Bit of everything Flashcards
What is a risk factor for MALT lymphoma
Hashimoto’s thyroiditis
what can cause torsades de pointes
- macrolides (azithromycin)
- congenital
- subarachnoid haemorrhage
- antipsychotics
- TCAs
- myocarditis
- hypothermia
- electrolyte imbalances
torsades de pointes on ecg
polymorphic ventricular tachycardia associated with a long QT interval
can be irregular
mx of torsades de pointes
IV magnesium sulphate
medication that can cause hyponatraemia and hypomagnesaemia
PPIs
contraindications of ACS mx when pt is hypotensive
GTN spray (worsens hypotension)
chest pain relieved by sitting forwards
pericarditis
signs of left ventricular free wall rupture secondary to cardiac tamponade
- diminished heart sounds
- raised JVP
- pulsus paradoxus (fall in systolic during inspiration)
what is cardiac tamponade
accumulation of pericardial fluid under pressure
mx of diabetic neuropathic pain
amitriptyline, duloxetine, gabapentin or pregabalin
palliative pain mx in pt with renal impairment
mild-moderate = oxycodone
severe = buprenorphine or fentanyl
presentation of peutz-jegher’s syndrome
- hamartomatous polyps in GIT (mainly small bowel-
small bowel obstruction is a common presenting complaint, often due to intussusception
gastrointestinal bleedin - pigmented lesions on lips, oral mucosa, face, palms and soles
risk of cancers increased by Hereditary non-polyposis colorectal cancer (HNPCC)
colorectal and endometrial
anticoagulant for mechanical heart valve
warfarin
causes of hypercalcaemia
main 2 accounting for 90%
1. hyperparathyroidism
2. malginancy
other causes
- sarcoidosis
- vit D intoxication
- drugs: thiazides + calcium containing antacids
- acromegaly
- thyrotoxicosis
- dehydration
- addison’s
- paget’s
mid-diastolic murmur loudest over the apex
mitral stenosis
commonly causes AF leading to TIA/stroke
early diastolic murmur loudest over the aortic area
aortic regurgitation
pansystolic murmur over the apex radiating to the axilla
mitral regurgitation
MR can cause AF, therefore the differentiating feature is the timing of the murmur (diastolic in mitral stenosis, systolic in MR)
systolic murmur over the tricuspid area
tricuspid regurgitation
very rare in developed country, usually caused by rheumatic fever or carcinoid syndrome
cause of mitral stenosis
RHEUMATIC FEVER
rarer causes:
- mucopolysaccharidoses
- carcinoid
- endocardial fibroelastosis
features of mitral stenosis
- dyspnoea
↑ left atrial pressure → pulmonary venous hypertension - haemoptysis: may range from pink frothy sputum to sudden haemorrhage secondary to rupture of thin-walled and dilated bronchial veins
- mid-late diastolic murmur (best heard in expiration)
- loud S1
- opening snap indicates mitral valve leaflets are still mobile
- low volume pulse
- malar flush
- atrial fibrillation: secondary to ↑ left atrial pressure → left atrial enlargement
how to calculate units of alcohol
Alcohol units = volume (ml) * ABV / 1,000
reasons to stop BB in acute heart failure
- shock aka BP < 90/60
- HR <50
- second or third degree heart block
side effects of ACEi
- cough
- hyperkalaemia (if >5.5 need to stop ACEi)
- angioedema
- first dose hypotension
what acid base imabalance does cushing’s cause
hypokalaemic metabolic alkalosis
levels of cortisol are high–> the cortisol that is not inactivated is free to bind to mineralocorticoid receptors–> increase in water and sodium retention, increased potassium excretion, and increased hydrogen ions excretion–> Low hydrogen ions= alkalosis and less potassium = hypokalemia
What scoring system is most appropriate for identifying if a pt with a PE can be managed as an outpatient?
PESI score (PE severity index)
what is ORBIT score
- Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
- Used to predict bleeding risk in patients on anticoagulation for AF
what is PERC criteria?
