cardio/ resp Flashcards
What signs are associated with mitral stenosis?
malar flush on cheeks.
regular, low-volume pulse
mid-diastolic murmur loudest with the patient leaning to left, at apex
Can cause AF due to atrial enlargement
Thinks ARMS - atrial regurg early murmur, followed by MS with mid murmur
What signs are associated with aortic regurgitation?
early diastolic murmur over aortic area: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
What are all MI patients discharged on?
beta blocker
aspirin
ticagrelor / second line anti-platelet (DAPT - this is stopped at 12 months post MI
ACE inhibitor
statin
1st, 2nd line and 3rd line mx of HF?
1st - BB (carvedilol or bisoprolol) + ACE-i
2nd - spironolactone (also think of SGLT-2 inhib if diabetic) then consider SGLT-2 inhib - in hfref
3rd- initiated by a specialist. Options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy
It cardiac arrest is witnessed on a monitor how should ALS be done
Witnessed cardiac arrest while on a monitor - up to three successive shocks before CPR
When do patients get fibrinolysis for a STEMI?
should be offered within 12 hours of the onset of symptoms if primary PCI cannot be delivered within 120 minutesof the time when fibrinolysis could have been given. Should be given wtih an antithrombin drug eg fondaparinux
dresslers syndrome - what is it?
dresslers syndrome is pericarditis secondary to MI, occurs 3-6 weeks after MI
What is Beck’s triad?
What can cause it?
Muffled heart sounds + JVP raised + hypotension indicate Beck’s Triad -> cardiac tamponade
LV free wall rupturet MI
Treatment for angina (initial)? 2nd line add in if uncontrolled? 3rd line?
Initial: bisoprolol, GTN, aspirin and statin OR if BB CI then start rate limiting CCB eg verapamil
2nd: longer-acting dihydropyridine calcium channel blocker should be added eg Nifedipine, amlodipine
3rd: a long-acting nitrate/ ivabradine/ nicorandil/ ranolazine + refer to cardiology for PCI assessment
What can be found on CXRs for bronchiectasis?
Parallel line shadows (often called tram-lines) are common in bronchiectasis and indicate dilated bronchi due to peribronchial inflammation and fibrosis.
What is the 4th line management for BP?
if potassium < 4.5 mmol/l add low-dose spironolactone
if potassium > 4.5 mmol/l add an alpha- or beta-blocker
When are prophylactic abx used in COPD? Which abx are used?
250mg azithromycin three times per week if:
Non-smoking
On maximum medical mx
Had pulmonary rehab
4 acute exacerbations in the last year (producing sputum), requiring hospital admission at least once.
Howdo you interpret lung function tests?(restrictive vs obstructive)
FVC - reduced, FEV1 - reduced FEV1/FVC - normal.
Restrictive lung disease - scarring of lung means reduced compliance and capacity.
Reduced forced vital capacity (FVC) as decreased compliance. FEV1 decreases at same rate so means when devided is normal.
FEV1 - reduced, FEV1/FVC - reduced
obstructive diseases eg COPD, asthma, or bronchiectasis
Obstruction to airflow which means it is hard to exhale. FEV1 is reduced. FVC is normal/ slightly low. So ratio is low.
Mx of spontaneous pnuemothorax? High risk features?
High risk features:
haemodynamically unstable
hypoxia
bilateral
underlying lung disease
>50 with sig smoking history
haemopneumothorax
If patient asx/ pneumothorax not big enough to drain - conservative mx
If patient sx + high risk + >2cm on CXR —> chest drain
If patient sx + low risk + >2cm on CXR —> needle aspiration/ ambulatory device
What are electrolyte causes of prolonged QT and potential VT?
hypocalcaemia, hypokalaemia, hypomagnesaemia
osler nodes vs janeway lesions?
Janeway lesions - erythematous macular or nodular lesions caused by septic emboli
osler nodes - painful erythematous lesions caused by immune complex deposition
what venturi mask should you use on CO2 retainers if NOT critically ill
28% Venturi mask at 4 litres/min is used prior to the results of blood gases in patients with risk factors for hypercapnia aiming for oxygen saturation of 88-92%.
If critically ill just whack on 15L
What are the rate limiting CCB? What are the dihydropyrodine CCB?
rate-limiting one such as verapamil or diltiazem
onger-acting dihydropyridine calcium channel blocker e.g. amlodipine, modified-release nifedipine
