cardiology/ haematology Flashcards
1
Q
how is angina different from MI?
A
Angina involve ischemia not cell death
MI involves cell death
2
Q
how does subendocardial vs transmural ischemia differ on ECG ?
A
subendocardial - st depression
transmural - st elevation
3
Q
epidemiology of pericarditis?
A
80-90% idiopathic
seasonal with viral trends
higher in young pts
4
Q
pericardium vs myocardium?
A
muscle in middle - myocardium
outlayer fibrous - pericardium
5
Q
most common none infectious cause of pericarditis?
A
neoplastic - breast cancer
6
Q
common relief of severe chest pain in pericarditis?
A
sitting forward
7
Q
signs of pericarditis?
A
pericardial rub
sinus techycardia
fever
signs of effusion
Kaussmauls signs - increase with JVP with inspiration
hypotension
8
Q
ecg of percarditis?
A
j point elevation
saddle shape of st depression
wide spread
pr depression - not always there
9
Q
additional test for pericarditis?
A
FBC - elevation in WBC
TROPONIN - elevation for myopericarditis
CXR - normal
10
Q
causes of left axis devation?
A
defects to conduction system of heart
ventricular tachycardia
MI
WPW
left ventricular hypertrophy
left BBB
11
Q
normal QRS length?
A
QRS complexes to be between 70 - 110 milliseconds
12
Q
wide QRS indicates?
A
bundle block branch
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
14
Q
If ST-elevation was noted in leads II, III and aVF, what would it suggest?
A
inferior MI due to inferior plane
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
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
17
Q
DURATION OF NORMAL PR INTERVAL ?
A
3- 5 SMALL BLOCK - 0.12-0.2 seconds
18
Q
What view of the heart do leads V1 and V2 represent?
A
spetal
19
Q
leads v3-v4 represent?
A
anterior
20
Q
What does ST-elevation suggest?
A
MI
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
22
Q
lead 1 is negative, lead 2 and 3 are isotonic/ positive what is diagnosis?
A
right axis deviation
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.
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
25
marks on figertips in infective endocarditis?
splinter haemorrhage
26
tandard treatment for strep viridans infective endocarditis?
Intravenous Benzylpenicillin for 4-6 weeks +/- synergystic gentamicin for the first 2 weeks.
27
danger of septic emboli in infectious endocarditis?
spread from trcuspid valve to pulmonary vein to the lungs and grows
28
staph aureus vs staph epidermis?
aureus - golden on BA + coag+
epidermis - white on BA + coag -
29
use of SAB agar?
yeast growth of candida spp
30
Candidal endopthalmitis?
growth on mitral valve can spread
can spread to retinal artery and grow in retina causing cloudy vision
31
group D' streptococcus?
enterococcus
32
beta haem lancefield group C?
cellulitis, pharyngitis
33
antibiotic for enterococci?
Intravenous amoxicillin and gentamicin for 4-6 weeks.
34
staph aureus infection treatment ?
vancomycin and rifampin
35
diagnosis of duke criteria for infective endocarditis?
2 majors or 1 major and 3 minor or just 5 minor
36
major criteria for duke criteria ?
- Positive blood culture with typical IE microorganism
- New partial dehiscence of prosthetic valve or new valvular regurgitation
37
minor criteria for duke criteria?
- 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
38
role of angiotensin 2
vascular growth
salt retention
increase TPR and CO
39
main clinical use of ACE inhibitors?
hypertension
heart failure
diabetic neuropathy
40
effect of reduced angiotensin 2 formation (ex. from ace inhibitors)
- hypotension
- acute renal failure - filtration drops
- hyperkalaemia
- teratogenic (feotal abnormalities) effects in pregnancy
41
why cough with ace inhibitors?
increase of kinins
dry cough
break down of bradykinin
42
examples of CCB?
dihydropyridines:
amlodipine
nifedipine
Phenylalkylamines:
verpamil
Benzothiazepines:
diltiazem
43
effect of dihydropyridines?
dont effect heart only impact peripheral resistance
peripheral arterial vasodilators
44
adverse effect of peripheral vasodilation?
caused by
flushing
headache
oedema
palpitation
mostly cause by dihydropyridines
45
adverse effects of negative chronotrophic effects ?
verapamil/ diltiazem
bradycardia
46
beta blocker worsens what conditions?
asthma
PVD - raynauds
Heart failure
47
two groups to start treatment of hypertension with NICE guidance ?
55 years or younger
or
over 55 years or afro carribbean any age
48
two types of heart failure?
LVSD (chronic) - left ventricular systolic dysfunction
HFPEF - preserved ejection fraction
49
most common cause of heart failure?
CAD
50
main benefit for heart failure?
vasodilatory therapy via neurohumoral blockade (RAAS - SNS) block sympathetic
51
second line treatment for HF?
aldosterone antagonists
- can create male boobs
or ARNI
OR sglt 2 inhibitors
52
ace inhibitor interolence
use ARBs!
53
ace inhibitor and ARB interolence
use nitrate combination
54
example of an ARNI?
Entresto
valsartan - angiotension 2 blocker
sucubitril - neprilysin inhibitor -increase sodium/water in urine
55
role of nitrates?
arterial and venous dilators
reduce pre load and after load
lower BP
56
use of nitrates?
angina
symptomaticly in heart failure
57
treatment for chronic stable angina
- GTN spray
- statins
- aspirin - antiplatelet
58
first line treatment of chronic stable angina? after symtomatic tx
beta blocker or CCB
59
pain relief for nstemi and stemi (ACS)
GTN SPRAY
opiates - herion - diamorphine - vasodilator
60
ACS therapy?
DUAL antipplatelet therapy - aspirin and clopidogrel
61
ACS treatment?
antithrombin therapy
consider GP 2B/3A INHIBITOR
62
CLASSS 1 antiarrhythmic drugs?
sodium channel blockers tx for brugada syndrome
63
class 2 antiarrhythmic drugs?
beta adrenoreceptors antagonists
tx for svt
64
class3 antiarrhythmic drugs example
prolong qt interval
amiodarone
sotalol
tx for Intravenous amiodarone is added if initial DC shocks are unsuccessful in arrhythmias
65
class 4 antiarryhthimic drugs ?
CCBs
66
digoxin?
cardiacglycoside - inhibit na/k pump
antiarrhythmic drugs
67
fallot spells?
pts go blue
hyopxia - blue deoxygenated blood from RV to the LV
68
how many suffer from tertiary of fallot?
1/1000 live births
69
atrial flutter vs atril fibrillation?
In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles
70
ecg of atrial flutter?
fast bpm - 150 bpm
No p-waves. Seesaw baseline
narrow QRS
71
most common congenitial heart defect?
VSD 4/1000
72
eisenmengers syndrome? signs ? reversible?
blue lips
severe pulmonary hypertension
clubbing fingers
non reversible
73
signs of small VSD?
small hole - loud systolic murmurs
buzzing sensation
normal HR and heart size
74
clinical signs of ASD?
pulmonary flow murmur
fised split second heart sound
big heart and pulmonary arteries
75
what is avsd associated with?
