Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DPD 2019 > Cases in general internal medicine 1 > Flashcards

Cases in general internal medicine 1 Flashcards

1
Q

Investigations for suspected MI

A
  1. ECG
  2. Troponin (perhaps 6hr or 12hr after)
    (if troponin +ve then coronary angiography, if -ve exercise tolerance test)
  3. Echocardiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classify the causes of chest pain

A

Cardiac: IHD, aortic dissection, pericarditis

Resp: PE, Pneumonia, Pneumothorax

GI: gastritis, eosophagitis, eosophageal spasm

MSK: costochondritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aortic dissection pain

Pericarditis pain

A

Aortic dissection: Tearing pain radiates to the back

Pericarditis: pleuritic pain worse on inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What from an examination might help you tell if there is aortic dissection

A

difference in BP between two arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What problem could a patient on steroids have with chest pain (rare case)

A

Possibly candidasis (fungal infection) due to immunosuppression due to steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First line for STEMI

A

PCI (percutaneous coronary intervention)

Clotbusters not first line now

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What leads would show changes in:

  1. Anterior MI
  2. Lateral MI
  3. Inferior MI
  4. Posterior MI

And which artery is affected in each case

When does troponin peak with MI?

What enzymes peak much earlier than troponin

Best cardiac biomarker for assessment of reinfarction during an MI admission

A 
• Anterior MI
– LAD
– V1‐V4
• Lateral MI
– Circumflex
– V5, V6, I, aVL
• Inferior MI:
– RCA
– II, III, aVF
• Posterior MI:
– Posterior descending artery
– ST depression in V1-4

It rises around 4-6 hours after, peaks at 18-24hrs. Then falls over the next 5 days for a large MI. For a small MI might only be a small increase

Myoglobin and CK isoforms will peak much sooner. and are cleared sooner.

CK-MB returns to normal within about 72hrs compared to 5-7 days for trop, so it can be useful to assess reinfarciton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DDx of collapse

A
  1. Hypoglycaemia
2. Cardiac
• Vasovagal
• Arrhythmia
• Outflow obstruction (aortic stenosis, HOCM, pulmonary embolism)
• Postural Hypotension
  1. Neurological
    • Seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations/what might you see on examination if you suspect the following:

  1. Arrhythmias
  2. Outflow obstruction
  3. Postural hypotension
A
  1. Arrhythmias- ECG (? Long QT), cardiac
    monitor, 24 hour tape
  2. Outflow obstruction (see below)- Low volume/slow rising
    pulse, ESM, Echocardiogram
  3. Postural hypotension- Lying/standing BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cause of long QT syndrome

A

Abnormal ventricular repolarization

Congenital e.g. mutations in K+ channels

Acquired: low K+/ Mg2+, drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What might you find in family history of patient with long QT syndrome

A

• FH of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to distinguish between mitral and tricuspid regurg murmurs

A

Both pansystolic murmurs, RILE. Right louder on inspiration and left louder on expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DDx of raised JVP

A
  • R heart failure
  • Tricuspid regurgitation
  • Constrictive pericarditis and cardiac tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What might cause right sided failure

A

– Secondary to L heart failure (CCF)

– Pulmonary HTN (PE, COPD etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What might cause truscupid regurg

A

– Valve leaflets

– R ventricle dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What might cause constrictive pericarditis

A

– Infection e.g. TB
– Inflammation: CTD e.g. lupus
– Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the types of tachycardia on ECG

What heart condition is most likely with chest infection

A

Sinus tachycardia, SVT, AF, VT and VF

Atrial fibrillation (legionnaires in particular is likely to present with AF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DDx for Sinus tachycardia

A

Sepsis,

hypovolaemia,

endocrine (thyrotoxicosis,
phaeochromocytoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DDx for SVT

A

Re‐entry circuit

20
Q

DDx for Atrial fibrillation

A

Thyrotoxicosis, alcohol

Heart: ischaemic heart disease, muscle, valve (mitral stenosis), pericardium

Lungs: pneumonia, PE, cancer

21
Q

DDx for VT

A

ischaemia, electrolyte

abnormality, long QT syndrome

22
Q

Management of SVT

A
  • Vagal maneuvers
  • Adenosine (cardiac monitor)
  • DC cardioversion if evidence of haemodynamic compromise
23
Q

Management of new onset AF

-risk stratification?

A

TREAT REVERSIBLE CAUSE

-Haemodynamically unstable:
DC cardioversion

-Haemodynamically stable with left thrombus:
RATE control with b-blocker/CCB (or digoxin/amiodarone if HF)
+
Anticoagulate
+
DC or pharmacological cardioversion 3-4 weeks later

-Haemodynamically stable, no left atrial thrombus, symptom onset <48hrs: 
CHADVASC SCORE 0-1: 
-Rate control with b-blocker/CCB 
\+ 
-DC or pharmacological cardioversion 
CHADVASC SCORE >2: 
-Rate control with b-blocker/CCB 
\+ 
-DC or pharmacological cardioversion AND heparin
\+ 
-Anticoagulation

Haemodynamically stable without left atrial thrombus, but symtpom onset >48hrs:
CHADVASC SCORE 0-1:
-Rate control with b blocker/CCB
-Give heparin
-Electrical or pharmacologic cardioversion once heparin established

CHADVASC SCORE >2

  • Rate control with b blocker/CCB
  • Anticoagulate
  • Electrical or pharmacological cardioversion follwoing 3-4 weeks of anticoagulation

Then, risk stratification for future stroke:
C - Congestive heart failure (or Left ventricular systolic dysfunction)
H- Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)
A2-Age ≥75 years
D-Diabetes Mellitus
S2-Prior Stroke or TIA or thromboembolism
V- Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
A- Age 65–74 years
Sc- Sex category (i.e. female sex)

Low-risk patients can be managed with aspirin, and high-risk patients require anticoagulation with warfarin.