- Pulmonary Embolism Rule Out Criteria
- used to rule out a PE
what is rockwood score?
scoring system used to categorise frailty
what is Wells score
predicts the likelihood of a patient having a PE or DVT
Features of proximal aortic dissection
- inferior myocardial infarction
- AR murmur
- tearing central chest pain
Mackler triad for Boerhaave syndrome:
- vomiting
- thoracic pain
- subcutaneous emphysema.
It commonly presents in middle aged men with a background of alcohol abuse.
Features of pneumothorax
- dyspnoea
- pleuritic chest pain
- Hx of asthma or marfan’s
Features of PE
- Sudden dyspnoea
- pleuritic chest pain
- Calf pain/swelling
- On COCP, malignancy
Features of pericarditis
- Sharp pain relieved by sitting forwards
- May be pleuritic in nature
Features of dissecting aortic aneurysm
- ‘Tearing’ chest pain radiating through to the back
- Unequal upper limb blood pressure
Features of GORD
- Burning retrosternal pain
- Other possible symptoms include regurgitation and dysphagia
Features of MSK chest pain
- Pain is often worse on movement or palpation
- May be precipitated by trauma or coughing
Features of shingles
Pain often precedes the rash
Inferior MI ECG changes
leads II, III , AVF
anterior MI ECG changes
V1-6
Mx of perforated peptic ulcer
Diagnosis- Erect CXR
Mx- laparotomy, small defects may be excised and overlaid with an ommental patch, larger defects are best managed with a partial gastrectomy
what or Boerhaaves syndrome
Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
Usually distal and on the left
Diagnosis of Boerhaaves syndrome
CT contrast swallow
Mx of Boerhaaves syndrome
Thoracotomy and lavage
< 12 hours after onset primary repair is feasible,
> 12 hours best managed by insertion of a T tube to create a controlled fistula between oesophagus and skin.
What is aortic dissection
- flap or filling defect within the aortic intima
- Blood tracks into the medial layer and splits the tissues with the subsequent creation of a false lumen. - It most commonly occurs in the ascending aorta or just distal to the left subclavian artery (less common)
Demographic for aortic dissection
Afro-carribean males aged 50-70 years
Classification of aortic dissection
Stanford
- Type A: lesions with a proximal origin (involves ascending aorta)
- Type B: distal to the left subclavian
DeBakey
- Type I: Starts in the ascending aorta and extends into the descending aorta
Type II: Limited to ascending aorta
Type III: Starts in the descending aorta and extends downward
Complications of MI
- cardiac arrest
- cardiogenic shock
- tachyarrhythmias
- chronic heart failure
- bradyarrhythmias
- pericarditis
- left ventricular aneurysm
- LVFWR
- VSD
- acute mitral regurgitation
Features of MEN1
Peptic ulceration, galactorrhoea, hypercalcaemia
Affects the endocrine system through development of neoplastic lesions in the pituitary gland, parathyroid gland and pancreas
Third-line therapy if a patient with heart failure has not responded to first-line (ACEi + beta-blocker) or second-line (aldosterone) therapy.
Hydralazine and nitrate
more effective in Afro-Caribbean patients
Mx of chronic heart failure
- 1st line: ACEi + BB (bisoprolol
- 2nd line: aldosterone antagonists (spironolactone or eplerenone). Can also use SGLT-2 inhibitors in reduced ejection fraction
- 3rd line: hydralazine and nitrate, ivabradine, digoxin or sacubitril-valsartan
- annual influenza vaccine and one off pneumococcal vaccine
what do statins interact severely with?
clarithromycin/erythromycin
(increase in statin conc due to inhibition of enzymes that metabolise statins)
apart from statins what else does clarithromycin interact with?
warfarin
when do you need to stop metformin
renal impairment, can cause lactic acidosis
what reverses dabigatran (DOAC)
idracizumab
what reverses apixaban or rivaroxaban
andexanet alfa
hard to get so can use prothrombin complex concentrate
reversal of warfarin
PCC
if unavailable FFP and IV vit K
reversal of heparin
protamine sulphate
what is the rockall score
used after endoscopy and designed to predict mortality and rebleeding risk following upper gastrointestinal bleeding.