21 trisomy (downsyndrome)
76
eisenmEngers syndrome is present in?
PDA and VSD
77
SIGNS OF aortic coarctation?
higher bp in right arm than left
incidental murmur
78
ventricular tachycardia (VT) ecg ?
rate
axis deviation
Rate 150
Rhythm Regular
Left axis deviation
PR/P wave Not visible
QRS Wide
79
ecg of WPW ?
shortened PR interval and slurred QRS upstroke – also know as a ‘delta wave’
qrs wave is not straight up and looks like a hill
80
ecg of Brugada Syndrome (Type 1)
leads V1 – V3 there is >2mm ST elevation, the T waves are inverted and the ST segment has a characteristic ‘coved’ shape.
81
ecg of percarditis
widespread saddle-shaped ST elevation and PR depression.
82
STEMI ecg?
PR/P wave Every p-wave followed by a QRS
QRS Narrow
ST/T wave ST elevation in II III and aVF
83
when are j waves present?
subarachnoid haemmorage
hypothermia
hypercalaemia
84
hypokaleamia on ecg?
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.
85
what conditions have u waves?
hypercalcaemia and thyrotoxicosis and hypokalemia
86
blockade of sodium channel on ecg?
widening of the QRS complex and lengthening of the QT interval
87
action of statins ?
HMG - CoA reductase inhibitors
inhibit production of LDL cholesterol in liver
88
saddle shaped st segment?
pr depression
pericarditis (enterovirus)
89
how is pericarditis chest pain different from MI?
pericarditis -- sharp and pleuric
MI - crushing and tight
90
high bp, under 55 years old or T2DB first line of treatment (not african descent) ?
ACEinhibitors
91
high bp, over 55 years or african/carribbean descent first line of treatment ?
CCB (amlodopine)
92
first line treatment for AF? cautions?
beta blockers - atenolol (not for asthma pts)
CCB - verapamil
93
when to use a doppler?
cramping in leg apon excertion - 1st line of investigation
94
ADENOSINE mechanism of action in tachycardia?
creates TRANSient heart block in AV node
short half life about 8-10 seconds
feeling of nausea and impending doom
95
where does endocardium recieve its blood supply?
ventricles not coronary arteries!
96
leads for left circumflex and diagnoal LAD?
1, aVL, v5-v6
97
leads for RCA (inferior of heart so also Left circumflex) ?
2, 3 aVF
98
leads for LAD?
v1- v4
99
when to oxygen in MI?
when under 94% saturation
100
when are CCB given during an MI?
Calcium channel blockers e.g. verapamil are only given if beta blockers are contra-indicated.
101
what drugs should be offered following an MI
DABS
DUAL antiplatelet therapy - aspirin
ACE inhibitor - ramipril
Beta blockers - propanolol
Statins - atorvastatin
102
prinzmedal angina ECG FINDINGS?
show ST elevation on an ECG along with STEMI and pericarditis
103
ABCD2 role?
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
104
QRISK3 role?
risk of developing a HA in next 10 years
105
HAS-BLED
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
106
The FRAX® tool
developed in SHEFFIELD!
evaluate fracture risk of patients
107
drugs for pci ?
Clopidogrel or prasugrel and aspirin
108
benefits of hypertensive treatment?
reduces risk of stroke by 40%
reduces risk of MI by 30%
increase life expectancy by 5 years
109
drugs which increase bp?
NSAIDS
SNRI - venlafaxine
corticosteroids
oral contraceptions - estrogens
stimulants - methylphenidate/ ritalin (adhd treatment)
anti TNFs
110
WHAT HAPPENS if stopping hypertensive mediation?
take for life because hypertension does come back when stopping
can stop if pre hypertensive
111
when to stop ACE i and ARBS?
when going in for surgery
112
volume of murmur in aortic stenosis ?
no effect on severity
113
prognosis of aortic stenosis ?
angina + as - 50%survive 5 years
syncope + as - 50% survive 5 years
114
what is TAVI?
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
115
when is TAVI required?
any symptomatic patients with severe Aortic stenosis
decreasing Ejection fraction - amount of blood pumped each time it beats
116
pansystolic murmur ?
sign of mitral regurgitation
apex to the axilla
117
death from mitral regurgitation?
progressive dysponea and heart failure
118
prophylactic vasodilators on mitral regurgiation use?
no indication to use ACE inhibitors as being helpful
119
WHEN WOUDL surgery BE NEEDED for severe MR
ANY symptoms at rest or excercise
consider is asymptomatic - EF lesss than 60%
new onset AF
120
systolic and diastolic pressure in aortic regurgitation?
WIDE PULSE PRESSURE
systolic is high because needs to more effort to get to aorta - high sv
diastolic is low
121
CXR IN aortic regurgitation?
enlarged cardiac silhouette and aortic root enlargment
122
when is surgery required in aortic regurgiation ?
breathlessness could be lung problems not heart failure
any symptoms at rest or excercise
asymtomatic - ef drops below 50%
123
gold standard for mitral stenosis ?
echo - gold standard - mitral valve mobility
124
when does patient qualify to surgery from mitral regurgitation?
any sympotomatic patient with NYHA class 3/4 symptoms
125
right axis deviation causes?
Left posterior fascicular block
– Right heart hypertrophy/strain
126
pr interval represents?
atrial depolarisation and conduction from atria to ventricles
127
small QRS causes?
obese patients
pericardial effusion
cardiac effusion
128
TALL QRS causes?
LEFT VENTRICLE hypertrophy
thin patient
129
causes of bradycardia?
av CONDUCTION problems
- av block
- LBBB
130
systematic ecg interpretation
rate
rhythm
axis
p, pr, qrs, st, qt
131
SVT vs VT QRS?
SVT - qrs narrow becuase quick
VT- qrs wide and passive
132
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
STEMI
133
* 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?
pericarditis
saddle shape ST elevation
PR depression
134
* 50y man
– No prior medical history
* Palpitations
– Missed beat
– ‘Thud’ or strong beat
– Brief racing/fluttering
ectopic beats
135
high burden Ventricle ectopic cause?
HF
136
high burden Atrial ectopic can progress tO?
AF
137
atrial fibrillation?
commonest sustained arhrythmia
138
medical treatment for AF?
treat underlying cuase
rate control - bb, ccb , digoxin
restore sinus rhythm acute
- pharmacologically cardioversion (flecainide / amiodarone)
maintain sinus rhythm
* Flecainide
* Dronedarone
* Sotalol
* Amiodarone
139
26y female PMH of ‘anxiety’
* Recurrent episodes of heart racing
– Sudden onset
– Breathless/panicky
ecg?
narrow complex SVT - AVNRT
no p waves - hidden in QRS
ATRIUM AND VENTRICLE AT SAME TIME
140
avnrt acute treatment
valsalva manoeuvres
cold water in face
adenosine
141
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?
