Cardio/resp/renal Flashcards
Sumatriptan cardiac risk?
Vasospasm -> dull chest pain
Cardiovascularly stable with broad complex tachy. Previous episodes of SVT with underlying LBBB
Rx?
Adenosine
[likely SVT again]
FEV1 cut off for pneumonectomy
<2L
Long QT + congenital deafness
Jervell-lange-neilson syndrome
LUL collapse
ABPI to require US and arteriogram
<0.5
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
55F
Wheeze, hot flushes worse with alcohol. Haemoptysis
=? rx?
Bronchial carcinoid
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]
Progressive muscle weakness with increase tone and cardiac conduction defects
Myotonic dystrophy
Poorly controlled heart failure despite optiomal medication
now ECG shows?
RX?
LBBB
Cardiac resynchronisation therapy defibrilator
Dialysis long term now with gut motility issues / carpal tunnel?
Beta2-microglobulin deposition
Flu like symptoms then significant pneumonia = ? rx?
Staph
Fluclox
linezolid if allergic
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]
Work with metals and now restrictive Lung fibrosis
Berylliosis
Brady cardia with compromise. What would dose of adrenaline be if you had no atropine
2-10mcg IV
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)
Symptomatic AS, what needs to happen before AVR?
Coronary angiography - as may need CABG at time of operation
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]
CURB65 points for?
Age > 65
confusion <9 on AMTS
Urea > 7
RR > 30
BP <90 Systolic or <60 diastolic
Pseudomonas pneumonia rx? second line?
Oral quinolone eg cipro OR
IV Tazocin
IV colistin second line
Obstructive LFTs how to differentiate COPD and Asthma
Transfer factor
COPD - likely low
Asthma - normal or raised
COPD mild mod severe FEV1
mod 50-70%
severe 30-49%
very severe <30%
(mild 70-80% with symptoms of cough / sob]
ANCAs ?
PR3 (C) ANCA - Granulomatosis with polyangitis
MPO (P) ANCA - Churg
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