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Phase 2a > cardiology/ haematology > Flashcards

cardiology/ haematology Flashcards

1
Q

how is angina different from MI?

A

Angina involve ischemia not cell death
MI involves cell death

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2
Q

how does subendocardial vs transmural ischemia differ on ECG ?

A

subendocardial - st depression
transmural - st elevation

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3
Q

epidemiology of pericarditis?

A

80-90% idiopathic
seasonal with viral trends
higher in young pts

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4
Q

pericardium vs myocardium?

A

muscle in middle - myocardium
outlayer fibrous - pericardium

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5
Q

most common none infectious cause of pericarditis?

A

neoplastic - breast cancer

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6
Q

common relief of severe chest pain in pericarditis?

A

sitting forward

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7
Q

signs of pericarditis?

A

pericardial rub
sinus techycardia
fever
signs of effusion
Kaussmauls signs - increase with JVP with inspiration
hypotension

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8
Q

ecg of percarditis?

A

j point elevation
saddle shape of st depression
wide spread
pr depression - not always there

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9
Q

additional test for pericarditis?

A

FBC - elevation in WBC
TROPONIN - elevation for myopericarditis
CXR - normal

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10
Q

causes of left axis devation?

A

defects to conduction system of heart
ventricular tachycardia
MI
WPW
left ventricular hypertrophy
left BBB

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11
Q

normal QRS length?

A

QRS complexes to be between 70 - 110 milliseconds

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12
Q

wide QRS indicates?

A

bundle block branch

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13
Q

An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?

A

atrial fibrilation - becuase p waves is artial depolarization

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14
Q

If ST-elevation was noted in leads II, III and aVF, what would it suggest?

A

inferior MI due to inferior plane

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15
Q

Second-degree heart block (Mobitz type 1)?
ecg findings

A

disease of the atrioventricular node. Typical ECG findings include progressive prolongation of the PR-interval with associated regular dropping of QRS complexes

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16
Q

first degree vs second degree heart block?

A

first degree - prolonged pr but always QRS
second (mobitz1) - continous prolonging of pr and a drop in qrs
second (mobitz2) - normal pr or slighlty prolong pr interval and a drop in QRS

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17
Q

DURATION OF NORMAL PR INTERVAL ?

A

3- 5 SMALL BLOCK - 0.12-0.2 seconds

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18
Q

What view of the heart do leads V1 and V2 represent?

A

spetal

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19
Q

leads v3-v4 represent?

A

anterior

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20
Q

What does ST-elevation suggest?

A

MI

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21
Q

An ECG reveals an absence of P-waves and an irregular rhythm. Which of the following is the most likely diagnosis?

A

atrial fibrillation

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22
Q

lead 1 is negative, lead 2 and 3 are isotonic/ positive what is diagnosis?

A

right axis deviation

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23
Q

A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?

A

wpw
This is typically caused by the presence of an accessory pathway between the atria and ventricles.

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24
Q

Tissue is submitted for microscopic evaluation. Evaluation of sections of the myocardium demonstrates evidence of apple green birefringence with polarised light, diagnonsis?

A

amyloidosis
protein called amyloid builds up in organs

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25
Q

marks on figertips in infective endocarditis?

A

splinter haemorrhage

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26
Q

tandard treatment for strep viridans infective endocarditis?

A

Intravenous Benzylpenicillin for 4-6 weeks +/- synergystic gentamicin for the first 2 weeks.

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27
Q

danger of septic emboli in infectious endocarditis?

A

spread from trcuspid valve to pulmonary vein to the lungs and grows

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28
Q

staph aureus vs staph epidermis?

A

aureus - golden on BA + coag+
epidermis - white on BA + coag -

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29
Q

use of SAB agar?

A

yeast growth of candida spp

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30
Q

Candidal endopthalmitis?

A

growth on mitral valve can spread
can spread to retinal artery and grow in retina causing cloudy vision

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31
Q

group D’ streptococcus?

A

enterococcus

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32
Q

beta haem lancefield group C?

A

cellulitis, pharyngitis

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33
Q

antibiotic for enterococci?

A

Intravenous amoxicillin and gentamicin for 4-6 weeks.

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34
Q

staph aureus infection treatment ?

A

vancomycin and rifampin

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35
Q

diagnosis of duke criteria for infective endocarditis?

A

2 majors or 1 major and 3 minor or just 5 minor

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36
Q

major criteria for duke criteria ?

A
  • Positive blood culture with typical IE microorganism
  • New partial dehiscence of prosthetic valve or new valvular regurgitation
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37
Q

minor criteria for duke criteria?

A
  • Predisposing factor: known cardiac lesion, recreational drug injection
  • Fever >38°C
  • Embolism evidence: arterial emboli, pulmonary infarcts, Janeway lesions,
    conjunctival hemorrhage
  • Immunological problems: glomerulonephritis, Osler’s nodes, Roth’s spots,
    Rheumatoid factor
  • Microbiologic evidence: Positive blood culture (that doesn’t meet a major criterion)
    or serologic evidence of infection with organism consistent with IE but not satisfying
    major criterion
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38
Q

role of angiotensin 2

A

vascular growth
salt retention
increase TPR and CO

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39
Q

main clinical use of ACE inhibitors?

A

hypertension
heart failure
diabetic neuropathy

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40
Q

effect of reduced angiotensin 2 formation (ex. from ace inhibitors)

A
  • hypotension
  • acute renal failure - filtration drops
  • hyperkalaemia
  • teratogenic (feotal abnormalities) effects in pregnancy
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41
Q

why cough with ace inhibitors?

A

increase of kinins
dry cough
break down of bradykinin

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42
Q

examples of CCB?

A

dihydropyridines:
amlodipine
nifedipine

Phenylalkylamines:
verpamil

Benzothiazepines:
diltiazem

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43
Q

effect of dihydropyridines?

A

dont effect heart only impact peripheral resistance
peripheral arterial vasodilators

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44
Q

adverse effect of peripheral vasodilation?
caused by

A

flushing
headache
oedema
palpitation
mostly cause by dihydropyridines

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45
Q

adverse effects of negative chronotrophic effects ?

A

verapamil/ diltiazem
bradycardia

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46
Q

beta blocker worsens what conditions?

A

asthma
PVD - raynauds
Heart failure

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47
Q

two groups to start treatment of hypertension with NICE guidance ?

A

55 years or younger
or
over 55 years or afro carribbean any age

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48
Q

two types of heart failure?

A

LVSD (chronic) - left ventricular systolic dysfunction
HFPEF - preserved ejection fraction

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49
Q

most common cause of heart failure?

A

CAD

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50
Q

main benefit for heart failure?

A

vasodilatory therapy via neurohumoral blockade (RAAS - SNS) block sympathetic

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51
Q

second line treatment for HF?

A

aldosterone antagonists
- can create male boobs
or ARNI
OR sglt 2 inhibitors

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52
Q

ace inhibitor interolence

A

use ARBs!

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53
Q

ace inhibitor and ARB interolence

A

use nitrate combination

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54
Q

example of an ARNI?

A

Entresto
valsartan - angiotension 2 blocker
sucubitril - neprilysin inhibitor -increase sodium/water in urine

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55
Q

role of nitrates?

A

arterial and venous dilators
reduce pre load and after load
lower BP

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56
Q

use of nitrates?

A

angina
symptomaticly in heart failure

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57
Q

treatment for chronic stable angina

A
  • GTN spray
  • statins
  • aspirin - antiplatelet
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58
Q

first line treatment of chronic stable angina? after symtomatic tx

A

beta blocker or CCB

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59
Q

pain relief for nstemi and stemi (ACS)

A

GTN SPRAY
opiates - herion - diamorphine - vasodilator

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60
Q

ACS therapy?

A

DUAL antipplatelet therapy - aspirin and clopidogrel

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61
Q

ACS treatment?

A

antithrombin therapy
consider GP 2B/3A INHIBITOR

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62
Q

CLASSS 1 antiarrhythmic drugs?

A

sodium channel blockers tx for brugada syndrome

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63
Q

class 2 antiarrhythmic drugs?

A

beta adrenoreceptors antagonists
tx for svt

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64
Q

class3 antiarrhythmic drugs example

A

prolong qt interval
amiodarone
sotalol
tx for Intravenous amiodarone is added if initial DC shocks are unsuccessful in arrhythmias

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65
Q

class 4 antiarryhthimic drugs ?

A

CCBs

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66
Q

digoxin?

A

cardiacglycoside - inhibit na/k pump
antiarrhythmic drugs

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67
Q

fallot spells?

A

pts go blue
hyopxia - blue deoxygenated blood from RV to the LV

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68
Q

how many suffer from tertiary of fallot?

A

1/1000 live births

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69
Q

atrial flutter vs atril fibrillation?

A

In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles

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70
Q

ecg of atrial flutter?

A

fast bpm - 150 bpm
No p-waves. Seesaw baseline
narrow QRS

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71
Q

most common congenitial heart defect?

A

VSD 4/1000

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72
Q

eisenmengers syndrome? signs ? reversible?

A

blue lips
severe pulmonary hypertension
clubbing fingers
non reversible

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73
Q

signs of small VSD?

A

small hole - loud systolic murmurs
buzzing sensation
normal HR and heart size

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74
Q

clinical signs of ASD?

A

pulmonary flow murmur
fised split second heart sound
big heart and pulmonary arteries

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75
Q

what is avsd associated with?

A

21 trisomy (downsyndrome)

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76
Q

eisenmEngers syndrome is present in?

A

PDA and VSD

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77
Q

SIGNS OF aortic coarctation?