WPW SYNDROME
DELTA WAVE - p and qrs are merged - av is being bypassed
142
TYPES OF AVRT
orthodromic - narrow
antidromic - broad
143
ELECTRICAL STORM
3 OR MORE VT or VF epsiodes in 24 hours
144
slow regulator ventricle
atrial flutter
signs?
heart block possible
145
presentation of MI in T2DM?
ATYPICAL
no chest pain
but sweating
146
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?
cardiac resynchronisation
LBBB - right ventricle before left ventricle
dysynchrony - ICD lead in left and right ventricle and get them to contract at same time
147
* 33y female
* Recent long haul flight from SE asia
* No recent
* Breathless with sharp right sided chest pain,
haemoptysis
ecg?
pulmonary embolism
sinus tachycardia
right ventricular strain
v1,2,3 - t wave inversion
148
lymphoid stem cell forms?
t and b lymphocytes
149
what is a plasma cell ?
differentiated b lymphocytes
150
high calcium , paraprotein and anaemia?
classic myeloma
151
smoldering myeloma symptoms?
asymptomatic
152
most common haematological cancers
1 - non hodgkins lymphoma
2 - multible myeloma
153
complications of systemic AL amyloidosis ?
Multible organ failure - extracelleular deposition of monoclonal immunoglobulin light chain fragment
154
test for myeloma?
whole body MRI/ ct
BONE MARROW BIOPSY
fbc
SEP
155
proteasome inhibitors examples? ?
treat myeloma
bortezomib (sc)
156
erythropoietin is made where?
kidneys
157
chronic heamolysis causes?
hypertension,
gallstones
kidney failure
158
traits of carrier of sickle cell?
increased risk of kidney cancer
rbc can sickle if hypoxic
159
test for sickle cell?
sickle solubility test
Hb Seperation
- gel/ capillary electrophoresis
- confirmatory test
160
pathophysiology of sickle cell?
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)
161
most common cause of death with sickle cell disease?
Pulmonary HTN and chronic lung disease (acute chest syndrome) most common cause of death in adults
162
what is happening?
lower resp tract infection
acute chest syndrome
pheumothorax
heart failure
sickle cell disease
acute chest syndrome
vaso- oclusive crisis of pulmonary vasculature
163
why do SCD have larger hearts ?
DUE TO CHRONIC ANAEMIA
164
treatment for acute chest syndrome?
exchange blood transfusion
exchanges sickle blood with healthy blood
165
preventing sickle cell disease?
stay warm and hydrated
hydoxycarbamide - increases HbF
regular blood transfusion
monitoring - transcranial dopplers
166
thalassaemia?
group of conditions which are a lack of heamoglobin production
167
epidemology of thalassemia?
ANYWHERE not northeren european - near equator line
168
major cause of death in thalassemia?
heart failure due iron excessive
169
alpha thalassemia cause death in utero?
yes from anaemia
170
indolent non hodgkin lymphoma
grow slowly
can live with for years with it - but generably incurable - advanced at presentation
171
3 types of cell lymphoma can be classified from?
b cell - 90%
t cell - 10%
nk cell <1%
172
risk factors for lymphoma?
primary immunodeficiency
secondary immunodeficiency - HIV
infections
autoimmune disease - rheumatoid arthritis
173
clinical presentation of indolent lymphoma?
painless - with lumps
B symptoms - fevers, night sweats + weight loss
bone marrow involvement
compression syndrome - spinal chord compression
174
indolent lymphoma bumps presentation ?
smooth
mobile
non tender
rubbery
175
Ix FOR LYMPHOMA
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
176
what is acute myeloid luekemia ?
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
177
what are MDS?
myelodysplastic syndromes
marrow + funny loooking
bone marrow cells fail to make adequate number of healthy blood cells
progresses to AML
178
LAB FEATURES OF MDS?
fbc - low blood cells
- rbc
-wc
-platelets
Blood film shows dysplastic (abnormal) features
179
LAB FEATURES OF AML?
white cells can be
- very low or very high
RBC - very low
PLatelets - low
Pre history of malignancy
blast cell with auer rods
180
differential diagnosis of AML?
* B12/ folate or mixed haematinic deficiency
* Infection (e.g. retroviral disease, herpesvirus) * Medications
* Autoimmune
* Liver disease (e.g. cirrhosis)
181
symptoms of presentation of AML?
anaemia
neutropenia - infections frequent
thrombocytopenia
182
high blast cells sign of?
sign of LEUKEMIA
183
mOorphology of MDS?
10% dysplasia in cell lines
blasts CELL - 0-19% within dysplaslia
184
morphology of acute myeloid leukaemia?
20% blast
now as low with 10% with defining genetic abnormalities
185
treatment for low blast cell count in mds?
stimulate marrow to increase blood cell production
alleviate symptoms due to low blood count
186
treat anaemia
Red cell transfusions
* Reduce/ treat any associated bleeding contributing to anaemia
erythropoeitin
187
thrombocytopenia treatment?
platelet transfusion
Tranexamic acids
188
5 year survival rates in all patient with AML?
15%
189
main cause of secondary hypertension?
conns synderom hyper aldosterone
190
young woman with palpitations, anxiety and super high bp?
pheochromocytoma
191
first line treatement for hypertension with T2DB?
ace inhibtiors or ARBs
192
pathophysiology of stable angina?
atherosclerosis is narrowing of coronary arteries that results in ischemia
193
stemi ecg afterwards
pathological q waves
194
SILENT MI in women
vomiting and nausea aswell
195
pathophysiological unstable angina?
greater degree of atherosclerosis than stable angina
ischemia but no necrosis
196
side effects of fribrinolysis?
risk of bleeding - subarachnoid haemorrage
197
MENMOMIC for complication from mi?
Death
Arrhythmia
R rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler syndrome
Embolism
Recurrence/ regurgitation
198
ix for heart failure
gold standard
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
199
standard treatment for heart failure
1. diuretics
2. ace inhibitors
3. beta blockers
4. digoxin - renal toxic
200
most common cause of HF?
IHD
201
systolic murmur ?
majority - unusal sound of heart beat
closure of av Valves
after S1 murmur s2
202
distolic murmur?
s1 s2 murmur
203
most common valve disease?
aortic stenosis
204
pathophysicology of aortic stenosis
narrowing of aortic stenosis - decresed stroke volume - increased afterload - increased left ventricular pressure- LV hypertrophy - increase oxygen demand - not met - ischemia
205
gold standard for IX for aortic stenosis?
echocardiogram - left ventricule size and function
206
pathophysiology of mitral regurgitation
- 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
207
gold standard for mitral stenoiss
echocardiogram - TOE is better and more senstitive
ecg - lah, af, lvh
cxr - lah
208
treatment of mitral stenosis?
vasodilator - ace inhibiotrs
rate control - bb
diuretics - fuosemide
209
aortic regurgitation pathophysiology
- stroke volume of left ventricle lowers - so lv compensates with hypertrophy - HEART FAILURE
- coronary arteries doesnt get enough blood so get ihd
210
tx of mitral stenosis
IE TREATMENT
vasodilators - ace inhibitors
monitor progress = worsens - surgery
211
where is the infection in IE?
infection in endocardium or vascular endothelium
212
IV drug users cause of IE?
s. aureus
213
tx for IE?
