Cardioresp Flashcards
Describe the kind of murmur heard in aortic stenosis
Crescendo decrescendo (diamond) Systolic murmur
Describe the murmur heard in aortic regurgitation and where best to auscultate for this
Diastolic murmur
Left seternal border
Describe the diagnostic findings of tension pneumothorax on CT and X-ray
Visceral pleural line visible
Describe the system used to assess need for hospitalisation in CAP
CRB-65
New mental confusion
Respiratory rate >30
Blood pressure <90 systolic
Age >65
Likely diagnoses of a patient presenting with central chest pain, fever, high pitched squeaky ‘rub’ heard at the left sternal edge and ST segment changes on ECG
- Pericarditis (upward conceived ST segment elevation with PR depression)
- STEMI
Discuss the components of dual anti-platelet therapy and use in ACS
- Aspirin 300mg and clopidogrel or ticagrelor or prasugrel
- NSTEMI
Which genetic disorder should be tested for in a younger patient presenting with signs and investigations positive for COPD
Alpha-1 Antitrypsin deficiency
How to differentiate a pleural effusion from pulmonary oedema
Effusion —>
Stony dull to percussion
Reduced tactile vocal fremetus
Reduced breath sounds on auscultation
What is Wolff Parkinson white syndrome
Supraventricular tachycardia caused by an accessory pathway
Possible causes of an ejection systolic murmur
- Aortic stenosis
- Pulmonary stenosis
- Atrial septal defect, tetralogy of Fallot
Management of acute supravebtricular tachycardia
If patient is compromised DC cardioversion
Otherwise
1) Vagal manoeuvres
2) IV adenosine
Management of acute AF
If patient is showing adverse signs (shock, myocardial Ischaemia chest pain or ECG changes syncope and heart failure) DC cardioversion and amiodarone if unsuccessful
Occlusion of the right coronary artery causing an inferior MI may lead to bradycardia, true or false
True
As the right coronary artery supplies the SAN node
What is the standard therapy for treating active TB
Initial phase
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
continuation
- Rifampicin
Isoniazid
Most common cause of community acquired pneumonia?
Strep. pneumoniae
Which organism is likely responsible for a pneumonia with haemolytic anaemia and erythema multiform
Mycoplasma pneumoniae
Suggest a suitable mask to administer oxygen for a critically ill patient in shock who is hypoxic
15 L/min reservoir mask
Target stats of 94-98%
Likely diagnosis for patient with chest pain and a raised JVP on inspiration
constrictive pericarditis
Kussmaul’s sign
Discuss diagnostic values of spirometry for asthma
FEV1/FVC <80% (20% drop in FEV1)
and
12% and 200mL reversibility of FEV1 following bronchodilator
What is the 3rd stage in the management of inadequate asthma control
Addition of LABA e.g salmetrol (BTS)
Addition of LTRA (NICE)
Pathophysiological process of pulmonary hypertension in COPD
Hypoxic pulmonary vasoconstriction –> narrowing of pulmonary vasculature and fibrosis –> right sided heart failure
What happens to the DLCO/TLCO in interstitial lung disease
decreased transfer factor
Common causative agent of hospital acquired pneumonia
gram negative
S. Aureus
S. pneumonia
anaerobes
Definition of hospital acquired pneumonia
24hrs after hospital admission, or within 7 days of discharge
Typical causative pathogen of cavitating multifocal consolidation pneumonia
S. Aureus
Common causative agent of pneumonia in COPD patients
Haemophilius Influenzae
Pneumonia associated with haemolytic anaemia and erythema multiform
Mycoplasma Pneumoniae
Risk factors for TB
HIV/AIDS
Poverty and overcrowding
immunosuppression
Heavy alcohol consumption
Suggest possible causes for a pleural effusion with raised LDH and protein levels
Infective
Inflammatory causes - RA/SLE, pancreatitis
Dressler’s syndrome
Neoplasm
Discuss cause of bifid P waves on ECG
P mitrale caused by left atrial enlargement due to mitral valve disease
Features of mitral stenosis
Hx of rheumatic heart disease AF Malar Flush Mid-diastolic murmur (low pitched) Features of pulmonary hypertension
Examination findings of the patient with aortic stenosis
- Ejection systolic murmur, crescendo decrescendo which radiates to carotids
- Slow rising pulse
- Heaving apex beat
- Systolic thrill
Commonly seen pathogen in bronchiectasis infective flare
pseudomonas aerginosa
Common causative pathogen in atypical pneumonia, spread by domesticated and exotic birds
Chlamydia psttaci
Causes of preserved ejection fraction HF (diastolic)
Chronic hypertension leading to —>
Ventricular Hypertrophy
Stiffened muscle -fibrotic scar tissue
Aortic stenosis
Cardiomyopathies, hypertrophic and restrictive
In a patient with pneumonia, dry cough and atypical chest signs, hyponatraemia and lymphopenia is most associated with which organism?
Legionella pneumoniae
In a patient with pneumonia, high fever, rapid onset and herpes labialis is most associated with which organism?
Strep. p
State the paraneoplastic features associated with small cell lung cancer
ADH
ACTH - Cushing’s
Lambert-Eaton syndrome
State the paraneoplastic features of squamous cell lung cancer
- PTH-rp causing hypercalacaemia
- Hypertrophic pulmonary osteoarthropathy
- Hyperthyroidism due to ectopic TSH
A 70-year-old woman is found to have a pan-systolic murmur after presenting with dyspnoea. A soft S1 and split S2 is also noted
mitral regurgitation
Progressive prolongation of the PR interval until a dropped beat occurs -
second degree heart block (Mobitz type I or Wenkebach)
Which valvular heart disease results in an S4 heart sound
Aortic stenosis
Causes of transudative pleural effusions
Congestive Heart Failure (CHF) Hepatic cirrhosis Hypoproteinemia Nephrotic syndrome Acute atelectasis Myxedema Peritoneal dialysis Meig's syndrome Obstructive uropathy
Which valvular heart disease may be associated with polycystic kidney disease
Mitral valve prolapse
Post MI complication associated with acute onset HF and pan systolic murmur
Ventricular septal defect
