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MRCEM INTERMEDIATE > Cardio-Respiratory > Flashcards

Cardio-Respiratory Flashcards

1
Q

Protein levels in transudate and exudative fluid

A

Transudate <25 g/L
Exudate >35g/L

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2
Q

Kussmaul’s sign

A

Kussmaul’s sign is a paradoxical rise in jugular venous pressure on inspiration

is usually indicative of limited right ventricular filling due to right heart dysfunction

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3
Q

Which wave should a DC shock be synchronised with?

A

R wave

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4
Q

Central venous wave form

a wave

c

x descent

v wave

y descent

A

Atrial systole (end diastole)

Isovolumetric contraction (early systole)

Rapid ventricular ejection (mid systole)

Ventricular ejection and isovolumetric relaxation (late systole)

Early ventricular diastole

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5
Q

Indications for starting NIV in COPD?

A

pH < 7.35
pCO2 > 6.5
RR > 23

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6
Q

CPAP starting pressure

A

5-10

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7
Q

BiPAP initial pressures for COPD

A

EPAP - 3 (higher if known OSA)

IPAP - 15 (20 if pH < 7.25)

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8
Q

FEV1/FVC ratio that indicates COPD?

A

<0.7

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9
Q

Pattern on ECG showing PE (In leads I-III)

A

S1, Q3, T3

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10
Q

Prolonged QTC in:

Women
Men

A

460

440

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11
Q

Pulse in AS

Pulse pressure

A

Slow rising

Narrow

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12
Q

Causes of acute AR

A

Aortic dissection
IE
Ruptured aortic valve leaflet

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13
Q

Pulse in AR

Pulse pressure

A

Water hammer

Widened

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14
Q

Where is AR best heard

A

L. sternal edge in expiration

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15
Q

Adverse features in arrhythmias

A

Shock
HF
Myocardial ischaemia
Syncope

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16
Q

MR murmur =

A

pansystolic

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17
Q

Dose for atropine

A

500mcg every 3-5 mins to a total of 3mg

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18
Q

Management of Mobitz type 2 HB with bradycardia

A

Treat as if adverse features ie 500mcg of atropine every 3-5 mins to a total of 3mg

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19
Q

How to manage tachycardia with adverse features

A

Synchronised cardioversion

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20
Q

How many J do you start at for synchronised cardioversion in a broad complex tachycardia

A

120-150J

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21
Q

How many J do you start at for synchronised cardioversion in a narrow complex tachycardia

A

70 - 120J

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22
Q

Pad position in AFib/flutter when doing synchronised cardioversion

A

AP

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23
Q

If cardioversion fails what drug can be given in tachycardia

A

300mg amiodarone over 10-20mins and reattempt

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24
Q

Regular broad complex tachycardia (VT) without adverse features, treatment

A

Amiodarone

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25
Q

Regular narrow complex tachycardia with BBB without adverse features, treatment

A

Treat as narrow complex if bundle branch already known

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26
Q

Irregular broad complex tachycardia (most likely AF with bundle branch block) treatment

A

Treat as irregular narrow complex (AF)

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27
Q

ECG features of atrial fibrillation in WPW

A

Rate > 200 bpm
Irregular rhythm, with extremely high rates in some places — up to 300 bpm (this is too rapid to be conducted via the AV node)
Wide QRS complexes due to abnormal ventricular depolarisation via AP
Subtle beat-to-beat variation in QRS morphology
Axis remains stable, unlike Polymorphic VT

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28
Q

Torsade de pointes management

A

Stop all QT prolonging drugs and give magnesium 2g over 10 mins

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29
Q

When not to give adenosine in narrow complex tachycardia

A

Atrial flutter

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30
Q

4 things that make a bradycardia at high risk of asystole

A

Recent asystole
Mobitz type II
Complete heart block with broad QRS
Ventricular pause >3 secs

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31
Q

Stable patient with WPW + AF

Unstable

A

Procainamide

Cardioversion

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32
Q

How to recognise an aortic regurgitation murmur

A

Diastolic
Soft, blowing
L. sternal edge
Heard best on expiration

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33
Q

Recognising TR

A

Soft pansystolic murmur, left sternal edge, heard best on inspiration, 3rd heart sound

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34
Q

High risk characteristics of a patient with a pneumothorax

A

Haemodynamic compromise
Significant hypoxia
Bilateral
Underlying lung disease
>50 + w/ smoking hx
Haemopneumothorax

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35
Q

Inability to complete sentences in one breath = what severity of asthma

A

Severe

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36
Q

Moderate adult asthma exacerbation

A

PEFR more than 50–75% best or predicted (at least 50% best or predicted in children) and normal speech, with no features of acute severe or life-threatening asthma.

