Block 31 Week 6 Flashcards
1
Q
occupational and enviromental lung diseases - deaths due to?
A
- deaths mainly due to PM2.5
- Deaths are due to IHD/stroke (58%), COPD (18%), lung cancer (6%)
2
Q
pollutants - particulate matter?
A
- A mix of solid and liquid droplets arising mainly from fuel combustion and traffic
- This has the greatest impact on peoples’ health
3
Q
pollutants - NO2?
A
- Arising mainly from road traffic and indoor gas cooking
4
Q
Pollutants - sulphur dioxide?
A
- Arises mainly from burning fossil fuels
- Associated with asthma and poor lung function
5
Q
most toxic PM?
A
- particulates are a mix of solid and liquid droplets in the air e.g. soot
- PM 2.5 are the most toxic and are associated with CR disease and lung cancer
6
Q
pollutants - ozone?
A
- Caused by the reaction of sunlight with pollutants from vehicle emissions
- A major factor associated with asthma
7
Q
indoor air pollution?
A
- Worldwide smoke fires used for cooking.
- Biomass fuels produce large amounts of particulate matter
- contributes to COPD and childhood respiratory infection
8
Q
occupational asthma?
A
- commonest cause of occupational lung disease in the UK
- interactionw smoking and atopy
9
Q
Work related asthma?
A
10
Q
occupational asthma causes
A
11
Q
identifying occupational asthma?
A
- ask abt occupation - are symptoms worse at work and are they better when they’re away from work - weekends/ holiday?
- peak flow diary
- challenge tests
12
Q
pneumoconiosis?
A
- lung disease resulting from inhalation of dusts
- Long latency between exposure and development of disease
13
Q
types of pneumoconiosis?
A
- Coal workers pneumoconiosis
- Silicosis
- Asbestosis
- Many other rarer causes (eg. Berylliosos, Bagossis etc).
14
Q
silicosis?
A
- rare
- looks like sarcoidosis
- predisposes to TB and LC
- Upper lobe nodules and lymph node calcification
15
Q
asbestos can cause a range of diseases?
A
- Benign asbestos related pleural plaques
- Asbestos related pleural effusions
- Diffuse pleural thickening
- Mesothelioma
- Lung fibrosis (asbestosis)
- Lung cancer
16
Q
asbtesosis on CXR
A
17
Q
Mesothelioma?
A
- almost always caused by occupational exposure
- long latency
- rising prev in UK despite being banned in the 70s
- incurable
18
Q
occupational lung cancer?
A
- Estimated to cause 10% of lung cancers in men
- Asbestos estimated to cause 60% of these but unclear whether has to cause fibrosis (asbestosis) first or direct effect
19
Q
other causes of occupational lung cancer?
A
- Also arsenic,chromium, coal gas, coke production, cadmium, chloromethyl ethers, silica, radon, soot
20
Q
the health and safety executive?
A
- independent regulator that aims to prevent work related death, injury and ill-health
- produce guidance
21
Q
organisations with responsibility for the environment and health?
A
- Deparment for environment, food and rural affairs
- PHE - air pollution
22
Q
the lung interstitium?
A
- the lung interstitium is the space between the linings of the alveolus and the blood capillary
23
Q
pulmonary fibrosis =
A
- pulm fibrosis: myofibroblasts increase in number, produce a lot of collagen expanding the interstitum
24
Q
ILD with known cause/ association?
A
- rheumatic/ CT disease
- RA
- scleoderma
- dermatomyositis
25
drugs causing pulm fibrosis?
* bleomycin - anti-cancer drug
* nitrofurantoin
* amiodarone - high dose
26
dust inhalation causing ILD?
* asbestosis
* silicosis
27
Smoking related ILD?
* Desquamative interstitial pneumonia
* respiratory bronchiolitis
* usual interstitial pneumonia (UIP) - severely fibrotic lung (honeycomb change)
* IPF if no cause
28
Clinical findings in pulm fibrosis?
* persistent bilateral basal fine inspiratory crackles on auscultation suggests pulm fibrosis
29
ILD Ix?
* high resolution CT scan
30
UIP CT
* peripheral and basal reticulation
* honeycomb cysts
* traction bronchiectasis - airways wider than they should be
* little ground glass changes
* no nodules
31
UIP pattern?
