping and spasm
  • perioral paraesthesia
  • Trousseau’s sign: carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
  • Chvostek’s sign: tapping over parotid causes facial muscles to twitch
  • If chronic: depression, cataracts
  • ECG: prolonged QT interval
167
Q

Hepatitis B shit

A

surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs
HBsAg normally implies acute disease (present for 1-6 months)
if HBsAg is present for > 6 months then this implies chronic disease (i.e. Infective)
Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease
Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists
HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity

168
Q

How long does it take for an arteriovenous fistula to develop

A

The time taken for an arteriovenous fistula to develop is 6 to 8 weeks

169
Q

What is the most common organism in SBP

A

Spontaneous bacterial peritonitis: most common organism found on ascitic fluid culture is E. coli

170
Q

in 2nd degree heart block …

A

In 2nd-degree type-II heart block, the PR interval is always the same size, it’s just that the QRS complex doesn’t occur after every P wave.

171
Q

Hepaotrenal syndrome management

A
  • vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation
  • volume expansion with 20% albumin
  • transjugular intrahepatic portosystemic shunt
172
Q

What is the management of proximal aortic dissections

A

Proximal aortic dissections are generally managed with surgical aortic root replacement.

173
Q

Third line heart failure treatment

A

ivabradine
- criteria: sinus rhythm > 75/min and a left ventricular fraction < 35%

sacubitril-valsartan
- criteria: left ventricular fraction < 35%
is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs
should be initiated following ACEi or ARB wash-out period

digoxin
= digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties
it is strongly indicated if there is coexistent atrial fibrillation

hydralazine in combination with nitrate
= this may be particularly indicated in Afro-Caribbean patients

cardiac resynchronisation therapy
= indications include a widened QRS (e.g. left bundle branch block) complex on ECG

174
Q

ALS points

A

ratio of chest compressions to ventilation is 30:2

chest compressions are now continued while a defibrillator is charged

during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock and then every 3-5 minutes (during alternate cycles of CPR).

a single shock for VF/pulseless VT followed by 2 minutes of CPR, rather than a series of 3 shocks followed by 1 minute of CPR

if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend ‘up to three quick successive (stacked) shocks’, rather than 1 shock followed by CPR

asystole/pulseless-electrical activity: adrenaline 1mg should be given as soon as possible. Should be treated with 2 minutes of CPR prior to reassessment of the rhythm

atropine is no longer recommended for routine use in asystole or pulseless electrical activity (PEA)

delivery of drugs via a tracheal tube is no longer recommended

following successful resuscitation oxygen should be titrated to achieve saturations of 94-98%. This is to address the potential harm caused by hyperoxaemia

175
Q

When should ACE inhibitors be avoided

A

ACE-inhibitors should be avoided in patients with HOCM

176
Q

When is Kussmaul’s sign present

A

The JVP increasing with inspiration is known as Kussmaul’s sign and can be a feature of constrictive pericarditis
- rare in Cardiac tamponade

177
Q

What is the difference between cardiac tamponade and constrictive pericarditis

A

Cardiac tamponade

  • absent Y descent
  • pulsus paradoxus is present
  • rare for Kussmaul’s sign

Constrictive pericarditis

  • X and Y present
  • pulses paradoxus is absent
  • Kussmaul’s sign is present
  • pericardial calcification on CXR
178
Q

Addisons disease can cause..

A

hyponatraemia

179
Q

A 74-year-old man is an inpatient on the care of the elderly ward having been admitted with a diagnosis of hospital acquired pneumonia.

Which one of the pathogens is the most likely cause of his illness?

A

Klebsiella pneumoniae

180
Q

A patient with cystic fibrosis has a cough productive of green sputum, which grows Pseudomonas.

Which oral agent has activity against Pseudomonas?

A

ciprofloxacin

181
Q

Regarding 5 amino-salicylic acid (5-ASA),

Which one of the following statements is true?

A

is associated with blood dyscrasias

182
Q

aspirin cannot be used in

A

pregnancy

183
Q

When do you use unsynchronised Cardioversion

A

pulseless VT/VF

184
Q

difference between end and loop stoma

A

end - one hole

loop = two holes

185
Q

You are talking to a patient about the role of autoantibodies being implicated in causing her disease.

Which one of the following diseases is characterized by auto-antibodies?

A

auto-immune haemolytic anaemia

186
Q

Appendix signs

A

Rovsing’s sign = pain > in RIF than LIF when the LIF is pressed

Psoas sign = pain on extending hip if retrocaecal appendix

Cope sign = pain on flexion and internal rotation of the right hip if appendix in close relation to obturator internus

pain on right during DRE - suggests an inflamed, low lying pelvic appendix

Year 3 - CR (44 decks)

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