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37
Q

Severe adult asthma exacerbation

A

PEFR 33–50% best or predicted
OR respiratory rate of at least 25/min
or pulse rate of at least 110/min
or inability to complete sentences in one breath
or accessory muscle use

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38
Q

Life-threatening adult asthma severity

A

PEFR less than 33% best or predicted
or oxygen saturation of less than 92%

OR NORMAL CO2

or altered consciousness
or exhaustion
or cardiac arrhythmia
or hypotension
or cyanosis
or poor respiratory effort
or silent chest
or confusion

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39
Q

What on an ECG is suggestive of a posterior STEMI ?

A

ST depression and upright TW in V1-3

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40
Q

What ECG finding is most suggestive of an NSTEMI

A

TWI in V2

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41
Q

First line treatment in a hypertensive emergency due to pheochromocytoma

A

Phentolamine (alpha blocker)

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42
Q

Define malignant hypertension

A

Hypertensive emergency with retinopathy grade III / IV

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43
Q

Define hypertensive emergency

A

A hypertensive emergency is severe hypertension (often defined as systolic blood pressure (BP) ≥ 180 mm Hg and/or diastolic blood pressure ≥ 120 mm Hg) with signs of damage to target organs (primarily the brain, cardiovascular system, and kidneys).

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44
Q

First line tx for malignant hypertension, hypertensive encephalopathy or ICH

A

Labetalol

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45
Q

Hypertensive emergency + MI 1st line tx

A

GTN + esmolol

Esmolol decreases HR
GTN reduces pre-load and cardiac output, so increasing coronary blood flow

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46
Q

Hypertensive emergency + APO 1st line tx

A

GTN or clevidipine

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47
Q

Hypertensive emergency + AKI 1st line tx

A

Fenoldopam

Decreases afterload and increases renal perfusion

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48
Q

Most common organism causing pneumonia

A

Streptococcus pneumoniae

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49
Q

ST elevation in V1 - V2

Myocardial area
Vessel

A

Septal
Proximal LAD

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50
Q

ST elevation in V3 - V4

Myocardial area
Vessel

A

Anterior
LAD

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51
Q

ST elevation in V5 - V6, I, aVL

Myocardial area
Vessel

A

Lateral
Left circumflex

52
Q

ST elevation in V1-4

Myocardial area
Vessel

A

Anteroseptal
LAD

53
Q

ST elevation in V3 - V6, I, aVL (R: II, III, aVF)

Myocardial area
Vessel

A

Anterolateral
LAD or left circumflex

54
Q

ST elevation in II, III, aVF (R: I, aVL)

Myocardial area
Vessel

A

Inferior
RCA

55
Q

ST elevation in R: V1 - V3 (P: V7 - V9)

Myocardial area
Vessel

A

Posterior
RCA or left circumflex

56
Q

What denotes near fatal asthma

A

Raised pCO2 and or requring mechanical ventilation with increased pressures

57
Q

Malar flush is seen in ?

A

Mitral stenosis

58
Q

Variant angina

A

Coronary artery spasm
Often at rest
Relieved by GTN

59
Q

After how many hrs is STEMI medically managed (ie no reperfusion therapies)

A

12 hrs

60
Q

When is thrombolysis offered instead of PCI

A

Can’t get to PCI centre within 120 mins

61
Q

First line DAPT in STEMI having PCI

Except over what age

A

Aspirin + Prasugrel

except in age over 75 due to bleeding risk / benefit

62
Q

If cocaine user presents with CP and ECG changes (even if symptoms resolving), how to treat

A

Treat as an NSTEMI

63
Q

Why is GTN contraindicated in an Inferior STEMI

A

Due to poor RV function, become preload dependent, GTN reduced preload

64
Q

Why inferior STEMI most likely to get HB

A

Right coronary supplies the SA and AV node

65
Q

Early complication of anterior STEMI

A

LV dysfunction and pulmonary oedema

66
Q

Pericarditis ecg changes

A

1) diffuse ST elevation and/or PR depression, 2) normalization of ST- and PR-segments, 3) diffuse T-wave inversions with isoelectric ST-segments, and 4) normalization of the ECG.

