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First year > c > Flashcards

c Flashcards

1
Q

Angina pectoris: drug management

A

aspirin and a statin in the absence of any contraindication

sublingual glyceryl trinitrate to abort angina attacks

beta-blocker or a calcium channel blocker then both if uncontrolled

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2
Q

symptoms and signs of ACS/MI

A 
chest pain.
typically central/left-sided
may radiate to the jaw or the left arm
dyspnoea
sweating
nausea and vomiting
appear pale and clammy
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3
Q

The two most important investigations when assessing a patient with chest pain are:

A

ECG

cardiac markers e.g. troponin

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4
Q

Anterior V1-V4

A

Left anterior descending

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5
Q

Inferior II, III, aVF

A

Right coronary

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6
Q

Lateral I, V5-6

A

Left circumflex

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7
Q

Treatment of ACS

A 
MONA
Morphine
Oxygen 94%>
Nitrates
Aspirin

second antiplatelet - clopidogrel, prasugrel and ticagrelor
GRACE in NSTEMI

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8
Q

investigations for aortic dissection

A

Chest x-ray
widened mediastinum

CT angiography of the chest, abdomen and pelvis is the investigation of choice
suitable for stable patients and for planning surgery
a false lumen is a key finding in diagnosing aortic dissection

Transoesophageal echocardiography (TOE)
more suitable for unstable patients who are too risky to take to CT scanner
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9
Q

Management of Type A aortic dissection

A

surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

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10
Q

management of Type B aortic dissection

A

conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

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11
Q

classify a type A aortic dissection

A

ascending aorta, 2/3 of cases

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12
Q

classify a type B aortic dissection

A

descending aorta, distal to left subclavian origin, 1/3 of cases

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13
Q

tear in the tunica intima of the wall of the aorta

A

aortic dissection

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14
Q

Patients may require inotropic support and/or an intra-aortic balloon pump.

A

cardiogenic shock

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15
Q

treatment for chronic heart failure

A

Loop diuretics such as furosemide will decrease fluid overload. Both ACE-inhibitors and beta-blockers have been shown to improve the long-term prognosis of patients with chronic heart failure.

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16
Q

most common cause of death following a MI

A

ventricular fibrillation

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17
Q

Pericarditis in the first _____ hours following a transmural MI is common

A

48

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18
Q

an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.

A

dresslers syndrome

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19
Q

Dressler’s syndrome tends to occur around ______ weeks following a MI.

A

2-6 weeks

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20
Q

This is seen in around 3% of MIs and occurs around 1-2 weeks afterwards. Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.

A

Left ventricular free wall rupture

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21
Q

what is the first line treatment for acute heart failure?

A

IV Loop diuretics

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22
Q

associated with colorectal cancer

A

Streptococcus bovis

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23
Q

So which features make pulmonary embolism more likely?

A

The relative frequency of common clinical signs is shown below:
Tachypnea (respiratory rate >16/min) - 96%
Crackles - 58%
Tachycardia (heart rate >100/min) - 44%
Fever (temperature >37.8°C) - 43%

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24
Q

Accounts for 80% of cases of pneumonia

Particularly associated with high fever, rapid onset and herpes labialis

A

Streptococcus pneumoniae (pneumococcus)

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25
Q

Particularly common in patients with COPD

A

Haemophilus influenzae

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26
Q

Often occurs in patient following influenza infection

A

Staphylococcus aureus

27
Q

One of the atypical pneumonias, which often present a dry cough and atypical chest signs/x-ray findings
Autoimmune haemolytic anaemia and erythema multiforme may be seen

A

Mycoplasma pneumoniae

28
Q

Classically seen in alcoholics

A

Klebsiella pneumoniae

29
Q

Typically seen in patients with HIV

Presents with a dry cough, exercise-induced desaturations and the absence of chest signs

A

Pneumocystis jiroveci

30
Q

Symptoms and signs of pneumonia

A 
Symptoms
cough
sputum
dyspnoea
chest pain: may be pleuritic
fever
Signs
signs of systemic inflammatory response
fever
tachycardia
reduced oxygen saturations
auscultation:
reduced breath sounds
bronchial breathing
31
Q

the classical x-ray finding in pneumonia is _____

A

consolidation

32
Q

pneumonia management

A

antibiotics: to treat the underlying infection
supportive care, for example:
oxygen therapy if the patient is hypoxaemic
intravenous fluids if the patient is hypotensive or shows signs of dehydration

33
Q

symptoms of pneumothorax

A 
dyspnoea
chest pain: often pleuritic
sweating
tachypnoea
tachycardia
34
Q

what differentiates a primary to secondary pneumothorax?