6 wekks of antibiotics - iv for 2 weeks and then oral
214
chewst pain in pericarditis?
sharp, pleuritic (worse on inspiration) cheat pain
worse lying down and relived by sitting forward
215
gold standard for ix of pericarditis?
ECG - SADDLE SHAPED ST ELEVATION (diagnostic)
216
MAIN COMPLICATION of pericarditis?
PERICARDIAL EFFUSION
filling of pericardium
cardiac tamponade - cant beat properly
217
ix for pericardial effusion ?
cxr- large globular heart
ecg - low qrs
echocardiogram - huge effusion
218
cause of PAD
ATHEROSCLEROSIS IN PERIPHERAL ARTIERIES
219
CAUSES OF PVD
blood clot in veins
220
symptoms of PAD?
intermittent claudication - cramping especially up hills and steps
221
treatment of dvt?
HEPARIN (doacs)
222
SVT examples
atrial fibrillation and atrial flutter
223
fibrillation vs flutter
fibrillation - no p waves - emergency
flutter - regular saw tooth
224
59 year old man with HTN doesnt like the medication that makes him cough - (5 years ago), what should next medication be?
because over 59 years old - ccb
amlodopine
225
pregancy and htn - what drugs not to give!
ace inhibitors and arbs never ever !
226
stable angina investigation?
ecg - normal or depressed st
excerise test but not for ppl with known CAD !
227
TX FOR STABLE ANGINA?
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
PCI FOR FIBRINOlysis for mi?
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
body response to hypoxia?
create more rbc increases erythropoetin
230
treatment for polycytheamia vera with less than 0.45 hemacrit in young people?
aspirin 75 mg daily
231
JAK2 mutation ?
cause of polycythaemia vera
232
ix for polycythaemia?
FBC
Bone marrow biopsy
Genetic testing for JAK2 gene
233
thrombocythemia
too many platelets
234
fevers, night sweats
weight loss >10% over last 6 months
what are these factors called?
constitutional factors very common in haematology
235
splenomegaly causes
infections
liver diseases - high pressure in portal vein
autoimmune conditions - RA
if all thes excluded - its cancer!
236
metamyelocytes?
precursor of nuetrophils
237
secondary cause of polycythaemia?
Due to; chronic hypoxia, poor oxygen delivery (e.g. high altitude), abnormal RBC structure and tumours which release high levels of EPO
238
treatment for cml?
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
differential diagnosis for high wcc?
infection
drugs - g-csf/ corticosteroids
Tissue ischemia
paraneoplastic
240
normal haemoglobin for women?
110 - 147 g/l
241
normal haemoglobin for man?
131 - 166 g/l
242
mcv?
mean cell volume - how big rbc are
could present a population of big and small cells - microcytic and macrocytic anaemia
243
what causes macrocytotic anaemia?
reticulocytosis
b12 deficiency
folate defieciency
244
neutrophil nucleus in b12 deficiency?
hyper- segmented neutrophil nucleus
multible lobes
245
how much iron can you body absorb a day ?
1mg/day
but u consume about 15mg/day
246
causes of iron defiency ?
GI bleeding (cancers), menstrual bleeding
impaired absorption - coeliac, gastroectomy, dietary (rare) - vegan, elderly
247
iron studies ?
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
management of iron deficiency?
iv vs oral?
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
how much folate is required a day? is it stored?
01.-0.2 mg/day
never stored
250
what is folate used for and where is it stored?
DNA replication
proximal jejunum
251
normal b12?
197 - 771 ng/l
252
patients in CML?
onset?
older - middle aged
slower
253
how many blast cell in bone marrow in CML?
LESS THAN <10%
254
CML, ET, P. VERA, MMM leads to ?
ACUTE leukemia
255
risk factor of cml?
IONISING RADIOTHERAPY
256
pathophysiology of cml?
ABL ch9 genes translocates and fuses with BCR ch22 to form BCR-ABL (PHILADELPHIA chromosome) - tyrosine kinase increase increase proliferation and decreases apoptosis
257
cells in CLL?
uncontrolled proliferation and accumulation of mature B lymphocytes and t lymphpcytes
258
cells in CML?
BASOPHIL, NEUTROPHIL, EOSINOPHIL
259
CELLS IN aml?
MYELOBLAst and common myeloid progenitor cells - LEADS To formation of basophil, neutrophils and eosinophils
260
cells in all?
small lymphocyte - which should form into t lymp and b lymph
261
most common form of lymphoma?
non - hodgkins (85%)
262
leukemia vs lymphoma?
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
myosis fungoides? cells involved? where?
low grade lymphoma of skin with t cells
264
85% of low grades lymphomas are? what mutation has occurred?
follicular lymphoma - look small and cleave
translocation OF BCL- 2 gene on chrom0some 14 to 18
265
sezary syndrome?
more aggressive form of mycosis fungoides - peripherally in blood
266
burkitt cell lymphoma?
high grade non hodgkins lymphoma
can be leukaemia
non cleaved small cells
excessive cell division of cell that produce Ig
267
VIRUS INVOLVED in burkitt lymphoma?
EBV
268
translocation of burkitts lymphoma?
8- 14 of tyrosine cynase gene
269
epidemiology of hodkins lymphoma?
under 20s and over 70s
previously exposed to ebv
270
reed steinberg cells look like?
owl eyes
271
ix for diagnosing heart failure
echocardiogram
bnp is initial ix in primary care
272
bilateral pleural effusion and cardiomegaly and worsening dry cough with swollen ankles can be a sign of ?
heart failure
273
redcued ejection fraction in heart failure treatment?
ACE I and BB
274
crackles and pulmonary congestion and pink sputum
tachycardia
fatigue
cyanosis
exertional dyspnea
sign of ?
left sided heart failure
275
postural hypotension?
when standing bp drops and doesnt raise after 3 minutes
can cause fainting
settles back down when they sit down
276
non pharamcological treatment for postural hypotension from medications?
pharmacological tx?
increase salt + drinking fluids
compression stockings
siitting - standing slowly
steroids!
277
epidemology of postural hypotension ?
elderly people
parkinsons disease
278
sx for infective endocarditis?
janeway lesion
osler nodes
splinter haemorrhages
roth spots
279
tx for infective endocarditis?
ecg, urinalysis, fbc - raised wbc , crp - high, blood cultures - microrganism, echo - vegetation on valves
280
myeloproliferative disorders example?
polycytheamia vera
essential thrombocythaemia (THROMBOCYTOSIS)
myelofibrosis
281
how are myeloproliferative disorders different from CML AND AML?
CML - only neutrophil, eosinophils, basophils
AML - myeloid progenitor cell which form rbc, neutrophils, eosinophils nd platelets
MD - RBC, platelets, fibroblasts
282
WHEN WOUDL TReatment of DVT BE MORE AGREssive ?
when consequences of dvt are very damaging ie. ischeamia/ necrosis
venous ulceration
283
function of heparin?
binds to antithrombin and increases activity
indirect thrombin inhibitor
inhibits 10a and thrombin formation
284
which has longer half life LMWH or heparin
LMWH - ONCE DAILY longer half life
heparin - very short 4 hours
285
heparin induced thrombocytopenia more common in LMWH or heparin?
heparin
286
how measure warfarin?