* IPF - IPF requires other causes of PF to be excluded on history and examination
* RA and other CTDs
* asbestosis
32
pathophys of IPF?
* lung epithelial injury e.g. from viral infection, tobacco smoke, dust inhalation, GORD or autoimmunity
* in a susceptibile indiv
* causes production of pro-fibrotic cytokines - TGFbeta, PDGF, CTGF
* causes activation and proliferation of fibroblasts which normally produce elastin into myofibroblasts which produce collagen
33
Genetic mutations in IPF?
* MUC5B - most common
* TERT telomerase reverse transcriptase
* SFTPC - surfactant protein C
34
epidemiology of IPF?
* mean age 70
* M:F 1.5-2: 1
* Median survival 3 years
35
CFs of IPF?
* progressive SOB on exertion, typically over 1 year or more in an older person (>50 yrs)
* sometimes a dry cough
* bibasal fine inspiratory (velcro) crackles
36
Spirometry pattern in IPF?
* spirometry shows restriction - reduced FVC and normal FEV1/FVC ratio but may be normal in mild disease
37
history and examination in IPF?
* history - environmental and occupational exposures
* physical examination - look for CT disease
38
clinical course in PF?
* can be stable
* slow progression
* rapid progression
* acute exacerbations
39
ARDS?
* also shows diffuse ground glass change
* can occur after traumatic injury
40
Tx of IPF?
* do not use steroids
* home oxygen
* breathlessness management - breathlessness clinic, pulmonary rehabilitation, low dose morphine
* lung transplantation for those who qualify - under 65
41
IPF - anti-fibrotics?
* nintedanib or pirfenidone
42
PF and scleroderma?
* pulmonary fibrosis is the commonest cause of death in scleroderma
* about 10% of ppl w RA will have clin sig PF
* Half of patients w scleroderma
43
NSIP pattern?
* ground glass change
* traction bronchiectasis
* biopsy: diffuse interstitial fibrosis
44
Organising pneumonia pattern?
* patchy consolidation
* air bronchograms
* biopsy: buds of granulation and fibroblastic tissue within air spaces
45
in a patient with a non-UIP pattern of ILD look for a?
CTD
46
NSIP and organsing pneumonia pattern
47
hypersensitivity pneumonitis?
* hypersensitivity pneumonitis
* inhalation of avian antigens can cause bird breeders lung
* IgG against bird antigens
48
common cause of HP
49
sarcoidosis?
* systemic inflammatory disease
* non caseating granulomas replacing lymph node tissue
* may self resolve or can progress into pulm fibrosis
50
acute sarcoidosis triad?
* arthiritis
* erythema nodosum - painful red patches on the shins
* bilateral hilar lymphadenopathy
51
sarcidosis can cause ?
* can cause hypercalcaemia by causing hydroxylation of vitamin D
* tends to get worse when vitamin D levels
* sarcoid granulomas can also produce ACE - cannot be used alone to diagnose or exclude sarcoidosis
52
diagnosing sarcoid?
* non caseating granulomas in one or more organs
* exclusion of infection - contacts and travel history, stains for mycobacteria and fungi
53
SOB - CV exam?
* Shortness of breath: may indicate underlying cardiovascular (e.g. congestive heart failure, pericarditis) or respiratory disease (e.g. pneumonia, pulmonary embolism).
54
Malar flush?
* Malar flush: plum-red discolouration of the cheeks associated with mitral stenosis.
55
pedal oedema/ ascites?
CHF
56
Signs associated with endocarditis?
- splinter haemorrhages
- janeway lesions
- osler's nodes
57
splinter haemorrhages?
* Splinter haemorrhages: a longitudinal, red-brown haemorrhage under a nail that looks like a wood splinter.
* Causes include local trauma, infective endocarditis, sepsis, vasculitis and psoriatic nail disease.
58
janeway lesions?
* Janeway lesions: non-tender, haemorrhagic lesions that occur on the thenar and hypothenar eminences of the palms (and soles).
* Janeway lesions are typically associated with infective endocarditis.
59
Osler's nodes?
* Osler’s nodes: red-purple, slightly raised, tender lumps, often with a pale centre, typically found on the fingers or toes.
* They are typically associated with infective endocarditis.