what is the blatchford score
assesses the need for intervention in patients presenting with upper gastrointestinal bleeding
what is the child-pugh score
assess liver function in patients with cirrhosis and predict surgical risk
sign of Mixed aortic valve disease
bisferiens pulse (when there is aortic regurg and stenosis)
reason for collapsing pulse
- aortic regurgitation
- patent ductus arteriosus
- hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
sign of severe left ventricular systolic (LVSD)
pulsus alterans
sign of aortic stenosis
slow rising pulse
sign of HOCM
jerky pulse
Mx of PE with haemodynamic instability
thrombolysis (alteplase)
Hypothermia on ECG
- bradycardia <60
- J waves
- Prolonged PR, QT and QRS intervals
- Shivering artefacts
- VT, VF or asystole
medication contraindicteed in VT
verapamil (CCB)
Most common cause of death following MI
VF
Triad of phaeochromacytoma
sweating, headaches, and palpitations in association with severe hypertension
what is hepatorenal syndrome
a type of functional kidney impairment that occurs in patients with advanced liver disease.
features
- ascites
- low urine output
- significant increase in serum creatinine.
Mx of hepatorenal syndrome
- 1st line: terlipressin (cause vasoconstriction of the splanchnic circulation)
- 2nd line: volume expansion with 20% albumin
- 3rd line: transjugular intrahepatic portosystemic shunt (TIPS)
Mx of bradycardia with adverse signs (shock, syncope, MI, heart failure)
500mcg atropine IV
2nd: transcutaneous pacing
risk factors for asystole (indicating the need for transvenous pacing)
- complete heart block with broad complex QRS
- recent asystole
- Mobitz type II AV block
- ventricular pause > 3 seconds
cause of raised prolactin
Causes of raised prolactin - the p’s
- pregnancy
- prolactinoma
- physiological
- PCOS
- primary hypothyroidism
- phenothiazines, metoclopramide, domperidone
drugs used for rate control of AF
BB, CCB, digoxin
BB contraindicated in asthma
drugs used for rhythm control of AF
BB, dronedarone, amiodarone, flecainide
causes of raised BNP
- heart failure
- myocardial ischaemia
- valvular disease
- > 70 y/o
- left ventricular hypertrophy, ischaemia
- tachycardia
- right ventricular overload, - hypoxaemia
- renal dysfunction (eGFR < 60)
- sepsis
- COPD
- diabetes or cirrhosis of the liver
what is BNP
B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain
test to differentiate between IBS and IBD
faecal calprotectin
drug that causes neutrophilia
corticosteroids e.g. dexamethasone
Mx of Wolff parkinson white syndrome
surgical: radiofrequency ablation of accessory pathway (definitive)
medical: sotalol, amiodarone, flecainide
prophylaxis of variceal haemorrhage
propanolol
prophylaxis for spontaneous bacterial peritonitis
ciprofloxacin or norfloxacin
most common type of lung cancer in non-smokers
lung adenocarcinoma (usually peripheral)
signs of haemochromatosis
- fatigue
- erectile dysfunction
- arthralgia
- bronze skin
most common cause of death in patients with HOCM
ventricular arrhythmia
hypertensive medication contradindicated in pregnancy
ACEi - cause oligohydramnios and risk fo cardiac/cranial defects
Mx of angina
- 1st line: BB or CCB (verapamil or diltiazem
- 2nd line: if using BB already add CCB (amlodipine, nifedipine)
posterior MI ECG findings
inversion of typical MI
- Q waves become tall R waves
- ST-elevation becomes ST-depression
- inverted T-waves become upright T-waves
Addisonian crisis acid imbalance
hyponatraemic, hyperkalaemic acidosis
what medication to avoid in bowel obstruction
metoclopramide (pro-kinetic can cause preforation)
what is atrial myxoma
benign tumour most commonly occurring in the left atrium
presentation of atrial myxoma
triad of:
1. mitral valve obstruction
2. systemic embolisation
3. constitutional symptoms such as breathlessness, weight loss and fever
echo: pedunculated heterogeneous mass typically attached to the fossa ovalis region of the interatrial septum
what is buerger’s disease?