INR aim for 2-3
287
how does DOAC work?
DIRECTLY ACTING FACTOR 2 OR 10
288
why is DOAC not used for metal heart valves?
RISK of thrombosis is very high after metal heart valve
DOAC is not a high enough anti coagulant so warfarin is used instead
289
function of clopidogrel?
inhibits ADP induced platelet aggregation by binding to p2y12
good for PCI
290
complication of dvt?
phlegmasia alba dolens (milk leg) + PE + ischaemia
291
WHY DOES DVT lead to ischaemia ?
rare complication - all veins are thrombosed
increased compartment pressure
292
ix for DVT?
d - dimer - not specific if positive
GOLD STANDARD - duplex ultrasound compression
CT or MR venogram
293
why can duplex ultrasound miss an acute DVT?
THROMBIS IS VERY FRESH AND will compress in acute setting
294
cause of spontanous dvt?
- exclude malignancy
- genetic testing not worth ix
295
ix for pe?
gold standard
ecg - sinus tachycardia
cxr will be normal
blood gases - hypoxia
d- dimer will be raised
GS - CTPA
296
if cant use anticoagulation for prevention of PE?
USE ivc FILTERS but not very common
297
what happens to the plaque when we get an acute clinical complication?
RUPTURE With thrombus formation
298
what is most potent risk factor in PAD?
1. smoking
2. hypertension
299
6 Ps for acute ischaemia?
pain, pallor, poikilothermia, pulselessness, paresthesia, and paralysis (dead muscles at this point)
300
cause of acute embolis
AF or MI
301
CHRONIC ISCHAEMIA epidemology?
have risk factors (smoking, hypertension, diabetes) and elderly
302
rest pain in chronic ischeami?
demand of muscle at rest is not met by what oxygen can be supplied
303
burger test?
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
distinction ext vs internal carotid artery
external has a branch
internal no branch
305
common location of aneurysms?
INFRA- RENAL AORTA
306
why would atherosclerosis cause occlusion or a dilation, what dictates this?
when walls of arteries get calcified due to athersclerotic plaque they become sicheamic and can dilate to become a baloon
307
IX for anuerysym?
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
why MRA over CTA?
mra doesnt include calcium - so easier to see with blocked calcium vessels
mra doesnt use radiation
309
risk rfactors modifatication for PVD
antiplatelets
statin
stop smoking
excercise
ACE inhibitors
excercise training
310
AAA tx
stent
open surgery - better long term resutls
311
virchows triangle causes of venous thrombis ?
hypercoagubiltiy
flow stasis
312
scoring system for DVT?
wells scoring over 3 points
313
role of warfarin?
inhibtis vitamin K dependant clotting factors 1972
instrisic
314
cells found in CLL?
smudge cells
315
treatment for CLL
imatinib is a tyrosine kinase inhibitor
316
causes of megaloblastic macrocytic anaemia
folate defiency
317
stages for CKD?
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
signs and symtpoms of non classical hodkins lymphoma?
PAIN AFTER DRINKING
popcorn reid steinberg cells
319
most common form of hyperthyroidism?
graves hyperthyroidism
320
Propylthiouracil when to use
tx for hyperthyroidism 2nd line to carbimazole (dont give to pregnant woman)
321
tx for hypothyroidism?
levothyroxine
322
ix for aortic dissection
Ct scan, cxr, trans oesphageal endoscopy (toe)
323
mnemonic for UTI causes?
K klebsiella
E ecoli
E enterococi
P proteus mirabalis
s STAPH SAPHrophytus
324
which troponin are specific to cardiac muscle?
necrosis of cardiac muscle
troponin I, T NOT C (SKELETAL ALSO HAS C)
325
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
heart failure with reduced ejection fraction
326
heart failure?
complex syndrome - CO is insufficient to meet metabolic requirement s of the body and accommodae venous return
327
stroke volume?
end diastolic volume - end systolic volume
328
preload?
initial strechting of cardiac myocytes prior to contraction represented by LV end diastolic volume
329
afterload?
the load the heart must eject blood against
330
3 key neurohormonal systems for heart function? how do they cause heart failure ?
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
causes of macrocytic anaemia?
alcholism
chronic liver disease
b12 defiency
332
two investigations for heamolytic anaemia to ix if heamolytic ?
reticulocyte count
haptoglobin - protein that binds to rbc fragments
direct antiglobulin test
333
pernicious aneamia?
intrinsic factor deficiency = less absorption of b12
damage to parietal cells
334
what are blast cells?
premature cells
335
polycythaemia?
high heamoglobin
336
thrombophilia vs thrombocytosis?
thrombophilia - forming clots
thrombocytosis - increased platelets
337
where does leakeamia vs lymphoma start?
leukaemia - bone marrow
lymphoma - lymph nodes
338
cells affected by leukeamia?
myeloid and lymphoid branch - blasts and white blood cells
339
leakeamia leads to ?
pancytopenia
heamoglobin low
platelet - low
wbc - low
340
acute vs chronic leukaemia?
acute - blast cells - more blast cells
chronic - mature cells - more of these cells
341
what can prothrombin time tell you about the liver?
if normal no problem with liver
342
hepatosplenomegaly present in Chronic leakeamia vs acute?
chronic leukaemia
343
lymphoma presentation?
painless lymph nodes
b symptoms - fever, night sweats, weight loss
344
staging for lymphoma?
ANN arbour staging
A - no symptoms
b - symptoms
345
previous infection and correlation with lymphoma?
EBV PREVIOUSly
346
light chains in urine?
bence jones
paraprotein in serum
347
how does myeloma causes kidneys disease?
immunoglobulin and light chains get stuc in kidneys
348
diagnostic ix for myeloma ?
bone marrow biopsy is diagnostic
u will do :
blood films
urine
serum electrophoreisis
x ray
349
1st line ix for chest pain?
ECG
350
ix for immune thrombocytopenia purpura
bone biopsy shows increase megakarocytes
platelet autoantibodies may be present
351
sx for immune thrombocytopenia purpura?
purpura - purple spots on skin
easy bruising -
bleeding gums
352
infections associated with immune thrombocytopenia purpura?
children - chicken pox
adults - HIV OR HEP C
353
IRST LINE AND SECOND LINE TX FOR itp ?
1ST -cortciosteroids
IV IgG
2nd - splenectomy
354
anaemia iron defiency signs?
spooon nails - kalonchya
brittle nails
palor
smooth tongue
355
signs of anaemia?
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
strain of protazoa in malaria that can cause relapses ? treatment?
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
chromosomal abnormalities in multible myeloma?
t(11:14)
358
2 features associated with AML?
downs syndrome
radiation
359
role of Allopurinol
prevent tumour lysis syndrome - prevents excess uric acid from chemo
tx for AML
360
managaement for CLL?