67
Q

Most specific test for HF

A

BNP, if <100 NOT YOUR HEART

68
Q

Drug that will aggrevate HF

A

NSAIDs

69
Q

Why might an early diastolic murmur be found in aortic dissection?

A

Stanford A, impacts on the root
Aortic regurgitation

70
Q

Where is beta blockers contraindicated for AF

A

Anyone with airway issues e.g. COPD / asthma
Insulin dependent diabetics
PVD

71
Q

When is flecanide contraindicated in AF

What is used instead for chemical cardioversion

A

Not had an echo
Any known structural heart disease

Amiodarone

72
Q

Classic hypothermia ECG change

A

J wave

73
Q

Microorganism in sub acute IE

A

Strep viridans (from the mouth)
settles on abnormal valves

74
Q

Valve targeted by Staph. areus causing IE (via IVDU usually)

A

Tricuspid

75
Q

Any murmur loader on inspiration is on which side?

A

Right

76
Q

Electrolyte abnormality leading to torsades

A

Hypocalcaemia

77
Q

Causes of a +ve V1

A

Posterior infarct
RBBBNormal in children and young adults.
Right Ventricular Hypertrophy (RVH) …
Right Bundle Branch Block (RBBB)
Posterior Myocardial Infarction (ST elevation in Leads V7, V8, V9)
Wolff-Parkinson-White (WPW) Type A.
Incorrect lead placement (e.g. V1 and V3 reversed)
Dextrocardia.

78
Q

Most common SVT in young patients

A

AV node re-entrant tachycardia

79
Q

Risk asystole

A

Recent asytole
Mobitz type 2
Complete HB with broad QRS
Ventricular pauses > 3 secs

80
Q

Average peak flow in men and women

A

600

450

81
Q

Chest drain size for pneumothorax

A

8-14

82
Q

High risk in context of pneumothorax

A

Haemodynamic instability
Hypoxia
Bilateral
Underlyinh lung disease
50+ w/ significant smoking hx
Haemopneumothorax

83
Q

When is a DOAC contrainidicated in diagnosed PE

A

Cancer
Anti phospholipid
Haemodynamic instability
Renal impairement

84
Q

FEV1/FVC ratio in restrictive lung disease

A

High FEV1/FVC ratio

85
Q

Which lung conditions need an increase I:E when ventilating

A

Obstructive, to get rid of CO2

86
Q

Criteria for the diagnosis of ARDS

A

Onset within 1 week
Bilateral opacities on CXR
Ratio of PaO2/FiO2 of <300 on PEEP 5 or CPAP 5

87
Q

Loading dose of aminophylline (IV)

A

5mg/kg over 10-20 mins

88
Q

Blood gas finding at altitude

A

Respiratory alkalosis

89
Q

The typical ECG features of WPW in sinus rhythm are:

A

Shortened PR (<120 ms)
Delta wave (slurring of the initial rise in the QRS complex)
Widening of the QRS complex (>110 ms)

90
Q

How to identify type A WPW

A

Predominantly positive delta wave and QRS in the precordial leads, can resemble RBBB in V1

91
Q

How to identify type B WPW

A

The delta wave and QRS complex are predominantly negative in leads V1 and V2 and positive in the other praecordial leads, resembling LBBB

92
Q

Bivalirudin

A

specific and reversible direct thrombin inhibitor (DTI). NICE recommends it as a possible treatment for adults with STEMI who are having percutaneous coronary intervention.

93
Q

Recognised risk factors for aortic dissection include:

A

Hypertension
Atherosclerosis
Aortic coarctation
Sympathomimetic drug use, e.g. cocaine
Marfan syndrome
Ehlers-Danlos syndrome
Turner’s syndrome
Tertiary syphilis
Pre-existing aortic aneurysm

94
Q

Wellens syndrome

A

is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for critical stenosis of the left anterior descending artery (LAD).

95
Q

Tietze’s syndrome

A

is a rare disorder that causes localized pain and tenderness in one or more of the upper four ribs.

96
Q

Fixed rate block can be due to what (2)

A

Mobitz I or Mobitz II atrioventricular block.

97
Q

How to determine the cause for a fixed rate block

A

QRS narrow - type 1

QRS wide - type 2

98
Q

Contra-indications to the use of adenosine include:

A

2nd or 3rd degree AV block
Sick sinus syndrome
Long QT syndrome
Severe hypotension
Decompensated heart failure
Chronic obstructive lung disease
Asthma

99
Q

Where does the electrical activity in AF usually originate from

A

The disorganised electrical activity in AF usually originates at the root of the pulmonary veins.