60
Causes of radio-radial delay include:
* Subclavian artery stenosis (e.g. compression by a cervical rib)
* Aortic dissection
* Aortic coarctation
61
collapsing pulse/ water hammer pulse?
* Normal physiological states (e.g. fever, pregnancy)
* Cardiac lesions (e.g. aortic regurgitation, patent ductus arteriosus)
* High output states (e.g. anaemia, arteriovenous fistula, thyrotoxicosis)
62
slow rising pulse is associated with?
aortic stenosis
63
occupational lung diseases?
64
Patients with idiopathic pulmonary fibrosis have typical findings on examination:
* Bibasal fine end-inspiratory crackles
* Finger clubbing
65
Diagnosis of interstitial lung disease involves:
* Clinical features
* High-resolution CT scan (HRCT) of the thorax (showing a typical “ground glass” appearance)
* Spirometry
66
Pirfenidone?
reduces fibrosis and inflammation through various mechanisms
67
Nintedanib?
reduces fibrosis and inflammation by inhibiting tyrosine kinase
68
Several drugs can cause pulmonary fibrosis:
* Amiodarone (also causes grey/blue skin)
* Cyclophosphamide
* Methotrexate
* Nitrofurantoin
69
Pulmonary fibrosis can occur secondary to other conditions:
* Alpha-1 antitrypsin deficiency
* Rheumatoid arthritis
* Systemic lupus erythematosus (SLE)
* Systemic sclerosis
* Sarcoidosis
70
hypersensitivity pneumonitis?
* a.k.a allergic alveolitis - involves type III and type 4 hypersensitivity reaction to an envionmental allergen
* Inhalation of allergens in patients sensitised to that allergen causes an immune response, leading to inflammation and damage to the lung tissue.
71
what is suggestive of hypersensitivity pneumonitis?
- raised lymphcoytes in bronchoalveolar lavage
72
HP - bird fancier's lung?
a reaction to bird droppings
73
HP - farmer's lung?
reaction to mouldy spores in hay
74
HP - mushroom workers lung?
reaction to specific mushroom antigens
75
HP - malt workers lung?
reaction to mould on barley
76
cryptogenic organising pneumonia
?
* involves a focal area of inflammation of the lung tissue.
* It can be idiopathic or triggered by infection, inflammatory disorders, medications, radiation, environmental toxins, or allergens.
77
COP - presentation?
* Presentation is similar to infectious pneumonia, with shortness of breath, cough, fever and lethargy.
* Inspiratory crackles may be heard on auscultation.
78
findings of COP?
* focal consolidation can be found on CXR
* lung biopsy is the definitive Ix
79
Bounding pulse = associated with
aortic regurg and CO2 retention
80
thready pulse =
associated with intravascular hypovolaemia in conditions such as sepsis
81
causes of raised JVP?
- RSHF (can be from PE)
- Tricuspid regurg
- constrictive pericarditis
82
Tricuspid regurg?
causes include infective endocarditis and rheumatic heart disease.
83
Constrictive pericarditis?
often idiopathic, but rheumatoid arthritis and tuberculosis are also possible underlying causes.
84
asterxis causes?
* asterixis - CO2 retention
* can also be caused by uraemia and hepatic encephalopathy
85
fine tremor?
beta-2 agonist use e.g. salbutamol
86
tracheal deviation?
* The trachea deviates away from tension pneumothorax and large pleural effusions.
* The trachea deviates towards lobar collapse and pneumonectomy.
87
increased TVF?
consolidation, tumour, lobar collapse
88
Decreased TVF ?
suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).
89
Bronchial breathing?
- harsh-sounding (similar to auscultating over the trachea), inspiration and expiration are equal and there is a pause between.
- This type of breath sound is associated with consolidation.
90
coarse crackles?
* Coarse crackles: discontinuous, brief, popping lung sounds typically associated with pneumonia, bronchiectasis and pulmonary oedema.
91
fine- end inspiratory crackles?
- often described as sounding similar to the noise generated when separating velcro.
- Fine end-inspiratory crackles are associated with pulmonary fibrosis.
92
increased vocal resonance?
* Increased volume over an area suggests increased tissue density (e.g. consolidation, tumour, lobar collapse).
93
decreased VR?
* Decreased volume over an area suggests the presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax).