Chemotherapy
Monoclonal antibodies (rituximab)
Bruton kinase inhibitors (ibrutinib)
361
signs for CLL?
enlarged rubbery non tender lymphnodes
anorexia
assymptomatic usually
362
complication of CLL?
Richter’s syndrome – transformation of CLL to an aggressive lymphoma
363
lymphoma assicaited after drinking?
hodkins lymphoma
364
ix for diagnosing hodking lymphoma?
FBC – anaemia, high ESR
CXR – wide mediastinum
Blood film – Reed-Sternberg cells
365
tx for hogdkins lymphoma
Chemotherapy ABVD treatment
Marrow transplant
366
causes of aortic dissection in young people?
marfans syndrome. ehler danos syndrome (strecthy skin) , pregnancy, trauma, male
367
type a vs type b aortic dissection?
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
main rf in aortic dissection?
HTN! smoking, trauma
369
complication of aortic dissection?
organ ischaemia -failure + shock
370
sx for aortic dissection?
tearing pain
acute chest pain
collapse
hypertensive
371
ix for aortic dissection?
cxr - broadening of mediastenum
echo
MRI/CT angiogram
GS - TOE - SHOWS ENTIRE AORTA
372
tx aortic dissection
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
causes of mitral valve prolapse?
marfans syndrome
degenerative myxomatous - excessive mucosal/ gelatin growth
374
what causes systolic mumurs/
ASMR
aortic stenosis
mitral regurgitation
S1 mumur s2
375
what causes diastolic murmur?
ARMS
aortic regurg
mitral stenoisis
s1 s2 murmur
376
where to hear mitral valve
left sternum midclavicular line in 5th intercostal space
377
where to hear aortic valve ?
right sternum 2nd intercostal space
378
here to hear pulmonary valve?
left sternum 2nd intercostal space
379
triscuspid area ?
left sternum 4th intercostal space
380
IX FOR mitral regurgiation?
TOE - prolapse, dilated LA, LV
ECG - atrial fib, lv hypertrophy
CXR- enlarged LV, LA, venous congestion, pulmonary oedma
381
diuretic for MR?
furosimide - loop diuretic
382
diuretic for MR?
furosimide - loop diuretic
383
causes of hypercalceamia?
hyperpth
bone maligancy
excess vit D - too much calcium absorbed in gut
thiazide increase reabsorption
384
tx for hyperclaceamia?
loop diuretics - increase excretion
rehydrate
glucocorticoids - decrease calcium absoprtion in gut
bisphosphinates + calcitonin
385
most common thalasseamia?
beta thalasseamia - no beta chain production
heterozygotes (minor) - no symptoms
homozygotes (major) - severe hypochomric anaemia
386
tx for thalassaemia beta?
haemapoeitic stem cell transplant
folic acid
splenectomy
387
pathophys for alpha thalasseamia?
4 deletions on chromosome 16
excessive Hb H = groups of beta chains (useless)
388
how does b12 defiency causeanaemia?
pernicious anaemia - autoimmune system attack IF or parietal cells and causes decrease of B12 absoprtion leading to decrease of RBC production
389
symptoms of pernicious anaemia?
weakness
fatigue
abdominal discomfort after eating
palpiations
jaundice
mouth ulcers
pins and needles
390
dx blood test of pernicious anaemia?
B12 LOW
MCV high - macrocytic
multilobe nuclei nuetrophils
Anti IF antibodies
391
tx for pernicious anaemia?
IM b12 hydroxycobalamin
392
who is affected by G6PD defiency?
males -x chromosomal
equator with malaria
393
blood film of G6PD?
heinz bodies
bite cells
blister cells
reticulocytes
heamolytic crisis
394
drugs to avoid with G6PD?
no oxidative stress protection
antimalarials - quinine
NSAIDS
FAVA beans
Nitrofurantoin - UTIs
ciprofloxacin
395
cp for g6pd defiency?
Fatigue, palpitations, shortness of breath, pallor
396
scoring for DVT? ?
Wells scoring
397
ejection fraction in systolic heart failure?
under 40%
normal - 50 - 70 %
398
ejection fraction in diastorlic heart failrue?
normal
becuase reduced preload so overall total volume is low anyway
399
causes of left sided heart failure?
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
why oedma during HF?
reduced blood to kidneys - release RAAS - fluid retention -pulomary oedma
401
why dyspnea and orthopnea in HF?
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
tx for left sided hf?
ABAL
ace inhibitors
BB
aldosterone antagonist - spirolactone
LOOP diuretics
pace makers
heart transpalnt
403
causes of right sided HF?
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
cp of right sided heart failure?
back up - excess interstitial fluid back up
jugular venous distention
hepatosplenomegaly
liver cirrhosis
ascites
pitting oedma
405
medications for heart failure side effcts?
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
Mnemonic for xray findings for heart failures
ABCDE
Alveolar oedma
Bat wing Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
E pulomonary effusions
407
inheritence of haemophillia A and B ?
X LINKED
408
where is factor 8 sdynthesized?
LIver and endothelial cells
protected by vWF
409
cp of severe heamophillia?
spontanous bleeding of skin, muscles + large joints
intracranial bleeeds
410
cp of haemophillia A and B ?
BLEEDING (musculoskeletal, skin)
raised APTT due to effect on intrinsic factor
normal PT
411
type 1 vs type 2 vWF disease?
type 1 - low number of normal vwf protein
type 2 - abnormal vWF protein
412
inheritance of VWF disease?
autosomal dom
413
cp of vwf DISEASE?
nose bleeds
bleeding
mennorhagia
414
ix for vWF disease?
normal pt + raised aptt
low vwf
normal factor 8 and 9 assay
415
tx for vwf disease?
no cure
desmopressin agonist - DDAVP
416
d dimer?
generation if fbinrin degranulation crosslinked (by factor XIII) fibrin.
It reflects ongoing
activation of the hemostatic system.
417
prothrombin time?
The prothrombin time is a measure of the integrity of the extrinsic and final common pathways of
the coagulation cascade.
418
APTT?
activated partial thromboplastin time
APTT – a measure of the functionality of the intrinsic and common pathways of the coagulation
cascade.
419
thrombin time
fibrin (1a) from fibrinogen (1)
hrombin time – Thrombin time is a screening coagulation test designed to assess fibrin formation
from fibrinogen in plasma.
420
fibrin degradation products?
Fibrin and fibrinogen-degradation product (FDP) testing is commonly
used to diagnose disseminated intravascular coagulation (DIC).
421
bacterial cause of guillain baree syndrome?
campylobacter jejuni
gram negative rods
422
DX of parkinsons?
purely clinical
bradykinesia + at least one clinical sign
423
parkinson dementia vs lewy body dementia?
parkisnon dementia - parkison and then dementia
lewy body dementia with parkinsonia -lewy body and then dementia
424
questions for suspected parkisnon?
slow progression - parkinson? sudden onset?
symmetrical vs asymmetrical - parkinsons
425
3 cardinal features of parkinsons?