24
Q

Management of VT

A

If no haemodynamic compromise: IV Amiodarone
• Look for & treat underlying cause
• ICD

Pulseless VT: defibrillate

25
Q

How does digoxin, adenosine and amiodarone work?

A

…….

26
Q

What is LVH by voltage criteria in ECG

A

Deep
S in V1/2
• Tall
R in V5/6

S in V
1 + R in V
5 or V
6
(whichever is larger) ≥ 7 
large squares
27
Q

ECG changes due to ischaemia?

A

• ST elevation, T wave inversion, Q waves (suggest old MI)

28
Q

What might be affected by arrhythmia or conduction defects on ECG

A
  • Rate, Rhythm

* Look at intervals: PR, QRS, QT

29
Q

What might be affected by ventricular strain or hypertrphy on ECG

What would indicate strain on the right heart and what could cause that

A

Axis, R, S

Prominent R waves (i.e. upstroke) in V1 is suggestive of a strained right heart (PE, COPD etc.)

30
Q

What are the following heart sounds associated with:

S1, S2, S3, and S4

A

Closure of mitral valve= S1
Closure of aortic valve= S2
Associated with ventricular filling (i.e. during heart failure) =S3 (very closely follows 2nd heart sound)
Associated with ventricular hypertrophy (i.e. during HTN) =S4 (very closely before the 1st heart sound)

31
Q

What heart sound with atrial septal defect

A

Fixed wide splitting of S2

32
Q

Management of acute HF

A
  • Sit up
  • Oxygen
  • Furosemide (IV)
  • (GTN infusion)
  • Treat the underlying cause
33
Q

Management of MI

A

STEMI: aspirin, clopidogrel, cath lab

NSTEMI: aspirin, clopidogrel, LMWH

34
Q

Management of:

VF
Pulseless VT
Asystole
PEA

A

You can’t shock or give adrenaline if hypothermia

ALS ALGORITHM

-VF/pulseless VT
Shock, 2 min CPR, assess rhythm, adrenaline every 3-5 mins, amiodarone after 3 shocks, correct reversible causes

-Asystole/PEA (NOT shockable rhythm)

2 mins CPR, adrenaline every 3-5 min, correct reversible causes

35
Q 
30 yr old woman 
• URTI
• Pleuritic chest pain
• Better when leaning 
forward

What is the differential

A

Pericarditis

36
Q

DDx of pleuritic chest pain

A

Pericarditis

PE

Pneumonia

Pneumothorax

Pleural pathology

Sub‐diaphragmatic pathology

37
Q

Pericarditis, give some associated symptoms (system) to ask about

A

Viral- pericarditis commonly follows a viral infection so ask about flu like symptoms, fever etc.

38
Q

What are reciprocal ECG changes?

A

Reciprocal change is a very important ECG finding, not only supporting the diagnosis of STEMI but also indicating a high-risk patient.

Reciprocal change is defined as ST-segment depression occurring on an ECG which also has ST-segment elevation in at least 2 leads in a single anatomic segment. (e.g. elevation in III and depression in aVL)

39
Q

Causes of outflow obstruction from left side (aorta) and right side (pulmonary trunk)

A

LEFT: aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM)

Right: PE

40
Q

What should you ask the patient if they had a collapse without warning and came around quickly after

A

Ask about sudden death (QT syndrome!)

41
Q

Differentiate AVNRT and AVRT, as types of supraventricular tachycardia

A

AVNRT:

AVRT:

NGL kind of baffling me rn…. use osmosis

Basically….
Fast, no p wave and regular: SVT

Fast, no pwave and irregular: AF

42
Q

What type of QRS complex in sinus tachy, SVT, AF and vf

A

All narrow QRS complexes apart from VF which is broad

43
Q

What would you think of if there was a deep S in v1/v2 and a tall r in v5/v6?

A

LVH by voltage critera:

S in V1 + R in V5 or V6 (whichever is larger) > or equal to 7 sqaures is LVH by voltage criteria (need to do echo to check)

Most common cause of LVH is hypertension, so this would suggest HYPERTENSION

44
Q

Causes of VF

A

4Hs:
-Hypoxia, hypothermia, hypovolaemia, hypokalaeamia

4Ts:
Tension pneumothorax, tamponade, toxins and thrombosis

45
Q

What causes the right heart failure in COPD

A

There is chronic hypoxia leading to vasoconstriction in the pulmonary vasculature

So the pressure goes up and there’s increased pressure for the heart to pump against

DPD 2019 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions