Cardio/resp/renal Flashcards by Hamish Reed-Embleton

Sumatriptan cardiac risk?

Vasospasm -> dull chest pain

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Cardiovascularly stable with broad complex tachy. Previous episodes of SVT with underlying LBBB
Rx?

Adenosine

[likely SVT again]

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FEV1 cut off for pneumonectomy

<2L

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Long QT + congenital deafness

Jervell-lange-neilson syndrome

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LUL collapse

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ABPI to require US and arteriogram

<0.5

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Clicking sound which is synchronous with heartbeat with normal CXR= ? Rx? How could you make Dx?

Small apical pneumothorax

If well - analgesia and follow-up in the clinic

Lateral decubitus CXR

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55F
Wheeze, hot flushes worse with alcohol. Haemoptysis
=? rx?

Bronchial carcinoid

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20M
Hypertrophied calves, weakness in proximal muscles. Heart failure
Raised CK

Becker muscular dystrophy
[Presents as mild duchenne which would be bad by age 5]

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Progressive muscle weakness with increase tone and cardiac conduction defects

Myotonic dystrophy

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Poorly controlled heart failure despite optiomal medication
now ECG shows?
RX?

LBBB
Cardiac resynchronisation therapy defibrilator

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Dialysis long term now with gut motility issues / carpal tunnel?

Beta2-microglobulin deposition

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Flu like symptoms then significant pneumonia = ? rx?

Staph

Fluclox
linezolid if allergic

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What are the absolute indications for insertion of a chest drain in an effusion after aspiration?

Organisms on gram stain / culture
Frank puss
LDH >1000
pH <7.2
Glucose <3.3

[Organisms or 1, (7.)2, 3.3]

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Work with metals and now restrictive Lung fibrosis

Berylliosis

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Brady cardia with compromise. What would dose of adrenaline be if you had no atropine

2-10mcg IV

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AF when anticoagulate? Score points?

≥2 for men or ≥3 for women is “moderate-high” risk and should otherwise be an anticoagulation candidate.

Chadsvasc
congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female)

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Symptomatic AS, what needs to happen before AVR?

Coronary angiography - as may need CABG at time of operation

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Previous TB and had an operation - what does this show?

Thoracoplasty - removal of ribs to a collapsed ara of lung

[Upper lobe ectomy would have elevated right hemidiaphragm and displacement of right hilum]

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CURB65 points for?

Age > 65
confusion <9 on AMTS
Urea > 7
RR > 30
BP <90 Systolic or <60 diastolic

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Pseudomonas pneumonia rx? second line?

Oral quinolone eg cipro OR
IV Tazocin

IV colistin second line

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Obstructive LFTs how to differentiate COPD and Asthma

Transfer factor
COPD - likely low
Asthma - normal or raised

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COPD mild mod severe FEV1

mod 50-70%
severe 30-49%
very severe <30%

(mild 70-80% with symptoms of cough / sob]

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ANCAs ?

PR3 (C) ANCA - Granulomatosis with polyangitis

MPO (P) ANCA - Churg

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Which diabetic drugs worsen heart failure

thiazolidinediones Eg pioglitazone

Aspergilloma rx in healthy? with poor functional status

Lobectomy Bronchial artery embolisation

Intermittent catheterisation with bacteruria but no evidence of sepsis rx?

Increase fluids + catheter change frequency

Nodular rash on shins, fatigue breathlessness =? rx?

Sarcoid Pred

CFTR mutation is

DF508

'crazy paving' pattern on CT Bronch - PAS positive proteinaceous fluid

Pulmonary alveolar proteinosis

Following needle aspiration of a pneumothorax, when would you put in a chest drain

Still >1cm

Mitral valve prothesis with clot and features of shock

IV alteplase - OR surgery if available If stable - IV heparin

Who gets a 6-week CXR following CAP

All >50 persistence of symptoms

RTA - reason? K? Conditions? Which can have urinary ph lowered by increasing acid load? Type 1 Type 2 Type 4

Type 1 distal - Failure of H+ secretion Autoimmune conditions/amphoB/liver disease HypoK Osteomalacia, renal stones, Nephrocalcinosis Type 2 proximal - Bicarb wasting Wilsons / heavy metal / myeloma / amyloid HypoK Uric acid stones, ostomalacia -Urinary pH lowered with increasing Acid load Type 4 - reduced aldosterone/resistance HyperK Addisons / long term NSAID

Test for orthostatic hypotension

Tilt table test

Blind but denying they can't see?

