check yoself Flashcards
causes of secondary hypertension
R - renal disease, renal artery stenosis
O - obesity
P - pregnancy / pre-eclampsia
E - endocrine, hyperaldosteronism (conns)
stage 2 + 3 hypertension
2
clinic = >160/100
AB = >150/95
3
clinic = >180/120
long term angina treatment
beta blocker - bisoprolol
CCB - amlodipine
others (not 1st line) long acting nitrates (isosorbide mononitrate) ivabradine nicorandil ranolazine
secondary prevention angina
aspirin
atorvastatin
acei
already on beta blocker
MI complications
D - death R - rupture of heart septum or papillary muscles E - edema (heart failure) A - aneurysm / arrhythmia D - Dresslers
AAA screening
men age 65-74
<3 normal
>3 monitored
homans sign
pain in calf on dorsiflexion of foot
DVT
common causes of AF
SMIRTH
S- sepsis / infection M - mitral / mechanical valve [athology I - intoxication (alcohol) R - rheumatic heart disease T- thyrotoxicosis H - Hypertension
AF rate control (first line)
BB (atenolol)
CCB (dil / vera)
** never together verapaKILLLLL !!!!
digoxin if fails - take a while to kick in, dangerous if hypokalaemic, slows AV conduction (more time to fill ventricle)
what anticoag if mitral stenosis associated AF
warfarin
when would you DC cardiovert in AF
if symptoms <48hrs or anticoagulated prior
do echo first to look for emboli
AF HR
300 - 600 bpm
irregularly irregular
atrial flutter HR
220-240bpm
regularly irregular
symptoms / causes of VT
dizziness / syncope
hypotension
usually triggered - hypoxia, electrolyte abnormalities
common in CHD or previous MI
mode of inheritance of brugada syndrome
autosomal dominant
ST elevation in RBBB in leads V1-3
cjanges may be seen after flecainide
2nd + 3rd heart block treatment
atropine IV
no improve - other inotropes = noradrenalin
defibrillate
long term = pacemaker
acute HF / oedema / cardiogenic shock
morphine
NIV / CPAP
inotropes - noradenalin infusion
dresslers pathophysio
AUTOIMMUNE response to cardiac damage - damaged heart muscle release previously encountered material that stimulates an immune response
HOCM management
high risj = ICD
low = amiodarone
genetic analysis
mode of inheritance of familial dilated cardiomyopathy
DCM
autosomal dominant
DCM can be sporadic - toxins, autoimmune
echo, CXR (cardiac enlargement)
same Mx as HF
drugs to close/open ductus arteriosus
open - prostaglandin E2
close - indomethacin
hereditary condition associated with coarctation of aorta
turner syndrome - monosomy X
corctation of aorta symptoms
headaches / nosebleeds - due to hypertension
claudication
delayed pulses
clinical features of tetralogoy of fallot
spasms of sub pulmonary muscles
episodes of severe cyanosis
cyanosis develops due to increased right sided pressure - right-to-left shunt
tetralogy of fallot conditions
VSD
overriding aorta
pulmonary stenosis
RV hypertrophy
tetralogoy of fallot treatment
treat each
spasms relieved by increasing systemic resitance using postural manoeuvres – squatting
marfans mode of inheritance
autosomal dominant - FBN1 mutation
50/50 - each child of one affected parent
marfans clinical features
heart - aortic aneurysm + dissection, mitral valve prolapse
eye - dislocated lenses, retinal detachment
tall, long arms, scoliosis
high arched palate
marfans management
BB (atenolol) - slows rate of dilation of aortic root
ARB
lifestyle - avoid long exercise, sedentary job
monitoring
genetic screening, counselling
normal ejection fraction
> 50%
ADH + angiotensin II - vasodilators/constrictors?
vasoconstrictors
chemical vasoconstrictors
serotonin
thromboxane A2
leukotrienes
what is pacemaker potential due to?
