Cardio And Resp Flashcards
Treatment for chronic bronchitis exacerbation?
Amoxicillin OR Tetracycline OR
Clarithromycin
Treatment for community acquired pneumonia?
Amoxicillin
If penicillin allergic: doxy or clarithromycin
Add flucloxacillin if staph ylococci suspected e.g. in influenza
Treatment for pneumonia with cause suspected to be aytypical?
Clarithromycin
Treatment for hospital acquired pneumonia?
Within 5 days of admission- co-amoxiclav or cefurotaxime
> 5days- piperacillin c tazobactam
OR
Broad spectrum cephalosporin (e.g. ceftazidime)
OR
Quinolone e.g. ciprofloxacin
What classes an asthma attack as severe?
One of following
- can’t complete sentences
- peak expiratory flow rate 33-50%
- RR >25
- Pulse >110
What classes an asthma attack as life threatening?
One of following
- peaks expiratory flow <33%
- O2 sats <92%
- silent chest
- cyanosis or feeble resp effort
- bradycardia
- dysarrythmia
- hypotension
- exhaustion, confusion or coma
Patient with a fever, dry cough and severe sob has severe Crohn’s. What is it likely to be and how what medication would you treat it with?
Pneumocystitis jiroveci pneumonia
Patient may be in long term steroids so immunosuppressed. Rare fungal cause
Co-trimoxazole
- a combo of trimethoprim and sulfamethoxazole
Which regions of an ECG are the lateral leads?
I, aVL, V5, V6
What regions on an ECG represent the anterior aspect of the heart?
What’s artery supplies it?
V1-V4
Supplied by the left anterior descending (LAD) artery
What regions on an ECG represent the inferior aspect of the heart?
What’s artery supplies it?
II, III, aVF
Right coronary artery
Changes to ECGs post STEMI?
Immediate
- hyperacute T waves
- then… ST elevation or new LBBB
Over next few days
- pathological Q waves
- T wave inversion
Complications post MI?
Cardiac arrest
Arrhythmias
Heart failure
DVT/PE
Pericarditis
Causes of acute pulmonary oedema?
Post MI
Valvular disease
Arrhythmias e.g. complete heart block
Non- cardiac
- fluid overload due to renal failure or overloaded
- post head injury
- ARDS
What region of an ECG is represented by I, II and aVF?
What artery supplies this area?
Inferior leads
Right coronary artery
Management of Tousades des pointes
Can spontaneously resolve or develop onto VT
Correct cause e.g electrolyte abnormality or medications
Magnesium infusion, even if Mg normal
Defibrillation if VT occurs
Symptoms of left ventricular failure
Dyspnoea
Reduced exercise tolerance
Fatigue
Paroxysmal nocturnal dyspnoea
Orthopnoea- worse lying flat
Wheeze
Cough- worse at night
Pink frothy sputum
CXR signs for heart failure
Cardiomegaly
Pleural effusions
Kerley B lines
Alveolar/interstitial oedema in bat wing distribution
Upper lobe diversion
Fluid in lung fissures
Furosemide MOA?
Competitively inhibits Na-K-2Cl cotransporter
in the thick ascending loop of Henle
reducing osmotic gradient for water reabsorption
Hypertensive retinopathy signs?
Silver/copper wiring
A-V nipping
Flame hemorrhages
Cotton wool spots
Papilloedema
ACEi side effects?
Dry cough
Hypotension- particularly first dose
Renal impairment
Hyperkalaemia
Angioedma/ urticaria
Hypertension complications?
Heart failure
Stroke
Aneurysmal disease
IHD
CKD- hypertensive nephropathy
Hypertensive retinopathy
Peripheral vasculopathy
Hypercholesterolaemia signs?
Xanthelasma- yellowing growths around eyes
Tendon xanthoma
Corneal arcus
Other xanthomatas e.g. palmar, eruptive, tuberous
Gout immediate and long term tx?
Immediate
- NSAIDS
- Colcichine
Long term (only)
- Allopurinol
Causes of AF?
Pneumonia
Heart failure
Post MI
PE
Hyperthyroidism
Alcohol excess
Endocarditis
Most common microorganism causing infective endocarditis?
Viridens streptococci
Eye manifestation of infective endocarditis?
Roth spot
Which are boat shaped retinal hemorrhages with a pale center
Criteria for diagnosing infective endocarditis?
Duke criteria
What causes an early diastolic murmur? And other signs of this cause?
Aortic regurgitation
Collapsing pulse
Wide pulse pressure
Displaced apex beat
Signs and symptoms of infective endocarditis?
Fever and new murmur- high suspicion
Symptoms
- fever
- rigors
- night sweats
- dyspnoea
- general malaise
Signs
- Hands: clubbing, splinter haemorages, Oslers nodes, Janeway lesions
- Eyes/fundi- Roth spots
- Urine dip- microscopic haematuria
IVDU endocarditis most common cause?
Staph aureus, more likely introduced from skin and venous system
ECG regions and their supplying artery?
Anterior aspect
LAD
V1-V4
Inferior aspect
RCA
II, III, aVF
Lateral aspect
Circumflex
I, V5, V6
ECG changes in I, V5 and V6. Region and artery supply?
Lateral aspect + aVL
Supplied by circumflex artery
ECG changes in II, III and aVF. Region and artery supply?
Inferior aspect
RCA
Difference between the second degree heart blocks Mobitz I (Wenkebank) and Mobitz II?
Mobitz I- PR interval progressivly lengthens until P wave dropped
Mobitz II- PR interval constant but P wave is often not followed by a QRS complex
What is first degree heart block?
Prolonged PR interval >0.2 seconds
Can be normal in athletes
Signs of right sided heart failure?
Raised JVP
Ankle oedema
Hepatomegaly
What is the CURB-65 score used for?
Stratifying risk for community acquired pneumonia assessing severity and guides whether tx should be as an in or outpatient
What are the scoring factors in the CURB-65
Confusion
Urea >7 mmol/l
Resp rate >30
BP sys <90 or dias <60
>65 yo
What do the points scored in the CURB-65 indicate for treatment?
And there prediction of mortality?
0-1: low risk- less than 3% mortality–> outpatient care
2: intermediate risk- 15% risk –> inpatient care
3-5: high risk- >15% risk –> inpatient/consider ITU
0-1:
Most common causes of CAP?
Haem.influenzae
Strep.pneumoniae
Mycoplasma.pneumoniae
Atypical
Staph.aureus
Legionella.pneumophila
What resp problem can cause Cushing’s syndrome?
Small cell lung cancers
Can release ACTH causing cortisol release, leading to cushings syndrome
COPD medical first line?
SABA OR SAMA
SABA e.g. salbutamol
SAMA e.g. salmeterol
2nd line COPD drug treatment?
If asthmatic features, likely steroid responsive- add LABA and ICS regularly
If no asthmatic features- LABA and LAMA regularly
Example of a LABA
Salmeterol
Formoterol
LAMA examples?
Long acting muscarinic antagonists
Tiotropium
Glycopyrronium
Features of cor pulmonale?
Peripheral oedema
Raised jugular venous pressure
Systolic parasternal heave
Loud o2
Management of cor pulmonale?
Loop diuretic for oedema e.g. furosemide
?long term O2 therapy
How do you differentiate between transudatuve and exudative pleural effusions?
Exudative- protein level >30g/L
Transudative- protein level <30g/L
Causes of transudative pleural effusions?
Cardiac failure
Cirrhosis
Renal failure
Causes of exudative pleural effusions?
Have high protein content
Commonly caused by
Infection
Inflammation
Malignancy