Cortical blindness - eg bilat occipital infarcts

pneumonia with autoimmune haemolytic anaemia

Mycoplasma pneumonia clarithromycin

Left lower lobe collapse

ASD and tricuspid defect in a baby

ebsteins abnormality

LBBB M shaped in aVL Notched R in 1 Monophasic R in v6

Palmar xanthoma =

dysbetalipoproteinaemia

What do they get

Yellow nail syndrome Bronchiectasis Pleural effusions lymphoedema

20s Episodes of collapse

Long QT - Romano ward syndrome most likely

CKD with low Ca and raised PTH first line Rx

Alphacalcidol

GPA which ANCA

cANCA

PR3 antibodies in

GPA

50s wheeze and SOB. CXR peripheral infiltrates Raised IgG and eosinophils =

Chronic eosinophilic pneumonia Allergic bronchopulmonary aspergilliosis would have raised IgE not IgG

Silent chest, exhaustion, cyanosis and arrythmia are all life threatn=ening asthma. What are the values also included PO2, PCO2, SPO2, PEF

PO2 <8 PCO2 4.6-6 (Normal ) spo2 <92% pef <33%

dominant HTN, HypoK, alkalosis and low renin / aldosterone = ? rx?

Liddle Amiloride

CKD then MRI with contrast now thickened skin and reduced joint movements

Nephrogenic systemic fibrosis

ECG which shows decreasing QRS amplitude from v1-v6, RAD, ? What condition do they often have

Dextrocardia Often get bronchietasis

Psuedomonas in sputum rx

Any of: 3rd generation cef - eg ceftazidime meropenem azetreonam

Noonan syndrome JVP prominent A waves Soft systolic murmur left sternal edge pitting oedema

Pulmonary stenosis [evidence R sided HF]

primary pulm HTN Rx if positive acute vasoreactivity testing? negative?

Positive CCB eg amlidipine Negative - PDE5 Inhibitor

Chronic cough and abnormal ECG which syndrome?

Kartageners Dextrocardia and bronciectasis

Which in RIPE should not be given with chronic liver disease

Pyrazidamine

Bronchiectasis

Preg with Sx of PE but no concern 1st line Ix?

CXR Then either CTPA (more risk to mother) or VQ scan (more risk to fetus)

Demonstrates?

Concave = obstructive

PE - Right heart strain A large S wave in lead I, Q wave in lead III inverted T wave in lead III §

Wilsons with increase urinary bicarb loss? Which other syndrome common to cause this type

RTA type 2 fanconi syndrome

Recent thrombolysis for MI Now shocked BP, raised JVP

ECG - electeral alterans with tachy = Tamponade needs cardiocentesis

angina 1st line rx for long term

B blocker or CCB

Taking cocaine

AVNRT Absence of p waves and pseudo r wave in v1

Chronic colonised with pseudomonas in CF and now worsening next line?

6 months azithro

Describe sarcoid granuloma

Prominent epitheliod cells with sparse lymphocytic infiltrate at the margins

SVT terminated now this which is?

WPW

1st line immunoupressant for systemic sclerosis

Mycophenolate

Farmer with pulm fibrosis

Extrinsic allergic alveolitis

Nephrotic syndrome in older adult

FSGN

Infertile, cough, sinusitis,

Kartegener syndrome look at heart

RBBB and ST elevation in right precordil leads following episode of VF is

Brugada

Fertility in CF

Men 98% infirtile women can get preg

Rheumatic heart disease and asthma in new fast AF

IV verapamil

Flash pulmonary oedema and HTN in <50? >50?

<50 Fibromuscular dysplasia >50 renl artery stenosis [Q should give renal function]

Bar splinter haemorhhages and olser / Janeway - other finding of IE

Microscopic haematuria

DVT, cerebral aneurysm, oral ulcers and anterior uveitis

Bechets

Pain on exercise with passing dark urine after? key ix?

McArdle syndrome Muscle biposy [CK too]

SIADH getting fluid restriction. 3 days in level still 125 rx?

Demeoxycline

sarcoid granulomas stimulate

1-alpha hydroxylase [leads to increased vit D and calcium absorption ]

Myastenia what Ix is most commonly positive

EMG 95% Anti Ach 85% Anti Musk 10%

Symptoms of ectopics bothersome but normal enough heart?