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
tx for parkinson
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
CP for guillain barre?
symmetrical ascending weakness
loss of DTRs - deep tendn reflexes
previous gastroenteric infection within 4 weeks
428
pathophysiology of guillain barre?
molecular mimicing
antibodies that attcak infection but also neurons
429
tx for essential tremor?
primidone low dose
beta blockers - propanolo up to 100 mg - contraindicated with stham
gabapentin - anti epileptic
430
ix fr guillain barre
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
tumour lysis syndrome?
tx?
chemo release uric acid = kidney failure
allopurinol
432
ix for perncious aneamia?
1st line - intrisic factor antibodies
2nd - gastric parietal cell antibodies
433
infectious cause of bed bound pnuemonia pts?
klebsiella
434
infectious cause of COPD pneumonia pts?
h. influenza
Pseudomonas aeruginosa (gram negative rod)
435
infectious cause of bird handlers pneumonia?
chlamydia psittacosis
gram negative
436
mnemonic of causes of atypical pnuemonia?
legions of psitacci MCQs
legionella
chlamydia psitacci
M – mycoplasma pneumoniae
C – chlamydydophila pneumoniae
Qs – Q fever (coxiella burnetii)
437
tx for fungal pneumonia?
treatment is with co-trimoxazole (trimethoprim/sulfamethoxazole)
438
protein defective in primary cilicar dyskenisa?
dynein - cilia cant move
439
most common pneumonia in HIV patients?
pneumocystitis pneumonia
440
CP of primary ciliary dyskinesia?
infertility
sinusitis
bronchiectasis
heart on right side
441
tx for primary ciliary dyskenisa?
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
causes of dyspnoea?
CHF - pulmonary oedma , aneamia
5 Ps
COPD
asthma
obesity
443
MRC scale ?
dyspnoea
1- strenous excercise
2 -walking inlice
3- walking flat
4 - breathless after 100 m
5 - after ADL (ACTIVITES OF DAILY LIVING )
444
5 Ps in dysnpoea?
pleuristy
pneumonia
pulmonary fibrosis
pulmonary cancer
pulmonary embolism
445
what stain allows for better mycobatceria detection?
Auramine Phenol 'AP' fluorescent stain. It allows faster and more sensitive detection of Mycobacteria.
446
tx for acute heart failure?
iv opaites
ionotropic agents - dobutamine
aortic balloon pump
447
role of cyclosporin?
imunosupressant for transplant rejection!
448
cyclosporin side effects?
nephrotoxicitiy!
interstitial nephritis
hyperureacemia
hyperlipideamia
htn
gum tissue hyperplasia
hirsutism
449
causes of epiglottitis? tx?
H. INFLEUNZA B
emergency!
airway opening
adrenaline
broad spec abx - cetriaxone
450
cp of epiglottitis?
sitting forward - tripod position
older children 2-7 year s
drooling
sitting still
no cough
451
croup tx?
steroids- dexamethasone
epinephrine
fluids and rest
452
cough in croup?
seal like
453
HLA DR2 autoimmune disesses?
SLE, goodpastures. MS, hepatitis
454
gender affected by goodpastures syndrome?
males
455
tissue affected by good pastures?
collagen type 4
basememt membranes!
alveoli and nephrons
456
tx for good pastures??
corticosteroids - prednisolone
plasma exchange
457
lung volume effected by restrictive lung diseases?
complience reduces
all volumes decrease
458
lung volumes effected by obstructuve lung diseases?
rv and erv increase
459
fvc fev1 and fev1/fvc in restrictive lung disease?
fvc - decreased
fev1 - normal
ratio - normal
460
causes fo t2 resp failure ?
copd
obstruction
opioid od
461
causes of t1 resp failure?
PE
acute asthma
pneumonia
462
bacterial causes of sinusitis?
s. pneumonia
morexella
h. influenzae
463
tx for sinusitis?
2 - 3self limiting
steroid nasal spray
abx - phenoxymethylpenicillin 500 mg four times a day for 5 days. or doxycycline
464
dx of chronic sinusitis ?
clinical
ct scan
rhinoscopy
465
dx of otitis media?
clincal
pain in ear
otoscopy - red inflammed ear drum - tympatic memebrane or fluid behind membrane
466
complications of otitis media?
glue ear - grommit
467
tx for otitis media?
amoxicillin
468
cause of whooping cough?
bordella pertussis - (gram - rods)
469
tx for whooping cough?
macrolide - clarithromycin
vaccination
470
dx of whoping cough?
clinical
contact PHE!
fbc
swabbing
471
most infectious phase of whooping cough?
catarhhal phase
runny nose and congestion
472
shift of oxygen dissociation curve to the right?
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
shift of oxygen dissociation curve to the left?
high pH
decrease temp
474
why is affinty for oxygen higher in fetal haem?
has to compete with mother heamo so must have higher affinity
475
signs and symptoms of life threatening asthma?
silent chest
PEFR <33%
cyanosis
exhaustion
476
important features for diagnosis of astham?
worse at night and in morning
reccurant
response to triggers
occur apart from colds
477
mech of gtn spray
increase cgmp
inhibit calcium channel
prevent vasoconstriction
478
aortic stenosis cp?
SAD
syncope
angine/ aneamia
dysnopnea
479
murmur in as
systolic ejection which radiates to carotid arteries
480
Name the pathological Korsakoff heart sound observed in a patient with aortic stenosis
before S1 = s4
481
Which two treatments are all patients started on in the management of heart failure, with the aim of slowing progression? in heart failure
ace inhibitors and beta blockers
482
3 cardinal signs of heart failure?
peripheral oedma
sob
fatigue
483
signs in becks triad and what is this a sign of?
Hypotension
Raised JVP
Muffled heart sounds
pericarditis
484
function of clopidogrel ?
inhibits ADP binding to platelet receptors
485
most common cause of bacterial tonsilitis ?
s. pyogenes
486
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?
right frontal lobe
487
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?
slow riding pulse and small volume
488
ecg of RBBB vs LBBB? causes RBBB
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
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?
STOP SMOKINGA DNEXCERCISE! only do angiplasty if these do not work
490
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?
aquired heamolytic aneamia
491
most likely cause from medications to cause hyponatreamia?
thiazide diuretics
492
cancerous cause of hypocalceamia?
tumour lysis syndrome
493
first line tx for hypercalceamia?
fluid ressus and then bisphsophinates
494
ix for over over 60 with iron def aneamia?
urgent endoscopy - risk of colon cancer
495
causes of iron defiency aneamia in children and adults?
malabsorption (ceoliac, IBD)
malnutritions
mennoragia
hookworm!
496
tx for iron def aneamia?
oral ferrous sullfate - SE- black stool , constipation
IV IRON
497
cp for thallseamia?
CHIpmunk facies
spelomegaly - over production of RBC due to heamolysis
aneamia sx
498
electrophoresis of beta thalaseamia?
low HbA
high HbF and Hba2
499
TX FOR BETA THALASSEAMIA?