A

higher bp in right arm than left
incidental murmur

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78
Q

ventricular tachycardia (VT) ecg ?
rate
axis deviation

A

Rate 150
Rhythm Regular
Left axis deviation
PR/P wave Not visible
QRS Wide

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79
Q

ecg of WPW ?

A

shortened PR interval and slurred QRS upstroke – also know as a ‘delta wave’
qrs wave is not straight up and looks like a hill

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80
Q

ecg of Brugada Syndrome (Type 1)

A

leads V1 – V3 there is >2mm ST elevation, the T waves are inverted and the ST segment has a characteristic ‘coved’ shape.

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81
Q

ecg of percarditis

A

widespread saddle-shaped ST elevation and PR depression.

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82
Q

STEMI ecg?

A

PR/P wave Every p-wave followed by a QRS
QRS Narrow
ST/T wave ST elevation in II III and aVF

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83
Q

when are j waves present?

A

subarachnoid haemmorage
hypothermia
hypercalaemia

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84
Q

hypokaleamia on ecg?

A

Classically hypokalaemia causes t-wave flattening with ST depression. In severe cases you may see a U-wave. This is a positive deflection following the t-wave but preceding the p-wave.

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85
Q

what conditions have u waves?

A

hypercalcaemia and thyrotoxicosis and hypokalemia

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86
Q

blockade of sodium channel on ecg?

A

widening of the QRS complex and lengthening of the QT interval

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87
Q

action of statins ?

A

HMG - CoA reductase inhibitors
inhibit production of LDL cholesterol in liver

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88
Q

saddle shaped st segment?
pr depression

A

pericarditis (enterovirus)

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89
Q

how is pericarditis chest pain different from MI?

A

pericarditis – sharp and pleuric
MI - crushing and tight

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90
Q

high bp, under 55 years old or T2DB first line of treatment (not african descent) ?

A

ACEinhibitors

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91
Q

high bp, over 55 years or african/carribbean descent first line of treatment ?

A

CCB (amlodopine)

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92
Q

first line treatment for AF? cautions?

A

beta blockers - atenolol (not for asthma pts)
CCB - verapamil

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93
Q

when to use a doppler?

A

cramping in leg apon excertion - 1st line of investigation

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94
Q

ADENOSINE mechanism of action in tachycardia?

A

creates TRANSient heart block in AV node
short half life about 8-10 seconds
feeling of nausea and impending doom

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95
Q

where does endocardium recieve its blood supply?

A

ventricles not coronary arteries!

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96
Q

leads for left circumflex and diagnoal LAD?

A

1, aVL, v5-v6

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97
Q

leads for RCA (inferior of heart so also Left circumflex) ?

A

2, 3 aVF

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98
Q

leads for LAD?

A

v1- v4

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99
Q

when to oxygen in MI?

A

when under 94% saturation

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100
Q

when are CCB given during an MI?

A

Calcium channel blockers e.g. verapamil are only given if beta blockers are contra-indicated.

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101
Q

what drugs should be offered following an MI

A

DABS
DUAL antiplatelet therapy - aspirin
ACE inhibitor - ramipril
Beta blockers - propanolol
Statins - atorvastatin

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102
Q

prinzmedal angina ECG FINDINGS?

A

show ST elevation on an ECG along with STEMI and pericarditis

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103
Q

ABCD2 role?

A

estimates risk of stroke after a suspected TIA.
age over 60
b - BP greater then 140/90
Clinical presentation - paralysis - 2/ just face - 1
d - duration 10- 59 min = 1. over 60 = 2
diabetes

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104
Q

QRISK3 role?

A

risk of developing a HA in next 10 years

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105
Q

HAS-BLED

A

estimates risk of bleeding on patients on anticoagulation
After CHA2DS2VASc
H HTN
Abnormal renal
Stroke history
B leeding risk - INR
L labile INR
Elderly > 65
Drug and alcohol abuse

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106
Q

The FRAX® tool

A

developed in SHEFFIELD!
evaluate fracture risk of patients

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107
Q

drugs for pci ?

A

Clopidogrel or prasugrel and aspirin

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108
Q

benefits of hypertensive treatment?

A

reduces risk of stroke by 40%
reduces risk of MI by 30%
increase life expectancy by 5 years

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109
Q

drugs which increase bp?

A

NSAIDS
SNRI - venlafaxine
corticosteroids
oral contraceptions - estrogens
stimulants - methylphenidate/ ritalin (adhd treatment)
anti TNFs

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110
Q

WHAT HAPPENS if stopping hypertensive mediation?

A

take for life because hypertension does come back when stopping
can stop if pre hypertensive

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111
Q

when to stop ACE i and ARBS?

A

when going in for surgery

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112
Q

volume of murmur in aortic stenosis ?

A

no effect on severity

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113
Q

prognosis of aortic stenosis ?

A

angina + as - 50%survive 5 years
syncope + as - 50% survive 5 years

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114
Q

what is TAVI?

A

transcatheter aortic valve replacement
catheter in femoral or subclavian artery
balloon in damaged valve
pass a new valve through aorta to sit above old damaged valve

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115
Q

when is TAVI required?

A

any symptomatic patients with severe Aortic stenosis
decreasing Ejection fraction - amount of blood pumped each time it beats

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116
Q

pansystolic murmur ?

A

sign of mitral regurgitation
apex to the axilla

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117
Q

death from mitral regurgitation?

A

progressive dysponea and heart failure

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118
Q

prophylactic vasodilators on mitral regurgiation use?

A

no indication to use ACE inhibitors as being helpful

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119
Q

WHEN WOUDL surgery BE NEEDED for severe MR

A

ANY symptoms at rest or excercise
consider is asymptomatic - EF lesss than 60%
new onset AF

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120
Q

systolic and diastolic pressure in aortic regurgitation?

A

WIDE PULSE PRESSURE
systolic is high because needs to more effort to get to aorta - high sv
diastolic is low

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121
Q

CXR IN aortic regurgitation?

A

enlarged cardiac silhouette and aortic root enlargment

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122
Q

when is surgery required in aortic regurgiation ?

A

breathlessness could be lung problems not heart failure
any symptoms at rest or excercise
asymtomatic - ef drops below 50%

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123
Q

gold standard for mitral stenosis ?

A

echo - gold standard - mitral valve mobility

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124
Q

when does patient qualify to surgery from mitral regurgitation?

A

any sympotomatic patient with NYHA class 3/4 symptoms

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125
Q

right axis deviation causes?

A

Left posterior fascicular block
– Right heart hypertrophy/strain

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126
Q

pr interval represents?

A

atrial depolarisation and conduction from atria to ventricles

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127
Q

small QRS causes?

A

obese patients
pericardial effusion
cardiac effusion

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128
Q

TALL QRS causes?

A

LEFT VENTRICLE hypertrophy
thin patient

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129
Q

causes of bradycardia?

A

av CONDUCTION problems
- av block
- LBBB

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130
Q

systematic ecg interpretation

A

rate
rhythm
axis
p, pr, qrs, st, qt

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131
Q

SVT vs VT QRS?

A

SVT - qrs narrow becuase quick
VT- qrs wide and passive

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132
Q

50 y man presents with 2 hours of central
crushing chest pain, sweaty, nauseated
He has a past history of hypertension and
smokes 20/d

A

STEMI

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133
Q
  • A 20y female presents with a history of sharp
    central chest pain, worse on inspiration and
    worse on lying flat
  • She is otherwise fit and well but has had a
    recent bad cold
    ecg?
A

pericarditis

saddle shape ST elevation
PR depression

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134
Q
  • 50y man
    – No prior medical history
  • Palpitations
    – Missed beat
    – ‘Thud’ or strong beat
    – Brief racing/fluttering
A

ectopic beats

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135
Q

high burden Ventricle ectopic cause?

A

HF

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136
Q

high burden Atrial ectopic can progress tO?

A

AF

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137
Q

atrial fibrillation?

A

commonest sustained arhrythmia

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138
Q

medical treatment for AF?

A

treat underlying cuase
rate control - bb, ccb , digoxin
restore sinus rhythm acute
- pharmacologically cardioversion (flecainide / amiodarone)
maintain sinus rhythm
* Flecainide
* Dronedarone
* Sotalol
* Amiodarone

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139
Q

26y female PMH of ‘anxiety’
* Recurrent episodes of heart racing
– Sudden onset
– Breathless/panicky
ecg?

A

narrow complex SVT - AVNRT
no p waves - hidden in QRS
ATRIUM AND VENTRICLE AT SAME TIME

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140
Q

avnrt acute treatment

A

valsalva manoeuvres
cold water in face
adenosine

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141
Q

16y male
* Came to UK 3 y ago.
* Told he had abnormal ECG in childhood, no
further details
* Complains of heart racing intermittenly,
sudden onset for up to an hour
ecg?

A

WPW SYNDROME
DELTA WAVE - p and qrs are merged - av is being bypassed

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142
Q

TYPES OF AVRT

A

orthodromic - narrow
antidromic - broad

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143
Q

ELECTRICAL STORM

A

3 OR MORE VT or VF epsiodes in 24 hours

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144
Q

slow regulator ventricle
atrial flutter
signs?

A

heart block possible

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145
Q

presentation of MI in T2DM?

A

ATYPICAL
no chest pain
but sweating

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146
Q

60y man
* Prev inferior MI
* Severe LV impairment
* NYHA Class II/III
* ECG SR 55, LBBB
* Treated with evidence based medical treatment
– Ramipril, Bisoprolol, Eplerenone, Atorvastatin, Aspirin
* What next?