94
Cardiac cycle?
* ventricular diastole
* lub = first heart sound = mitral and triscupid pulled closed
* venticular systole
* dub = second heart sound = aortic + pulmonary pushed closed
95
murmurs made louder by inspiration vs expiration?
* murmurs made louder by inspiration = right sided
* by expiration = left sided
96
systolic murmurs are?
- aortic stenosis
- mitral regurg
- MR ASS - mit regurg, aortic stenosis, systolic
97
aortic stenosis?
* turbulent blood flow through narrowed valve
* murmur may muffle the heart sound - second heart sound can be quieter or louder - associated with pulm hypertension
98
congenital aortic stenosis - causes?
* bicuspid aortic valve
* presents in infancy
99
aortic stenosis causes in 30-40 year olds?
*Bicuspid, typically symptoms develop from 30-40 years+
100
calcification of normal/ tricuspid valve?
* most common
* 65+ years
* occurs earlier in renal failure and high cholesterol
101
triad of aortic stenosis?
* effort dyspnoea
* effort dizziness/ syncope
* effort angina
102
sudden cardiac death in aortic stenosis?
* sudden cardiac death - rare without classic triad first
103
where is the aortic stenosis murmur heard?
* heard over the aortic area, radiation to the carotids
104
other features of AS?
* slow rising pulse and narrow pulse pressure - below 30
* absent second heart sound or loud P2
105
apex beat and signs of? in AF
* forceful apex beat - indicated LVH
* possible signs of heart failure
106
signs of severe aortic stenosis?
* radiation to carotids
* slow rising pulse and narrow pulse pressure
* loud p2
* signs of HF
107
Ix of AS?
echo
108
Tx of AS?
* monitoring - symptoms, severity of stenosis, LV function
* surgery
* TAVI for high risk
109
Mitral regurg?
* 2nd most common murmur
* leaky mitral valve which allows blood to backflow into the atria after ventricular systole
* pansystolic murmur - occurs all throughout systole
110
causes of mitral regurg - intrinsic valve problems?
* Myxomatous degeneration
* Rheumatic Heart Disease - most common cause of mitral regurg
* Infective Endocarditis
* Chordal Rupture/Prolapse - cords not attached to PM and flails backwards causing regurg
* Papillary Muscle Rupture (IHD)
111
MR causes - secondary/ functional (dilatation of ventricle)?
* those w LV dysfunction develop a dilated ventricle which doesn't work very well, mitral annulus stretches apart and leaflets can't compensate for that and the valve becomes incompetent
* Tx aims to improve dilatation of the ventricle
112
MR from dilatation of ventricle - patients often present with?
* patients often asymptomatic for years so presentation and signs often that of heart failure
113
CFs of MR?
* Displaced (down and round), diffuse apex beat resulting from volume overload (dilated LV)
* Loud pan systolic murmur at apex - same intensity throughout
* Radiation of murmur to (usually left) axilla/back
114
markers of severity in mitral regurg?
* displaced apex
* loud pan systolic murmur - loudness reflects seveity in regurgitation murmurs
* radiation to axilla/ back
115
medical Tx of MR?
HF Tx
* diuretics
* ACEi to maintain systolic function of LV
116
surgical Tx of MR?
* indicated if LV is enlarging progressively or if intrusive symptoms
* mitral valve repair or mitral valve replacement
117
causes of systolic murmurs?
- AS
- MR
- pulmonary stenosus
- tricuspid regurg
118
pulm stenosis?
* radiation to axilla/ back
* present in younger population
* one of the most common types of congenital HD
119
pulm stenosis is louder in?
inspiration
120
tricuspid regurg?
* radiation to the liver (blood goes down to IJV)
* accenuated in end inspiration
121
tricuspid regurg - hypertrophic cardiomyopathy?
Outflow tract mumur
122
tricuspid regurg - coarction of aorta?
radio-radio delays and BP change
123
tricuspid regurg - VSD?
very loud, no accenuation
124
what are the diastolic murmurs?
- aortic regurg
- mitral stenosis
- De ARMS
125
aortic regurg?
* backflow of blood into LV
* pressure equalizes much quicker so flow stops
* described as decreshendo diastolic murmur
126
aortic regurg signs?
