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Bit of everything Flashcards

1
Q

What is a risk factor for MALT lymphoma

A

Hashimoto’s thyroiditis

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2
Q

what can cause torsades de pointes

A
  • macrolides (azithromycin)
  • congenital
  • subarachnoid haemorrhage
  • antipsychotics
  • TCAs
  • myocarditis
  • hypothermia
  • electrolyte imbalances
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3
Q

torsades de pointes on ecg

A

polymorphic ventricular tachycardia associated with a long QT interval
can be irregular

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4
Q

mx of torsades de pointes

A

IV magnesium sulphate

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5
Q

medication that can cause hyponatraemia and hypomagnesaemia

A

PPIs

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6
Q

contraindications of ACS mx when pt is hypotensive

A

GTN spray (worsens hypotension)

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7
Q

chest pain relieved by sitting forwards

A

pericarditis

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8
Q

signs of left ventricular free wall rupture secondary to cardiac tamponade

A
  • diminished heart sounds
  • raised JVP
  • pulsus paradoxus (fall in systolic during inspiration)
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9
Q

what is cardiac tamponade

A

accumulation of pericardial fluid under pressure

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10
Q

mx of diabetic neuropathic pain

A

amitriptyline, duloxetine, gabapentin or pregabalin

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11
Q

palliative pain mx in pt with renal impairment

A

mild-moderate = oxycodone
severe = buprenorphine or fentanyl

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12
Q

presentation of peutz-jegher’s syndrome

A
  • 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
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13
Q

risk of cancers increased by Hereditary non-polyposis colorectal cancer (HNPCC)

A

colorectal and endometrial

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14
Q

anticoagulant for mechanical heart valve

A

warfarin

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15
Q

causes of hypercalcaemia

A

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

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16
Q

mid-diastolic murmur loudest over the apex

A

mitral stenosis
commonly causes AF leading to TIA/stroke

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17
Q

early diastolic murmur loudest over the aortic area

A

aortic regurgitation

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18
Q

pansystolic murmur over the apex radiating to the axilla

A

mitral regurgitation
MR can cause AF, therefore the differentiating feature is the timing of the murmur (diastolic in mitral stenosis, systolic in MR)

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19
Q

systolic murmur over the tricuspid area

A

tricuspid regurgitation
very rare in developed country, usually caused by rheumatic fever or carcinoid syndrome

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20
Q

cause of mitral stenosis

A

RHEUMATIC FEVER
rarer causes:
- mucopolysaccharidoses
- carcinoid
- endocardial fibroelastosis

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21
Q

features of mitral stenosis

A
  • 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
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22
Q

how to calculate units of alcohol

A

Alcohol units = volume (ml) * ABV / 1,000

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23
Q

reasons to stop BB in acute heart failure

A
  • shock aka BP < 90/60
  • HR <50
  • second or third degree heart block
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24
Q

side effects of ACEi

A
  • cough
  • hyperkalaemia (if >5.5 need to stop ACEi)
  • angioedema
  • first dose hypotension
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25
Q

what acid base imabalance does cushing’s cause

A

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

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26
Q

What scoring system is most appropriate for identifying if a pt with a PE can be managed as an outpatient?

A

PESI score (PE severity index)

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27
Q

what is ORBIT score

A
  • Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
  • Used to predict bleeding risk in patients on anticoagulation for AF
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28
Q

what is PERC criteria?

A
  • Pulmonary Embolism Rule Out Criteria
  • used to rule out a PE
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29
Q

what is rockwood score?

A

scoring system used to categorise frailty

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30
Q

what is Wells score

A

predicts the likelihood of a patient having a PE or DVT

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31
Q

Features of proximal aortic dissection

A
  • inferior myocardial infarction
  • AR murmur
  • tearing central chest pain
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32
Q

Mackler triad for Boerhaave syndrome:

A
  1. vomiting
  2. thoracic pain
  3. subcutaneous emphysema.
    It commonly presents in middle aged men with a background of alcohol abuse.
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33
Q

Features of pneumothorax

A
  • dyspnoea
  • pleuritic chest pain
  • Hx of asthma or marfan’s
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34
Q

Features of PE

A
  • Sudden dyspnoea
  • pleuritic chest pain
  • Calf pain/swelling
  • On COCP, malignancy
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35
Q

Features of pericarditis

A
  • Sharp pain relieved by sitting forwards
  • May be pleuritic in nature
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36
Q

Features of dissecting aortic aneurysm

A
  • ‘Tearing’ chest pain radiating through to the back
  • Unequal upper limb blood pressure
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37
Q

Features of GORD

A
  • Burning retrosternal pain
  • Other possible symptoms include regurgitation and dysphagia
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38
Q

Features of MSK chest pain

A
  • Pain is often worse on movement or palpation
  • May be precipitated by trauma or coughing
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39
Q

Features of shingles

A

Pain often precedes the rash

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40
Q

Inferior MI ECG changes

A

leads II, III , AVF

41
Q

anterior MI ECG changes

A

V1-6

42
Q

Mx of perforated peptic ulcer

A

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

43
Q

what or Boerhaaves syndrome

A

Spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting.
Usually distal and on the left

44
Q

Diagnosis of Boerhaaves syndrome

A

CT contrast swallow

45
Q

Mx of Boerhaaves syndrome

A

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.

46
Q

What is aortic dissection

A
  • 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)
47
Q

Demographic for aortic dissection

A

Afro-carribean males aged 50-70 years

48
Q

Classification of aortic dissection

A

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

49
Q

Complications of MI

A
  • cardiac arrest
  • cardiogenic shock
  • tachyarrhythmias
  • chronic heart failure
  • bradyarrhythmias
  • pericarditis
  • left ventricular aneurysm
  • LVFWR
  • VSD
  • acute mitral regurgitation
50
Q

Features of MEN1

A

Peptic ulceration, galactorrhoea, hypercalcaemia

Affects the endocrine system through development of neoplastic lesions in the pituitary gland, parathyroid gland and pancreas

51
Q

Third-line therapy if a patient with heart failure has not responded to first-line (ACEi + beta-blocker) or second-line (aldosterone) therapy.

A

Hydralazine and nitrate
more effective in Afro-Caribbean patients

52
Q

Mx of chronic heart failure

A
  • 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
53
Q

what do statins interact severely with?

A

clarithromycin/erythromycin
(increase in statin conc due to inhibition of enzymes that metabolise statins)

54
Q

apart from statins what else does clarithromycin interact with?

A

warfarin

55
Q

when do you need to stop metformin

A

renal impairment, can cause lactic acidosis

56
Q

what reverses dabigatran (DOAC)

A

idracizumab

57
Q

what reverses apixaban or rivaroxaban

A

andexanet alfa
hard to get so can use prothrombin complex concentrate

58
Q

reversal of warfarin

A

PCC
if unavailable FFP and IV vit K

59
Q

reversal of heparin

A

protamine sulphate

60
Q

what is the rockall score

A

used after endoscopy and designed to predict mortality and rebleeding risk following upper gastrointestinal bleeding.

61
Q

what is the blatchford score

A

assesses the need for intervention in patients presenting with upper gastrointestinal bleeding

62
Q

what is the child-pugh score

A

assess liver function in patients with cirrhosis and predict surgical risk

63
Q

sign of Mixed aortic valve disease

A

bisferiens pulse (when there is aortic regurg and stenosis)

64
Q

reason for collapsing pulse

A
  • aortic regurgitation
  • patent ductus arteriosus
  • hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
65
Q

sign of severe left ventricular systolic (LVSD)

A

pulsus alterans

66
Q

sign of aortic stenosis

A

slow rising pulse

67
Q

sign of HOCM

A

jerky pulse

68
Q

Mx of PE with haemodynamic instability

A

thrombolysis (alteplase)

69
Q

Hypothermia on ECG

A
  • bradycardia <60
  • J waves
  • Prolonged PR, QT and QRS intervals
  • Shivering artefacts
  • VT, VF or asystole
70
Q

medication contraindicteed in VT

A

verapamil (CCB)

71
Q

Most common cause of death following MI

A

VF

72
Q

Triad of phaeochromacytoma

A

sweating, headaches, and palpitations in association with severe hypertension

73
Q

what is hepatorenal syndrome

A

a type of functional kidney impairment that occurs in patients with advanced liver disease.

features
- ascites
- low urine output
- significant increase in serum creatinine.

74
Q

Mx of hepatorenal syndrome

A
  • 1st line: terlipressin (cause vasoconstriction of the splanchnic circulation)
  • 2nd line: volume expansion with 20% albumin
  • 3rd line: transjugular intrahepatic portosystemic shunt (TIPS)
75
Q

Mx of bradycardia with adverse signs (shock, syncope, MI, heart failure)

A

500mcg atropine IV
2nd: transcutaneous pacing

76
Q

risk factors for asystole (indicating the need for transvenous pacing)

A
  • complete heart block with broad complex QRS
  • recent asystole
  • Mobitz type II AV block
  • ventricular pause > 3 seconds
77
Q

cause of raised prolactin

A

Causes of raised prolactin - the p’s
- pregnancy
- prolactinoma
- physiological
- PCOS
- primary hypothyroidism
- phenothiazines, metoclopramide, domperidone

78
Q

drugs used for rate control of AF

A

BB, CCB, digoxin
BB contraindicated in asthma

79
Q

drugs used for rhythm control of AF

A

BB, dronedarone, amiodarone, flecainide

80
Q

causes of raised BNP

A
  • 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
81
Q

what is BNP

A

B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain

82
Q

test to differentiate between IBS and IBD

A

faecal calprotectin

83
Q

drug that causes neutrophilia

A

corticosteroids e.g. dexamethasone

84
Q

Mx of Wolff parkinson white syndrome

A

surgical: radiofrequency ablation of accessory pathway (definitive)
medical: sotalol, amiodarone, flecainide

85
Q

prophylaxis of variceal haemorrhage

A

propanolol

86
Q

prophylaxis for spontaneous bacterial peritonitis

A

ciprofloxacin or norfloxacin

87
Q

most common type of lung cancer in non-smokers

A

lung adenocarcinoma (usually peripheral)

88
Q

signs of haemochromatosis

A
  • fatigue
  • erectile dysfunction
  • arthralgia
  • bronze skin
89
Q

most common cause of death in patients with HOCM

A

ventricular arrhythmia

90
Q

hypertensive medication contradindicated in pregnancy

A

ACEi - cause oligohydramnios and risk fo cardiac/cranial defects

91
Q

Mx of angina

A
  • 1st line: BB or CCB (verapamil or diltiazem
  • 2nd line: if using BB already add CCB (amlodipine, nifedipine)
92
Q

posterior MI ECG findings

A

inversion of typical MI
- Q waves become tall R waves
- ST-elevation becomes ST-depression
- inverted T-waves become upright T-waves

93
Q

Addisonian crisis acid imbalance

A

hyponatraemic, hyperkalaemic acidosis

94
Q

what medication to avoid in bowel obstruction

A

metoclopramide (pro-kinetic can cause preforation)

95
Q

what is atrial myxoma

A

benign tumour most commonly occurring in the left atrium

96
Q

presentation of atrial myxoma

A

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

97
Q

what is buerger’s disease?

A

also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.

98
Q
A

Finals (10 decks)

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