CARDIAC AND RESPIRATORY EOCP Flashcards
What are the red flags in every history?
Unexplained weight loss, Night sweats, Chest Pain, Syncope
What are common signs of Right sided HF
Ankle swelling, Sacral oedema, Ascites and Raised JVP
What is Claudication?
Poor Arterial blood supply to the muscles of the leg, causing cramps and pain whilst walking
Clinical Signs of Tension Pneumothorax?
Deviated Trachea, Hyperresonant chest, JVP distended
Why isn,t it reccommended to order X-ray for tension pneumothorax?
EMERGENCY! SHOULD BE OBVIOUS FROM EXAMINATION FINDINGS
What test can rule out P.E?
D-Dimer test can rule it out. If D-Dimer is negative then NO P.E. But if positive doesnt confirm P.E
What Score is used to test risk of P.E?
Wells Score
What imaging is used to confirm P.E?
CTPA (CT pulmonary angiogram)
What do you do if Wells Score is more than 4?
Go straight to CTPA to confirm P.E
Below what score in WELLS do you do D-dimer test for P.E?
4
What are common symptoms of P.E?
Shortness of Breath, PLEURITIC CHEST PAIN (SHARP, STABBING PAIN), could be DVT, Haemoptysis
What is Pleuritic chest Pain?
Sharp, stabbing Pain
What kind of Pain is felt in Angina
Tight band squeezing pain
What might a symptom of productive cough lead you to think of as a cause?
Chest infections, such as Pneumonia
What test would you use instead of CTPA for P.E and why?
V/Q mismatch scan (Ventilation/Perfusion)
3 common complications of diabetes
Retinopathy, Nephropathy, Neuropathy
What does collapsing pulse check? And how?
To check for Aortic valve regurgitation. You can feel a strong, forceful pulse that strongly increases then rapidly decreases. The pulse increases because of high stroke volume in left ventricle being pumped up, but then due to leaky valve, this blood falls back, hence increasing the volume of blood inside left ventricle
Why check teeth in Cardio Ex
Looking for any signs of infection ad this could spread to the heart as endocarditis
Possible investigations for SOB? (Bedside)
02 Saturation levels, Blood Pressure, C02 levels through ABG/VBG, Respiratory Rate, Check Peak expiratory Flow
What is Peak flow like in a pneumothorax?
Normal, as no obstruction
How is peak flow affected in COPD or Asthma?
Decreased as there is obstruction of bronchioles
Why check eyes in a heart examination?
Cholesterol deposits in and around eye, that could indicate hyperlipidemia
When inspecting hands in Cardio Ex, what we looking for?
Clubbing of nails, tar stains, Kolynchia (when nails became concave or spooned)
Why check tongue in cardio Ex?
Look for cyanosis (becomes blue) as indicaes Hypoperfusion
Some signs of Heart Failure?
kerley B lines, Pleural effusion, cardiomegaly
Why does heart enlarge in HF?
Because the Heart has to work so hard to pump the blood that it leads to hypertrophy of the heart muscle, hence a bigger heart.
What are Kerly B lines?
Represent thickened interlobular septa on Xray and are seen on lungs bases (could be because of pleural effusion)
Why is flattened diaphragm a sign of COPD
Because hyperinflated lungs pushed diaphragm down
X ray feature in HF?
Increased Cardiothoracic ratio(due to cardiomegaly?)
Signs of Peripheral Vascular Disease?
Intermittent claudication, discoloured toenails, hair loss
What do you look for in chest?
abnormal Chest shape, any scars
Why do some people have a decreased crico-cartilage distance?
This can be caused by a Hyper-inflated chest (can be seen in COPD patients)
What is a thrill?
A thrill is the vibration of a heart murmur, which is caused by faulty valves, and can be palpated by placing finger tips on the four valvular areas of chest left sternal edge in 2nd intercostal space for Pulmonary valve, Right sternal edge inn 2nd intercostal space for aortic valve, and left sternal edge in 4th intercostal place for bicuspid valve, and apex of heart for mitral valve
How do you look for thrills?
Thrills can be palpated by placing finger tips on the four valvular areas of chest left sternal edge in 2nd intercostal space for Pulmonary valve, Right sternal edge inn 2nd intercostal space for aortic valve, and left sternal edge in 4th intercostal place for bicuspid valve, and apex of heart for mitral valve
What is a heave?
Felt when heart has left ventricular hypertrophy (feels like an abnormally large heart beating)
What is normal saturation in a healthy person?
99/100%
Why do we measure Mean Cell Volume in hose who have drunk excess alcohol?
Alcohol can cause macrocytosis…which can lead to anemia
What is Type 1 Resp Failure?
Low O2, Normal CO2
What is Type 2 Resp failure?
Low O2, High C02 (this is the case in COPD)
How to treat Pneumothorax?
Like pricking a ballon bust, you can fine aspirate the air from the pleural area or use chest drain.
2 types of spontaneous pneumothorax?
Primary - No underlying issue
Secondary - Underlying disease present.
side effect of ACE inhibitor?
Dry, Itchy cough
Which Wbc test is done to investigate asthma?
Eosiniphils
What blood test is done for HF?
BNP test (B type natriuretic Peptide), higher levels of this protein in blood reflects worsening Heart failure
What scan done to confirm Restrictive lung disease?
High resolution CT scan
Fine inspiratory crackles present in which type of lung disease? Obstructive or restrictive?
Restrictive lung disease (pulmonary fibrosis)
what are coarse crackles?
Brief, uncontinuous popping lung sounds (kind of like bubbling)..associated with bronchiaectasis, pneumonia, pulmonary oedema
what are fine inspiratory crackles?
They sound like velcro/fire burning wood
How to manage Asthma?
Stepwise approach: Relievers (used quickly to relieve asthma symptoms) Short acting Beta Agonist
Preventors (Used daily to prevent asthma symptoms occuring in first place): Long Acting Beta Agonist
Under what clinci measured B.P is B.P considered normal?
140/90
What do you do If clinic measured B.P is less than 140/90?
Monitor every 5 years, and if B.P closer to 140/90 then measure more often
Between Which clinic measured B.P do you send patient to do ABPM/HBPM?
Between 140/90 to 179/119 mmHg
At what Clinic B.P do you assess for target organ damage?
180/120 above
What would make you do Same day specialist review in case of hypertension?
If patient displays retinal haemorrhage, papilloedema or life threatenming symptoms
Post ABPM, what B.P would be considered stage 1?
135/85- to 149/94
Post ABPM what B.P is stage 2?
150/95 mmHg or more
How to manage hypertension in a 65 year old black man
- Give CCB. 2. CCB and ACEi/ARB 3. CCB and ACEi/ARB and Thiazide like diuretic 4. Beta blocker or alpha blocker if potassium level is more than 4.5mmol/L
spironolactone if potassium level is less than 4.5 mmol/L
How to manage Hypertension in an indian 30 year old?
specialist Review for secondary causes and assess long term benefits and limitations of treatment (as under 40),
How to mange hyper tension in gary a white middle aged 54 yr old?
1.ACEi/ARB
2.ACEi/ARB + CCB
3. ACEi/ARB + CCB /Thiazide like diuretic
4. Spironolactone if Potassium less than 4.5mmol/L
Beta Blocker if potassium is more than 4.5mmol
Side egffects of ACEi?
Dry itchy cough (As it stops bradykinin breaking down)
Angio-oedema (facial swelling)
Main side effect of CCB?
Ankle oedema, facial flushing
How to investigate organ damage in hypertensives?
Eyes (do a fundoscopy) Kidney damage (urine dipstick, for proteinuria)
difference between ABPM and HBPM?
ABPM is measured 14 times over a space of a day and has to be carried baround everywhere by patient
HBPM is measured twice a day everyday for 5-7 days, in a time decided by patient
What is spirometry and its use?
Method to assess ling function by asking patient to inspire fully and expire forcefully
differentiates between Obstructive lung disease and restrictive lung disease
What drugs should a patient avoid before a spirometry?
Long acting bronchodilators -12 hrs
Short acting bronchodilators - 4 hrs
Long acting anti-cholinergics - 24 hrs
short acting anti-cholingerics - 6 hrs
What activities should a patient avoid before a spirometry?
Smoking - 24 hrs prior to the test
Stremuous exercise - 30 minutes prior to the test
Large meal - 2 hrs prior to the test
What is FVC?
Forced Vital Capacity: Volume of air expired forcefully after a full, deep inspiration.
What us FEV1?
Forced Expiratory Volume 1: Volume of air expired forcefully in one second, after a full, complete inspiration.
What is normal peak flow expiratory rate?
580l/min
What PEFR score would be abnormal?
Anything that is between 79% and 50% of normal PEFR
What PEFR score would be emergency?
Anything that is less than 50% of normal
What FEV1/FVC ratio would be Obstructive lung disease?
When FEV1/FVC ratio is less than 0.7
In this, FEV1 is decreased (<80% of predicted normal)
And FVC stays about normal
What FEV1 and FVC values would be Restrictive lung disease?
FEV1 is decreased (<80% of predicted normal)
FVC is also decresed (<80% of predicted normal)
But since boith are decreased, the FEV1/FVC ratio remains same
Difference between obstructive and restrictive lung disease?
Obstructive: inflamed airways..bronchioles affected
Restrivtive: Actual lung tissue affected (lung volume affected , as lung gets stiff and doesnt fully expand)
Why do some people have barrel chest appearance?
Too much air trapped in lungs as airways have collapsed. Seen in Emphysema (where the airways have collapsed due to loss of alveolar function, and so air is trapped in lungs
What factors need to be considered to calculate normal predicted Spirometry values?
Age, height, gender(sex), ethnicity
What is required for consistent, good spirometry results?
3 volume time graphs that are 5% within each other, or within 100ml of each other.
Use the best of the 3 graphs
What factors could affect spirometry and give inaccurate results?
Coughing while expiration Mouth not sealed properly Taking an extra breath while expiring Sub-maximal effort Expiring slowly
What is Ejection systolic murmur?
Crescendo- descendo mumur heard during Systole of heart, and conditions include (Aortic and pumonary stenosis)
What is Pan-systolic murmur?
This is murmurs heard during Mitral regurgitation and tricuspid regurgitation
If a mumur radiates to carotid arteries what murmur does it indicate?
Aortic stenosis
If a murmur radiates to axilla what murmur does it indicate?
mitral regurgitation