- collapsing pulse
- Wide PP
- early diastolic murmur
127
aortic regurg - murmur?
murmur heard at left sternal edge (patient leaning forward, end-expiration)
128
Signs of AR - Corrigan's sign?
visible carotid pulsations
129
Signs of AR - De Musset sign?
head bobbing
130
Signs of AR - Quinke's sign?
nail bed pulsations - red flashes within the nail bed. marker of serverity
131
Signs of AR - pistol shot femorals?
due to large forward stroke volume
132
Signs of AR -Duroziez’s murmur?
to-and fro- murmur in femoral (large forward and backward flow in aorta)
133
causes of AR - diseases affecting the aortic valve?
* Rheumatic Heart Disease
* Infective Endocarditis
* Lupus
134
causes of AR - diseases resulting in dilatation of the aortic root?
* Aortic Aneurysm (hypertension)
* Marfan’s syndrome
* (Ankylosing spondylitis)
* Syphilis (late sign)
135
aortic dissection =
acute AR
136
Aortic regurg Tx?
* Diuretics -symptom control
* ACEi - maintains systolic function of left ventricle
137
mitral stenosis murmur?
* low pitched mid diastolic murmur - use bell
* stops at first heart sound
138
mitral stenosis is almost exclusively ? in origin?
rheumatic in origin so may also have aortic valve problems
139
MS signs?
* Low-pitched rumbling mid-diastolic murmur (apex in left lateral position)
* Opening snap (rigid valve opening) precedes murmur
* Malar Flush / ‘Mitral Facies’
140
Other signs of MS - cardiac?
* Signs of Heart Failure
* Usually in AF
* Right ventricular Heave if secondary pulmonary hypertension
141
MS - tapping?
apex beat (palpable S1)
142
markers of severity of MS?
* malar flush
* signs of HF
* AF
* RV Heave
* tapping apex
143
medical Tx of Mitral stenosis?
- Diuretics - symptom control
- Rate control / Anticoag - if in AF
144
surgery in the Tx of mitral stenosis?
- Mitral Valvotomy - balloon used to open the valve
- Mitral Valve Replacement
145
other causes of diastolic murmurs?
- pulm regurg
- tricuspid stenosis
- patent DA
146
# common cause
Pulm regurg?
* pulm regurg - loud
* common consequence of surgery for teratology of fallot
147
tricuspid stenosis?
* tricuspid stenosis - accetuated in end inspiration
148
patent ductus arteriosus?
* patent ductus arteriosus - continous machinery murmur - due to patent duct still being open so there will be a diastolic component
* not accenuated by respiration
149
valvular lesions Ix?
* echo
* ECG
* Stress testing is sometimes done in those who are asymptomatic or have minor symptoms
150
systole =
occurs between S1 and S2 heart sounds
151
diastole =
between S2 and S1
152
stenosis -> ? murmur?
* Stenosis of the aortic or pulmonic valves will result in a systolic murmur, as blood is ejected through the narrowed orifice.
153
echocardiograms?
* echocardiograms use sound waves to produce images of the heart as it moves
* shows blood flow through the heart and heart valves
* can tell us about pumping function of the heart, the valve function, size of the heart chambers
154
Infective endocarditis ?
* can be a life threatening condition associated w severe complications
* Infection of the endocardium may involve one or more heart valves or an intracardiac device (e.g. prosthetic valve).
155
types of infective endocarditis?
- native valve endocarditis
- prosthetic valve endocarditis
- IVDA
156
Native valve endocarditis?
normal valves without previous intervention. May be acute or subacute.
157
PVE?
may occur early (< 1 year) or late (> 1 year) following surgical intervention. Account for 10-20% of cases.
158
Intravenous drug abuse (IVDA) endocarditis?
- classically affects the tricuspid valve (50%).
- Staphylococcus aureus most common microorganism.
159
IE RF?
* age
* male
* IV drug use
* poor dental hygeine
* immunosuppression or haemodialysis
160
Cardiac RF for IE?
* Structural or valvular HD
* Congenital HD
* prosthetic heart valves
* previous IE
161
most common cause of IE?
* The most common cause of IE overall is Staphylococcal aureus, which is the usual pathogen in IE associated with intravenous drug use (IVDU) and prosthetic heart valves.