Bisoprolol for symptom control

Bloods in HSV encephalitis

Normal WCC raised CRP

Vaccine followed by pain in shoulder and 1 sided weakness

Brachial neuritis

Jamacain with bihilar lymphadeonpathy on CXR + sx of cardiac failure next iX

CT chest

Sx of heart failure with normal ejection fraction?

Restrictive cardiomyopathy

Nephrotic syndrome treated then couple weeks later mild pyrexia and sudden deterioration in renal function

Renal vein thrombosis

Trauma -> surgical emphysema and pleural effusion with mild raised amylase

Oesophageal rupture

tilt table test -> 4s pause rx

Dual chamber pace maker

hilar mass suspicious of malignancy on CXR ix in order?

CT Then bronch

CURB rx

1 - oral home 2 - IV 3 - hdu

CKD5 with rapid progressive sclerosis cause?

galoinium exposure (angio) [b-2-microglobin is slow sx]

Pericarditis stepwise rc

NSAID Colchicine Pred

U waves in V2-5 most obvious [Small deflection following T wave]

benzbromarone for gout issue

Increases urate excretion -> increased urate renal stones

FHx CV disease Raised LDL/Triglycerides =? rx? 2nd?

Familial combined hyperlipidaemia Statin 1st line [eZETIMBE second] [Fibrates added for hypertriglyceridemia really high or only things raised]

Mesothelioma at L apex Plaques on diaphragm

Loss of vision then common peroneal palsy ANCA negative Livido reticularis Renal aneurysms

PAN

LTOT in COPD in those with PaO2 <8 + what?

Peripheral oedema Polycythemia (HCT >55%) or Pulm HTN [Peri, poly, pulm]

Colonic Ca removal and now endocarditis 1 week later but strep bovis not an option

Bacteroides fragilis

Presents as CF but with low protein and normal albumin

X linked hypogammaglobulinaemia

RVH Right axis deviation (+150 degrees). Dominant R wave in V1 (> 7 mm tall; R/S ratio > 1) Dominant S wave in V6 (> 7 mm deep; R/S ratio < 1). Right ventricular strain pattern with ST depression and T-wave inversion in V1-4.

Asx new diagnosis of mobitz type 1 block rx?

Discharge

Marfans with 2.5cm PTX stable

Aspirate

High altitude pulm odema rx ? 2nd?

High concentration O2 nifedipine second line

High altitude pulm odema rx ? 2nd?

High concentration O2 nifedipine second line

Key Ix for coarctation

Echo

Sickle cell which RTA

Type 1

Few syncopal sensations and QT 0.49s rx

B blocker

Make diagnosis of AIN

Biopsy

IHD LVF COPD in stable fast AF borderline low BP

IV digoxin

MI 2 weeks later pyrexic with raised ESR cardiomegaly and pericardial effusion = ? rx?

Dresslers Aspirin 650mg QDS

Angina Rx if already on BB and CCB

Ivabradine / nitrate

slow aortic root dilation in marfans

Bisoprolol

Previous chemoradio now SOB ECG - small voltage QRS Decrease of BP on inspiration

Pericardial effusion

When can you diagnose obestety hypoventilation syndrome

BMI >30 PCO2 >6.5 during the DAY [absence of other causes eg opioids] [They may have coexistent OSA!]

Alports gets a renal transplant and then few months later rapidly worsening renal function and kidney failed

Anti GBM disease (both collagen IV]

30s weight loss and new murmur with episodes of collapse. Murmur variable on position. clubbing Calcification on CXR

Atrial myexoma

30s weight loss and new murmur with episodes of collapse. Murmur variable on position. clubbing Calcification on CXR

Atrial myxoma

Definitive Dx of sarcoid

Transbronchial biopsies [not endobronchial]

COPD on Salbutamol. Next line if No reversibility? Reversibility?

None - LAMA + LABA Some - LABA + ICS

SOBOE with noisy breathing Ix

Flow volume loop - likely upper airway

LVF on ramipril. Worsening sx and evidence of overload on exam next line

Spironolactone [both better heart and diuretic]

FVC for respiratory support in gillian barre

<20ml/kg eg 50kg = 1L

LLL collapse sail sigh - double heart border

Jewish, nephrotic syndrome, severe fevers, arthritis

Familal mediterranian fever

Brugada