decrease K+ efflux
neurotransmitter + receptor in negative chronotropic effect
acetylcholine via muscarinic M2 receptors
erbs point
3rd ICS left sternal edge
role of aldosterone
(steroid hormone) acts on kidneys to increase sodium + water retention
-> increasing PV + BP
natriuretic peptides
made by heart - also brain + others
released in response to cardiac distension
decrease renin secretion - decreasing BP
(vasodilators - decrease SVR + BP)
antidiuretic hormone
(vasopressin)
increases reabsorption of water (conserves it) - concentrates urine
–> increases extracellular + PV - increase CO+BP = vasoconstriction
where oesophagus begins
C6
barretts is premalignant condition to what
adenocarcinoma
**ablation only if dysplastic
what must happen prior to H pylori testing
2 weeks PPI free
how would bacillus cereus appear on a gram stain
purple rod - gram positive bacillus (so would listeria monocytogenes)
has heat resistant spores
what can campylobacter be precursors of
guillan barre = 1-2 weeks post infection
travellers diarrhoea
biggest risk factor for E coli 0157 progressing to HUS
antibiotics - AVOID
upper GI bleeds scorng
glasgow blatchford - risk of having upper GI bleed
rockall score - post endoscopy for risk of rebleed / overall mortality
management of bowel obstruction
ABC analgesia IV fluids - usually hypokalaemic + alkalotic NG tube - drain stomach nil by mouth catheterise
IV fluids to hydrate the patient and correct electrolyte imbalances
commonest site of diverticular disease
sigmoid
related to low fibre diet
treatment of diverticulitis
mild = ciprofloxacin + metronidazole
severe = IV fluids, IV antibiotics + bowel rest
mallorys hyaline antibodies
alcoholic liver disease (acute hepatitis)
chronic active hepatitis
hep b incubation
1-6months
mrker of viral replication in hep b
HBeAg
Ag NOT Ab
hep c treatment
protease inhibitors for 8-12 weeks
daclarasvir + sofosbuvir
or
sofosbuvir + simeprevir
always 2+ drugs - reduces resistance
no vaccine available
IBD screening
faecal calprotectin -
released due to inflammation of intestines
genetic predisposition to crohns
NOD2/CARD15 - involved in mucosal defences
prior to coeliac testing
must be on gluten diet for 6 weeks prior
why do coeliac get vaccines
pneumoccocal + annual flu
–> due to hyposplenism
other complications - vit deficiency, osteoporosis, subfertility, small bowel adenocarcinoma
2nd line ix in cholecystitis
cholescintography - HIDA scan
pancreatits scoring
glasgow score - PANCREAS mneumonic
pancreatitis management
ABCDE
IV fluids
analgesia
monitoring - treat underlying causes/complications
cirrhosis scoring
child-pugh
MELD - percentage 3 month mortality
diet for people with cirrhosis
high protein
low sodium
stable varices treatment
propanolol - non-selective BB
band ligation
injection of sclerosant
maybe TIPSS
bleeding varices treatment
terlipressin
vit K + fresh frozen plasma
prophylactic broad-spectrum antibiotics
urgent endoscopy - sclerosant / banding
sengstaken-blakemore tube if fails - balloon inflates to stop bleeding
management of spontaneous bacterial peritonitis (SBP)
culture then antibiotics
usually IV cephalosporin - cefotaxime
fatty liver investigations
raised gamma-GT
elevated MCV
elevated (ALT/AST)
US + CT show fatty infiltration
–> fatty changes on US = increased echogenicity
what vitamin is sometimes given to patients with fibrosis
vit E
cholangiocarcinoma tumour
CA19-9
bowel cancer screening in scotland
50-72 y/o home FIT every 2 years
FAP, HNPCC, IBD - regular colonoscopy
- FIT can be used in GP for those who dont meet 2 week referral
difference between anterior resection + APR
anterior - sigmoid + upper rectum (faecal incontinence)
APR - rectum + anus (permanent colostomy, anus sutured)
difference between zero and first order kinetics
zero - elimination of a constant AMOUNT of a drug (alcohol, eg 4g every hour) - metabolic pathway is saturated
first - elimination of a constant PERCENTAGE (eg always half)
% bioavailability of an IV drug
100%
bioavailability = amount of drug which enters the systemic circulation - will always be 100% for an IV preparation
first line drug in reducing cholesterol
statins
overwhelming compensatory mechanism thats activated to combat volume loss
increased sympathetic activity
most likely group of oraganisms to cause hospital acquired pneumonia
gram negative
trisomy 13
pateau
how does intracellular calcium contribute to cell death
by increasing mitochondrial permeability
where do robertsonian translocations take place on the chromosome
near or at centromeres
lectin-like molecules function
as PRRs
2 cell types predominantly found in granulation tissue
endothelial cells
myofibroblasts
yellow sharps bin with blue lid
medicine vials with residual medicines
red bag
soiled laundry