* Other commonly isolated bacteria are Streptococcal and Enterococcal species
162
non infective endocarditis?
* endocarditis may occur in the absence of infection
* it is due to sterile platelet thrombi on heart valves
* causes: advanced malignancy, lupus, RA
163
Fungal caues of endocarditis?
* associated w poor prognosis - ~50% mortality
* Candida species (e.g. C. albicans, C. stellatoidea)
* Aspergillus species
164
pathophys of IE?
* IE occurs when bacteria enter the bloodstream and deposit onto the endocardial surface of the heart.
* Classically, a dental procedure is associated with a brief bacteraemia that our immune system is able to control.
* However, in patients with underlying cardiac disease (e.g. rheumatic heart disease) it can lead to deposition and adherence of bacteria.
* Once deposited on the endocardial surface, the organisms adhere and eventually lead to invasion and destruction of the valve leaflets.
* The key pathological process in IE is formation of infected vegetations.
165
IE is characterised by?
formation of vegitations on cardiac valves
166
- IE vegitations lead to?
* forms vegitations which leads to regurgitant murmurs and eventually congestive cardiac failure
* If this process occurs acutely (e.g. acute IE secondary to Staphylococcal aureus) it can lead to acute heart failure and cardiogenic shock. T
167
Order of valves affected in endocarditis?
mitral -> aortic -> tricuspid -> pulmonary valves
168
CFs of IE - most common?
fever and cardiac murmur
169
symptoms of IE?
* Fever (90%)
* Malaise, lethargy
* Anorexia
* Weight loss
* Abdominal pain: splenic abscess
170
urinary changes in IE?
* Haematuria: renal embolic phenomenon
171
Cardiac symptoms of IE?
shortness of breath, chest pain, palpitations
172
Murmur in endocarditis?
pansystolic murmur of mitral regurgitation or early diastolic murmur of aortic regurgitation classical
173
other clinical signs of IE?
- features of HF
- petechia
- splinter haemorrhages, janeway lesions, oslers nodes
- roth spots
174
roth spots?
exudative, oedematous hemorrhagic lesions of the retina with pale centre (immune complex deposition). Subacute > acute.
175
Ix for IE?
* TT echo followed by a transoesophageal echo (TOE) to look for local complications
* blood cultures
* CT, MRI, CT-PET
176
other tests for IE?
* urine dip (haematuria/proteinuria)
* ecg - prolonged PR interval is suggestive of para-aortic abscess
* CT/ US of thorax and abdomen - pulmonary or splenic abscesses
* CT/ MRI for neuro complications
177
Findings on TTE/TOE suggestive of IE include:
* Vegetation
* Abscess formation
* Pseudoaneurysm
* Valve perforation
* New dehiscence of a prosthetic valve
178
Staph A endocarditis Tx?
flucloxacillin
179
MRSA IE Tx?
* MRSA or penicillin allergy: vancomycin
180
strep IE tx?
* penicillin, or amoxicillin or ceftriaxone or gentamicin or vancomysin
181
surgery for IE?
* Heart failure (e.g. new acute heart failure with haemodynamic compromise)
* Uncontrolled infection (e.g. abscess formation or persistently positive blood cultures)
* Prevention of embolisation (e.g. large vegetations)
182
Ab prophylaxis of IE?
* cardiac procedures
* dental procedures
* resp tract procedures - e.g. bronchoscopy
* GI procedures - e.g. TOE, colonoscopy
* urological procedures - cytoscopy
* obstetric procedures - vaginal/ caesarian delivery
183
Cardiac complications of IE?
* HF most freq and most severe
* cardiac: heart failure, perivalvular abscess, pericarditis, cardiac tamponade
184
Neurological complications of IE?
stroke, abscess, meningitis, encephalitis, haemorrhage, seizures
185
Metastatic infection from IE?
mycotic aneurysm, embolisation, abscess formation
186
Embolisation sequaelae from IE?
stroke, blindness, ischaemic limb, splenic/renal infarct, pulmonary embolism, myocardial infarction
187
how can pathogens get to the heart?
* bacteria/ fungi can get to the heart by entering the bloodstream from infectionns elsewhere in the body - e.g. urinary or GI tract ot skin or after surgical or dental procedures
188
what else can you get with IE?
* chills
* night sweats
189
Later symptoms of IE?