A

cardiac resynchronisation
LBBB - right ventricle before left ventricle
dysynchrony - ICD lead in left and right ventricle and get them to contract at same time

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147
Q
  • 33y female
  • Recent long haul flight from SE asia
  • No recent
  • Breathless with sharp right sided chest pain,
    haemoptysis
    ecg?
A

pulmonary embolism
sinus tachycardia
right ventricular strain
v1,2,3 - t wave inversion

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148
Q

lymphoid stem cell forms?

A

t and b lymphocytes

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149
Q

what is a plasma cell ?

A

differentiated b lymphocytes

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150
Q

high calcium , paraprotein and anaemia?

A

classic myeloma

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151
Q

smoldering myeloma symptoms?

A

asymptomatic

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152
Q

most common haematological cancers

A

1 - non hodgkins lymphoma
2 - multible myeloma

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153
Q

complications of systemic AL amyloidosis ?

A

Multible organ failure - extracelleular deposition of monoclonal immunoglobulin light chain fragment

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154
Q

test for myeloma?

A

whole body MRI/ ct
BONE MARROW BIOPSY
fbc
SEP

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155
Q

proteasome inhibitors examples? ?

A

treat myeloma
bortezomib (sc)

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156
Q

erythropoietin is made where?

A

kidneys

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157
Q

chronic heamolysis causes?

A

hypertension,
gallstones
kidney failure

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158
Q

traits of carrier of sickle cell?

A

increased risk of kidney cancer
rbc can sickle if hypoxic

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159
Q

test for sickle cell?

A

sickle solubility test
Hb Seperation
- gel/ capillary electrophoresis
- confirmatory test

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160
Q

pathophysiology of sickle cell?

A

Point mutation of the B globin gene (glutamic acid to valine) resulting in a HbS variant
Under stress (cold/infection/dehydration/hypoxia/acidosis), the RBCs become deoxygenated and the HbS polymerises causing the cells to become rigid and sickle
Carriers are protected from Plasmodium falciparum malaria (evolutionary advantage to being heterozygous)

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161
Q

most common cause of death with sickle cell disease?

A

Pulmonary HTN and chronic lung disease (acute chest syndrome) most common cause of death in adults

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162
Q

what is happening?
lower resp tract infection
acute chest syndrome
pheumothorax
heart failure
sickle cell disease

A

acute chest syndrome
vaso- oclusive crisis of pulmonary vasculature

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163
Q

why do SCD have larger hearts ?

A

DUE TO CHRONIC ANAEMIA

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164
Q

treatment for acute chest syndrome?

A

exchange blood transfusion
exchanges sickle blood with healthy blood

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165
Q

preventing sickle cell disease?

A

stay warm and hydrated
hydoxycarbamide - increases HbF
regular blood transfusion
monitoring - transcranial dopplers

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166
Q

thalassaemia?

A

group of conditions which are a lack of heamoglobin production

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167
Q

epidemology of thalassemia?

A

ANYWHERE not northeren european - near equator line

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168
Q

major cause of death in thalassemia?

A

heart failure due iron excessive

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169
Q

alpha thalassemia cause death in utero?

A

yes from anaemia

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170
Q

indolent non hodgkin lymphoma

A

grow slowly
can live with for years with it - but generably incurable - advanced at presentation

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171
Q

3 types of cell lymphoma can be classified from?

A

b cell - 90%
t cell - 10%
nk cell <1%

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172
Q

risk factors for lymphoma?

A

primary immunodeficiency
secondary immunodeficiency - HIV
infections
autoimmune disease - rheumatoid arthritis

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173
Q

clinical presentation of indolent lymphoma?

A

painless - with lumps
B symptoms - fevers, night sweats + weight loss
bone marrow involvement
compression syndrome - spinal chord compression

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174
Q

indolent lymphoma bumps presentation ?

A

smooth
mobile
non tender
rubbery

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175
Q

Ix FOR LYMPHOMA

A

lymph node biopsy - core needle biopsy/ excision node biopsy
CT neck/ thorax/ abdomen/ plevis or pet ct
bloods
ESR - RAISED - The erythrocyte sedimentation rate is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour

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176
Q

what is acute myeloid luekemia ?

A

pAcute myeloid leukaemia (AML) is a heterogeneous clonal malignancy characterised by
– immature myeloid cell proliferation (defined as ≥20% “blasts”)
and
– bone marrow failure

progression from MDS

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177
Q

what are MDS?

A

myelodysplastic syndromes
marrow + funny loooking
bone marrow cells fail to make adequate number of healthy blood cells
progresses to AML

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178
Q

LAB FEATURES OF MDS?

A

fbc - low blood cells
- rbc
-wc
-platelets
Blood film shows dysplastic (abnormal) features

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179
Q

LAB FEATURES OF AML?

A

white cells can be
- very low or very high
RBC - very low
PLatelets - low
Pre history of malignancy
blast cell with auer rods

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180
Q

differential diagnosis of AML?

A
  • B12/ folate or mixed haematinic deficiency
  • Infection (e.g. retroviral disease, herpesvirus) * Medications
  • Autoimmune
  • Liver disease (e.g. cirrhosis)
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181
Q

symptoms of presentation of AML?

A

anaemia
neutropenia - infections frequent
thrombocytopenia

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182
Q

high blast cells sign of?

A

sign of LEUKEMIA

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183
Q

mOorphology of MDS?

A

10% dysplasia in cell lines
blasts CELL - 0-19% within dysplaslia

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184
Q

morphology of acute myeloid leukaemia?

A

20% blast
now as low with 10% with defining genetic abnormalities

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185
Q

treatment for low blast cell count in mds?

A

stimulate marrow to increase blood cell production
alleviate symptoms due to low blood count

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186
Q

treat anaemia

A

Red cell transfusions
* Reduce/ treat any associated bleeding contributing to anaemia
erythropoeitin

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187
Q

thrombocytopenia treatment?

A

platelet transfusion
Tranexamic acids

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188
Q

5 year survival rates in all patient with AML?

A

15%

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189
Q

main cause of secondary hypertension?

A

conns synderom hyper aldosterone

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190
Q

young woman with palpitations, anxiety and super high bp?

A

pheochromocytoma

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191
Q

first line treatement for hypertension with T2DB?

A

ace inhibtiors or ARBs

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192
Q

pathophysiology of stable angina?

A

atherosclerosis is narrowing of coronary arteries that results in ischemia

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193
Q

stemi ecg afterwards

A

pathological q waves

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194
Q

SILENT MI in women

A

vomiting and nausea aswell

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195
Q

pathophysiological unstable angina?

A

greater degree of atherosclerosis than stable angina
ischemia but no necrosis

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196
Q

side effects of fribrinolysis?

A

risk of bleeding - subarachnoid haemorrage

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197
Q

MENMOMIC for complication from mi?

A

Death
Arrhythmia
R rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler syndrome
Embolism
Recurrence/ regurgitation

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198
Q

ix for heart failure
gold standard

A

GS: BNP increase correlates with severity
cxr: Aalveolar oedma - batwing
B lines kerley - like strectch marks
c ardiomegaly - enlarged heart
DILATED upper lobe vessels
Effusions - blunted angles
echocardiogram gold standard

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199
Q

standard treatment for heart failure

A
  1. diuretics
  2. ace inhibitors
  3. beta blockers
  4. digoxin - renal toxic
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200
Q

most common cause of HF?

A

IHD

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201
Q

systolic murmur ?

A

majority - unusal sound of heart beat
closure of av Valves
after S1 murmur s2

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202
Q

distolic murmur?

A

s1 s2 murmur

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203
Q

most common valve disease?

A

aortic stenosis

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204
Q

pathophysicology of aortic stenosis

A

narrowing of aortic stenosis - decresed stroke volume - increased afterload - increased left ventricular pressure- LV hypertrophy - increase oxygen demand - not met - ischemia

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205
Q

gold standard for IX for aortic stenosis?

A

echocardiogram - left ventricule size and function

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206
Q

pathophysiology of mitral regurgitation

A
  • blood goes back to left atrium - hypertrophy
  • ventricle is not pumping as much blood so grows larger to increase stroke volume - coronary arteries cant provide
  • back flow to pulmonary veins - increased pulmonary pressure - increased pulmonary arteries pressure
  • eventually heart failure
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207
Q

gold standard for mitral stenoiss

A

echocardiogram - TOE is better and more senstitive
ecg - lah, af, lvh
cxr - lah

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208
Q

treatment of mitral stenosis?

A

vasodilator - ace inhibiotrs
rate control - bb
diuretics - fuosemide

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209
Q

aortic regurgitation pathophysiology

A
  • stroke volume of left ventricle lowers - so lv compensates with hypertrophy - HEART FAILURE
  • coronary arteries doesnt get enough blood so get ihd
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210
Q

tx of mitral stenosis

A

IE TREATMENT
vasodilators - ace inhibitors
monitor progress = worsens - surgery

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211
Q

where is the infection in IE?

A

infection in endocardium or vascular endothelium

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212
Q

IV drug users cause of IE?

A

s. aureus

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213
Q

tx for IE?

A

6 wekks of antibiotics - iv for 2 weeks and then oral

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214
Q

chewst pain in pericarditis?

A

sharp, pleuritic (worse on inspiration) cheat pain
worse lying down and relived by sitting forward

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215
Q

gold standard for ix of pericarditis?

A

ECG - SADDLE SHAPED ST ELEVATION (diagnostic)

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216
Q

MAIN COMPLICATION of pericarditis?

A

PERICARDIAL EFFUSION
filling of pericardium
cardiac tamponade - cant beat properly

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217
Q

ix for pericardial effusion ?