A

Primary- no underlying lung disease

secondary- underlying lung disease

35
Q

recommendations for primary pneumothorax

A

if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise, aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

36
Q

when should a chest drain be inserted in pneumothorax

A

if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.

37
Q

how long do patients with secondary pneumothorax have to be admitted for?

A

At least 24 hours

38
Q

management of acute asthma

A

admission - all patients with life threatening asthma and patients with severe asthma that are not responding to initial treatment.

Oxygen - 15L rebreather mask target 94-98%

high-dose inhaled SABA e.g. salbutamol, terbutaline

oral corticosteroid
all patients should be given 40-50mg of prednisolone orally (PO) daily, which should be continued for at least five days or until the patient recovers from the attack

ipratropium bromide

IV magnesium sulphate

39
Q

Beclometasone dipropionate

Fluticasone propionate

A

Inhaled corticosteroids (ICS)

40
Q

Salmeterol

A

Long-acting beta-agonists (LABA)

41
Q

patients on a SABA + ICS whose asthma is not well controlled should be offered a ______

A

leukotriene receptor antagonist, not a LABA

42
Q

what is classified as a transudate pleural effusion and give examples

A

Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

43
Q

what is classified as an exudate pleural effusion and give examples

A 
Exudate (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
44
Q

where the volume of fluid in the pleural space is substantially greater than normal

A

pleural effusion

45
Q

give signs/symptoms of upper GI bleed

A

haematemesis
often bright red but may sometimes be described as ‘coffee gound’

melena
the passage of altered blood per rectum
typically black and ‘tarry’

46
Q

Dysphagia may be associated with weight loss, anorexia or vomiting during eating
Past history may include Barrett’s oesophagus, GORD, excessive smoking or alcohol use

A

Oesophageal cancer

47
Q

There may be a history of heartburn

Odynophagia but no weight loss and systemically well

A

oesophagitis

48
Q

There may be a history of HIV or other risk factors such as steroid inhaler use

A

Oesophageal candidiasis

49
Q

Dysphagia of both liquids and solids from the start
Heartburn
Regurgitation of food - may lead to cough, aspiration pneumonia etc

A

achalasia

50
Q

More common in older men
Represents a posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Typical symptoms are dysphagia, regurgitation, aspiration and chronic cough. Halitosis may occasionally be seen

A

pharyngeal pouch

51
Q

Other symptoms may include extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids

A

Myasthenia gravis

52
Q

steady worsening of dyshpagia over a few weeks in an older patient suggests _______

A

malignancy

53
Q

give management of crohn’s

A

SG5A/M
stop smoking!

glucocorticoids (oral, topical or intravenous) eg. beclomethasone, betamethasone, budesonide.

5-ASA drugs (e.g. mesalazine) are used second-line to glucocorticoids but are not as effective

azathioprine or mercaptopurine*

metronidazole is often used for isolated peri-anal disease

54
Q

what is used first line to maintain remission of crohn’s disease

A

azathioprine or mercaptopurine is used first-line to maintain remission

55
Q

what classifies ulcerative colitis as mild, moderate and severe?

A

mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

56
Q

give treatment for mild to moderate UC

A

aminosalicylate eg . balsalazide, mesalazine, olsalazine and sulfasalazine

oral aminosalicylate

if remission still not achieved stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid

57
Q

should be treated in hospital
intravenous steroids are usually given first-line
intravenous ciclosporin may be used if steroid are contraindicated
if after 72 hours there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery

A

severe UC

58
Q

mechanism of beta blockers

A

β1 receptor antagonist

59
Q

mechanism of spironolactone

A

c) Aldosterone receptor antagonist

60
Q

mechanism of atropine

A

M2 muscarinic antagonist

61
Q

Pulmonary valve

A

Left second intercostal space, at the upper sternal border

62
Q

Aortic valve

A

Right second intercostal space, at the upper sternal border

63
Q

Mitral valve

A

Left fifth intercostal space, just medial to mid clavicular line

64
Q

Tricuspid valve

A

Left fourth intercostal space, at the lower left sternal border

First year (10 decks)

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