100
Q

How to recognise subendocardial ischaemia

Which artery is affected

A

ST depression in leads V2-V6, I, II and aVF
ST elevation in aVR

Left main coronary

101
Q

Three beta-blockers licensed for use in chronic heart failure

A

bisoprolol, carvedilol and nebivolol.

102
Q

When is glucagon recommended in bradycardia?

A

If the bradycardia is caused by beta-blockers or calcium-channel blockers

103
Q

Decubitus angina

A

generally occurs in patients with congestive cardiac failure and severe coronary artery disease. As the patient lies down the increased intravascular volume places strain on the heart and triggers chest pain episodes.

104
Q

Definitive treatment for brugada

A

insertion of an implantable cardioverter-defibrillator (ICD)

105
Q

At what creatinine level is fondaparinux contraindicated in NSTEMI

A

creatinine above 265 micromoles per litre

106
Q

Lown-Ganong-Levine syndrome, ECG findings

A

Sinus rhythm with a very short PR
Narrow QRS complexes
Absence of a slurred upstroke (delta wave)

107
Q

Initial dose of adenosine in heart transplant patients

A

3mg

108
Q

True Trifascicular Block

A

Right bundle branch block
Left axis deviation (Left anterior fascicular block)
Third degree heart block

109
Q

Incomplete trifascicular block”

A

Right bundle branch block
Left axis deviation (= left anterior fascicular block)
First degree AV block

110
Q

bifascicular block - two parterns

A

RBBB + LAFB

111
Q

Aminophylline maintenance infusion

A

infusion of 500-700 mcg/kg/hour

112
Q

Antibiotic therapy in whooping cough

A

Macrolide antibiotics are used first-line:
Clarithromycin for babies aged less than 1 month

Azithromycin or clarithromycin for children aged 1 month or older and for non-pregnant adults

Erythromycin for pregnant women.

They just reduce the length of infectivity

113
Q

When is Oral Fluid Testing (OFT) recommended in whooping cough

A

Child 2-16 yrs old, cough for 14 days or more

At least 1yr after the vaccine

114
Q

Optimal plasma therapeutic range for theophylline

A

10-20mg/L

115
Q

When is an XR indicated in asthma?

A

Suspected pneumomediastinum

Suspected consolidation

Life-threatening asthma

Failure to respond to treatment satisfactorily

Requirement of ventilation

116
Q

Chlamydia psittica antibiotic choice

A

tetracycline or doxycycline for 2-3 weeks

117
Q

The borders are of the safe triangle for inserting a chest drain are:

A

Base of the axilla
Lateral border of latissimus dorsi
Lateral border of pectoralis major
5th intercostal space

118
Q

How long after an aminophylline dose should a level be taken?

A

4-6hrs

119
Q

Gold-standard investigation for the confirmation of a case of Legionnaires’ disease?

A

Isolation and culture from a sputum sample

120
Q

Cavitating upper lobe pneumonia may indicate

A

Klebsiella pneumoniae

121
Q

Criteria for antibiotic prophylaxis for whooping cough

A

Onset of disease in the index case is within the preceding 21 days and;

There is a close contact in one of the two priority groups

Group 1. At increased risk of severe or complicated infection (vulnerable)
Infants under one year who have received less than three doses of pertussis vaccine

Group 2. At increased risk of transmitting the infection to individuals in Group 1:

Pregnant women at greater than 32-weeks gestation

Healthcare workers working with infants and pregnant women

Individuals working with infants too young to be vaccinated (<4 months old)

Individuals sharing a household with infants too young to be vaccinated (<4 months old)

122
Q

Q fever

A

Highly infectious zoonotic infection caused by Coxiella burnetti.

It is most commonly seen as an occupational disease affecting farmers, slaughterhouse workers and animal researchers.

123
Q

Treatment for Q fever

A

2 weeks of oral doxy

124
Q

Löfgren’s syndrome is described as being a triad of:

A

Bilateral hilar lymphadenopathy on chest X-ray

Erythema nodosum

Arthralgia (particularly affecting the ankles)

125
Q

What type of cancers are pancoasts tumours usually?

A

Non small cell cancers

126
Q

What predicts the 24-hour risk of critical respiratory illness in patients admitted from ED with COVID-19.

A

qCSI

MRCEM INTERMEDIATE (18 decks)

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