also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.
how does carbon monoxide kill you
CO binds to the site on haemoglobin normally occupied by oxygen, thereby reducing the oxygen-carrying capacity of the blood. This leads to tissue hypoxia and eventually death.
what is social selection/mobility health inequality
ill health can limit social mobility due to decreased ability to work, and decreased income, leading to lower social class, which in turn can contribute to health inequalities.
what is artefact health inequality
Artefact would be proposing that the observed differences are due to differences in measurement
what is cultural/behavioural health inequality
differences in behaviour cause differences in health.
what is idealist health inequality
would be suggesting that individuals’ construction of health is different in different groups, so they might define health differently
what is materialist health inequality
emphasises the role of economic and social factors, such as income, education, and employment, in shaping health outcomes.
how to calculate absolute risk reduction
ARR = risk in control group - risk in treatment group
what is a categorical variable
be grouped into categories (e.g. blood type, race)
what is a continuous variable
can take any value within a range
what is a discrete variable
only takes certain values usually integers (number of children)
what is a nominal variable
those that have no intrinsic order or ranking (e.g. hair colour, occupation)
life threatening complication of chemotherapy
tumour lysis syndrome
ix for tumour lysis syndrome
urate
most appropriate way to assess risk of developing a pressure sore?
Waterlow score
how to treat animal/human bite-
- co amoxiclav if broken skin or high risk area
following a first unprovoked or isolated seizure if brain imaging and EEG normal how can they not drive
6 months
Patients cannot drive for x months after a seizure if there is abnormal brain imaging or an abnormal EEG.
12 months
Patients cannot drive for x months after a stroke or TIA.
1 month
Patients cannot drive for x months if they have multiple TIAs over a short period.
3 months
how to differentiate TRALI from TACO
by the presence of hypotension in TRALI vs hypertension in TACO
what is TRALI
- Transufusion related acute lung injury
- Fever and hypotension present KEY
- Caused by interaction with anti-WBC antibodies in donor blood and recipient WBCs
- causes immune complex deposition in pulmonary capillaries
- Absence of heart failure
- signs of respiratory distress (tachypnoea, low saturations)
what is TACO
- transfusion related circulatory overload
- Caused by lack of attention to fluid balance
- pulmonary oedema/fluid overload occur within hours
- signs of heart failure: ↑JVP, ↑PCWP
- hypertensive
Local anesthetic toxicity can be treated with…
IV 20% lipid emulsion
salicylate poisoning metabolic derangement
aspirin overdose
- respiratory alkalosis initially, breathing fast
- then metabolic acidosis as aspirin is essentially an acid
- makes you drowsy etc.
how to give TPN
central line (causes phlebitis peripherally)
spread of ovarian cancer
Confined to the ovaries (Stage 1)
Local spread within the pelvis (Stage 2)
Spread beyond the pelvis to the abdomen (Stage 3)
most common site for lymphatic spread is the para-aortic lymph nodes. The most common site for haematological spread is the liver.
how does lidocaine work?
Blockage of sodium channels disrupting the action potential
serious side effect of suxamethonium anaesthesia
malignant hyperthermia
how to treat Malignant hyperthermia induced by suxamethonium
IV dantrolene therapy
reversal of benzos
flumazenil
test for torn meniscus
McMurray’s test
how to detect accidental oesophageal intubation
capnography (End tidal carbon dioxide monitoring)
winging of the scapula. Long thoracic nerve innervates which muscle?
serratus anterior
adverse effects of lithium
- tremor
- diabetes insipidus
- weight gain
- IIH
- hyperparathyroidism and hypercalcaemia