A

cxr- large globular heart
ecg - low qrs
echocardiogram - huge effusion

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218
Q

cause of PAD

A

ATHEROSCLEROSIS IN PERIPHERAL ARTIERIES

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219
Q

CAUSES OF PVD

A

blood clot in veins

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220
Q

symptoms of PAD?

A

intermittent claudication - cramping especially up hills and steps

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221
Q

treatment of dvt?

A

HEPARIN (doacs)

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222
Q

SVT examples

A

atrial fibrillation and atrial flutter

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223
Q

fibrillation vs flutter

A

fibrillation - no p waves - emergency
flutter - regular saw tooth

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224
Q

59 year old man with HTN doesnt like the medication that makes him cough - (5 years ago), what should next medication be?

A

because over 59 years old - ccb
amlodopine

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225
Q

pregancy and htn - what drugs not to give!

A

ace inhibitors and arbs never ever !

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226
Q

stable angina investigation?

A

ecg - normal or depressed st
excerise test but not for ppl with known CAD !

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227
Q

TX FOR STABLE ANGINA?

A

Modify risk factors: smoking cessation, exercise, weight loss
GTN spray (to be used during episodes of chest pain)
Beta blocker or Calcium channel blocker
Revascularization (PCI or CABG)

228
Q

PCI FOR FIBRINOlysis for mi?

A

pci - if symptoms within 12 hours and possible to have pci within 120 min
fibrinolysis - if symptoms within 12 hours and not possible to have pci within 120 min

229
Q

body response to hypoxia?

A

create more rbc increases erythropoetin

230
Q

treatment for polycytheamia vera with less than 0.45 hemacrit in young people?

A

aspirin 75 mg daily

231
Q

JAK2 mutation ?

A

cause of polycythaemia vera

232
Q

ix for polycythaemia?

A

FBC
Bone marrow biopsy
Genetic testing for JAK2 gene

233
Q

thrombocythemia

A

too many platelets

234
Q

fevers, night sweats
weight loss >10% over last 6 months
what are these factors called?

A

constitutional factors very common in haematology

235
Q

splenomegaly causes

A

infections
liver diseases - high pressure in portal vein
autoimmune conditions - RA
if all thes excluded - its cancer!

236
Q

metamyelocytes?

A

precursor of nuetrophils

237
Q

secondary cause of polycythaemia?

A

Due to; chronic hypoxia, poor oxygen delivery (e.g. high altitude), abnormal RBC structure and tumours which release high levels of EPO

238
Q

treatment for cml?

A

pcr for BCR; ABL1
imatinib 400 mg daily
monitor FBC FOR HAEMatological remssion
reasses spleen size every 3 month
monitor bcr;abl1 every 3 motnhs

239
Q

differential diagnosis for high wcc?

A

infection
drugs - g-csf/ corticosteroids
Tissue ischemia
paraneoplastic

240
Q

normal haemoglobin for women?

A

110 - 147 g/l

241
Q

normal haemoglobin for man?

A

131 - 166 g/l

242
Q

mcv?

A

mean cell volume - how big rbc are
could present a population of big and small cells - microcytic and macrocytic anaemia

243
Q

what causes macrocytotic anaemia?

A

reticulocytosis
b12 deficiency
folate defieciency

244
Q

neutrophil nucleus in b12 deficiency?

A

hyper- segmented neutrophil nucleus
multible lobes

245
Q

how much iron can you body absorb a day ?

A

1mg/day
but u consume about 15mg/day

246
Q

causes of iron defiency ?

A

GI bleeding (cancers), menstrual bleeding
impaired absorption - coeliac, gastroectomy, dietary (rare) - vegan, elderly

247
Q

iron studies ?

A

serum iron - not helpful
transferrin (transport iron) saturation - goes down in deficiency because number of transferrin is increased but saturated trsanferrin is low
iron binding capacity - blood as capacity to absorb iron - high in defiency

248
Q

management of iron deficiency?
iv vs oral?

A

ix blood loss
- mennoragia
replace iron - oral iron (ferrous sulphte 200mg once a day ) with orange juice vit C
IV iron no faster than oral
keep giving after 3 months of normal iron levels

249
Q

how much folate is required a day? is it stored?

A

01.-0.2 mg/day
never stored

250
Q

what is folate used for and where is it stored?

A

DNA replication
proximal jejunum

251
Q

normal b12?

A

197 - 771 ng/l

252
Q

patients in CML?
onset?

A

older - middle aged
slower

253
Q

how many blast cell in bone marrow in CML?

A

LESS THAN <10%

254
Q

CML, ET, P. VERA, MMM leads to ?

A

ACUTE leukemia

255
Q

risk factor of cml?

A

IONISING RADIOTHERAPY

256
Q

pathophysiology of cml?

A

ABL ch9 genes translocates and fuses with BCR ch22 to form BCR-ABL (PHILADELPHIA chromosome) - tyrosine kinase increase increase proliferation and decreases apoptosis

257
Q

cells in CLL?

A

uncontrolled proliferation and accumulation of mature B lymphocytes and t lymphpcytes

258
Q

cells in CML?

A

BASOPHIL, NEUTROPHIL, EOSINOPHIL

259
Q

CELLS IN aml?

A

MYELOBLAst and common myeloid progenitor cells - LEADS To formation of basophil, neutrophils and eosinophils

260
Q

cells in all?

A

small lymphocyte - which should form into t lymp and b lymph

261
Q

most common form of lymphoma?

A

non - hodgkins (85%)

262
Q

leukemia vs lymphoma?

A

leukemia - too many blast cells (immature precursor to WBC, rbc AND PLATELETS- not differentiated properly or at all)
lymphoma - too many lymphocytes (originally from lymph nodes)

263
Q

myosis fungoides? cells involved? where?

A

low grade lymphoma of skin with t cells

264
Q

85% of low grades lymphomas are? what mutation has occurred?

A

follicular lymphoma - look small and cleave
translocation OF BCL- 2 gene on chrom0some 14 to 18

265
Q

sezary syndrome?

A

more aggressive form of mycosis fungoides - peripherally in blood

266
Q

burkitt cell lymphoma?

A

high grade non hodgkins lymphoma
can be leukaemia
non cleaved small cells
excessive cell division of cell that produce Ig

267
Q

VIRUS INVOLVED in burkitt lymphoma?

A

EBV

268
Q

translocation of burkitts lymphoma?

A

8- 14 of tyrosine cynase gene

269
Q

epidemiology of hodkins lymphoma?

A

under 20s and over 70s
previously exposed to ebv

270
Q

reed steinberg cells look like?

A

owl eyes

271
Q

ix for diagnosing heart failure

A

echocardiogram
bnp is initial ix in primary care

272
Q

bilateral pleural effusion and cardiomegaly and worsening dry cough with swollen ankles can be a sign of ?

A

heart failure

273
Q

redcued ejection fraction in heart failure treatment?

A

ACE I and BB

274
Q

crackles and pulmonary congestion and pink sputum
tachycardia
fatigue
cyanosis
exertional dyspnea
sign of ?

A

left sided heart failure

275
Q

postural hypotension?

A

when standing bp drops and doesnt raise after 3 minutes
can cause fainting
settles back down when they sit down

276
Q

non pharamcological treatment for postural hypotension from medications?
pharmacological tx?

A

increase salt + drinking fluids
compression stockings
siitting - standing slowly
steroids!

277
Q

epidemology of postural hypotension ?

A

elderly people
parkinsons disease

278
Q

sx for infective endocarditis?

A

janeway lesion
osler nodes
splinter haemorrhages
roth spots

279
Q

tx for infective endocarditis?

A

ecg, urinalysis, fbc - raised wbc , crp - high, blood cultures - microrganism, echo - vegetation on valves

280
Q

myeloproliferative disorders example?

A

polycytheamia vera
essential thrombocythaemia (THROMBOCYTOSIS)
myelofibrosis

281
Q

how are myeloproliferative disorders different from CML AND AML?

A

CML - only neutrophil, eosinophils, basophils
AML - myeloid progenitor cell which form rbc, neutrophils, eosinophils nd platelets
MD - RBC, platelets, fibroblasts

282
Q

WHEN WOUDL TReatment of DVT BE MORE AGREssive ?

A

when consequences of dvt are very damaging ie. ischeamia/ necrosis
venous ulceration

283
Q

function of heparin?

A

binds to antithrombin and increases activity
indirect thrombin inhibitor
inhibits 10a and thrombin formation

284
Q

which has longer half life LMWH or heparin

A

LMWH - ONCE DAILY longer half life
heparin - very short 4 hours

285
Q

heparin induced thrombocytopenia more common in LMWH or heparin?

A

heparin

286
Q

how measure warfarin?

A

INR aim for 2-3

287
Q

how does DOAC work?

A

DIRECTLY ACTING FACTOR 2 OR 10

288
Q

why is DOAC not used for metal heart valves?

A

RISK of thrombosis is very high after metal heart valve
DOAC is not a high enough anti coagulant so warfarin is used instead

289
Q

function of clopidogrel?

A

inhibits ADP induced platelet aggregation by binding to p2y12
good for PCI

290
Q

complication of dvt?

A

phlegmasia alba dolens (milk leg) + PE + ischaemia

291
Q

WHY DOES DVT lead to ischaemia ?

A

rare complication - all veins are thrombosed
increased compartment pressure

292
Q

ix for DVT?

A

d - dimer - not specific if positive
GOLD STANDARD - duplex ultrasound compression
CT or MR venogram

293
Q

why can duplex ultrasound miss an acute DVT?

A

THROMBIS IS VERY FRESH AND will compress in acute setting

294
Q

cause of spontanous dvt?

