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AIP > CHEST PAIN > Flashcards

CHEST PAIN Flashcards

1
Q

What needs to be seen on an ECG to make a diagnosis of a STEMI suitable for thrombolysis?

A
  • >2mm ST elevation in adjacent chest leads OR
  • >1mm in adjacent limb leads OR
  • new LBBB
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2
Q

How long should be left between serial troponins and what is considered a significant discrepancy in terms of %?

A

6 hours

20%

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3
Q

What score estimates mortality risk for UA/NSTEMI?

A

TIMI score

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4
Q

What is the GRACE score?

A

The GRACE Score is a prospectively studied scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality.

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5
Q

Name the 6 key drugs in initial ACS management including dose and route

A
  1. aspirin 300mg PO
  2. clopidogrel 600mg
  3. oxygen 15L/min in hypoxic patients
  4. diamorphine 2.5-10mg IV PRN for pain relief
  5. Metoclopramide 10mg IV
  6. GTN spray
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6
Q

What is the ideal time from door to balloon?

What time is permitted?

A
  • 90 minutes
  • 12 hours
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7
Q

During PCI what additional drug is typically given?

A

additional anticoagulant e.g. heparin or fondaparinux

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8
Q

If PCI is not available within what period of time there should be thromobolysis with what medication?

A
  • 2 hours
  • tPa (streptokinase/alteplase)
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9
Q

What is the GRACE score used for?

A

To assess 6 month-3 year mortality risk following a diagnosis of ACS

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10
Q

What is the medical management of NSTEMI and UA?

A

Dual antiplatelet therapy with aspirin and clopidogrel

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11
Q

What is the change associated with Barrett’s oesophagus?

A

Stratified squamous to columnar

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12
Q

What is the definitive management of a tension pneumothorax?

A

Chest aspiration into 2nd ICS MCL

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13
Q

What is Virchow’s triad?

A
  1. Hypercoagulability
  2. Haemostasis
  3. Endothelial injury
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14
Q

What Well’s score is considered indicative of DVT or PE?

A

>2

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15
Q

What is the management for PE?

A

DOAC as bridging and actual therapy

You can place a vena cava filter in patients who continue to develop thrombi despite anticoagulation – but remember that implanting a filter without adequate anticoagulation will increase the risk of thrombus.

Thrombolysis may be used if the PE is deemed ‘Massive’ – 50mg alteplase – as long as no contraindications

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16
Q

What is the gold standard investigation for PE? What is the alternative and in what scenario should it be used?

A
  • CTPA
  • V/Q scan in cases with renal dysfunction
17
Q

Name 3 causes of a transudate pleural effusion

A
  1. LV failure
  2. Cirrhosis
  3. Nephrotic syndrome
18
Q

Name 3 causes of an exudative pleural effusion

A
  1. PE
  2. Infection- pneumonia
  3. Neoplasm
  4. TB
19
Q

What criteria is used to distinguish between transudate and exudate pleural effusion?

A

Light’s criteria was developed in 1972 to help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases:

  • exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
  • if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
    • pleural fluid protein divided by serum protein >0.5
    • pleural fluid LDH divided by serum LDH >0.6
    • pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
20
Q

What is the first line medical therapy for pericarditis?

A

High dose NSAIDs 9naproxen 250mg QDS) for 1-2/52, alongisde PPIs will ususally resolve symptoms

21
Q

What is Beck’s triad and what is it a sign of?

A
  • Distant heart sounds
  • Distended JVP
  • Decreased arterial blood pressure
22
Q

What is the gold standard investigation of aortic dissection?

Name 3 other imaging modalities that can be used

A

MRI angiography

  1. Transoesophageal USS
  2. Transthoracic USS
  3. CT with contrast
23
Q

What are the causes of delirium?

A

P - Pain

I - Infection

N - Nutrition

C - Constipation

H - Hydration

E - Endocrine + Electrolyte

S - Stroke

M - medication and Alcohol

E - Environmental

24
Q
A
25
Q

In STEMI, what period of time must PCI be available within? If PCI cannot be achieved within this time then perform fibrinolysis

A

120 m

26
Q

After fibrinolysis what should happen to check effectiveness of treatment?

If treatment is not effective what should happen?

A
  • ECG WITHIN 60-90m
  • PCI
27
Q

What glycaemic control should be initiated post-MI?

A

dose-adjusted insulin infusion

AIP (19 decks)

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