* swelling of feet and legs
* SOB
* irregular heartbeat
190
enterococcal IE?
*Men > Women
- Median age 59-65 years
191
Jobs at risk of sillicosis?
- mining
- slate works
- foundries
- potteries
192
Features of sillicosis?
- upper zone fibrosing lung disease
- 'egg-shell' calcification of the hilar lymph nodes
193
194
Tx of enterococcal IE?
*Amoxicillin + gentamicin or ceftriaxone standard treatment
195
ejection systolic murmurs?
- AS
- hypertrophic obstructive cardiomyopathy
- PS
- ASD
- teratology of fallot
196
Ejection systolic murmurs louder on expiration?
- AS
- hypertrophic obstructive cardiomyopathy
197
Ejection systolic murmurs louder on insp?
- pulm stenosis
- ASD
- ToF
198
Pansystolic/ holosytolic murmurs?
- mitral/ tricuspid regurg
- VSD
199
mitral/ tricuspid regurg character?
high-pitched and 'blowing' in character
200
Tricuspid regurg vs mitral regrurg?
tricuspid regurgitation becomes louder during inspiration, unlike mitral reguritation
201
VSD?
- harsh murmur
- holosytolic
202
what are the late systolic murmurs?
- mitral valve prolapse
- coarctation of aorta
203
early diastolic murmurs?
- aortic regurg
- pulm regurg
204
aortic regurg and pulm regurg?
high pitched, blowing murmur
205
Mid-late diastolic murmurs?
- MS
- austin flint murmur
206
mitral stenosis character?
'rumbling' in characterA
207
Austin flint murmur?
severe aortic regurgitation, again is 'rumbling' in character
208
cont machine-like murmur?
patent ductus arteriosus
209
RILE?
Right-sided murmur → heard best on Inspiration
Left-sided murmur → heard best on Expiration
210
RCA supplies?
- II, III, aVF - inferior leads
211
AS symptoms?
syncope, angina, dyspnea (SAD)
212
Murmur in AS?
ejection systolic, described as crescendo-decrescendo. Radiates to the carotids.
213
where is AS best heard?
expiration in the aortic area
214
Additional signs of AS?
- Sustained apex
- Slow rising pulse
- Narrow pulse pressure
- Heart sounds:
- Soft S2 (sign of severe disease)
- S4
- Reversed splitting of S2
215
cogenital associations of PS?
- ToF
- congenital rubella syndrome
216
Symptoms of PS?
syncope, fatigue
217
acquired causes of PS?
- Carcinoid syndrome
- rheumatic fever
218
Murmur in PS?
ejection systolic, described as crescendo-decrescendo. Often associated with a thrill.
219
220
post-mI AV block affects?
- RCA
- II, III, aVF
221
Anteroseptal MI?
- v1 - v4
- LAD
222
inferior MI?
- 2, 3, aVF
- RCA
223
antereolateral MI?
- v1 -v6
- avL
- proximal LAD
224
lateral MI?
- I
- aVL
- +/- V5-V6
- Left circumflex
225
Posterior MI?
- changes to V1-V3
- usually left circumflex also RCA
226
posterior MI - reciprocal changes seen:
- horizontal ST depression
- tall, broad R waves
- upright T waves
- dominant R wave in V2
227
How is posterior MI confirmed?
Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)
228
moderate asthma exacerbation?
- PEFR 50-75%
- RR less than 25
- Pulse less than 110bpm
229
Severe asthma exacerbation features?
- PEFR 33-50%
- can't complete sentences
- RR > 25
- pulse over 110
230
Can't complete sentences =
severe asthma
231
Life threatening asthma features?
- < 33%
- O2 below 92 and normal CO2
232
Other features of life threatning asthma?
- silent chest
- cyanosis
- bradycardia/ hypotension
- confusion, coma, exhaustion
233
silent chest =
life threatening
234
Near fatal asthma?
raised pCO2 and or requiring mechanical ventilation
235
Mx of acute asthma exacerbation?
- O2 if hypoxic
- bronchodilation - SABA
- prednisolone for 5 days
236
ipatropium bromide?
- life threatning/ severe asthma
- pps who haven't resp to beta agonists, steroids
237
IV magnesium sulfate?
mmonly given for severe/life-threatening asthma
238