A
  • exclude malignancy
  • genetic testing not worth ix
295
Q

ix for pe?
gold standard

A

ecg - sinus tachycardia
cxr will be normal
blood gases - hypoxia
d- dimer will be raised
GS - CTPA

296
Q

if cant use anticoagulation for prevention of PE?

A

USE ivc FILTERS but not very common

297
Q

what happens to the plaque when we get an acute clinical complication?

A

RUPTURE With thrombus formation

298
Q

what is most potent risk factor in PAD?

A
  1. smoking
  2. hypertension
299
Q

6 Ps for acute ischaemia?

A

pain, pallor, poikilothermia, pulselessness, paresthesia, and paralysis (dead muscles at this point)

300
Q

cause of acute embolis

A

AF or MI

301
Q

CHRONIC ISCHAEMIA epidemology?

A

have risk factors (smoking, hypertension, diabetes) and elderly

302
Q

rest pain in chronic ischeami?

A

demand of muscle at rest is not met by what oxygen can be supplied

303
Q

burger test?

A

hold foot up at an angle and will it go pale and white
then dangle legs on side of bed skin goes blue and then bright red
positive for ischeamia

304
Q

distinction ext vs internal carotid artery

A

external has a branch
internal no branch

305
Q

common location of aneurysms?

A

INFRA- RENAL AORTA

306
Q

why would atherosclerosis cause occlusion or a dilation, what dictates this?

A

when walls of arteries get calcified due to athersclerotic plaque they become sicheamic and can dilate to become a baloon

307
Q

IX for anuerysym?

A

ABPI - bp of both arms and take effected leg bp compare
duplex ultrasound
bloods- lipids, glucose, renal fucntion, fbc, clotting, vasultic screen
cross sesctional imaging

308
Q

why MRA over CTA?

A

mra doesnt include calcium - so easier to see with blocked calcium vessels
mra doesnt use radiation

309
Q

risk rfactors modifatication for PVD

A

antiplatelets
statin
stop smoking
excercise
ACE inhibitors
excercise training

310
Q

AAA tx

A

stent
open surgery - better long term resutls

311
Q

virchows triangle causes of venous thrombis ?

A

hypercoagubiltiy
flow stasis

312
Q

scoring system for DVT?

A

wells scoring over 3 points

313
Q

role of warfarin?

A

inhibtis vitamin K dependant clotting factors 1972
instrisic

314
Q

cells found in CLL?

A

smudge cells

315
Q

treatment for CLL

A

imatinib is a tyrosine kinase inhibitor

316
Q

causes of megaloblastic macrocytic anaemia

A

folate defiency

317
Q

stages for CKD?

A

stage 1 normal 90ml/min - but other tests show kidney failure
stage 2 60 - 89 ml/min
stage 3a - 59 - 45 ml/min
stage 3b - 30 - 44 ml/min

318
Q

signs and symtpoms of non classical hodkins lymphoma?

A

PAIN AFTER DRINKING
popcorn reid steinberg cells

319
Q

most common form of hyperthyroidism?

A

graves hyperthyroidism

320
Q

Propylthiouracil when to use

A

tx for hyperthyroidism 2nd line to carbimazole (dont give to pregnant woman)

321
Q

tx for hypothyroidism?

A

levothyroxine

322
Q

ix for aortic dissection

A

Ct scan, cxr, trans oesphageal endoscopy (toe)

323
Q

mnemonic for UTI causes?

A

K klebsiella
E ecoli
E enterococi
P proteus mirabalis
s STAPH SAPHrophytus

324
Q

which troponin are specific to cardiac muscle?

A

necrosis of cardiac muscle
troponin I, T NOT C (SKELETAL ALSO HAS C)

325
Q

bi basal inspiratory crackles
hr/ bp normal
no additional heart rate
peripheral oedema
displaced apex beat
BNP is high
breathless on excersersion
cxr = cardiomegaly
echo reduced ventricular ejection fraction?
previous stemi

A

heart failure with reduced ejection fraction

326
Q

heart failure?

A

complex syndrome - CO is insufficient to meet metabolic requirement s of the body and accommodae venous return

327
Q

stroke volume?

A

end diastolic volume - end systolic volume

328
Q

preload?

A

initial strechting of cardiac myocytes prior to contraction represented by LV end diastolic volume

329
Q

afterload?

A

the load the heart must eject blood against

330
Q

3 key neurohormonal systems for heart function? how do they cause heart failure ?

A

RAAS
sympathetic system
natriuretic peptides - distention releases anp/bnp = decreases renin, dilation, increase gfr and sodium excretion

causes blood volume increase and fluid excess and venous constriction = long term causes hypertrophy, fibrosis, myocyte death, reduces CO

331
Q

causes of macrocytic anaemia?

A

alcholism
chronic liver disease
b12 defiency

332
Q

two investigations for heamolytic anaemia to ix if heamolytic ?

A

reticulocyte count
haptoglobin - protein that binds to rbc fragments
direct antiglobulin test

333
Q

pernicious aneamia?

A

intrinsic factor deficiency = less absorption of b12
damage to parietal cells

334
Q

what are blast cells?

A

premature cells

335
Q

polycythaemia?

A

high heamoglobin

336
Q

thrombophilia vs thrombocytosis?

A

thrombophilia - forming clots
thrombocytosis - increased platelets

337
Q

where does leakeamia vs lymphoma start?

A

leukaemia - bone marrow
lymphoma - lymph nodes

338
Q

cells affected by leukeamia?

A

myeloid and lymphoid branch - blasts and white blood cells

339
Q

leakeamia leads to ?

A

pancytopenia
heamoglobin low
platelet - low
wbc - low

340
Q

acute vs chronic leukaemia?

A

acute - blast cells - more blast cells
chronic - mature cells - more of these cells

341
Q

what can prothrombin time tell you about the liver?

A

if normal no problem with liver

342
Q

hepatosplenomegaly present in Chronic leakeamia vs acute?

A

chronic leukaemia

343
Q

lymphoma presentation?

A

painless lymph nodes
b symptoms - fever, night sweats, weight loss

344
Q

staging for lymphoma?

A

ANN arbour staging
A - no symptoms
b - symptoms

345
Q

previous infection and correlation with lymphoma?

A

EBV PREVIOUSly

346
Q

light chains in urine?

A

bence jones
paraprotein in serum

347
Q

how does myeloma causes kidneys disease?

A

immunoglobulin and light chains get stuc in kidneys

348
Q

diagnostic ix for myeloma ?

A

bone marrow biopsy is diagnostic
u will do :
blood films
urine
serum electrophoreisis
x ray

349
Q

1st line ix for chest pain?

A

ECG

350
Q

ix for immune thrombocytopenia purpura

A

bone biopsy shows increase megakarocytes
platelet autoantibodies may be present

351
Q

sx for immune thrombocytopenia purpura?

A

purpura - purple spots on skin
easy bruising -
bleeding gums

352
Q

infections associated with immune thrombocytopenia purpura?

A

children - chicken pox
adults - HIV OR HEP C

353
Q

IRST LINE AND SECOND LINE TX FOR itp ?

A

1ST -cortciosteroids
IV IgG

2nd - splenectomy

354
Q

anaemia iron defiency signs?

A

spooon nails - kalonchya
brittle nails
palor
smooth tongue

355
Q

signs of anaemia?

A

anaemia, jaundice, hepatosplenomegaly and ‘Black Water Fever’.
Black water fever is a complication of malaria causing haemolysis of RBCs which results in Hb being
released directly into the urine.

356
Q

strain of protazoa in malaria that can cause relapses ? treatment?

A

P. ovale and P. vivax can form hypnozoites in the liver which can lie dormant for years and cause
relapses.
- primaquine can be given to eliminate these – however be careful as this can
cause haemolysis in those with G6PD. Primaquine is also contraindicated in pregnancy and
breastfeeding.

357
Q

chromosomal abnormalities in multible myeloma?

A

t(11:14)

358
Q

2 features associated with AML?

A

downs syndrome
radiation

359
Q

role of Allopurinol

A

prevent tumour lysis syndrome - prevents excess uric acid from chemo
tx for AML

360
Q

managaement for CLL?

A

Chemotherapy
Monoclonal antibodies (rituximab)
Bruton kinase inhibitors (ibrutinib)

361
Q

signs for CLL?

A

enlarged rubbery non tender lymphnodes
anorexia
assymptomatic usually

362
Q

complication of CLL?

A

Richter’s syndrome – transformation of CLL to an aggressive lymphoma

363
Q

lymphoma assicaited after drinking?

A

hodkins lymphoma

364
Q

ix for diagnosing hodking lymphoma?

A

FBC – anaemia, high ESR
CXR – wide mediastinum
Blood film – Reed-Sternberg cells

365
Q

tx for hogdkins lymphoma

A

Chemotherapy ABVD treatment
Marrow transplant

366
Q

causes of aortic dissection in young people?

A

marfans syndrome. ehler danos syndrome (strecthy skin) , pregnancy, trauma, male

367
Q

type a vs type b aortic dissection?

A

artieral blood into media of aorta creates false lumen
type A - ascending aorta - proximal to Left subclav branch
type b - descending aorta - distal to LS branch

368
Q

main rf in aortic dissection?

A

HTN! smoking, trauma

369
Q

complication of aortic dissection?

A

organ ischaemia -failure + shock

370
Q

sx for aortic dissection?

A

tearing pain
acute chest pain
collapse
hypertensive

371
Q

ix for aortic dissection?