BLOOD TRANSFUSIONS
IRON chelating aganets to prevent iron overload
500
chromosome affected by alpha thalasseamia?
chromsome 16
501
alpha thalaseamia trait?
asympotomatic - 1 loci deleted on chromsome 16
502
most accureate dx for alpha thalaseamia?
genetic studies
503
geentic mutation in sickle cell anaemia?
GAG -> GTG on 6th codon of beta globulin
504
complcations of sickle cell aneamia?
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
ix and dx of sickle cell aneamia?
FBC and blood film- normocytic normochromic aneami with raised reticulocytes
sickle cell RBC
dx- hb electrophoresis
506
triggers for acute heamolytic aneamia in patients with g6pdH DEF?
fava beans consumptions
sulphonylureas (sulph- medications)
moth balls
antimalarials
507
mutation in polycyhteamia vera?
JAK 2 mutations
508
coombs test ?
RBC accumilation with coombs reagent
positive for autoimmune heamolytic aneamia associated wth SLE
509
DEVELOPMENT OF hereditory pherocystosis ?
common tx?
northern european
autosomal dom
splenectomy as young child
510
blood film of pernicious aneamia?
cabot rings
511
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?
immune thrombocytopenia purpura
512
viral cause of aplastic aneamia?
parovirus b19
513
turbulent blood flow in heart?
valves - growth in turbulence
514
tx for pericarditis?
NSAIDS
COLCHINE
ppi
515
clinical features of cardiac tamponade?
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
tx for tamponade
periocardiocentisis
517
stage 1 htn?
stage 2
140/90 - ambulance - 135/85
stage 2 - 160/100 - ambulnce - 150/95
518
signs and symptoms of right sided heart failure?
peripheral oedma
raised JVP
HEPATOMEGALY
ascites
519
signs and symtpoms of left sided heart failure?
pulmonary oedma
fatigue
noctural SOB
520
cxr of heart failure?
Alveolar oedma - bat-wing opacification
B KERLEY B LINES
CARDIOMEGALY
Dilated upper lobe vessle
E fffusion of pleura
521
tx for heart failure?
ACE nibitors + arbS
bb
MINERALcorticosteroid - spirolactone
SGLT2 INHIBITOR
522
tx for stable for atrial fibrillation?
history - within 48 hours
rate + rythm control (amiodorone )
over 48 hours
RATE control (BB/ CCB) + ANTIcoag
523
POST ACS preventiive ?
1. ACE
2. aspirin
3. P2Y12 inihbitors - clopidrgrel
4. BB
5. high dose statin
PPi
524
side effects of vermapril?
bradycardia + HF
525
ideal time to do PCI after MI?
2 HOURS AFTER ONSET OF SYMTPOMS
526
tx for NSTEMI?
1. ASPIRIN
2. fondapirux
GRACE scoring for CV events
low risk - aspirin + P2Y12 inhibitor
high - angiography
duel antiplatelets
527
imediate tx for MI?
Morphine - venodi;lation
Oxygen
Nitarets
Apirisn
528
most common causative organism for peritonitis?
e.coli
klesiella
529
causes of ejection systolic murmur
aortic stenosis
hcm
pulmonary stenosis
atrial septal defect - back flow into pulmonary valves
530
auses of pansystolic murmur?
mitral regurg
tricuspid regurgitation
blood still leaking
531
ECG SHOWING PROMINENT jugular V wave inticates?
pulmonary hypertension and heart failure
532
pressure within pulmonary htn?
over 20 mmHg
533
CP OF PULMONARY HTN?
dysnopea, fatigue, SOB, peripheral oedma
534
ix for pulmonary htn?
right heart catheterisation is GS
535
first line tx for supraventricular tachycardia?
vagal mounevre
536
pathophysiology of AVNRT?
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
ecg of supraventricular tachycardia?
narrow complex
retrograde p waves
538
tx for SVT?
unstable - synchronised DC shock
stable - vagal manoeuvre - blow into tube + carotid massage
IV adenosine
BB
539
DRUG CONTRAINDICATED IN HEART FAILURE?
CCB NEGATIVLY ionotrophic
540
BNP vs NT probnp?
BNP - ACTIVe short half life
NT proBNP - inactive lasts longer
541
what are kerly b lines?
fluid leaking into interlobular septum - short lines - heart failure!
542
first line tx for arrythmias?
ECG
543
2 cardiac causes of arrythmia?
WPW, AF
544
2 non cardiac causes of arrythmia?
hyperthyroidism
stress
anxiety
pheochromocytoma
alcohol
floraquinolones
545
feeling rapid regular pounding in neck and palpitations?
SV arrythmias
546
palpitations on awaking , sign of?
AF
547
SE of heparin?
bleeding, pain at injection site and low blood platelets.
inhibits fibrin and Xa
INSTRISIC AND COMMON PATHWAY
548
SE of warfarin?
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
CP of pE?
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
arterial ulcers vs venous ulcers?
arterial -
more peripheral
pain
well defined
deep + small
venous
larger
superficial
iregular board
mid calf to ankle
venous excema
551
ix for peripheral vascular disease?
ankle brachial pressure index
duplex us
angiogrphy - CT or MRI
552
TX FOR pvd?
excercise/ lifestyle and co morbitiy managment
statins
clopidogrel
naftidrofuryl oxalate - vasodilator
surgery
stenting
endarterectomy - removal of plaque
bypass surgery
553
tx for acute limb ischeamia?
endosvascular thrombolysis
endovascular thrombectomy
endarectomy
bypas surgery
554
thiazide vs loop diuretic ?
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
example of antiemtic drugs sontraindicated in parkinsons disease?
Metoclopramide - dopamine antagonists
556
examples of COX inhibitors?
ibuprofen
paracetmol - weak inhibiton of COX2 (not involved in gastruc ulcers!)
celecoxib
diclofenac
557
mechanism of clopidogrel
P2Y12
ADP antagonist and binds irreveribly to surface of platelets
558
side effects of sulfonylureas?
3rd line tx for T2DM
gliclazide
tolbutamide- hypoglyceamia
appetite and weight gain
SIADH
CHOLESTATIC LIVER DISEASE
559
sideroblastic vs iron def anaemia?
mimic eachother - both microcytic and hypochromic
sidero - high iron and ferritin and can be drug induced (TB)
560
presentation of WVf DISEASE VS HEAMOPHILLIA 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
virus associated with burkitts lymphoma?
EBV
562
bloods in DIC?
desseminated intravascular coagulation
low fibringoen, low platelets and high d dimer
563
CAUSES OF HAEMOLYTIC ANAEMIA
inherited - sickle cell
- thalaseammia
acquired - metallic valve replacement
- autoimmune
564
aortic stenosis xray?
pulmonary oedma
cardiomegaly
calcification of aorta
565
LFT particuarily involved with AFLD?
GGT
gamma glutamyl transferase
566
b12 aneamia features? related to what conditions? blood film?
macrocytic
T1DM
oval macrocytes and
hypersegmented neutrophils
567
side effects CCB?
Flushing
Increase glucose + urea
Gi upset
Headache
Tachycardia
Edema
Dizziness