A

cxr - broadening of mediastenum
echo
MRI/CT angiogram
GS - TOE - SHOWS ENTIRE AORTA

372
Q

tx aortic dissection

A

pain control and htn management
type A - surgery
type B - medical MAP of 60-70 mmhg - BB (labetalol)/ CCB - MINIMAL ACCESS ENDOLUMINAL REPAIR - return blood from false to true lumen or stent

373
Q

causes of mitral valve prolapse?

A

marfans syndrome
degenerative myxomatous - excessive mucosal/ gelatin growth

374
Q

what causes systolic mumurs/

A

ASMR
aortic stenosis
mitral regurgitation
S1 mumur s2

375
Q

what causes diastolic murmur?

A

ARMS
aortic regurg
mitral stenoisis
s1 s2 murmur

376
Q

where to hear mitral valve

A

left sternum midclavicular line in 5th intercostal space

377
Q

where to hear aortic valve ?

A

right sternum 2nd intercostal space

378
Q

here to hear pulmonary valve?

A

left sternum 2nd intercostal space

379
Q

triscuspid area ?

A

left sternum 4th intercostal space

380
Q

IX FOR mitral regurgiation?

A

TOE - prolapse, dilated LA, LV
ECG - atrial fib, lv hypertrophy
CXR- enlarged LV, LA, venous congestion, pulmonary oedma

381
Q

diuretic for MR?

A

furosimide - loop diuretic

382
Q

diuretic for MR?

A

furosimide - loop diuretic

383
Q

causes of hypercalceamia?

A

hyperpth
bone maligancy
excess vit D - too much calcium absorbed in gut
thiazide increase reabsorption

384
Q

tx for hyperclaceamia?

A

loop diuretics - increase excretion
rehydrate
glucocorticoids - decrease calcium absoprtion in gut
bisphosphinates + calcitonin

385
Q

most common thalasseamia?

A

beta thalasseamia - no beta chain production
heterozygotes (minor) - no symptoms
homozygotes (major) - severe hypochomric anaemia

386
Q

tx for thalassaemia beta?

A

haemapoeitic stem cell transplant
folic acid
splenectomy

387
Q

pathophys for alpha thalasseamia?

A

4 deletions on chromosome 16
excessive Hb H = groups of beta chains (useless)

388
Q

how does b12 defiency causeanaemia?

A

pernicious anaemia - autoimmune system attack IF or parietal cells and causes decrease of B12 absoprtion leading to decrease of RBC production

389
Q

symptoms of pernicious anaemia?

A

weakness
fatigue
abdominal discomfort after eating
palpiations
jaundice
mouth ulcers
pins and needles

390
Q

dx blood test of pernicious anaemia?

A

B12 LOW
MCV high - macrocytic
multilobe nuclei nuetrophils
Anti IF antibodies

391
Q

tx for pernicious anaemia?

A

IM b12 hydroxycobalamin

392
Q

who is affected by G6PD defiency?

A

males -x chromosomal
equator with malaria

393
Q

blood film of G6PD?

A

heinz bodies
bite cells
blister cells
reticulocytes
heamolytic crisis

394
Q

drugs to avoid with G6PD?

A

no oxidative stress protection
antimalarials - quinine
NSAIDS
FAVA beans
Nitrofurantoin - UTIs
ciprofloxacin

395
Q

cp for g6pd defiency?

A

Fatigue, palpitations, shortness of breath, pallor

396
Q

scoring for DVT? ?

A

Wells scoring

397
Q

ejection fraction in systolic heart failure?

A

under 40%
normal - 50 - 70 %

398
Q

ejection fraction in diastorlic heart failrue?

A

normal
becuase reduced preload so overall total volume is low anyway

399
Q

causes of left sided heart failure?

A

usually systolic
damage to myocardium
cant contract as forcefully
- coronary artery athersclerosis = IHD
previous MI causes ischaemia
- high bp = hypertrophy (fills into ventricular chamber space making it small) - more 02 required and coronary arteries sqeezed
- dilated cardiomyopathy = muscles walls get thinner and weaker
- aortic stenosis
- restrictive cardiomyopthy - stiffer walls

400
Q

why oedma during HF?

A

reduced blood to kidneys - release RAAS - fluid retention -pulomary oedma

401
Q

why dyspnea and orthopnea in HF?

A

fluid in lungs due to fluid retention and increased pressure in pulomonary arteries
cant exchange o2 and co2 as well because of fluid build up

402
Q

tx for left sided hf?

A

ABAL

ace inhibitors
BB
aldosterone antagonist - spirolactone
LOOP diuretics
pace makers
heart transpalnt

403
Q

causes of right sided HF?

A

CAUSED BY LEFT
increased pulmonary artery pressure
left to rught shunt - septal defect
hypertrophy of right ventricle
chronic lung disease (hypoxia) = pulomary arterioles constrict and increase blood pressure

404
Q

cp of right sided heart failure?

A

back up - excess interstitial fluid back up

jugular venous distention
hepatosplenomegaly
liver cirrhosis
ascites
pitting oedma

405
Q

medications for heart failure side effcts?

A

Beta blockers: Bradycardia, hypotension, fatigue, dizziness
ACE inhibitors: Hyperkalaemia, renal impairment, dry cough, lightheadedness, fatigue, GI disturbances, angioedema
Spironolactone: Hyperkalaemia, renal impairment, gynaecomastia, breast tenderness/hair growth in women, changes in libido
Furosemide: Hypotension, hypoatraemia/kalaemia,
Hydralazine/nitrate: Headache, palpitation, flushing
Digoxin: Dizziness, blurred vision, GI disturbances

406
Q

Mnemonic for xray findings for heart failures

A

ABCDE
Alveolar oedma
Bat wing Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
E pulomonary effusions

407
Q

inheritence of haemophillia A and B ?

A

X LINKED

408
Q

where is factor 8 sdynthesized?

A

LIver and endothelial cells
protected by vWF

409
Q

cp of severe heamophillia?

A

spontanous bleeding of skin, muscles + large joints
intracranial bleeeds

410
Q

cp of haemophillia A and B ?

A

BLEEDING (musculoskeletal, skin)
raised APTT due to effect on intrinsic factor
normal PT

411
Q

type 1 vs type 2 vWF disease?

A

type 1 - low number of normal vwf protein
type 2 - abnormal vWF protein

412
Q

inheritance of VWF disease?

A

autosomal dom

413
Q

cp of vwf DISEASE?

A

nose bleeds
bleeding
mennorhagia

414
Q

ix for vWF disease?

A

normal pt + raised aptt
low vwf
normal factor 8 and 9 assay

415
Q

tx for vwf disease?

A

no cure
desmopressin agonist - DDAVP

416
Q

d dimer?

A

generation if fbinrin degranulation crosslinked (by factor XIII) fibrin.
It reflects ongoing
activation of the hemostatic system.

417
Q

prothrombin time?

A

The prothrombin time is a measure of the integrity of the extrinsic and final common pathways of
the coagulation cascade.

418
Q

APTT?

A

activated partial thromboplastin time
APTT – a measure of the functionality of the intrinsic and common pathways of the coagulation
cascade.

419
Q

thrombin time

A

fibrin (1a) from fibrinogen (1)
hrombin time – Thrombin time is a screening coagulation test designed to assess fibrin formation
from fibrinogen in plasma.

420
Q

fibrin degradation products?

A

Fibrin and fibrinogen-degradation product (FDP) testing is commonly
used to diagnose disseminated intravascular coagulation (DIC).

421
Q

bacterial cause of guillain baree syndrome?

A

campylobacter jejuni
gram negative rods

422
Q

DX of parkinsons?

A

purely clinical
bradykinesia + at least one clinical sign

423
Q

parkinson dementia vs lewy body dementia?

A

parkisnon dementia - parkison and then dementia
lewy body dementia with parkinsonia -lewy body and then dementia

424
Q

questions for suspected parkisnon?

A

slow progression - parkinson? sudden onset?
symmetrical vs asymmetrical - parkinsons

425
Q

3 cardinal features of parkinsons?

A

bradykinesia - writing smaller/ buttons/ small steps GATE
asymmetrical reduction in arm swing
tremor - at rest / unilateral
rigidity - pain/ increased tone
hypomimia - mask like face

426
Q

tx for parkinson

A

LDOPA - only give if severe! resistance develops quickly (levodopa + decarboxylase inhibiotrs)

anticholinergics - lower aCH levels
symptomatic therapy
MAO - B inhibitors - rasagiline
dopamine agonists - ropinirole

427
Q

CP for guillain barre?

A

symmetrical ascending weakness
loss of DTRs - deep tendn reflexes
previous gastroenteric infection within 4 weeks

428
Q

pathophysiology of guillain barre?

A

molecular mimicing
antibodies that attcak infection but also neurons

429
Q

tx for essential tremor?

A

primidone low dose
beta blockers - propanolo up to 100 mg - contraindicated with stham
gabapentin - anti epileptic

430
Q

ix fr guillain barre

A

clinical diagnosis with brightons criterias
Bloods: exclude other causes
U&Es: electrolyte abnormalities resulting in neuropathic symptoms
B12 and folate: deficiency associated with neurological features
TFTs: to exclude hypothyroidism as a cause of weakness
LFTs: elevation of hepatic enzymes is associated with more severe disease
Anti-ganglioside antibodies: can be used to differentiate GBS variants, e.g. anti-GQ1b antibody in Miller-Fisher syndrome
Cultures: stool or sputum sample if there are ongoing infective features, e.g. gastroenteritis
Lumbar puncture for CSF: raised protein with normal WBC count is typical, although an initial normal protein level does not exclude GBS
Spirometry: to monitor respiratory function as 20% of patients require mechanical ventilation at some stage

431
Q

tumour lysis syndrome?
tx?

A

chemo release uric acid = kidney failure
allopurinol

432
Q

ix for perncious aneamia?

A

1st line - intrisic factor antibodies
2nd - gastric parietal cell antibodies

433
Q

infectious cause of bed bound pnuemonia pts?

A

klebsiella

434
Q

infectious cause of COPD pneumonia pts?

A

h. influenza
Pseudomonas aeruginosa (gram negative rod)

435
Q

infectious cause of bird handlers pneumonia?

A

chlamydia psittacosis
gram negative

436
Q

mnemonic of causes of atypical pnuemonia?

A

legions of psitacci MCQs
legionella
chlamydia psitacci
M – mycoplasma pneumoniae
C – chlamydydophila pneumoniae
Qs – Q fever (coxiella burnetii)

437
Q

tx for fungal pneumonia?

A

treatment is with co-trimoxazole (trimethoprim/sulfamethoxazole)

438
Q

protein defective in primary cilicar dyskenisa?

A

dynein - cilia cant move

439
Q

most common pneumonia in HIV patients?

A

pneumocystitis pneumonia

440
Q

CP of primary ciliary dyskinesia?

A

infertility
sinusitis
bronchiectasis
heart on right side

441
Q

tx for primary ciliary dyskenisa?

A

same as bronchectasis
Antibiotics: for recurrent infections
Postural drainage: to remove excess mucus
Chest physio
Mucolytics
Bronchodilators e.g. nebulised salbutamol: useful for asthma or COPD sufferers
Anti-inflammatory agents e.g. long term azithromycin can reduce exacerbation frequency

442
Q

causes of dyspnoea?

A

CHF - pulmonary oedma , aneamia
5 Ps
COPD
asthma
obesity

443
Q

MRC scale ?

A

dyspnoea
1- strenous excercise
2 -walking inlice
3- walking flat
4 - breathless after 100 m
5 - after ADL (ACTIVITES OF DAILY LIVING )

444
Q

5 Ps in dysnpoea?

A

pleuristy
pneumonia
pulmonary fibrosis
pulmonary cancer
pulmonary embolism

445
Q

what stain allows for better mycobatceria detection?

A

Auramine Phenol ‘AP’ fluorescent stain. It allows faster and more sensitive detection of Mycobacteria.

446
Q

tx for acute heart failure?

A

iv opaites
ionotropic agents - dobutamine
aortic balloon pump

447
Q

role of cyclosporin?

A

imunosupressant for transplant rejection!

448
Q

cyclosporin side effects?

A

nephrotoxicitiy!
interstitial nephritis
hyperureacemia
hyperlipideamia
htn
gum tissue hyperplasia
hirsutism

449
Q

causes of epiglottitis? tx?

A

H. INFLEUNZA B
emergency!
airway opening
adrenaline
broad spec abx - cetriaxone

450
Q

cp of epiglottitis?

A

sitting forward - tripod position
older children 2-7 year s
drooling
sitting still
no cough

451
Q

croup tx?

A

steroids- dexamethasone
epinephrine
fluids and rest

452
Q

cough in croup?

A

seal like

453
Q

HLA DR2 autoimmune disesses?

A

SLE, goodpastures. MS, hepatitis

454
Q

gender affected by goodpastures syndrome?

A

males

455
Q

tissue affected by good pastures?

A

collagen type 4
basememt membranes!
alveoli and nephrons

456
Q

tx for good pastures??

A

corticosteroids - prednisolone
plasma exchange

457
Q

lung volume effected by restrictive lung diseases?

A

complience reduces
all volumes decrease

458
Q

lung volumes effected by obstructuve lung diseases?

A

rv and erv increase

459
Q

fvc fev1 and fev1/fvc in restrictive lung disease?

A

fvc - decreased
fev1 - normal
ratio - normal

460
Q

causes fo t2 resp failure ?

A

copd
obstruction
opioid od

461
Q

causes of t1 resp failure?

A

PE
acute asthma
pneumonia

462
Q

bacterial causes of sinusitis?

A

s. pneumonia
morexella
h. influenzae

463
Q

tx for sinusitis?

A

2 - 3self limiting
steroid nasal spray
abx - phenoxymethylpenicillin 500 mg four times a day for 5 days. or doxycycline

464
Q

dx of chronic sinusitis ?

A

clinical
ct scan
rhinoscopy

465
Q

dx of otitis media?

A

clincal
pain in ear
otoscopy - red inflammed ear drum - tympatic memebrane or fluid behind membrane

466
Q

complications of otitis media?

A

glue ear - grommit

467
Q

tx for otitis media?

A

amoxicillin

468
Q

cause of whooping cough?

A

bordella pertussis - (gram - rods)

469
Q

tx for whooping cough?

A

macrolide - clarithromycin
vaccination

470
Q

dx of whoping cough?

A

clinical
contact PHE!
fbc
swabbing

471
Q

most infectious phase of whooping cough?

A

catarhhal phase
runny nose and congestion

472
Q

shift of oxygen dissociation curve to the right?

A

CADET raise right
Co2 - affinity to o2 decrease because low o2
Acid
DPG - binds to beta chains of haem - 02 affinty decrease
excercise
Temp - o2 released more readily

raise in temp
increase H+ - low pH

473
Q

shift of oxygen dissociation curve to the left?

A

high pH
decrease temp

474
Q

why is affinty for oxygen higher in fetal haem?

A

has to compete with mother heamo so must have higher affinity

475
Q

signs and symptoms of life threatening asthma?

A

silent chest
PEFR <33%
cyanosis
exhaustion

476
Q

important features for diagnosis of astham?

A

worse at night and in morning
reccurant
response to triggers
occur apart from colds

477
Q

mech of gtn spray

A

increase cgmp
inhibit calcium channel
prevent vasoconstriction

478
Q

aortic stenosis cp?

A

SAD
syncope
angine/ aneamia
dysnopnea

479
Q

murmur in as

A

systolic ejection which radiates to carotid arteries

480
Q

Name the pathological Korsakoff heart sound observed in a patient with aortic stenosis

A

before S1 = s4

481
Q

Which two treatments are all patients started on in the management of heart failure, with the aim of slowing progression? in heart failure

A

ace inhibitors and beta blockers

482
Q

3 cardinal signs of heart failure?

A

peripheral oedma
sob
fatigue

483
Q

signs in becks triad and what is this a sign of?

A

Hypotension
Raised JVP
Muffled heart sounds
pericarditis

484
Q

function of clopidogrel ?

A

inhibits ADP binding to platelet receptors

485
Q

most common cause of bacterial tonsilitis ?

A

s. pyogenes

486
Q

The wife of a right-handed 28 year old man with a three-year history of seizures has
managed to record a typical seizure on video. During the seizure, his eyes and head
initially turn to the left, the left arm extends before the whole body stiffens, goes rigid
and then begins to shake vigorously. The shaking subsides gradually over one
minute.
In which part of the brain is this seizure likely to have started?

A

right frontal lobe

487
Q

An 80 year old man mentions some exertional breathlessness whilst consulting his
General Practitioner for another complaint. The GP hears an ejection systolic
murmur that radiates to the neck but notes that mild aortic valve stenosis has been
recorded previously. The GP is not sure whether the patient’s valvular heart disease
has progressed sufficiently to potentially account for the new complaint of
breathlessness.
Which feature of the clinical examination would suggest that the aortic stenosis is
now severe?

A

slow riding pulse and small volume

488
Q

ecg of RBBB vs LBBB? causes RBBB

A

RIGHT SHOWS MARROW - mshape QRS
left shows WILLIAM - w shape QRS

RIGHT- pulmonary embolism
right heart failure
right ventricular hypertrophy
left - AORTIC STENOSIS , HTN, LEFT VTRCILE

489
Q

A 70 year old man, who smokes 20 cigarettes per day, suffers from intermittent
claudication. He can only walk 100 yards before cramp like pain in his right calf stops
him. The pain is eased by stopping. Imaging shows his femoral artery is occluded.
He wants some help to improve his walking, which treatment do the current NICE
guidelines recommend?

A

STOP SMOKINGA DNEXCERCISE! only do angiplasty if these do not work

490
Q

A 40 year old man is admitted with jaundice. Urine analysis shows no evidence of
bilirubin in the urine.
Which is the most likely cause of this man’s jaundice?

A

aquired heamolytic aneamia

491
Q

most likely cause from medications to cause hyponatreamia?

A

thiazide diuretics

492
Q

cancerous cause of hypocalceamia?

A

tumour lysis syndrome

493
Q

first line tx for hypercalceamia?

A

fluid ressus and then bisphsophinates

494
Q

ix for over over 60 with iron def aneamia?

A

urgent endoscopy - risk of colon cancer

495
Q

causes of iron defiency aneamia in children and adults?

A

malabsorption (ceoliac, IBD)
malnutritions
mennoragia
hookworm!

496
Q

tx for iron def aneamia?

A

oral ferrous sullfate - SE- black stool , constipation
IV IRON

497
Q

cp for thallseamia?

A

CHIpmunk facies
spelomegaly - over production of RBC due to heamolysis
aneamia sx

498
Q

electrophoresis of beta thalaseamia?

A

low HbA
high HbF and Hba2

499
Q

TX FOR BETA THALASSEAMIA?

A

BLOOD TRANSFUSIONS
IRON chelating aganets to prevent iron overload

500
Q

chromosome affected by alpha thalasseamia?

A

chromsome 16

501
Q

alpha thalaseamia trait?

A

asympotomatic - 1 loci deleted on chromsome 16

502
Q

most accureate dx for alpha thalaseamia?

A

genetic studies

503
Q

geentic mutation in sickle cell anaemia?

A

GAG -> GTG on 6th codon of beta globulin

504
Q

complcations of sickle cell aneamia?

A

splenic sequestration - large spleen due to blockage
vasoocclusive crisis - block of bone blood supply
acute chest crisis - vasooccusion of pulmonary blood supple - resp distress

505
Q

ix and dx of sickle cell aneamia?

A

FBC and blood film- normocytic normochromic aneami with raised reticulocytes
sickle cell RBC
dx- hb electrophoresis

506
Q

triggers for acute heamolytic aneamia in patients with g6pdH DEF?

A

fava beans consumptions
sulphonylureas (sulph- medications)
moth balls
antimalarials

507
Q

mutation in polycyhteamia vera?

A

JAK 2 mutations

508
Q

coombs test ?

A

RBC accumilation with coombs reagent
positive for autoimmune heamolytic aneamia associated wth SLE

509
Q

DEVELOPMENT OF hereditory pherocystosis ?
common tx?

A

northern european
autosomal dom
splenectomy as young child

510
Q

blood film of pernicious aneamia?

A

cabot rings

511
Q

A 2-year-old boy is brought into the emergency department with a non-blanching rash. He has had a recent viral illness featuring coryza and cough, which resolved two weeks ago.

On examination, he is well-perfused, and his heart sounds are normal. There is no neck stiffness, neurological deficit or photophobia. There are numerous non-blanching petechiae on his arms, legs, and chest.

A urine dip is unremarkable. What is the most likely diagnosis?

A

immune thrombocytopenia purpura

512
Q

viral cause of aplastic aneamia?

A

parovirus b19

513
Q

turbulent blood flow in heart?

A

valves - growth in turbulence

514
Q

tx for pericarditis?

A

NSAIDS
COLCHINE
ppi

515
Q

clinical features of cardiac tamponade?

A

becks triad
raised JVP
hypotension
quiet heart sounds

dysnopneas
pulsus paradoxus
kussmal breathering deep and labored breathing pattern
ECG electrical alterans - QRS keeps switching in heights - > echocardiogram (dx)

516
Q

tx for tamponade

A

periocardiocentisis

517
Q

stage 1 htn?
stage 2

A

140/90 - ambulance - 135/85
stage 2 - 160/100 - ambulnce - 150/95

518
Q

signs and symptoms of right sided heart failure?

A

peripheral oedma
raised JVP
HEPATOMEGALY
ascites

519
Q

signs and symtpoms of left sided heart failure?

A

pulmonary oedma
fatigue
noctural SOB

520
Q

cxr of heart failure?

A

Alveolar oedma - bat-wing opacification
B KERLEY B LINES
CARDIOMEGALY
Dilated upper lobe vessle
E fffusion of pleura

521
Q

tx for heart failure?

A

ACE nibitors + arbS
bb
MINERALcorticosteroid - spirolactone
SGLT2 INHIBITOR

522
Q

tx for stable for atrial fibrillation?

A

history - within 48 hours
rate + rythm control (amiodorone )

over 48 hours
RATE control (BB/ CCB) + ANTIcoag

523
Q

POST ACS preventiive ?

A
  1. ACE
  2. aspirin
  3. P2Y12 inihbitors - clopidrgrel
  4. BB
  5. high dose statin
    PPi
524
Q

side effects of vermapril?

A

bradycardia + HF

525
Q

ideal time to do PCI after MI?

A

2 HOURS AFTER ONSET OF SYMTPOMS

526
Q

tx for NSTEMI?

A
  1. ASPIRIN
  2. fondapirux

GRACE scoring for CV events
low risk - aspirin + P2Y12 inhibitor

high - angiography
duel antiplatelets

527
Q

imediate tx for MI?

A

Morphine - venodi;lation
Oxygen
Nitarets
Apirisn

528
Q

most common causative organism for peritonitis?

A

e.coli
klesiella

529
Q

causes of ejection systolic murmur

A

aortic stenosis
hcm
pulmonary stenosis
atrial septal defect - back flow into pulmonary valves

530
Q

auses of pansystolic murmur?

A

mitral regurg
tricuspid regurgitation
blood still leaking

531
Q

ECG SHOWING PROMINENT jugular V wave inticates?

A

pulmonary hypertension and heart failure

532
Q

pressure within pulmonary htn?

A

over 20 mmHg

533
Q

CP OF PULMONARY HTN?

A

dysnopea, fatigue, SOB, peripheral oedma

534
Q

ix for pulmonary htn?

A

right heart catheterisation is GS

535
Q

first line tx for supraventricular tachycardia?

A

vagal mounevre

536
Q

pathophysiology of AVNRT?

A

in AVNRT two pathways short and long
pre mature atrial impulse and conducts fast or slow pathwaybecuase other pathywaise is not in refractoring period

537
Q

ecg of supraventricular tachycardia?

A

narrow complex
retrograde p waves

538
Q

tx for SVT?

A

unstable - synchronised DC shock
stable - vagal manoeuvre - blow into tube + carotid massage
IV adenosine
BB

539
Q

DRUG CONTRAINDICATED IN HEART FAILURE?

A

CCB NEGATIVLY ionotrophic

540
Q

BNP vs NT probnp?

A

BNP - ACTIVe short half life
NT proBNP - inactive lasts longer

541
Q

what are kerly b lines?

A

fluid leaking into interlobular septum - short lines - heart failure!

542
Q

first line tx for arrythmias?

A

ECG

543
Q

2 cardiac causes of arrythmia?

A

WPW, AF

544
Q

2 non cardiac causes of arrythmia?

A

hyperthyroidism
stress
anxiety
pheochromocytoma
alcohol
floraquinolones

545
Q

feeling rapid regular pounding in neck and palpitations?

A

SV arrythmias

546
Q

palpitations on awaking , sign of?

A

AF

547
Q

SE of heparin?

A

bleeding, pain at injection site and low blood platelets.
inhibits fibrin and Xa
INSTRISIC AND COMMON PATHWAY

548
Q

SE of warfarin?

A

pass blood in your urine or faeces
pass black faeces
have severe bruising
have long nosebleeds – lasting more than 10 minutes
have bleeding gums
cough up blood or have blood in your vomit
experience unusual headaches
have heavy or increased bleeding during your period, or any other bleeding from your vagina (in women)
extrinsic and common pathway (2,7,9,10) - 1972 blokck vitamin K synthesis

549
Q

CP of pE?

A

dyspnoea, chest pain particularly upon breathing in, and coughing up
blood. Fever and sweating may also occur
- Signs include: hypoxia, tachypnoea, tachycardia and sometimes a mild fever

550
Q

arterial ulcers vs venous ulcers?

A

arterial -
more peripheral
pain
well defined
deep + small

venous
larger
superficial
iregular board
mid calf to ankle
venous excema

551
Q

ix for peripheral vascular disease?

A

ankle brachial pressure index
duplex us
angiogrphy - CT or MRI

552
Q

TX FOR pvd?

A

excercise/ lifestyle and co morbitiy managment

statins
clopidogrel
naftidrofuryl oxalate - vasodilator

surgery
stenting
endarterectomy - removal of plaque
bypass surgery

553
Q

tx for acute limb ischeamia?

A

endosvascular thrombolysis
endovascular thrombectomy
endarectomy
bypas surgery

554
Q

thiazide vs loop diuretic ?

A

thiazide -DCT
blocking the sodium–chloride transporter and increasing sodium chloride excretion.

loop diuretic - loop of henle
Loop diuretics function in thick ascending limb of the loop of Henle by blocking the sodium–chloride–potassium cotransporter and increasing sodium, potassium, and chloride excretion

555
Q

example of antiemtic drugs sontraindicated in parkinsons disease?

A

Metoclopramide - dopamine antagonists

556
Q

examples of COX inhibitors?

A

ibuprofen
paracetmol - weak inhibiton of COX2 (not involved in gastruc ulcers!)
celecoxib
diclofenac

557
Q

mechanism of clopidogrel

A

P2Y12
ADP antagonist and binds irreveribly to surface of platelets

558
Q

side effects of sulfonylureas?

A

3rd line tx for T2DM
gliclazide
tolbutamide- hypoglyceamia
appetite and weight gain
SIADH
CHOLESTATIC LIVER DISEASE

559
Q

sideroblastic vs iron def anaemia?

A

mimic eachother - both microcytic and hypochromic
sidero - high iron and ferritin and can be drug induced (TB)

560
Q

presentation of WVf DISEASE VS HEAMOPHILLIA a?

A

WVF - platelet based - gum bleeeding, nose bleeding and GI bleeds
Haemophillia A - presents early in life with DEEP bleeding - large muscle bleeding

both have normal platelet and pT but prolonged APTT

561
Q

virus associated with burkitts lymphoma?

A

EBV

562
Q

bloods in DIC?

A

desseminated intravascular coagulation
low fibringoen, low platelets and high d dimer

563
Q

CAUSES OF HAEMOLYTIC ANAEMIA

A

inherited - sickle cell
- thalaseammia
acquired - metallic valve replacement
- autoimmune

564
Q

aortic stenosis xray?

A

pulmonary oedma
cardiomegaly
calcification of aorta

565
Q

LFT particuarily involved with AFLD?

A

GGT
gamma glutamyl transferase

566
Q

b12 aneamia features? related to what conditions? blood film?

A

macrocytic
T1DM
oval macrocytes and
hypersegmented neutrophils

567
Q

side effects CCB?

A

Flushing
Increase glucose + urea
Gi upset
Headache
Tachycardia
Edema
Dizziness

Phase 2a (9 decks)

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